dangerous thoughts

The New York Times has a rather disturbing front-page article today about the proliferation of prescription drugs -- in particular, behavior modification meds -- being dispensed to children at summer sleepaway camps. Sort of reads like another obituary for childhood innocence in America.

Now, I am in no position to judge how many kids are being helped versus harmed by the growing use of anti-depressants and anti-ADHD stimulants like Ritalin. And I have to assume that for at least some kids these meds are lifesavers. But the more I read about this trend, the more concerned I am that we are overreacting in medicalizing normal child behavior, overprescribing heavy-duty drugs with not insignificant potential side effects, and thereby needlessly putting a lot of kids at risk just to make ourselves as adults feel good.

It's passages like these in today's Times story that really make you wonder:

[M]any experts say family doctors who do not have expertise in psychopharmacology sometimes prescribe drugs for anxiety disorders and depression to children without rigorous evaluation, just as they do for adults.

“There is no doubt that kids are more medicated than they used to be,” said Dr. Edward A. Walton, an assistant professor of pediatrics at the University of Michigan and an expert on camp medicine for the American Academy of Pediatrics. “And we know that the people prescribing these drugs are not that precise about diagnosis. So the percentage of kids on these meds is probably higher than it needs to be.”

A few medicines growing in popularity, like Abilify and Risperdal, are used for a grab bag of mood disorders. But according to the Physicians’ Desk Reference, the encyclopedia of prescription medications, they can have troublesome side effects in children and teenagers, including elevated blood sugar or the tendency toward heat exhaustion, which requires vigilance by counselors in long, hot days on the ball fields.

Some doctors, nurses and camp directors are uneasy about giving children so-called off-label drugs like Lexapro and Luvox. Such medications are used for depression and anxiety, and have been tested only on adults but can legally be prescribed to children. Clonidine is approved as a medication for high blood pressure but is routinely used for behavioral and emotional problems in children.

This debate has been bubbling on the periphery of American public life for the last several years, and there have been a few obscure Congressional hearings on the subject here and there. But I hope this Times story, by underscoring just how prevalent these drugs are, will help elevate this discussion as a matter of public policy and prod our attention-deficited leaders in Washington to take some concrete action.

The fact is, we're not just talking about a minor cultural phenomenon anymore, but a major health issue affecting the lives of millions of families. And before we allow the mass medicalizing of children's behavior go any further, it would nice to have some credible answers to the hard questions that continue to be raised about this trend. Is it necessary? Is it safe? What role are the pharmaceutical companies playing in "stimulating" demand for these meds? What will it take to bring the medical community to a consensus? I'm sure more than a few parents would like to know.