Saturday, December 12, 2009

Poor kids prescribed more antipsychotic drugs

An article in the New York Times says a team of researchers have found that kids on Medicaid (I.e., poor kids) are given antipsychotic medicines 4 times more often than kids on private insurance, and they they get it for less serious conditions.

Obvious questions include why and what is the result? Should we give fewer drugs to poor kids or more drugs to middle class kids? If we're giving too many,  how do we stop?

Some in the article suggest that doctors and poor parents give their kids drugs because it makes them easier to handle and is easier for all concerned, including parents, than therapy or counseling. Or it may be because Medicaid pays less for therapy than private insurance does, so Medicaid doctors give poor kids what they can afford on their Medicaid allowance, which is drugs rather than therapy. Or maybe poor kids are sicker than middle-class kids; maybe the buildup of cortisol stress of living in poverty causes more mental illness. One person in the Times article suggested this might be part but not all of it. If it is true, we have a public health issue we need to deal with.

And it is not at all clear that psychotherapy is better than drugs at controlling mental illnesses. The big disadvantage of  drugs is that if they are prescribed for conditions that they don't have, the drugs can cause much more serious problems than therapy is likely to if therapy is tried on a condition the kid doesn't have. For example, there is some concern lately that bipolar disorder is being diagnosed in kids who don't have it. Therapy is less likely to screw up such a kid's life permanently than drugs, partly because it's less effective.

So it's not  obvious on the surface how big a problem this is, but there is enough of a chance that it's a big one that we need to look further into it.

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