Off-Label Prescribing For Young Children

Disclaimer: I have no background and no formal education in healthcare. This blog post shares a concern about the public health and offers recommendations for further reading.  A link to an article in The New York Times appears at the end of this post.

The overprescribing of drugs has a weird, contradictory history.  For decades, we’ve had concerns about the prescribing habits of doctors who encourage or force patients to take medications (psychotropics and others) which may not be well-suited for those people.  On the other hand, when prescription medicines are advertised directly to the public — as they are in New Zealand and the United States — patients and caregivers in the family will nag doctors for medications they don’t need.  A vase of flowers, placed just right in a video or print ad, may encourage you to take pills for a condition you don’t even have.

There are other disturbing situations we hear less about.  The Times article reports that young kids and infants with intense neurological conditions are treated with medicines unapproved for patients their age.  For those children, the consequences of withholding treatment can be dangerous, but at the same time doctors have no idea how some medications will affect children’s short-term behavior or long-term development.

One of the general complaints seems to be lack of research in prescribing these drugs to kids.  Another legitimate concern might be that anyone who volunteers (or is volunteered on his or her behalf by a guardian) is the proverbial canary in the coalmine.

We must accept that there are no simple answers to complicated problems.  At the same time, the public should be as enlightened as possible.

Drugs are marketed to doctors by pharmaceutical representatives whose main obligation is to the company’s bottom line.  After doctors in Germany were ordered by the government to stop prescribing Paxil to kids, the reps who marketed to doctors in the U.S. were still giving starter packs of the drug to pediatricians.  The German government had stopped that practice because of increased suicidal behavior among young Paxil users.

(Apologies for the fact that I can’t find a source to credit for the Paxil claim.  I’m recalling it from memory.  It was in multiple news reports many years ago.)

Doctors don’t have time to research every drug independently.  They rely on marketing reps to stay informed, and those marketing reps may not be completely informed themselves if they’re repeating corporate-approved claims.

Sometimes children get the brunt of it, other times it’s adults who suffer.  Although I can’t find a functional link to Ben Wallace-Wells’ Rolling Stone article about the marketing and overprescribing of Zyprexa (a drug approved to treat schizophrenia), the Jan. 28, 2009 issue of that magazine is recommended.  The article is a long bastard, but worth every minute of your time.

Some patients have specific needs which leave care providers with two choices: Neglect the problem or prescribe something while wearing the proverbial blindfold.  Either way, the prognosis doesn’t sound good.

When corruption is involved, we should identify it and deal with it responsibly.  Harming a patient with medication isn’t always the product of corruption, though, as the Times article explains.  Sometimes it happens because there are more crises than answers.

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