Strattera Deaths (German TV Request) False Reports from Eli Lilly

Wed Nov 12, 2008

We have received a request from a German TV crew who is doing a special on Lilly’s newer ADHD medication, Stratera. These investigative reporters from Germany are doing a 45 minute piece and looking for experiences of tragedy /suicide or severe adverse reactions in children treated for ADHD with this drug. I know we have had reports, but I do not keep close track anymore of which drug is involved after so many cases because all these drugs work basically the same way. An antidepressant is an antidepressant no matter what you callmit or what you prescribe it for or how you explain its supposed uniqueness. So if you or someone you know has been through a Strattera-induced nightmareand would be willing to help get some exposure of this in the press, please get in touch with me so that I can put you in touch the reporters.

O nce you read the following article on Strattera deaths you will see how very important it is to get information about this drug out to the public –

especially throughout the UK and Europe. What is going on here IS CRIMINAL!!
And here is just one example out of the article below that is full of data on how
the government agency in the UK who oversees these drugs is ignoring
critical information – even fatalities, and doing NOTHING but making excuses
for their own behavior:

MHRA has for almost three years been in possession of data showing that
Strattera in many cases actually can cause or worsen the œcondition it is
claimed to alleviate. More than 700 reports were submitted to the manufacturer,
Eli Lilly, about Strattera inducing “œpsychomotor hyperactivity. Lilly called
this an exacerbation of the “œunderlying ADHD”. If we would apply this to
the area of real medicine and to diabetes we could say that the patient got a
diabetes medication with resulting heavy increase in blood sugar level. Such a
medication would probably be withdrawn very fast from the market. But the
MHRA has not yet, after three years, succeeded to get even a bad quality review
of these cases done not even from the manufacturer.

Do read the rest of the information because it is clearly eye opening!! This
newer ADHD drug, Strattera, which is really an SSRI antidepressant, is
getting away with murder right under everyone’s noses. So definitely if you
know someone who is willing to talk to this news crew about their experience with
this drug, please do let me know ASAP.

Thank you,

Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness
_www.drugawareness.org_ (http://www.drugawareness.org/) &
_www.ssristories.org_ (http://www.ssristories.org/)
Author of Prozac: Panacea or Pandora? – Our
Serotonin Nightmare & the audio, Help! I Can’t
Get Off My Antidepressant!!! ()

_atracyphd1@…_ (mailto:atracyphd1@…)

_http://www.newmediaexplorer.org/sepp/2008/10/20/strattera_adverse_effects_uk_
medicines_agency_refuses_to_act.htm#_
(http://www.newmediaexplorer.org/sepp/2008/10/20/strattera_adverse_effects_uk_me\
dicines_agency_refuses_to_act.htm#
)

October 20, 2008
_Print this article_
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Strattera adverse effects: UK Medicines Agency refuses to act
By Sepp Hasslberger

Categories
_Pharma_ (http://www.newmediaexplorer.org/sepp/pharma.htm)

Janne Larsson, an investigator and reporter in Sweden, has obtained
information about adverse event reports on Eli Lilly’s ADHD drug Strattera,
using the Swedish freedom of information laws. The data, coming from both the FDA’s
adverse reaction database and from reports to the UK’s Medicines agency, shows
numerous adverse effects and scores of deaths by suicide.

Yet the agency, even after repeated prodding by Larsson to initiate action,
has refused to budge or even acknowledge that there is a problem. MHRA
apparently accepts the drug’s producer Eli Lilly’s data rather than its own and
the
FDA’s adverse event reports.

Image credit: _Monheit Law_
(http://www.monheit.com/strattera/contact_lawyer.asp)

Larsson says: An investigation of MHRA™s handling of the harmful effects of
the ADHD drug Strattera has proven the following:

MHRA has ignored data about instances of death among children in connection
with Strattera treatment. At least 41 children have died. The agency has not
investigated the reported cases and does not even have a compiled summary of
cases with fatal outcome. Further the agency has allowed the manufacturer Eli
Lilly to give false information about the number of fatal cases and has
taken no action against the company once the false information was revealed.

MHRA has for almost three years been in possession of data proving that
Strattera can cause agitation, mania and psychotic reactions with hallucinations
among children. Yet no warning has been issued to doctors and parents. The
agency has withheld these disastrous consequences despite clear evidence. Due
to bureaucratic procedures no warnings have been issued even if Eli Lilly reluc
tanly conceded to include these harmful reactions in its information to the
public almost a year ago.

MHRA has for almost three years been in possession of data showing that
Strattera in many cases actually can cause or worsen the œcondition it is
claimed to alleviate. More than 700 reports were submitted to the manufacturer,
Eli Lilly, about Strattera inducing œpsychomotor hyperactivity. Lilly called
this an exacerbation of the œunderlying ADHD. If we would apply this to
the area of real medicine and to diabetes we could say that the patient got a
diabetes medication with resulting heavy increase in blood sugar level. Such a
medication would probably be withdrawn very fast from the market. But the
MHRA has not yet, after three years, succeeded to get even a bad quality review
of these cases done“ not even from the manufacturer.
The background data for these conclusions can be found in the following text
and in the linked documents. When reading the data below please remember the
promise from the MHRA: we take any necessary action to protect the public
promptly if there is a problem._MHRA, About us_
(http://www.mhra.gov.uk/Aboutus/index.htm) [1]

Note that the linked documents (within letters described below) in most
cases could not be obtained in UK where the issuance of them would be deemed as
prejudicing œthe ability of the Assessory body to offer impartial advice and
where the MHRA wants to allow marketing authorisation holders the chance to
respond to regulatory action and make commercial decisions before data are
in the public domain. (MHRA, e-mail about FOIA-request, 29th September,
2006). However the documents could be obtained in Sweden, even if the MHRA has
tried to stop the issuance of them by implying that publication could threaten
the relations between Sweden and UK.
Deaths among children in connection with Strattera treatment

In May I submitted detailed data about cases of Strattera death to the MHRA.
1st October I finally got an answer from the Scientific Assessor of the
Vigilance and Risk Management of Medicines (VRMM). 7th October I got an answer
from Professor Kent Woods, CEO of the MHRA, referring to the letter sent by the
Scientific Assessor.

My data about Strattera deaths can be found _in the letter_
(http://jannel.se/Strattera.death2.pdf) Strattera: Eli Lilly gave false
information about
deaths from Strattera treatment “ a request for full investigation from 15th
May. [2]
The answer from the Scientific Assessor shows that MHRA is continuing to
ignore data about instances of death among children and adults in connection
with Strattera treatment. Despite limited resources and having to rely on data
released by reluctant medical agencies I had been able to produce a summary of
reported cases of Strattera death. Thats much more than the MHRA, with its
immense resources, had been able to do.

The agency was provided with specific data about instances of death forming
an excellent starting point for a full investigation. But instead of using
the data the MHRA used its energy to explain why it is impossible to
investigate these cases further, and in doing so presents some remarkable
comments.

The Scientific Assessor states _in the letter 1st October_
(http://jannel.se/Reply.from%20MHRA.Assessor.October.pdf) [3]:

in order to calculate the total number of reports with a fatal outcome
it is not simply a case of adding up reports with a fatal outcome mentioned
in our assessment reports of the PSURs [Periodic Safety Update Reports] and
those available on the FDA website as these different sources may contain
duplicate information. [Emphasis added.]

I fully agree and it takes only a casual reading of my letter from 15th May
to find out that much care has been taken to exclude possible duplicates. It
is quite easy to see that the data presented about fatal cases in my letter
is NOT simply a case of adding up reports with a fatal outcome. The only
way to come to another conclusion would be not to look in the first place and
it is a condemnation of the effectiveness of the agency to state the following
in the letter:

We have looked at the data you have sent us to see if they can add insight
to the statutory sources of data we have received and do not think that they
are of benefit as we cannot verify their source or accuracy. (p. 3)
[Emphasis added.]

I must add to all the data provided in my letter 15th May that the our

of the information about fatal cases is FDA™s Medwatch system and the PSURs
(submitted directly to the MHRA). I must make it clear that is very easy for
a lay person to find out that almost all reports about fatal outcome from
Strattera treatment submitted to the FDA came from Eli Lilly!

Thus the our of the information about fatal cases was in most of the
cases the manufacturer itself“ Eli Lilly. And yet the MHRA has not been able
to verify the source or accuracy of the information. The MHRA Scientific
Assessor states in the letter:The sources of data that regulators use such
as company data, spontaneous adverse reaction reports and literature are set
out in European and national law.
My FOIA request earlier this year to get a compilation of fatal cases in
connection with Strattera treatment was answered 12th August:

Thats very good and now we know that the data I submitted to the MHRA about
all fatal cases from Strattera treatment “ in the absolute majority of cases
were known by and reported via the manufacturer Eli Lilly.
The MHRA holds no data other than that previously released to you [the
misleading data from Eli Lilly in November 2007, see my letter from 15th May
for
more data] which was the data provided by the company. If you have any
questions about FDA data or the data provided by the company, you should
contact those organisations.

In other words the MHRA didn’t have a compiled summary of cases with fatal
outcome in August and the agency has not to this point been able to compile
such a summary.

As the agency has not been capable of getting the data or not even been
capable of using the specific data submitted for its use in a full
investigation NO action is taken despite the many verified deaths among
children in connection with Strattera treatment. This disregard for the safety of children is a scandal which should lead to a full formal investigation by the
Department of Health.

Drug induced agitation, mania and psychosis with hallucinations

Ive been contacted by parents asking if Strattera can induce mania and
psychosis with hallucinations. Their children have had such symptoms. The
parents have not found any warnings about it and their childrens doctors don’t
think that the symptoms are caused by the drug. The parents were desperate.

However the MHRA has known for almost three years that Strattera can cause
agitation, mania and psychotic reactions with hallucinations among children,
but has refused to issue warnings about it.

The Scientific Assessor from the MHRA _in the letter of 1st October_
(http://jannel.se/Reply.from%20MHRA.Assessor.October.pdf) [3] now confirms my
earlier arguments that the agency had knowledge about these effects a long time ago:

following an initial request in the assessment report for the Periodic
Safety Update for the period (dates 27-05-2005 to 26-11-2005) we asked Eli
Lilly for more information to enable us to review this issue in more detail. (p. 2)

This means that in the period ending 26th November, 2005 at the time when
Strattera was approved only in UK and four other European countries, but not
in the 22 additional European countries where it is now approved Eli Lilly
and the MHRA had knowledge about these disastrous effects in children taking
Strattera. But neither the MHRA nor Eli Lilly told anything about it and
Strattera was approved in 20 additional European countries in April 2006.
Image credit: _Wikimedia Commons_
(http://commons.wikimedia.org/wiki/Image:Strattera_atomoxetin.jpg)

Professor Kent Woods, CEO of the MHRA seems to be very misinformed by his
staff when answering about Strattera in a recent _letter of 7th October, 2008_
(http://jannel.se/answer.kent.woods.pdf) . In the letter Professor Woods
states [4]:

The MHRA is committed to ensuring that all safety concerns are subject to
robust scientific assessment and the best possible regulatory action is taken
in a timely manner. We strive to maintain the highest standards of work and
review our practices to ensure these standards are maintained or improved
upon where necessary. (p. 1)

In their 3rd March, 2006 report Psychiatric Adverse Events Associated with
Drug Treatment of ADHD: Review of Postmarketing Safety Data [5], the FDA
stated that there was compelling evidence for a likely causal association
between [Strattera/amphetamine drugs] and treatment emergent onset of signs and/or
symptoms of psychosis or mania, notably hallucinations, in some patients.

(p. 17) 360 reports about the drug inducing these effects had been received
up to June 2005.

From this FDA report the MHRA had knowledge about the œcompelling evidence for Strattera causing these effects on or about 3rd March, 2006 but did nothing.

In August the same year (2006) the MHRA requested the same data set from Eli
Lilly that was submitted to the FDA and which formed the basis of the FDA
report for Strattera. The data was sent to the MHRA some days later. But the
agency then decided not to do anything with the information. Instead it was
decided that Eli Lilly the manufacturer should do an analysis of the data
and submit its conclusions to the agency.

Professor Kent Woods says in his letter: An important aspect to this [ robust scientific assessment, highest standards] is ensuring that data from all available sources have been consider This may be true in some other area but it is definitely not true for the
safety work around Strattera. A very good example of this is the complete
rejection of the robust scientific assessment of Strattera in the FDA report.
Answering the question why the agency did not use the compelling evidence for harm in the FDA report _an official at the MHRA declared in a letter_
(http://jannel.se/mhraanswer.pdf) [6]:

Changes to European product information are based on assessment by EU
regulators, agreement between member states and in line with legal requirements
about product information, not on conclusions of FDA assessors. (25th May,
2007) [Emphasis added.]

Responsible officials at the MHRA had instead decided to rely completely on
the analysis of the manufacturer of the drug Eli Lilly. (In an article in
the Daily Mail this summer, Andrew Herxheimer, editor of the Drug and
Therapeutics Bulletin, and emeritus fellow of the Cochrane Centre commented:
Asking a drug company to review its own product is crazy, but it goes on quite a lot.
) [7]

At the end of 2007/beginning 2008 Eli Lilly submitted its review of
Strattera induced agitation, mania and psychosis with hallucinations to the
MHRA. It was a complete whitewash.

In summary: FDA was very clear about the psychosis-inducing effects of
Strattera; the MHRA did not listen. Instead the MHRA turned to the
manufacturer. Eli Lilly tried to explain away all the bad results found in its review. For
the full history about MHRA’s failure in this area and for a comparison of
the FDA report with the Lilly report, please see the following letter: _The
ADHD drug Strattera“ actions needed now_
(http://jannel.se/letter.mhra.strattera.jan08.pdf) [8] from January 2008, and
the letter _The ADHD drug Strattera“
an analysis of reports of drug induced mania, psychosis and hallucinations_
(http://jannel.se/strattera.mhra.March.08.pdf) [9] from March 2008.

In the letter from March [9] Eli Lilly’s whitewash report for the period up
to November 2007 is presented. At the end of that report Lilly says [10]:

Nevertheless, Lilly will consider adding language regarding psychotic symptoms
including hallucinations to its product information sheet. (p. 1279)

Larsson – _Suicides & Psychiatric Drugs_
(http://www.newmediaexplorer.org/sepp/suicide.psychiatricdrugs.pdf)

And so we come to October 2008 and the letters from Professor Kent Woods and
from the Scientific Assessor for Strattera. We are reassured that the MHRA
is acting to ensure that Strattera is used as safely as possible that

all safety concerns are subject to robust scientific assessment and the best
possible regulatory action, that any new safety signals are evaluated in
an independent, scientifically robust manner (Woods); we are told that

discussions between European Member States and Eli Lilly are ongoing to agree
on the most appropriate information to be included in the product information
for patients and prescribers; we are told to be patient, to understand that
it takes time from the point where œupdates have been agreed for inclusion in
the product information to the point where these will appear in the packs
in the market place due to movement of stock in the supply chain, and that
the appearances are estimated to be within the next 6 months (Scientific
Assessor).

It is probably hard to find a more obvious violation of the promise¦ we
take any necessary action to protect the public promptly if there is a
problem than the case described above. The worried parents still have no answers if
Strattera can induce the symptoms they find in their children. And the MHRA
knew about it three years ago but withheld the data. This should be
included in the investigation of the agency by the Department of Health.

Strattera causing hyperactivity“ the condition it was supposed to alleviate In my earlier letter to the Department of Health (29th August) I took up the data about the 700 forgotten cases of hyperactivity. I referred to my _letter 2nd January to the MHRA_
(http://jannel.se/letter.mhra.strattera.jan08.pdf) [8] and gave data about the
fact that Eli Lilly had withheld sensitive information and classified harmful effects as an exacerbation of the underlying ADHD.

The logical solution would have been for the MHRA to request all data about
this security risk, followed by an independent review of the data. But this
was not done and as expected nothing is still done. MHRA asked Lilly for an
explanation about this signal stemming from Periodic Safety Update Report
5 (dates 27-05-2005 to 26-11-2005) but got no answer. Three years later the
Scientific Assessor from the MHRA writes in the letter from 1st October:

The information submitted by the MAH [Market Authorization Holder] has been
evaluated and the MAH will be requested to provide further detailed
information within the next 2 months to ensure the issue has been investigated
in a thorough and scientific manner. (p. 2) [3]

The MHRA got this safety signal almost three years ago and is still in
the process of getting some sensible answers from Eli Lilly.

————

I again request the Department of Health to take action. This does not
concern only the children in UK; it concerns the children in the whole of
Europe, indeed it concerns all the children of the world.

The failure of the agency will also mean that psychiatrists within The
Guideline Development Group in NICE can push through more treatment with
Strattera and other ADHD drugs. The MHRA is withholding the clear evidence for
harmful effects and the psychiatrists with close relations to the manufacturers
of the drugs can unimpeded recommend these medicines to unsuspecting
doctors and parents.

The answers given by Professor Kent Woods and the Scientific Assessor did
not in any way handle my concerns. On the contrary, they finally proved that a
full formal investigation of the matters raised above is needed.

Yours sincerely,

Janne Larsson

Reporter – investigating psychiatry
Sweden
_janne.olov.larsson@…_ (mailto:janne.olov.larsson@…)

[1] MHRA, About us, _http://www.mhra.gov.uk_ (http://www.mhra.gov.uk/)
[2] Larsson, Strattera: Eli Lilly gave false information about deaths from
Strattera treatment“ a request for full investigation, May 15, 2008,
_http://jannel.se/Strattera.death2.pdf_ (http://jannel.se/Strattera.death2.pdf)
[3] MHRA, Re: letter of 9th September 2008 to “Assessor responsible for
Strattera, October 1, 2008,
_http://jannel.se/Reply.from%20MHRA.Assessor.October.pdf_
(http://jannel.se/Reply.from%20MHRA.Assessor.October.pdf)
[4] MHRA, Re: Open letter to Pr. Kent Woods (10th August 2008), October 7,
2008
_http://jannel.se/answer.kent.woods.pdf_
(http://jannel.se/answer.kent.woods.pdf)
[5] FDA, Psychiatric Adverse Events Associated with Drug Treatment of ADHD:
Review of Postmarketing Safety Data, released March 3, 2006.
_http://www.fda.gov/ohrms/dockets_
(http://www.fda.gov/ohrms/dockets/AC/06/briefing/2006-4210b_11_01_AdverseEvents.\
pdf
)
[6] MHRA, answer FOI request, May 25, 2007,
_http://jannel.se/mhraanswer.pdf_ (http://jannel.se/mhraanswer.pdf)
[7] Daily Mail, Heart attacks and suicides… yet the dangers were all kept
so quiet. So how CAN you trust your medicine? July 7, 2008,
_http://www.dailymail.co.uk/_
(http://www.dailymail.co.uk/health/article-1033132/Side-effects-include-suicide-\
heart-attacks-So-prescribed-drugs.html
)
[8] Larsson, The ADHD drug Strattera – actions needed now, January 2, 2008,
_http://jannel.se/letter.mhra.strattera.jan08.pdf_
(http://jannel.se/letter.mhra.strattera.jan08.pdf)
[9] Larsson, The ADHD drug Strattera – an analysis of reports of drug
induced mania, psychosis and hallucinations, March 9, 2008,
_http://jannel.se/strattera.mhra.March.08.pdf_
(http://jannel.se/strattera.mhra.March.08.pdf)
[10] Eli Lilly, Cumulative review of Spontaneous Case Reports of Mania,
Psychotic Disorders, Hallucinations, and Agitation, Appendix 16 to Periodic
Safety Report 9 for Strattera, 2008,
_http://jannel.se/Lilly_psychosis_strattera.pdf_
(http://jannel.se/Lilly_psychosis_strattera.pdf)

See also:

_Doctors told to curb use of Ritalin in hyperactive children_
(http://www.timesonline.co.uk/tol/news/uk/science/article4813727.ece)
_Children’s suicide attempts raise concerns about ADHD medication_
(http://www.theglobeandmail.com/servlet/story/RTGAM.20080703.wadhd03/BNStory/spe\
cialScie

nceandHealth/home)
_The ADHD drug Strattera: Lilly to issue warnings about psychosis,
hallucinations, mania and agitation_ (http://jannel.se/strattera.psychosis.doc)
_Strattera side effects_ (http://www.bonkersinstitute.org/stratteraffex.html)

_Strattera – 10,988 adverse “psychiatric reactions” reported in less than
three years_ (http://www.24-7pressrelease.com/view_press_release.php?rID=16662)
_Attention Deficit Hyperactivity Disorder? No, they’re just naughty, say
experts_
(http://www.dailymail.co.uk/news/article-1031436/Attention-Deficit-Hyperactivity\
-Disorder-No-theyre-just-naughty-say-experts.html#
)

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4/9/2001 – Back-to-back documentaries tonight and tomorrow.

Back-to-back documentaries on children and psychotropic
medications, tonight and tomorrow night, on A&E and PBS.
Here’s a review from the NEW YORK TIMES.

Mark

http://www.nytimes.com/2001/04/09/arts/09MCDO.html?pagewa
nted=print

April 9, 2001

Television Review: Ifs, Ands or Buts of Drugs for Restless U.S.
Children

By C McDONALD

By pure coincidence, two documentaries on two different
channels are arriving back to back tonight and tomorrow to
examine the same issue: the widening and sometimes
harrowing use of psychoactive drugs in America to modify
children’s behavior. Suffice it to say that the programs ˜ the first
on A&E, the other on PBS ˜ are in many ways redundant.

They even largely look alike: both of these well-made
presentations are structured around intimate portraits of people
caught up in this anguishing phenomenon.

Thus, over two nights, we encounter seven boys and girls, some
illustrating the drugs’ benefits, others telling of depression,
malnourishment, even psychosis after being put on
medications. We’re also introduced to Adderall, Zoloft,
Wellbutrin, Cylert, Dexedrine and, most prevalent of all, Ritalin ˜
drugs administered to help troubled children sit still in school,
concentrate, get along with others (including the teacher) and
have fruitful lives.

Given the programs’ similarities, the obvious question is, which
is the one to watch: “Generation Rx: Reading, Writing and
Ritalin,” one of Bill Kurtis’s “Investigative Reports,” to be shown
on A&E tonight, or “Medicating Kids,” a Frontline special
appearing on PBS tomorrow?

The answer is not so cut and dried. Both hourlong
documentaries are serious, sometimes startling contributions to
an important discussion over the increasing ˜ and some say
spurious ˜ diagnosis of attention deficit disorder and attention
deficit hyperactivity disorder in children (up to four million cases,
by one estimate). And for all the parallels, each program
contains an angle or two that the other doesn’t.

The A&E program, for instance, looks at the alternative of
long-term drug-free behavior therapy. The Frontline
documentary, more aggressively, suggests that drug
manufacturers and certain pliable doctors may have entered into
unholy alliances to promote the use of the drugs among
children.

What’s more, watching both programs affords an illuminating
opportunity to see how two of the lamentably few investigative
bodies still standing in television journalism can differ so
markedly in tone even when plowing the same ground.

The Kurtis production wastes no time in establishing a darkly
dramatic approach, not to mention tipping its hand to its
sympathies. “It’s scary: we’re polluting our best resource,” says
an anonymous, unchallenged voice in the opening. “Putting our
kids on these drugs when they really don’t need it.” Mr. Kurtis, the
host, asserts that use of the drugs may challenge “the very
essence of childhood itself.”

Frontline takes a more measured tack, which ultimately gives it
the edge, declaring at the outset its more open-minded
intentions: “We wanted to know why kids are being prescribed
these drugs and whether or not they help.”
All sides get a fair hearing in both reports: those who say the
drugs have rescued many children from calamitous lives, and
those who say the drugs have been wildly overprescribed,
leading in one case, recalled on Frontline, to a 12-year-old boy’s
classroom suicide attempt using a pencil.

Both presentations also acknowledge that it is too early to know
the drugs’ long-term effects. But only Frontline seems willing to
end on an honestly inconclusive note. On A&E, Mr. Kurtis can’t
resist a loaded sign- off about Einstein and the scientist’s own
apparent attention deficit as a child. Where might we be, Mr.
Kurtis seems to ask, if the father of relativity had been a child of
Ritalin?

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1/9/2000 – The Legal Drugging Of America

The Legal Drugging Of America

Here is a recent article from Arianna Huffington. – Mark M.
———-

The Legal Drugging Of America: A Status Report
Filed December 23, 1999
by Arianna Huffington

Two reports out this month highlight the continuing trend toward the
legal drugging of America.

The Surgeon General’s report on the state of the nation’s mental health
found that 22 percent of the population has a diagnosable mental
disorder.” At the same time, a study by the National Institute of
Mental Health concluded that we are under-medicating our children and
that for those diagnosed with attention-deficit hyperactivity disorder,
drugs — specifically Ritalin — are more effective than therapy.

The big drugmakers will no doubt use these studies as additional
weapons in their ongoing war to make mood-altering drugs the solution
to all life’s problems. Our magazines are already stuffed with ads
portraying pharmaceutical giants as noble enterprises, engaged in
nothing but the pursuit of pure science and the public good. And our
television screens are filled with commercials for drugs to cure
shyness and so-called “social phobias.”

The Food and Drug Administration has recently approved Effexor XR, a
drug for “generalized anxiety disorder” — the garden-variety
free-floating anxiety that has plagued humanity since the expulsion
from Eden. Mark Twain summed it up this way: “I am an old man, and
have known a great many troubles, but most of them never happened.”

These days, the assumption seems to be that drugs can take care of
everything unpleasant in the human condition. “At Pfizer,” one ad
boasts, “we look to the future with the knowledge that the only thing
incurable is our passion.” What the ad doesn’t mention is that drug
company profits (Pfizer’s last year were $3.35 billion) are often spent
not on finding cures for serious diseases but for “lifestyle”
maladies — baldness, toenail fungus, and of course any interruption to
a perpetually sunny mood. Not one major drug company in the United
States has an in-house research program on malaria, for example, but
sales of pharmaceutical drugs for pets are approaching $1 billion
annually.

The major flaw of the Surgeon General’s report is the lumping together
of dramatically disparate conditions. According to Surgeon General
David Satcher himself, “tragic and devastating disorders such a
schizophrenia, depression, and bipolar disorder, Alzheimer’s disease,
the mental and behavioral disorders suffered by children, and a range
of other mental disorders affect nearly one in five Americans in any
year.” This is a classic example of pseudo-scientific sleight of hand:
linking schizophrenia to childhood behavioral problems as though they
are in any meaningful sense on the same continuum.
It is this mind-set that has led to the Ritalin epidemic — with the
number of kids taking the powerful drug skyrocketing from 1 million in
1990 to 4 million today. And now along comes a study that says the
answer to those many instances where Ritalin has proved ineffective is
to simply up the dosage. As Dr. Peter Jensen from the National
Institute of Mental Health put it, “You find the dose that achieves
the absolute possible total benefit for this child … That’s the dose
you want, not the lowest possible dose that you can get by on.” It’s
ingenius, if Ritalin isn’t working, try more Ritalin. As they used to
say in the ’60s, “Why do you think they call it dope?”

It’s doubly tragic that these reports have arrived at a time when we’re
facing a crisis in managed health care. Because a diagnosis of a mental
disorder will almost always prompt managed care companies to take the
cheap way out — drugs rather than therapy, no matter how potentially
dangerous the long-term side effects, especially on children’s growing
brains.

Making this growing emphasis on drugs especially troubling is the
conclusion by federal investigators that the FDA has “no quality
control system” to track adverse drug reactions. Currently, doctors
and hospitals are not even legally required to report patients’ drug
side effects to the FDA. As a result, in one year, from the beginning
of June 1997 to the end of May 1998, the agency got only 13,825 such
reports even though in hospitals alone approximately 180,000 patients
die every year from drug reactions.

Even if the FDA moves from a voluntary to a mandatory reporting system,
the agency has only 80 employees to monitor more than 3,000
prescription drugs. Over the past year and a half, the agency has
banned only five drugs that it previously had approved but now deems
dangerous. But every year 2 million Americans are hospitalized due to
drug side effects.

“Most errors are not caused by stupidity, incompetence or neglect, but
by system failures that allow them to occur,” said David Lawrence,
head of Kaiser Permanente, suggesting that the safety tests done by
drug companies are not enough, and that the companies fail to educate
physicians and hospital workers on the proper administration of their
drugs.

As drugs, and the conditions treatable by drugs multiply, can we
continue to tolerate such slipshod oversight of a powerful industry
that so affects our lives — and our deaths? Or continue to rely on
reports tainted by the drug industry’s assumption that millions of
Americans are suffering from mental disorders whose cure is just a pill
pop away? Oh, the infinite possibilities of an America where everyone
has finally admitted to a mental disorder, and everyone is blissed-out
on appropriately high doses of the newest wonder drugs.

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10/28/1999 – STUDY QUESTIONS TREATMENT OF VERY YOUNG WITH PSYCHOTROPIC MEDS

YOU MAY BE INTERESTED IN A NEW STUDY WHICH APPEARS IN THIS MONTH’S
JAMA, QUESTIONING THE TREATMENT OF VERY YOUNG CHILDREN (3 AND UNDER)
WITH PSYCHOTROPIC DRUGS. HERE’S A SUMMARY AND A LINK.

Diagnosis of Attention-Deficit/Hyperactivity Disorder and Use of
Psychotropic Medication in Very Young Children

Marsha D. Rappley, MD; Patricia B. Mullan, PhD; Francisco J. Alvarez;
Ihouma U. Eneli, MD; Jenny Wang, PhD; Joseph C. Gardiner, PhD

Conclusions

Children aged 3 years or younger had ADHD diagnosed and received
markedly variable psychotropic medication regimens. Little information
is available to guide these practices. The presence of comorbid
conditions and injuries attests to these children’s vulnerability.
Resources must be identified that will enable physicians to better
respond to the compelling needs of these children and their families.

Editor’s Note: The authors point out a pressing need to define better
diagnostic criteria and effective treatment in very young children.
There seems to be a real deficit in attention to this
problem.—Catherine D. DeAngelis, MD

http://archpedi.ama-assn.org/issues/v153n10/full/poa8497.html

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