As my colleague Curtis Brainard here at The Observatory suggests, she might have done better turning her investigative skills on whether Texas foster kids are being over-medicated—a tough-enough story in itself. And if she discovered that was true, she could have reported on what might be done to correct the problem.
Or she might have confined herself to investigating the doctors treating these kids and their connections to drug companies. That, indeed, was the headline on the story: “Some Texas foster kids’ doctors have ties to drug firms.” Again, if she nailed that story, she could have followed up with reporting on what the state might do to confront that issue.
Ramshaw’s story, I fear, will leave most readers thinking that the vast majority of kids are being over-diagnosed and over-medicated by a greedy alliance of doctors and drug companies. There is no doubt that that happens. Drug companies are often far too aggressive in pushing their medications, to the detriment of patients, and doctors should not have such strong financial ties to drug companies.
Most mental health professionals, and the parents of mentally ill children, however, think that the problem is exactly the opposite: too many mentally ill kids are not getting the treatment they desperately need.
Reporters who venture into this territory cannot let heart-tugging anecdotes lead readers to faulty conclusions. We need to be acutely aware of the political and public policy debates into which our stories fall. Whether she intended to or not, Ramshaw has given lots of ammunition to critics who say we’re vastly over-medicating our kids. Fair enough, if the reporting backs it up. But in this case, the reporting falls short.
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What’s unfortunate about Paul Raeburn’s criticism of my series is that he casts aside a central tenet of the story: It’s about Texas foster children, not all children.
These are kids who often don’t have a parent looking out for their best interests. In a system where foster parents get paid more for kids with particularly troublesome diagnoses, and many doctors are on drug company payrolls, the sense is that there’s little incentive to take a conservative approach to prescription.
Raeburn’s critique of my story includes passages he took out of context, including the anecdote he references about a little boy who died in state foster care. That story was about the little boy’s older sister (no longer a teenager) who was undoubtedly drugged into a near stupor for years while herself in foster care. The death of this young woman’s brother – and the irony that both of them were, for the first time in their lives, on several psychiatric drugs at once -- only compounds her tragedy.
As to Raeburn’s beef with the “high” percentage of foster kids treated with psychiatric drugs: Yes, I agree. It would have been lovely to say with authority the X percent of U.S. kids are on psychiatric meds. But Raeburn knows as well as I do that these numbers don’t exist, which is why I included the best numbers available – from a national pharmaceutical study. They appear to be far lower than the 1 in 3 Texas foster care average, though Raeburn either missed that paragraph or chose to ignore it.
Raeburn asserts that these doctors don’t necessarily have a stake in drug companies’ success. What, then, constitutes a stake? Many doctors are awarded stock options – which are useless if drug companies fail. And I don’t know of many drug companies that offer lucrative consulting contracts while they’re circling the drain.
Finally, I agree with Raeburn that the U.S. isn’t flush with child psychiatrists. But that doesn’t mean that radiologists and gastroenterologists should be the ones deciding whether Texas foster kids should be taking psychiatric drugs.
Raeburn takes my story about a particular group of children – Texas foster kids – and extrapolates it to a giant population: all children.
Raeburn knows his stuff. And as I told him yesterday, I'm always up for a good skewering. But it’s less fun when someone with a personal sensitivity to an issue puts words in your mouth.
Emily Ramshaw
Posted by Emily Ramshaw on Thu 21 Aug 2008 at 05:06 PM
I can attest to the fact that far too many foster kids are taking far too many psychotropic medications. I've noted it in the short period of time I've been a witness, and pointed it out to my collegues who generally agree. What's to be done? I don't know. What I do know is that when a six year old girl is taking Risperdal, Adderall, Stratera, and several other medications during the day and diphenhydramine at night to sleep, something isn't right.
Kids in foster care are screwed up before they ever get there in a lot of cases. However, no one is served by drugging them through life.
Posted by Sarah on Thu 21 Aug 2008 at 11:06 PM
All across the country, child "protective" services do all in their (substantial) power to pressure both parents and children onto psychiatric drugs. The pharmaceutical industry is the number one profit-making industry in the country. Everything you hear about psychiatry and "mental illness" is a lie. Read Peter Breggin, John Breeding, Robert Whitaker, to name a few. We all have difficulties because how we've been hurt, and what we really need is love and caring and emotional healing. But if you don't have the ability to question the concepts on which the institutions of this society are built, or to question your own assumptions and biases, then you don't want to know.
Posted by Connie Schuster on Thu 21 Aug 2008 at 11:25 PM
Mr. Raeburn is, if anything, being too kind in his evaluation of Ms. Ramshaw's hyperbolic and misleading reporting in the Dallas Morning News.
While there are significant problems with the relationship between the pharmaceutical industry and clinical practitioners, stating that these doctors are "on the payroll" of the pharma companies conjures up Hollywood-style images of corrupt cops. The statement that "many doctors are awarded stock options" is ludicrous on its face. (Some physicians involved in developing a new drug may be offered options, but these are a tiny minority of those who write prescriptions.)
Similarly, stating that researchers get grants that "often exceed $100,000" immediately after describing the honoraria for giving a presentation at a professional meeting or symposium implies that the $100,000+ represents income to the physician. While a fraction of it might be taken as income, the bulk of it goes to pay for the expenses of conducting the studies. (Yes, there are issues with pharma company involvement in clinical research, but with the dramatic decline in the availability of federal funds, researchers are faced with fewer choices when it comes to funding. There are stories to be done there, but this one isn't it.)
Off-label prescribing, which she refers to misleadingly as "without federal approval," is a function of the FDA regulations for drug testing and the economics of testing drugs for multiple uses. Yet the tone of her description wrongly hints at nefarious doings.
Inappropriate polypharmacy--the use of multiple psychiatric drugs simultaneously--is an ongoing issue. But the response shouldn't be a knee-jerk abandonment of all psychiatric medications on children. Nor should we take an older sister's or a mother's appraisal of the lack of need for medication as unbiased or the gospel truth.
The list goes on. It was a missed opportunity for effective public education that will likely have unintended negative consequences.
Posted by Lawrence Kutner, Ph.D. on Fri 22 Aug 2008 at 04:17 PM
My son, Evan Kitchens, was one of the children mentioned in Emily's report. I am thankful for her reporting and quite honestly Dr. Kutner, I pray that her well researched reporting does have negative consequences. I am sure that you were directing your comment on "negative consequences to what you think are benefits to children in Foster Care. I, on the other hand, and refering to the consequences that should be and will soon be imposed on the doctors and Drug Companies.
The numbers are there to support her findings. Her report was based on FACT. My only regret about the report was that it did not paint a better picture for the readers to understand just how drugged these children are.
While the "Great State of Texas" had custody of my son, he was on more medication than what was recommended for an adult. How can someone, much less a doctor, justify that? I saw children so medicated in these facilities that they could not even carry on a conversation. Their words were unclear, eyes glazed over, no affect, afraid to interact with adults...you tell me...HOW CAN THAT BE JUSTIFIED?
I want to tell you just exactly what my "unbiased gospal truth" is based on. When I got Evan back and took him off of all the drugs that he was given, I saw a child that I had never seen. Within 1 year, he was on the honor roll at school. He began to interact with peers. His communication bloomed and then he began to share with me his experiences in RTC's. They are horrific and I hope that you, as a parent, will never have to hear the stories he tells. Stories of DOCTORS ordering him into the quiet room and taking his clothing away, leaving him with only a mattress, pillow and a paper gown for 3 (yes, I said THREE) days. Not allowing me to see him, no contact with anyone that was not an employee of the hospital. After finally getting an emergency order from a judge to get him out of issolation, did they tell me their logic behind this abuse. I quote "When you strip a child of their dignity, they will comply to gain it back". All of this because he refused to go to bed. Evan's medical records reflect that he had been for weeks (yes, i said WEEKS) telling DOCTORS that he was being sexually abused by another resident and the DOCTORS did not believe him. They noted in his records that they thought he was having dreams. It was not until other children told those very doctors that they had witnessed the sexual abuse.
My son has Autism. I, like yourself, realise that Autism poses a huge challenge on famlies. Evan was never the victom of abuse until I took him to doctors, despirate to find solutions and respite for my other children. That is what mothers do. We trust (in my case, trusted) doctors to help us find the right path for Evan. All we ever got were pills. I have a huge amount of samples that were given to us by PEDIATRIC PSYCS! Samples (54 to be exact) of Seroquel. How is it that they jsut have samples laying around by the case! If the AstraZeneca does not recommend the use of Seroquel in children, then how did the Pediatric Psyc get those samples. How did he get the toys "Seroquel" printed on them in his office. I would like to hope that AstraZeneca has a catalog that docs can purchase these items out of, but I have yet to find one. You and I both know that they are handed out by Reps, there for one purpose. The more that prescribes thier med, the more they make.
All of that being said, I still say there is more to this.....
Can you think of a more captive market for testing drugs than Foster Care? I once asked one of the nurses at Laurel Ridge Hospital what Evan was on after I noticed they had drawn his blood. she replied....Seroquel. I asked her to tell me what she knows about it and she said..."not much, I jsut know that I give it to all the kids here..some get more and some get less, but they all get it.
I would really like to know, Dr. Kutner, if you would take the time to answer this extremely bias mother, JUST HOW DO YOU JUSTIFY THAT?
Mary Kitchens
Posted by Mary Ktchens on Thu 4 Sep 2008 at 01:27 AM