|The DSM 'House of Cards' is about to Collapse - look at article about medical ethics and sign petition.|
The Ethics and Science of Medicating Children
Jacqueline A. Sparks
The University of Rhode Island, Kingston, RI
Barry L. Duncan
Institute for the Study of Therapeutic Change
Ft. Lauderdale, Florida.
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Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an empirical house of cards, driven by an industry that has no conscience about the implications of its ever growing, and disturbingly
younger, list of consumers. Recognizing that most mental health professionals do not have the time, and sometimes feel ill-equipped to explore the controversy regarding pharmacological treatment of children, this article discusses the four fatal flaws of drug studies to enable a critical examination of research addressing the drugging of children.
The four flaws are illustrated by the Emslie studies of Prozac and children, which offer not only a strident example of marketing masquerading as science, but also, given
the recent FDA approval of Prozac for children, a brutal reminder of the danger inherent in not knowing how to distinguish science from science fiction. The authors argue that
an ethical path requires the challenge of the automatic medical response to medicate children, with an accompanying demand for untainted science and balanced information to inform critical decisions by child caretakers.
ETHICAL CONCLUSION: FIRST DO NO HARM
With all this largesse and publicity raining benevolently down, is it any wonder that people become hypnotically fixated on the brouhaha about a “revolution” in pharmaceuticals and overlook the boring fine print of the drug studies with their more negative implications? Is it any wonder that mental health professionals, who do not have the time to sift through the doublespeak, become beguiled into believing that privileging drugs is a matter of scientific fact? And consequently, how many will know that in the Emslie studies Prozac only outperformed placebo on a few clinician-rated measures, or the sleight of hand presentation of the integrity of the double blind; or the interesting design choice of withdrawing behavior therapy long before endpoint measurement in the MTA?
The time has come to take a long and critical look at the rapid encroachment of drug money and drug marketing influence on those who have the least power to just say no— children. Given that drugs are essentially foisted upon youths without their consent, and the efficacy and safety of drugs for youths has yet to be established, we consider the practice of prescribing drugs to youths as clearly the last resort, and in many cases, unethical, until other options have been discussed. The problem is, in the current pharmaceuticalsaturated climate, it becomes increasingly difficult to have other options. The tale of drugs’ magical powers to solve life’s dilemmas is so compelling, so ubiquitous, there is literally no room for anything else. When faced with the difficult decisions about how best to help, parents, child professionals, and significant caretakers, with all the best intentions, too easily go for the medicine cabinet.
What is required is a shift, or, more likely, a reconnection with what parents and therapists know and have experienced over and over—that most people can and will develop solutions to even the most daunting dilemmas given support and encouragement, that the impetus to health has many avenues and sometimes takes unorthodox routes, and that change will and does occur naturally and universally. At its core is a faith in change and the human tendency to find a way even out of the heart of darkness. Children are no exception. We should not discount the abilities of children to rise to the occasion and to conquer difficult situations in their lives, particularly with the love and support of key adults. Nor should we discount the accuracy of the youngest voices to tell us what is working
or what might help. We can protect children, and we can allow them into the equation, giving them a say in their lives (Duncan & Sparks, 2002).
Most often, children trust that adults know and do what is best for them. We must not betray this trust. We simply cannot be blasé about accepting the increasingly automatic medical response, but must demand high quality, untainted science and accurate, balanced information to inform critical decisions by child caretakers. Our ethical position is that families should make the decisions they believe will be most helpful for their
youngest members. At the same time, we believe professionals are duty bound, by the ethics of our various professions, to ferret out the good science from the bad and to learn to critically analyze claims in Web sites, brochures, press releases, and scientific studies regarding medications for children. We recommend a vigorous critique of what has come 36 Sparks and Duncan to be everyday understanding of what works for children and teenagers as they navigate sometimes difficult paths to adulthood. We are obligated to be purveyors of this information to those who must make the final choice, the families themselves.
Finally, we believe therapists are obligated to not take the easy road by abandoning tried and true counseling skills in favor of a “quick fix.” Being up-to-date on the latest pediatric psychopharmacology at the expense of adding to or strengthening other practices only bolsters medical dominance and diminishes the choices we can offer. When concerned parents approach us, we should be ready and willing with a range of nonmedical strategies. We assert that heroic youths and heroic parents should have a full range of options for making this journey on their own terms.
Only then can we claim that we first do no harm.
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