Kate Kielceski
John Minbiole
CAS 138T
29 March 2013
Rough Draft
In 2011, the Kaiser Health Foundation estimated that over 3.76 billion medications were prescribed in the United States alone. This figure averaged to over 11 prescriptions per American. The Foundation also accounted for the skewed ratios within the population and approximated that children between 0 and 18 were taking four medications. More starling is the number of improperly prescribed drugs or drugs prescribed for the wrong reason. Dr. Mark Olfson, a professor of clinical psychology at Columbia University shared his fears about this frightening trend with Reuters saying, “Only a small percentage of antipsychotic treatment of children (6 percent) and adolescents (13 percent) is for FDA-approved clinical applications,” (National Disaster…1). One major problem is the over-prescription and incorrect prescribing of drugs to children and adolescents for disorders like ADHD. In a study done of adolescents in North Carolina, Angola and colleagues found that of the 7.3% of children taking a stimulant drug, only 3.4% showed unequivocal signs of needing them. Drugs are being prescribed too often and with not enough accuracy, particularly for ADHD. This issue is a major issue on the current political agenda and something needs to be done about it.
According to Dr. Daniel F. Connor, Attention Deficit Hyperactivity Disorder is the “most extensively studied pediatric mental health disorder.” Yet ADHD has a history littered with disagreements, discrepancies and opposing viewpoints. ADHD was first described in 1902 by and English pediatrician, Sir George Frederick. His diagnoses focused on symptoms of hyperactivity and impulsivity. The disorder was defined many ways during the 20th Century. It wasn’t until 1980 that ADHD was officially recognized by the DSM-III, which focused on the inattention aspect of the disorder. Finally the DSM-IV categorized the disorder into three subcategories: combined, inattentive and hyperactive-impulsive. This is the ADHD most people are familiar with today.
Despite finally having an agreed upon definition, the disorder was not widely diagnosed. Before 1970, ADHD was rarely diagnosed. However, between 1980 to 2007, “there was an almost 8-fold increase of ADHD prevalence in the United States compared with rates of 40 years ago,” (Problems of Overdiagnosis…1). In addition to a huge change in the last 40 years, the trend has been high even since the 1990s. Safer and colleagues have assessed the percentage of kids who have been diagnosed in recent years. They estimate that in the late 1990s, about 4% of American children had been diagnosed with ADHD. Comparatively, they believe in 2007 this figure has risen to 7.8% of kids age 4 to 17, almost doubling the figure of 20 years earlier (Problems of Diagnosis…1).
The statistics clearly support the claim that ADHD has been increasingly diagnosed and that prescriptions as treatment are on the rise. The debate lies in the details. Why have ADHD diagnoses and in turn prescription medications increased so drastically in recent years? What is the cause? The two most basic arguments take directly opposite stances. One side argues for an increased awareness of the disorder and a movement to help kids overcome their struggle. The counterargument is the over-prescription of stimulants due to greedy doctors, over-concerned or fearful parents, and a flawed health care system that prevents doctors from really understanding their patients’ cases. The latter argument holds up under further investigation.
Paragraph with information on both sides but in support of the second argument.
The evidence supports the claim that America has a drug problem. We are a culture of quick-fixes but unfortunately in the case of health care, this method is often more detrimental than beneficial. What can be done about this problem?
There are many possible solutions to this problem. Some are more feasible and manageable than others. A rather large and complicated solution would encompass and affect more than just the over-prescription of medication to treat ADHD. This solution would be a revolution in the health care system. When patients only have 15 minutes with a doctor, there is no way that a doctor can fully understand the patients’ histories, symptoms, daily routines, lifestyles and other facts necessary to fully diagnose a disorder. Sanford Newmark, head of the pediatric integrative neurodevelopmental program at the University of California, agrees with this stance. He claims that a “thorough history and examination [are] needed for an accurate assessment,” (Are ADHD Medications Overprescribed? 1). He believes such a solution would involve talking to parents, the child and teachers, as well as reviewing school records and other testing.” This change would prevent children and youth who are simply immature, distracted or undisciplined from being put on powerful medications they do not actually need.
Groups such as the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) should enforce further, stricter policies and regulations on the prescribing of drugs to children once it is determined that they really need medications for ADHD.
Counterargument:
-More advanced technology allows for more medications and more solutions.
-New technology not well-researched (side effects, long-term effects)
-An increased awareness lead to more visits to doctors, ergo, more prescriptions.
-More prescriptions -> more money for doctors.
-Fear of imperfections in society -> prescriptions fix problems.
Solution/Policy:
-Stricter FDA regulations
-If ADHD route is taken, policy for more in-depth testing.
DSM
Health care issues, not enough time.
Honestly, I had a lot of other writing due this week so I didn’t have as much time to work as I was hoping. In addition, I also slightly changed the focus of my paper after my conference. Any input would be great, but keep in mind this is still and extremely rough draft. Thanks!