More Kids Are Taking More Meds Than Ever Before
24 CommentsBy Ed Silverman // November 3rd, 2008 // 8:41 am
More American children are taking pills for diabetes, high blood pressure and cholesterol than ever before, reflecting a rise in chronic diseases related to obesity. The use of drugs for type-2 diabetes, in particular, doubled in children ages 5 to 19 and statins rose by 15 percent between 2002 and 2005, according to a study published in the journal of the American Academy of Pediatrics.
The study tracked the prescription records collected by Express Scripts, the pharmacy benefits manager, for about 3 million children a year. The use of drugs for asthma rose 47 percent and high blood pressure meds rose 2 percent, the study found (here it is).
“Ten or 15 years ago we weren’t even discussing these conditions, which were mainly in adults,” Emily Cox, a senior director of research at Express Scripts, tells Bloomberg News. “Now, we are seeing a growing number of children being treated for chronic conditions that they are going to take into adulthood.”
Drug use was especially high among girls, who were more than twice as likely to be taking a diabetes med as boys, even though girls aren’t more likely to have the disease, the researchers said. Cox suggests this may be because girls visit the doctor twice as much as boys.
There was also a 40 percent rise in drugs for attention deficit hyperactivity disorder with the increase for girls, at 63 percent, rising faster than for boys, at 33 percent. And ADHD drug use rose in among 15 to 19 year olds, an age group for which use typically declines as teenagers are taken off the meds. That may be a sign that ADHD drugs are being used more as stimulants to help teens keep up with schoolwork or for recreational use, Cox posits.
Doctors may be also prescribing more medicines to children after a 1997 law encouraged drugmakers to study the effects of their medicines in adolescents, Bloomberg notes.
Salmon
Let’s not forget antipsychotics.
Already Grassley has demonstrated that it’s 1% of all kids 6 - 18 yo. Even if it’s a valid use early onset is concentrated in the 16 and 17 year olds this clearly indicates blatent over use.
Even though Beiderman’s Zyprexa study in adolescents showed efficacy in bipolar it was only in kids with hypermania (i.e. YMRS (Young Mania Ratign Score) > 30, mania so severe that most were probably psychotic). Yet NIMH wants docs to treat at YMRS’s of 4 - 7. But of course Lilly is on NIMH’s science advisory board.
By the way did anyone notice that the recently reported Zoloft and Cognitive behavior Therapy resulted in suicides in the Zoloft arm but not in the none Zoloft Arms.
For the incremental amount of improvement I’m not sure it’s worth the risk.
Salmon
atlex
Salmon,
“By the way did anyone notice that the recently reported Zoloft and Cognitive behavior Therapy resulted in suicides in the Zoloft arm but not in the none Zoloft Arms.” (sic)
I’m not going to let your statement go unchallenged. It is a clear lie! Here is a quote from the study: “Rates of adverse events, including suicidal and homicidal ideation, were not significantly greater in the sertraline group than in the placebo group. No child in the study attempted suicide.”
Atlex
sadteacher
Isn’t anyone curious about why all these kids need these drugs? I don’t believe doctors are overprescribing or pharma is marketing to kids/doctors/parents, these kids are REALLY sick.
LILLI
To sadteacher—-What about Ritalin? I know there are children that need medications—-Pharma must make sales!
Lisa Van S
Sadteacher,
Would you like to provide the Pharmalot readers with your Name and Medical License Number. I feel sorry for your students.. students deserve a kind, compassionate, efficient, and upbeat educator, not a self proclaimed “Sadteacher”.
Dan A.
Pharma is marketing to kids vicariously through front groups, such as CHADD.
Psych doctors are paid the most by pharma compared with other medical specialties.
Other reasons may exist as well, yet put these two together, and it’s simple math that allows such unreasonable and unnecessary prescribing that ultimately is harming our children in the U.S. Apathy allows this behavior to continue.
Lisa Van S
Atlex,
The Zoloft Study failed to include the number of dropouts, and those lost to followup. Numbers that should be considered significant.
Dr March was the Clinical trial investigator for the famous TADS Study. FDA’s reviewer Dr. Mosholder, a Child and Adolescent Phsychiatrist, testified under oath before the Energy and Commerce’s Subcommittee on Oversight and Investigations, that the TADS Study did not meet FDA’s standard for approval, this study is no different than that of the TADS.
12 year old Candace Downing was prescribed zoloft for the treatment of test anxiety. She hung herself from her canopy bed. Side Note, she was a friend of FDA’s, Dr. Thomas Laughren.
When Candace’s mother testified before the FDA, Dr Laughren didnt have the dcency to look into her eyes, He bowed his head in shame.
Lisa Van S
Parents of Daughters should be alarmed and concerned in regards to this study. “YOUR DAUGHTERS” have a 147% chance of being “drugged”. Im surprised at the lack of outrage on this issue.
atlex
Lisa,
Your comments, while of note, isn’t relevant to my point regarding Salmon. He blatantly lied and all I did was point that out.
I’ll save my comments on your other statements for another day.
Atlex
atlex
Above should read “Your comment ….”
Salmon
The increase was in suicidality which is a predictor of suicide.
Atlex
By the way I did not lie. I was simply quoting another blog. A lie would mean that I mistated facts intentionally which I did not do.
Honest mistakes happen, and assuming what you said about me is also an honest mistake I think you owe me an apology.
Salmon
Salmon
PS
Let’s all get away from an honest mistake and look at the real issue here. The overprescribing and misuse of drugs in children.
This article will probably be used to push off label use without adequate safety information in children. Right now we have a signal for the potential for increased suicide risk from a drug which is we already know is labeled to increase suicide in children, but which only happened after congress got involved.
So is the slight increase in efficacy for OCD really worth the risk of a child killing themselves?
Don’t we usually reserve drugs that commonly cause death to illnesses that have an even greater liklihood of death?
Salmon
atlex
Salmon,
I’ll take you at your word regarding an “honest mistake.” However, in your response, you made almost the same “honest mistake” again. The study does not show an increase in suicidality as you state. Here a direct quote from the study: “Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group.”
I have some disagreements with your second response, but do agree that prescribing of medication in children should be done with great care and should be regularly examined for unintended negative consequences.
Atlex
Marilyn Mann
A recent post I wrote on ezetimibe use in kids seems relevant:
http://www.gooznews.com/archives/001233.html
Salmon
Atlex,
I stand by my remarks regarding suicidality.
Suicidality includes not only suicidal and homocidal ideation and suicide attempts but actions such as self injury and even thoughts of self harm. These are metrics that Columbia University used when they verified the conclusions of two different groups of FDA reviewers on suicidality with antidepressants in adolescents.
The rate of suicidality was approximately 2 out of 300 on Zoloft. I’ve seen raw data on suicide and suicidality rates in other studies and the rate of completed suicide for other drugs is typically around double the rate of suicidality. Based on the sample size for the entire study and the rates of completed suicide for other drugs I would have to say that even before the study began it should have been obvious to anyone familiar with the expected rates for antidepressants that there was a very low chance of seeing any completed suicides.
It’s very important that companies include enough subjects in these studies to properly evaluate the risk, otherwise it’s likely to be entirely missed in practice. This is simply because of the numbers.
A typical child psychiatrist can only see about 500 patients a year and fewer are going to be on any particular drug. Thus a child psychiatrist might see 1 suicide every several years and they are likely to think that it’s the underlying disease and not think it’s the drug. Only companies and the maybe the FDA are likely to collect sufficient postmarketing safety information to make the connection.
Salmon
atlex
Salmon,
Be my guest to stand by completely made up data. Go look at the study itself. Your data is incorrect. See Table 3 at this link.
http://content.nejm.org/cgi/content/full/NEJMoa0804633#T3
Atlex
Salmon
Thank you for referring me to the data table. I stand corrected. Based on what is presented in this table I have to agree, that in this study report there was no greater amount of suicidality reported on Zoloft as compared to placebo.
I was simply sloppy and thought that the 2 cases were both on Zoloft.
Salmon
Lisa Van S
Atlex,
One only has to ask two questions in regards to the Zoloft Study…
Does this Study meet the requirements for FDA approval?
Why was this study not!.. presented to FDA approval.
These are the only two questions that matter!… Who the Hell cares what the Media or the Industry apologists have to say.
Lisa Van S
Salmon and Atlex,
Do the two of you really care about the validity of this study? Then tell the NIMH and Pfizer to release the “RAW DATA”…… Its just that simple!!!
Lisa Van S
One more thought!! It was Pfizer who combined two negative studies to form one positive. Pretty Sad… Kindergarten Math… Ouch!!!!
atlex
LVS,
First, this is not a Pfizer sponsored study. Based on the stusy’s write-up, Pfizer was only asked to supply study medication and nothing more. There is no reason for Pfizer to sponsor a study for Zoloft since the product has lost exclusivity (almost all use of sertraline is in its generic form and not branded Zoloft). For that same reason, there is no entity with any interest in taking this study to the FDA for “approval.” Your speculation has no basis in reality or logic; it amounts to nothing more than baseless conspiracy theory.
Atlex
An FDA Reviewer
Lisa,
If you really want to do something useful.
See the comments from the following post about the FDA reviewer who is being fired
(http://www.pharmalot.com/2008/10/preemption-the-business-case-of-the-century/#comments)
and get people to have Congress look into it.
The person is a pediatric psych drug reviewer.
An FDA Reviewer
Lewis
Has anyone noticed that the data used for this study came from Express Scripts - a PBM? Based on their business model, they don’t get paid if the drugs don’t get dispensed. What is their incentive to curb this trend and what policies are they implementing to ensure appropriate prescribing? Who are they really working for?
Trolla
Interesting - focus of comments is on the anti-psychotic drugs, and not the others being rx for kids: diabetes, hypertension and cholesterol meds. The main contributor - obesity. Our kids eat too much take out junk (sweets, designer beverages, fried foods) and portions are too big. Too little exercise. Nutrition needs to be addressed as well.