Tantrums: The Normal Psychosis of Childhood or
Why Drug Advertising should be Limited
Early in my life some wordsmith coined this definition of tantrums. The diagnosis of adult psychiatric disorders in children became much more frequent after the publication in 1998 of a book The Bipolar Child, The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder by Demitri and Janice Papolos. This book caused an enormous increase in the diagnosis of bipolar disorder in children. This disease is also called manic-depressive psychosis. These events are similar to the fad of diagnosing attention deficit disorder a few years earlier.
In both instances the ability of the pharmaceutical industry to advertise prescription drugs to the general public, granted in the early 1990s, greatly contributed to these diagnostic and therapeutic fads. The problem is aggravated by the fact that brain stimulants improve personal efficiency in normal people and antipsychotic medications also reduce disruptive behavior in normal children with such behaviors. This ensures that the initial results of erroneous treatment are quite likely to seem favorable.
The problems from speed, the street name for one of the brain stimulants, and similar drugs are well known to the public. The medications effective for bipolar disorder cause obesity consistently plus diabetes and disordered sexual development rather frequently. Expert consensus is that it is best to muddle along with ordinary disruptive behavior in childhood and postpone the diagnosis of bipolar disorder, or at least its treatment, until adolescence.
We have been talking about the hazards of misleading the public with too much hype in the media of some relatively rare conditions resulting in much meddlesome treatment. There are many examples over a long period of time of commercial interests intentionally misleading the public about medical matters. The tobacco companies’ efforts to sow doubt about the health problems of smoking were quite successful for forty years.
Did you ever hear of Librium? When its patent was about to expire, its manufacturer vigorously promoted Valium and successfully retained exclusive rights in Librium’s former niche for another patent cycle. Somewhat similarly, Nexium is replacing Prilosec for acid indigestion. A great many sleeping pills have appeared on the market for a slightly different reason: each one in turn was found to be habit-forming, and each new one at least partially overcame this expectation when first introduced, thus becoming widely used until the history was repeated. Ironically, the least habit-forming “sleeping pill” was promoted only as an antidepressant. It was not widely used but is still on the market as trazadone (generic name). If you really need a pill for sleep, it is one of the best. Please note that all sleeping pills reduce personal efficiency and aggravate symptoms of dementia for several days after use especially in the elderly. Again ironically, the longest acting drugs are the least habit-forming because their continued presence is like a gradual reduction in dose of a short-acting agent, but they accumulate after daily use with persistent addling of the mind for weeks after stopping them. Similarly, methadone is a long acting narcotic useful in treating narcotic addicts.
There are many more minor examples of creating mild confusion of the public for commercial gain. Most of these examples are mixtures of two generic drugs, both of them useful for a particular condition. Combining them justifies a new brand name and a new patent with the same privileges as the patent holder of an innovative new medication with a novel and perhaps “breakthrough” mechanism of action. Ask your pharmacist whether your medication might be one of such combinations. If so, negotiate the two drugs as two separate generic prescriptions for a fraction of the cost. In our country manufacturers of generic drugs are inspected to be sure that they follow all “good manufacturing practices”—a truly meaningful requirement. Some generic manufacturers are also big name companies that make most of their profits from patented drugs.
Finally, write to Congress requesting that our country stop advertising prescription-only medications to the general public. It is a totally unnecessary and counterproductive expense. We are currently the only country that permits this type of advertising—New Zealand discontinued it a year or two ago.
John A. Frantz, MD, April 14, 2007