Map of life expectancy at birth from Global Education Project.

Monday, June 26, 2006

Treading smartly and cautiously down the wrong path?

Sutcliffe and Wong in BMJ view with concern the explosive rise in prescribing of psychotropic drugs to children -- in which the U.S. has set the pace but other countries are catching up. They also anticipate that children will soon become a growing market (sorry about that) for anti-obesity drugs.

They call for high quality clinical studies so that decisions about prescribing to children can be based on evidence that the treatments are effective and that the benefits outweigh the risks. Most of these drugs prescribed for children today have not been tested in children and are prescribed "off label." Maybe more clinical trials are a good idea but as we have argued here many times, "effectiveness" of psychotropic drugs is defined as statistically significant responses to changes in scores on questionnaire scales, usually over a short period of time. Furthermore these effects are compared either to doing nothing, or to other drugs.

Children are not obese because they aren't taking the right drugs, they are obese because they consume too many calories -- often in the form of sugar water -- and don't get enough exercise -- because they are watching television and playing computer games. Similarly, children often present behavior problems because of their family, school and social environment. That could mean either that the environment has caused them to misbehave, or it could mean that behavior that might be okay in a different environment is problematic in the one they happen to be in. (Which of those options you believe in a particular case could be a value judgment, of course.) Children may also indeed have innate deficits in social skills, or difficult personalities, which most people think would be problematic in most plausible social environments.

But in any of these cases, feeding them mind altering chemicals may be a simple-minded option that drives out the right solutions. Since this option is promoted by corporations that stand to make billions of dollars from it, we ought to look at it very skeptically in all cases. They have millions of dollars to spend on these clinical trials which will then "prove" that the drugs are beneficial. But nobody will have spent millions of dollars to try family counseling or different ways of organizing the school environment, or better ways of rescuing kids from abusive circumstances, or teaching children behavioral skills, or promoting physical activity and better nutrition. Changing society and/or healing souls isn't easy, but maybe that means we ought to work harder at it.

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