My friend and frequent correspondent John Ryan has sent me a series of illuminating e-mails on the use and likely overuse of powerful psychotropic prescription drugs for common childhood behaviors. John, a retired software and hardware engineer who lives in Las Cruces, New Mexico (currently working as an adjunct math professor) , was such a font of information when I approached that subject in my column that it occurred to me that, using my blog, I could cut out the middle man. His thoughts are just better read than quoted. John, born and raised in Texas, added that his “interest in psychotropic drugs and the psycho-pharmaceutical complex was initiated by a tragedy in his family in 2002, which is still too painful for him to write about in detail.”
John Ryan’s blog within a blog:
There has been an exponential increase in the past few years of children, some mere toddlers, being diagnosed with "diseases" such as Bipolar disorder and ADHD, compared with past years.
The explosion of diagnosis of Bipolar in children coincided with the 1999 publication of "The Bipolar Child," Written by New York psychiatrist Demitri Papolos. Supporters of early diagnosis and treatment say the book empowered parents and informed clinicians. Critics say it is rife with pseudoscience and exaggeration.
According to Peter Breggin M. D.:
The promotion of drugging 'bipolar children,' has been enormously successful. Before the 1990s, doctors hardly ever diagnosed bipolar disorder in children. In fact, I do not recall hearing the diagnosis given to any children prior to the 1990s. A recent survey in the scientific literature showed that there was a forty-fold increase in diagnosing bipolar children between 1994 and 2003. (3) The survey found that 90.6% were receiving psychiatric medications, including 60.3% on mood stabilizers like Depakote and 47.7% on antipsychotics like Risperdal and Zyprexa, with most on combinations.
Children are being prescribed mood stablizers (Depakote, Neurontin), amphetamine stimulants [Dexedrine, Aderall, Ritalin (methylphenidate)], antipsychotics (Seroquel, Clozaril, Risperdal, Zyprexa, Abilify, Geodon), antidepressants [SSRIs (Strattera, Zoloft, Paxil, Prozac), benzodiazepines (Librium, Klonopin, Valium, Xanax)]. Often a cocktail of several of these drugs are prescribed simultaneously. Most are prescribed to children off-label (non-FDA-approved for children).
There are no laboratory tests or brain scans that are definitive of childhood "disorders" such as ADHD, bipolar d., oppositional defiant d., conduct d., mathematics d., written expression d., and others that are listed in the American Psychiatric Association's billing bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM merely lists symptoms. For example, the 18 symptoms for ADHD, any 6 of which qualify for a diagnosis, consist of a list of behaviors that adults find objectionable, such as "is often easily distracted by external stimuli," "often fidgets with hands or feet or squirms in seat," "often has difficulty playing or engaging in leisure activities quietly," "often talks excessively." These "disorders" were voted into existence by committees of psychiatrists.
Children are diagnosed on flimsy grounds of temper tantrums and irritability, when often the children are just reacting with typical childhood exuberance to troublesome events in their lives over which they have no control. These diagnoses are often given by doctors after consulting with a school nurse, teacher, or parent, and without even having seen the child. School personnel learn which doctors are amenable to such diagnoses, and call on those doctors.
In the February 2009 New York Review, former New England Journal of Medicine editor and Senior Lecturer in Social Medicine at Harvard Medical School, Dr Marcia Angell, wrote:
Although it is illegal to promote drugs for use in children if the FDA has not approved them for that use, the law is frequently circumvented by disguising marketing as education or research. Eli Lilly recently agreed to pay $1.4 billion to settle civil and criminal charges of marketing the anti-psychotic drug Zyprexa for uses not approved by the FDA (known as "off-label" uses). Zyprexa, which has serious side effects, is one of the drugs frequently used off-label to treat children diagnosed with bipolar disorder.
On September 2, 2008, the Law Project for Psychiatric Rights filed a lawsuit against the State of Alaska aimed at stopping the over-prescribing of psychotropic drugs to children covered by public health care programs in that state.
The lawsuit seeks an injunction to stop Alaska from authorizing or paying for psychotropic drugs prescribed to children in foster care or children covered by Medicaid "without safeguards being in place to make sure proper decision making occurs."
"It is absurd to think all these children have a mental illness," states Jim Gottstein, director of the LPPR. "They are being drugged because they are bothering people."
According to Vera Sherav of the Alliance for Human Research Protection:
The government financed cash cow is the driving force behind the unprecedented use of highly toxic drugs -- singly and in totally untested drug combinations--for children who are precluded from refusing.
The numbers of children being 'diagnosed' with serious mental illness and forced to take psychotropic drugs is astounding: In Texas 60% of children in foster care are being drugged; in Massachusetts 66%, in Florida 50%.
The skyrocketing of the diagnosis of Bipolar Disorder in the last ten years, is largely due to the work of Dr. Joseph Biederman, Professor of Child Psychiatry at Harvard and at Massachusetts General Hospital..
According to Lawrence Diller, M. D.,
Biederman and his colleagues at Harvard are the professionals most responsible for developing and promoting those standards of care -- which include diagnosing preschool children as young as 2 with bipolar disorder and treating them with multiple medications.
Biederman shocked the child psychiatric world in 1996 by announcing that nearly a quarter of the children he was treating for attention deficit hyperactivity disorder also met his criteria for bipolar disorder. Up until then bipolar disorder was rarely diagnosed in teenagers and unheard of in prepubertal children. Biederman could justify his findings by simply broadening the semantic definitions of a previously more circumscribed condition contained within the "Diagnostic and Statistical Manual of Mental Disorders."
Biederman has produced a number of studies and papers purporting to demonstrate the validity of his diagnosis and treatment, which focused only on the individual.
Dr. Diller, the author of "The Last Normal Child," further states: "The bipolar diagnosis in young children is an absurdity and its drug cocktail treatment, an obscenity, when they prematurely close the door to otherwise potentially profound changes in family behavior."
It has recently been discovered that Dr. Biederman concealed more than 1.4 million dollars in payments from various drug companies for conducting "education" courses, honoraria, consulting, and research.
According to the New York Times: [http://www.nytimes.com/2008/11/30/opinion/30sun2.html?_r=1]
Earlier this year, Congressional investigators discovered that Dr. Joseph Biederman, a world-renowned child psychiatrist at Harvard Medical School and Massachusetts General Hospital, had failed to report to Harvard at least $1.4 million in income from drug companies, in violation of the university's conflict-of-interest guidelines.
Now, internal drug company e-mail and documents that surfaced in a lawsuit have sketched out what looks like an unsavory collaboration between Dr. Biederman and Johnson & Johnson to generate and disseminate data that would support use of an antipsychotic drug, Risperdal, in children, a controversial target group.
These days toddlers who display "Terrible twos" behaviour had better be careful. Lest they be drugged into submission. I have no doubt that had ADHD and Bipolar Disorder been around when I was a child, I would have been diagnosed with at least one of them.
Just for fun, here is Dr. Biederman's rap sheet:
Joseph Biederman, M.D., Professor, Department of psychiatry, Harvard University Medical School; Chief of the Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA. Receives research support from the following sources: Abbott Laboratories, Bristol-Myers Squibb, Cephalon, Eli Lilly, Janssen, McNeil-PPC Inc., Neurosearch, New River Pharmaceuticals, Novartis, Pfizer, and Shire Pharmaceuticals; a speaker for Cephalon, Eli Lilly, McNeil-PPC Inc., Shire Pharmaceuticals, UCB Pharma, Novartis; on advisory boards of Cephalon, Eli Lilly, Janssen, McNeil-PPC Inc., Novartis, and Shire Pharmaceuticals. (http://www.adhdhome.org/cme_information.html; accessed 1/16/07)
Research support from Shire, Eli Lilly, Wyeth, Pfizer, Cephalon, Janssen, and Noven. Speakers bureau for GlaxoSmithKline, Eli Lilly, Pfizer, Wyeth, Shire, Alza, and Cephalon. Scientific Advisory Board for Eli Lilly, Celltech, Shire, Noven, and Alza/McNeil. (J. Clin. Psychiatry 2002;63:s12)
Research on the effect of long-release Adderall on children with attention-deficit hyperactivity disorder funded by Shire Pharmaceuticals, the maker of Adderall. (Pediatrics 2002;110:258-66)