Ped Med: Pediatric treatments questioned

SAN FRANCISCO, July 6 (UPI) -- Recent research casts children in a new medical light that illuminates the error of some doctors' ways.

In one study, reported in the Archives of Pediatrics and Adolescent Medicine, neuroscientists employing special scanners measured brain activity that provides direct evidence that even premature infants -- long thought incapable of such feeling -- can suffer genuine pain.

The investigators determined a newborn displays more than just a reflex reaction when his foot is lanced for a routine post-birth blood test.

"We undertreat pain in children, regardless of the severity," said Dr. Cheston Berlin, professor of pediatrics and pharmacology at Pennsylvania State Children's Hospital in Hershey, who was not part of the study.

On the flip side are cases with too many hands reaching for the medicine bottle.

"We're overutilizing many drugs, like those used for the common cold or bacterial infections," said Dr. Charles Prober, associate chairman of pediatrics at the Stanford University School of Medicine.

That applies to medicines on both sides of the prescription aisle.

For one study, published in the Harvard Health Letter, coughed up some findings that may be hard to swallow for a nation that shells out $3.5 billion a year on over-the-counter products that purport to stifle hacking.

The money could be better spent elsewhere, the researchers proposed, pointing out guidelines from the American College of Chest Physicians suggest many of the "active" ingredients in cough remedies may be about as effective as a sugar pill.

In fact, the scientists advised, those who do find relief in the cough-and-cold section of the supermarket may be experiencing nothing more than the so-called placebo effect.

"We're overusing OTC preparations (although there is) not a lot of information they're doing a lot of good," Prober said. "Watchful waiting is the best strategy for colds and the like, but other strategies have not much utility."

Critics think that assessment is particularly applicable to the expanding use of psychiatric drugs in children and adolescents.

They say medicines for the mind are prescribed for mental maladies that cannot be reliably tracked with a biological test or rigorously traced to a physical cause and that, in comparison to, say, cancer or heart disease, do not appear to present a clear and present danger.

"All psychoactive drugs currently used in children are prescribed in much too cavalier a fashion, bathing the growing brain of a child in toxic substances in high concentrations, (which) is bound to have adverse effects on a child's growth and development that we can't even begin to identify," said Dr. Peter Breggin, psychiatrist, author and longtime critic of the use of psychiatric medications in children who has testified in numerous lawsuits against drug manufacturers.

The medical majority takes exception to such views, arguing the pharmaceuticals revolutionized psychiatric practice, helped liberate thousands of institutionalized patients and are freeing a new generation of troubled youth to pursue their dreams unimpeded by mental demons.

To them, the rising rates of those afforded a chemical solution tell the story of success.

By any measure, the soaring numbers leave little doubt that the turn toward pharmacology as the treatment of choice for depression, inattention, anxiety, obsession, compulsion, mania and other psychological conditions has reached pediatricians' and child psychiatrists' door.

One 10-year review of nearly 900,000 youths on Medicaid and in a private health maintenance organization found more than twice as many children and adolescents took a wide variety of psychiatric drugs -- including antipsychotics, the so-called mood stabilizers used to treat schizophrenia but also prescribed for mania or aggression -- in 1996 than did their counterparts a decade earlier.

The hike kicked up the rates to nearly adult levels, the authors noted.

Yet few safety studies of the drugs -- most of them unapproved for younger age groups -- were conducted in children, they added. Even fewer explored the medicines' long-range impact.

Overall, some 6 percent of those under 20, or nearly 5 million Americans, are prescribed psychotropic medications, according to an article in Psychiatric Times.

What many critics find particularly disconcerting is the trend's creep toward ever younger age groups, with stimulants, antidepressants and tranquilizers doled out even to toddlers.

A study in the Journal of the American Medical Association, for one, reported a tidal swell of up to 300 percent in psychiatric drug use by children ages 2 to 4 in a four-year period.

An estimated 190,000 to 285,000 tots took the medicines for conditions ranging from tantrums and fear of the dark to separation anxiety and sleep difficulties, the authors said.

In virtually all such cases, the doctor must look beyond the label and make a judgment call as to the type and amount of medicine needed.

"Because data about psychotropic drug safety and efficacy in adults have not been extended to children, new psychopharmacological research is required before clinicians can use these agents to treat psychiatric disorders in the preschool-age group," one analysis concluded.

"Since there is virtually no clinical research on the consequences of pharmacologic treatment of behavioral disturbances of very young children, is there a basis for concern about these prescribing practices?" another inquired.

With the brain getting its bearing on visual processing, language, motor skills and other vital functions during these critical formative years, it would seem prudent to establish a definitive answer to that pivotal question, psychiatrist Dr. Joseph Coyle of Harvard Medical School wrote in JAMA.

Perhaps money's got something to do with it, he proposed, noting many state Medicaid programs restrict reimbursements for evaluating children's behavioral disorders and limit the assessment to one professional per day.

"Thus, the multidisciplinary clinics of the past that brought together pediatric, psychiatric, behavioral and family dynamic expertise for difficult cases have largely ceased to exist," Coyle wrote.

"As a consequence, it appears that behaviorally disturbed children are now increasingly subjected to quick and inexpensive pharmacologic fixes as opposed to informed, multimodal therapy associated with optimal outcomes."

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(Note: This column is based on dozens of reports, conferences and more than 200 interviews with specialists in children's health issues. Wasowicz is the author of the new book, "Suffer the Child: How the Healthcare System Is Failing Our Future," published by Capital Books.)

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(e-mail: lwasowicz@upi.com)