PedMed: In praise of non-drug solutions

SAN FRANCISCO, July 30 (UPI) -- Concerned about America's growing dependence on drug treatments, many promoters and protectors of children's health favor shifting at least some of the balance of therapeutic power away from the pharmaceutical Goliath.

As the Food and Drug Administration points out in one of its consumer guides, "Medical treatments come in many shapes and sizes."

Some of them may be worthy of more attention than they're getting, specialists said.

"We've a war on drugs, yet drug company representatives are dropping by doctors' offices with brochures and samples, buying doctors lunch so doctors don't think of massage or music therapy because no musicians are putting ads in medical journals or taking doctors to lunch," said Dr. Kathi Kemper, chair of holistic and integrative medicine and professor of pediatrics and public health sciences at Wake Forest University School of Medicine in North Carolina.

"Medical journals are filled with drug ads. ... They are not filled with yogurt ads. There are no broccoli sponsorships of major lectureships that I'm aware of. Historically, we've gone to Merck or Ross or some other big drug company that sponsors awards at medical meetings. We don't have apple-sponsored awards. Sales representatives are not bringing biofeedback samples to doctors' offices."

A chorus of similar concerns resonates in the mental-health field.

While advances on the genetics and neurological fronts have pushed forward the frontier of understanding of psychiatric conditions, critics have expressed unease that the drive has come at the cost of pushing back the social, psychological and cultural factors that may also come into play but cannot be solved with a bottle of pills.

"A whole huge industry is constantly bringing updates on pharmaceutical products to pediatricians' door," said clinical psychologist Tamar Chansky, founder of the Children's Center for OCD (Obsessive-Compulsive Disorder) and Anxiety in Plymouth Meeting, Pa. "How is the word getting out about non-pharmaceutical treatments?"

Poor publicity is but a strand in the complex web of reasons non-pharmaceutical solutions don't get the respect many feel they deserve.

The net result is that even though in its policy statement the American Academy of Child and Adolescent Psychiatry emphasizes its admonition that "psychiatric medication should not be used alone," more often than not, it is.

For example, a study of 223 children ages 3 and younger diagnosed with attention-deficit/hyperactivity disorder found more than half were prescribed psychotropic medication, yet fewer than a third were receiving psychological services.

"Good research shows medication can be effective and even lifesaving for some, but medication alone is rarely the answer," said child and adolescent psychiatrist Dr. David Fassler, a trustee of the American Psychiatric Association.

A host of studies attest to that.

These include investigations by William Pelham Jr., distinguished professor of psychology, pediatrics and psychiatry at the University of New York at Buffalo who has conducted numerous clinical trials of ADHD medications, many with industry grants.

Given a fair shake, his extensive research indicates, behavioral therapy -- the only non-drug intervention federally approved as an ADHD remedy -- might not only make a difference in a child's behavior but also, when drugs are necessary, lower the dose of medication needed to exert an effect by as much as 67 percent.

Acknowledging the swift and transforming power of pharmaceuticals, Pelham and colleagues nevertheless noted the side effects that saddle medicines and the lack of sound scientific showing that prolonged drug use in children produces more benefits than risks provide "an argument for using combined behavioral and stimulant treatments."

Used alone, Pelham said, ADHD medications fail to deliver on such ultimate goals as avoidance of substances abuse, domestic problems, school dropout, delinquency and criminal behaviors.

"There have been many studies of this over the past 40 years, and not one has found beneficial long-term effects of stimulants," said Pelham, who favors relying on behavioral remedies as the first-line defense against ADHD.

Solutions such as the Summer Treatment Program for children with ADHD, which he launched a decade ago, teach educators, parents and their offspring techniques and skills to improve daily behavior, giving youngsters a better shot at success in scholastic and social arenas, Pelham said.

Among other studies pointing to the benefits of non-drug treatments, a review of 13 investigations showed cognitive behavioral therapy -- aimed at mapping out abnormal thoughts and irrational reactions and developing a way to cope with them -- eased anxiety symptoms in 56 percent of the children and adolescents undergoing the treatment, researchers said.

While it, too, has limitations and downsides, the therapy appears to produce enduring effects -- unlike medications that tend to stop working when they wear off, scientists said in The Cochrane Database of Systematic Reviews.

"The behavioral and cognitive-behavioral treatments with more empirical support are still 'under-trained' in terms of staff and not sufficiently recognized," said Stephen Hinshaw, professor and chair of psychology at the University of California, Berkeley.

Despite their skimpy recognition, parent-inclusive, family-based therapies can be effective for substance abuse and conduct disorders in tots and teens, a 10-year research review concluded.

In addition, the analysts pointed to their potential for limiting property destruction, aggression and other behavior problems that often characterize ADHD and even for easing depression and anxiety.

Like Pelham's summer-camp sessions, these programs may incorporate positive reinforcement, awarding points for good behavior or enhancing problem-solving skills.

Family therapy can take some of the load off a child stressed by a family beset by drug abuse, marital discord or neglect or a parent affected by an offspring with autism or other long-term condition, study leader Dr. Allan Josephson of the Bingham Child Guidance Center in Louisville, Ky., told a media briefing sponsored by the American Medical Association and National PTA.

"Those involved with the diagnosis and treatment of mental disorders have been reluctant to discuss family issues in depth," he said. "They're afraid to blame the family, and, at times, it seems pharmacology may have replaced working with the family. But the family has not gone away, and its influence remains as powerful as ever."

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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)