Should a doctor ever withhold info on BAD side effects?

[AntiPharm]

Should a doctor ever withhold info on BAD side effects?', 'This is a very real concern of mine because one class of drug with serious effects are being prescribed to kids (and adults) at many times the rate of just a few years ago… and they are now being used for a lot of disorders they originally were not meant to treat (ADD, Depression, Bipolar, ADHD, various Anxiety Disorders, Phobias, etc.)… not because studies show them to be the right drug… it is more because drug reps can show a doctor that the patient will be more “treatment compliant” if he is on them.

If the doctor actually told the parents or the patients about the side effects it would drastically reduce the number of patients willing to take them. Because… what was always suspected has shown to be true from the results of the National Institute of Mental Health’s (NIMH) huge Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study of several atypical antipsychotics and one typical antipsychotic. CATIE is the largest, longest, and most comprehensive trial ever conducted investigating the effectiveness of antipsychotic drug treatment (1460 people over an 18 month period).

Drug company studies to qualify for FDA approval last several weeks and the FDA often asks for long term studies to be done after the drug hits the market. Drug companies have no reason to follow through with the long term studies because they might show something bad and the drug will get pulled. The FDA has never yanked a drug simply because the drug company did not do the long term studies it promised to do in order to get approval to go to market.

In 1994, a study doing before and after MRIs of patients taking antipsychotics showed clear changes in the brain (American Journal of Psychiatry 1994; 151:1430–1436). There has always been loads of anecdotal evidence that the new atypical antipsychotics were no better than the old as far as often irreversible brain damage (Tardive Dyskinesia aka TD). But it took over a decade before the NIMH decided to do a long term study itself. The results were sobering (especially for the huge number of kids now on the stuff). 13 to 17 percent of the people on the drugs got TD beyond “mild incapacitation" even though most of the patients stopped taking the drugs during the 18 month trial. http://www.medscape.com/viewarticle/529174_15 It found the percentage of people getting brain damage steadily increased the longer they took the drugs. Another study showed 34% of patients with brain damage after only 5 years of antipsychotics.

The rates of getting the lifespan shortening Metabolic Syndrome were extreme too. Even using an arbitrary measure (weight gain > 7% over course of the study)… one drug had 30% getting that deadly side effect. The largest population who has had long term exposure to antipsychotics is schizophrenics. They have an average 20% shorter lifespan and no one knows how much of that decrease is due to antipsychotic drugs.

Now… maybe it is ok for a doctor to hide this from a schizophrenic patient because he may not be competent enough to make an informed decision… does that mean the family should not be told? And how about the mom with a hyperactive kid… is it right to withhold this info from her when either of those side effects could damage her kid for life? How about telling a person with anxiety that there is a choice… learn effective coping mechanisms or gamble with your life?

There are other drugs which can have clearly bad life altering effects… telling a patient too much may keep him from a treatment where the positives clearly outweigh the negatives… but should a doctor assume the responsibility of making those decisions for the patient?

[1DayAAT]

Both Depression and Bipolar Disorder have mortality rates higher than almost any other disease (including most cancers). These could be life saving drugs for those people.

If a person had a deadly cancer and needed chemotherapy or some drug to increase their chance of living... shouldn't the doctor make the best case for doing that instead of scaring the patient with a bunch of possible problems?

[NoPocketCash]

I beg to differ...

A patient has a right to know the possible risks and benefits of any therapy... no matter how strongly the doctor has an opinion about it.

Just as any surgeon tells you upfront about risks... a doctor needs to be both knowledgeable (and not knowledge acquired through drug reps and drug company sponsored continuing education requirements) and he needs to inform the patient or family (if the patient is not competent).

Anything less is unethical and the doc is just being a shill for the drug industry.

[AntiPharm]

This is a VERY disturbing article. Numerous psychiatrists and parents are saying that they have no choice but drug kids into oblivion with med cocktails, but if you click on the graphic on the side you will see that there is ABSOLUTELY NO WAY half a million kids need to be on antipsychotics or 2 million on antidepressants... etc.

And the use is skyrocketing...
Quote:
From 2001 to 2005, the use of antipsychotic drugs in children and teenagers grew 73 percent, Medco found. Among girls, antipsychotic use more than doubled.
http://www.nytimes.com/2006/11/23/healt ... &th&emc=th

I am SURE the doctors have not discussed the long term very damaging effects of antipsychotics on kids.
Quote:
Andrew Darr of Caldwell, Idaho, whose sons took medications, said that he was opposed to it from the start.

[dlcnurse]

I firmly believe in behavior modification techniques be tried before starting any antidepressants. I have had experience with this personally when my own son at a very young age was a typical boy who acted up in school. The school nurse suggested medications and went so far as to write a letter to such effect to our attending physician at the time. I refused the meds. Instead, I enrolled my son along with us (parents) in a behavior modification therapy program and it worked great.

That is not to say that it will work for every child but it certainly is worth a shot before resorting to medications that have very serious side effects. And no I don't believe that doctors should withhold any information in regards to the medications, regardless of what it is used for. But on the same token, parents need to take the initiative and ask as many questions as possible about the medication, side effects, interactions, etc.. so it is a responsibility of both parties.

[dlcnurse]

I recently received a journal watch for May 11, 2007 in my email today.

LINKS BETWEEN INDUSTRY PAYMENTS AND THE USE OF ANTIPSYCHOTICS IN CHILDREN PROBED....

Industry payments to Minnesota psychiatrists for speaking engagements and other activities rose sixfold from 2000 to 2005, while prescriptions of antipsychotics to children in the state's medicaid program rose nine-fold, the New York Times Reports.

The story examines general trends in the use, often off-label, of atypical antipsychotics in children, and it focuses on Medicaid data from Minnesota between 2000 and 2005 because its the one states that requires disclosure of industry payments to physicians.

Among the Time's findings:

Psychiatrists who recieved $5000 or more from manufacturers of atypical antipsychotics on average wrote three times as many prescriptions for those drugs in children as those who recieved under that amount.

Psychiatrists received a median of $1750 each from industry from 2000 to 2005, more than any other medical specialty in Minnesota.

The cost to the state of antipsychotic drugs used in children increased 14-fold from 2000 to 2005 from $521,000 5o $7.1 million.

The Times quotes Steven Hyman, former director of NIMH: There's an irony that psychiatrists ask patients to have insights into themselves, but we don't connect the wires in our own lives about how money is affecting our profession and putting our patient's at risk"

An abstract available to view and read enlightens the statistics much more is found in a Journal Watch Psychiatry on treating children with antipsychotics... http://psychiatry.jwatch.org/cgi/conten ... 2006/621/1

Parents really need to be vigilant in making sure that their children are being treated appropriately, only taking medications as a last resort, and research their children's illness and seek out ALL the options for their children and their well-being. Be aware of the studies out there and what it could mean for their child/children.

These articles really shed a different light on whether our children need these drugs or is it because of some type of payment or kickback that is promoting the drug use by such methods as this. These are just a few of the statistics since Minnesota is monitored but what is happening in our other states????? If this has become 6-fold here, multiply that by 51 other states. That number is staggering!

Certainly gives more food for thought in protecting our children and making sure that they are being treated for optimal living and not money padding someone elses pockets.

[jimithy]

updated and checked for broken links. 8/10/2011 by jimithy