Children's Mental Health, Social Decay, and Big Profits

The number of pre-adolescent children diagnosed with bipolar disorder has skyrocketed since the mid-1990s, according to a very sketchy Associated Press article today summarizing a study by Dr. Mark Olfson of Columbia University and the New York State Psychiatric Institute and partially funded by NIMH.

Throughout the mid 1990s the number of kids diagnosed with, and medicated for, ADHD also increased dramatically. One explanation was that the medical community (and society at large) had become more comfortable acknowledging the existence and validity of pathological psychiatric conditions. Another camp argued that parents who were unwilling to discipline unruly kids were jumping at the possibility that a pathological dysfunction was to blame, thus absolving them of the charge of failure to discipline.

I'm sure that there is some truth to both positions. The real question is what lies at the heart of the increase? By the title of my entry, I bet you can guess where I'm headed: Money. Always follow the money. My outrage this time was ignited by a recent episode of the Australian Broadcasting Company's Radio National program "Background Briefing" entitled "Mentally Ill Children." The transcript is here:

http://www.abc.net.au/rn/backgroundbriefing/stories/2007/2012718.htm#transcript

You can listen to the radio show by streaming or downloading the audio from the same page.

The obvious link between profits and psychiatry can be seen in the MASSIVE amount of money being thrown into advertising campaigns for "new" psychotropic drugs. The pharmaceutical industry is happy to validate any diagnosis that they can sell a "cure" for. If you want a disturbing example of the lengths to which big pharma will go to make money, do an internet search for "Neurontin," an anti-seizure drug that Pfizer Pharmaceuticals and its subsidiary Warner-Lambert manufactured. Although the FDA approved the use of Neurontin as an anti-siezure medication in 1993, Pfizer and its subsidiaries heavily marketed Neurontin to psychiatrists for a variety of unapproved ("off-label") uses. They pushed its use for bipolar disorder, ADD, migraines, drug/alcohol withdrawal, restless-leg syndrome, and even Lou Gehrig's disease, despite scientific studies showing it to be ineffective for these conditions. In 2004 Warner-Lambert pled guilty and paid more than $430 million to resolve criminal and civil charges that its off-label marketing of Neurontin was illegal and fraudulent. In addition, over 300 lawsuits were filed alleging that Neurontin contributed to suicidality in certain patients. More information on this case can be found here:

http://www.fda.gov/fdac/features/2004/404_wl.html

Parents of children that have been flagged by school counselors as problems can attest to another phenomenon: If a psychologist or psychiatrist diagnoses the child as having a coping disorder or other non-pathological condition, their insurance company is likely to refuse reimbursement or payment for treatment. However, they will reimburse healthcare providers if the condition is pathological and medication is prescribed. Since it's easier for a psychologist or psychiatrist to collect fees from an insurance company than from an individual, guess which alternative the professional is likely to choose: Follow the money.

Are we as a society becoming less tolerant of people that fall outside the "norms" of behavior? Wasn't Albert Einstein a poor student? I think he ended up OK even without Ritalin. Why are kids that don't want to conform to the expectations of the majority shunned as pariahs? I'm really worried that after generations of "fixing" kids who are different we will crush the creative spirits that make our life interesting. Fortunately, there are still parents who welcome this diversity of thought. I just hope our schools don't take on the role of thought police. Orwell's 1984 didn't just warn against a political hell, but a social one as well. We'd do well to heed his warning (though obviously we haven't).