Salon.com > Lawrence H. Diller

A prescription for disaster

Thu, 23 May 2002 19:19:00 +0000

Ten-year-old Shaina Dunkle had been taking the psychiatric drug desipramine (trade name, Norpramin) for her attention-deficit/hyperactivity disorder (ADHD) last year, when she suddenly fell and had a grand mal seizure. She died within minutes in the arms of her mother, who watched helplessly as her daughter's life ended. Shaina's autopsy revealed no other cause for her death than the desipramine. Her parents, in the small central Pennsylvania town of Smithtown, struggled privately with tremendous guilt and anger until they began to learn more about their daughter's treatment. Now, the outrage they feel about the circumstances of Shaina's death has prompted them to go public with their concerns.

Shaina Dunkle should never have been on this drug. In the late 1980s, child psychiatrists promoted desipramine for the treatment of ADHD. But by the mid-1990s, reports of seven sudden deaths of children taking the medication in appropriate doses for ADHD led most doctors to abandon desipramine for other, "safer" medications. According to Shaina's parents, desipramine was offered to them as a once-a-day drug that, unlike Ritalin, the most commonly prescribed medication for ADHD, had no abuse potential. However, when used properly Ritalin has not been implicated in sudden death (the one reported exception was a 14-year-old boy who died suddenly after taking the drug for more than 10 years). The Dunkles were never told of the increased risk for this catastrophic side effect related to desipramine.

An end run to marketing victory

Thu, 18 Oct 2001 19:30:00 +0000

In a step that represents an escalation in the influence of the pharmaceutical industry over parents and children, Alza Corp. has announced that it will use television commercials in its campaign to promote Concerta, a drug for the treatment of attention deficit/hyperactivity disorder (ADHD). Alza, which pioneered direct-to-consumer print ads to address ADHD last year, becomes the first drug company to promote -- on TV -- the use of a medication for a children's psychiatric disorder.

The groundbreaking TV ads for Concerta will not directly mention the drug -- that would be illegal. Concerta, like most of the medications used to treat ADHD in children, is a stimulant, which makes it a candidate for potential abuse. For this reason, its production, like that of Ritalin, is tightly controlled by the Drug Enforcement Administration (DEA), and its promotion is subject to controls set by the 1971 United Nations Convention on Psychotropic substances. According to these rules, monitored by the U.N. Narcotics Control Division, drug companies are not allowed to market controlled substances directly to consumers.

Defusing the explosive child

Wed, 18 Jul 2001 19:10:00 +0000

In my 23 years practicing behavioral pediatrics, I've seen dozens of parenting manuals come and go, their titles the checkpoints of popular thinking about child rearing in America. In the '80s, "The Difficult Child" by Stanley Turecki popularized the workings of childhood "temperament and fit" in a sensible and practical manner. In the early '90s, Mary Kurcinka's euphemistically titled "The Spirited Child" anticipated the boom in the attention-deficit hyperactivity disorder (ADHD) diagnosis and reflected the ethos of the now waning self-esteem movement in child psychology.

Now we have "The Explosive Child" by child psychologist Ross W. Greene. Originally published in 1998 and released this year in paperback, the book offers, as its subtitle suggests, "a new approach for understanding and parenting easily frustrated, chronically inflexible children." While Greene's approach may be valid for some extreme cases, "The Explosive Child" overpathologizes difficult children and is likely to have a pernicious effect on our already-lax culture of parenting. (Expect the publication next year of "The Lethal Child" and perhaps by the end of this decade "The Thermonuclear Child.")

Just say yes to Ritalin!

Mon, 25 Sep 2000 19:30:00 +0000

Public school administrators, long the enthusiastic adherents of a "Just Say No!" policy on drug use, appear to have a new motto for the parents of certain tiny soldiers in the war on drugs: "Medicate or Else!" It is a new and troubling twist in the psychiatric drugs saga, in which public schools have begun to issue ultimatums to parents of hard-to-handle kids, saying they will not allow students to attend conventional classes unless they are medicated. In the most extreme cases, parents unwilling to give their kids drugs are being reported by their schools to local offices of Child Protective Services, the implication being that by withholding drugs, the parents are guilty of neglect.

At least two families with children in schools near Albany, N.Y., recently were reported by school officials to local CPS offices when the parents decided, independently, to stop giving their children medication for attention-deficit hyperactivity disorder. (The parents of one student pulled him from school; the others decided to put their boy back on medication so that he could continue at his school.)

Dying on Ritalin

Thu, 27 Apr 2000 16:00:00 +0000

Ritalin is once more in the news. In just the past two months, a survey found large increases in the use of the stimulant drug -- prescribed most commonly to treat hyperactivity and depression -- for toddler misbehavior. What's more, newspapers reported the widespread recreational use of Ritalin on college campuses and by adults. And now, a medical examiner in Pontiac, Mich., has released findings strongly linking long-term use of Ritalin to the death of a 14-year-old boy.

The teen died at home while playing on his skateboard. Initially, it was thought that he had injured himself in a fall, but the medical examiner found the cause of death to be cardiac arrest secondary to blockage of coronary arteries that supplied blood to his heart. Such changes in the blood vessels are not ordinarily found in children so young, but are typical of the damage seen in adults who chronically abuse stimulants. The boy had been taking Ritalin for attention-deficit hyperactivity disorder under a doctor's prescription for 10 years. The medical examiner believed that no other reason could account for the changes in the child's heart. At least two other children who were taking Ritalin have recently died, in Texas and Ohio. These cases will now be investigated further.

Extreme Ritalin

Fri, 31 Mar 2000 17:00:00 +0000

Ritalin was very busy last week. Twice, the controversial drug for the treatment of attention deficit-hyperactivity disorder (ADHD) made it to TV network news shows and the front pages of newspapers across the country. First Hillary Clinton, in her capacity as children's advocate, announced that the National Institutes of Health would fund a multimillion dollar study of ADHD and Ritalin use in very young children. This followed publication in JAMA of a survey that found toddlers in increasing numbers were being given Ritalin and other psychiatric drugs. Later in the week, a story on the death of a college student from illegal use of psychiatric drugs also reported on the widespread availability of prescription stimulants on campuses throughout the country.

A preliminary study from Wisconsin has found that one in five college students has used Ritalin, Dexedrine or Adderall without a doctor's supervision. The medications are usually obtained from students who've received the drug legally from a doctor for the treatment of ADHD.

Psych meds for kids: Too much, too soon?

Fri, 10 Mar 2000 17:00:00 +0000

The opposing voices in the "debate" over the use of psychotropic medications in children veer toward hyperbole. One reviewer likened the process to "dueling grade-B movies," where supporters of drug therapy view doctors as noble knights freeing children and their families from the tyranny of a biologically based mental illness, and the other side has physicians, especially psychiatrists, as evildoers who sedate and control children's behavior by drugging them at the behest of their parents and teachers.

This dichotomy, while appealing to TV talk shows and tabloid journalism, doesn't do justice to the motives of nearly everyone involved. Nor does it describe the economic, bureaucratic and social realities that can lead to an 8-year-old boy taking three psychiatric drugs simultaneously.

The discussion is complicated by the fact that children are dependent on their caregivers and are not allowed to make the final decision about their own care. At best, children are offered informed choice but not consent. Also, because children are in a developmental stage, the stakes are higher when they take medication. Parents and doctors are concerned that the medications may affect normal physical and developmental growth, leaving, in essence, permanent side effects.

Kids on drugs

Thu, 09 Mar 2000 17:00:00 +0000

I've practiced behavioral pediatrics since 1978 in Walnut Creek, Calif., an affluent suburb of San Francisco. I have evaluated and treated more than 2,000 children who struggle with behavior and performance at home or at school. Last year alone, I wrote more than 400 prescriptions for Ritalin or a similar stimulant. I am not against prescribing psychiatric medication to children.

But I've become increasingly uneasy with the role I play and the readiness of families and doctors to medicate children.

I recently obtained some information from the National Disease and Therapeutic Index of IMS Health that adds to my uneasiness about the number of children taking psychiatric drugs in the United States.

IMS Health is to drug companies what the A.C. Nielsen company is to television networks. The pharmaceutical industry relies on it to report on the latest trends in medication usage. The company recently surveyed changes in doctors' use of psychiatric drugs on children between 1995 and 1999 and found stimulant drug use is up 23 percent; the use of Prozac-like drugs for children under 18 is up 74 percent; in the 7-12 age group it's up 151 percent; for kids 6 and under it's up a surprising 580 percent. For children under 18, the use of mood stabilizers other than lithium is up 40-fold, or 4,000 percent and the use of new antipsychotic medications such as Risperdal has grown nearly 300 percent.