The New York Times editorial today got it right:
"Many experts believe that attention deficit hyperactivity disorder is overdiagnosed and that the stimulants to treat it are overprescribed, thanks mostly to the marketing muscle of the drug industry and prescribing fads in the medical profession. The renegade advisory panel was right to throw its weight against this trend."
It is no longer possible not to notice the lack of medical justification for current psychotropic drug prescribing practices.
The extent of harm resulting from the three classes of prescribed psychotropic drugs–psychostimulants, antidepressants and antipsychotics–has yet to be tallied.
Contact: Vera Hassner Sharav
THE NEW YORK TIMES
February 12, 2006
A Surprising Warning on Stimulants
Last week’s recommendation by a federal advisory panel that stimulants like Ritalin should carry a strong warning about their dangers was a brave effort to slow the drug promotion juggernaut that frequently drives use beyond reasonable bounds. The panel had simply been asked by the Food and Drug Administration to recommend research into possible cardiovascular risks from the drugs. But the panelists went further and urged regulators to require the strongest possible warning labels.
To be sure, the decision was made by a narrow 8-to-7 majority of the panel, which heard only fragmentary data on known adverse effects. Actual proof of harm is uncertain. F.D.A. officials said that there were reports of strokes and heart problems among people taking the stimulants in recent years, and 25 sudden deaths. That is not a very high number, but such reports are notoriously incomplete and the stimulants have long been known to increase blood pressure and heart rates, posing potential risks to some patients. A biostatistician on the panel suggested that the stimulants might be more dangerous to the heart than the painkiller Vioxx, which was withdrawn from the market because of its cardiovascular risk.
The panel’s action is best understood as a response to an alarming upsurge in use of stimulants that many have deemed unwarranted. Some 2.5 million children and 1.5 million adults take the stimulants, mostly to treat attention deficit hyperactivity disorder. Adult use has jumped sharply in recent years, and panelists were particularly disturbed to learn that some 10 percent of all 10-year-old boys in this country are on attention deficit drugs, a number they deemed far beyond need.
Top F.D.A. officials expressed reluctance to issue too strong a warning based on uncertain evidence, lest they scare people away from potentially beneficial therapy. Some leading psychiatrists voiced the same worry. But the prime function of a strong warning label is to force doctors to think twice before prescribing. That is presumably salutary even if it does depress drug sales a bit.
Many experts believe that attention deficit hyperactivity disorder is overdiagnosed and that the stimulants to treat it are overprescribed, thanks mostly to the marketing muscle of the drug industry and prescribing fads in the medical profession. The renegade advisory panel was right to throw its weight against this trend.
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