How did the once modest medical specialty of child psychiatry become the aggressive “pediatric psychopharmacology” that finds ADHD, pediatric conduct disorder, depression, bipolar disorder, oppositional defiant disorder, mood disorders, obsessive-compulsive disorders, mixed manias, social phobia, anxiety, sleep disorders, borderline disorders, assorted “spectrum” disorders, irritability, aggression, pervasive development disorders, personality disorders, and even schizophrenia under every rock? And how did this branch of psychiatry come to find the answer to the “psychopathologies” in the name of the discipline itself: pediatric psychopharmacology? Just good marketing. Pharma is wooing the pediatric patient because that’s where the money is. Just like country and western songs about finding love where you can when there is no love to be found at home. Pharma has stopped finding “love” in the form of the new blockbuster drugs that catapulted it through the 1990s and 2000s. According to the Wall Street Journal, new drugs made Pharma only $4.3 billion in 2010 compared with $11.8 billion in 2005—a two-thirds drop.
Doctors have a “growing fear of prescribing new drugs with unknown side effects,”explains the Journal, and the government is cracking down on illegal marketing. But also, private and government insurers are less willing to “cough up money for an expensive new drug—particularly when a cheap and reliable generic is available.
It’s gotten so bad, AstraZeneca, whose controversial Seroquel® still makes $5.3 billion a year though it is no longer new, now conducts “payer excellence academies” to teach sales reps to sell insurers and state healthcare systems on its latest drugs. No wonder Pharma is finding “love” by prescribing drugs to the nation’s youngest (and oldest) patients, who are often behavior problems to their caregivers, who make few of their own drug decisions, and who are often on government health plans.
“Children are known to be compliant patients and that makes them a highly desirable market for drugs,” says former Pharma rep Gwen Olsen, author of Confessions of an Rx Drug Pusher. “Children are forced by school personnel to take their drugs, they are forced by their parents to take their drugs, and they are forced by their doctors to take their drugs. So, children are the ideal patient-type because they represent refilled prescription compliance and ‘longevity.’ In other words, they will be lifelong patients and repeat customers for Pharma.”
Just as it used to be said in obstetric circles, “Once a cesarean, always a cesarean,” it’s also true that “once a pediatric psychiatric patient, always a pediatric psychiatric patient.” Few, indeed, are kids who start out diagnosed and treated for ADHD, bipolar disorder, and other “psychopathologies” who end up on no drugs, psychologically fine, and ready to run for class president. Even if they outgrow their original diagnoses—a big “if” with a mental health history that follows them—the side effects from years of psychoactive drugs and their physical health on mental, social, and emotional development take their toll. Even children on allergy and asthma drugs, which are promoted for kids as young as age one, are now known to develop psychiatric side effects according to emerging research.
Kids who start out with psychiatric diagnoses are not only lifers—they are expensive lifers usually shuttled into government programs that will pay for psychiatric drug “cocktails” that can approach $2,000 a month. What private insurer would pay $323 for an atypical antipsychotic like Zyprexa®, Geodon®, or Risperdal®, when a “typical” antipsychotic costs only about $40?
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