As a practicing child and adolescent psychiatrist, I have been following with great interest the recent media attention being paid to young people, mental illness and the pharmaceutical industry. This is a topic that has been of continuing concern to the medical and non-medical communities. It raises a variety of important questions regarding the relationships between patients, physicians and drug companies; there are a variety of factors that have yet to be addressed.
There is no question that pharmaceutical companies provide money for research into the utility, benefits and risks of their products. Most people would likely agree that the absence of truly unbiased research (free from profit motive) is a grievous concern. But in the world in which we live, there are very limited funds available for research into childhood psychiatric disorders. The criticism that privately funded research should be ignored, viewed as strongly biased, or condemned, is of concern to professional and non-professionals alike. We must not be afraid to ask the seemingly obvious question, "From where is this money going to come?"
It's an impossible situation. We psychiatric and other physician prescribers all acknowledge that there is a paucity of literature and research on children and psychiatric drugs. As concerned doctors, we are acutely aware of the potential conflicts of interest. Yet there is a significant shortage of government and other potentially non-biased sources (e.g. a bipolar organization without links to any drug company) to aid us in solving this problem. There is an implicit mistrust on the part of the public that researchers who are engaged in pharmaceutical industry sponsored studies will be biased toward a positive medication effect. This concern, which should not be dismissed lightly, will result in less child and adolescent mental health research. By merely complaining about an already flawed system and refusing to look to creative means of funding additional research we continue to do a great disservice to our many children who are already in excruciating pain.
How do we emerge from the quagmire of a need for many more studies into psychotropic medication use in children when there is limited government funding for this action and drug company money is best not be used? How then can the studies be done? This conundrum of funding without attachment to the outcome has yet to be adequately addressed.
In the United States today, recent estimates indicate that one in 10 children and adolescents suffer from a serious emotional problem. Yet only one in five receives the mental health intervention they need. Emotional illness is often less obvious than a physical disorder. If you have depression and it's not severe, you can hide it from your coworkers and family. If you have diabetes, even those at work can see your caution with your diet and other visible signs of your illness. Unfortunately, the psychiatric equivalent of a blood sugar level is not yet available. This does not mean it is not possible to screen for mental illness.
Whatever statistics one likes to cite, the common thread is that there are children out there in tremendous pain. These are young people who may be experiencing feelings of extreme sadness, self-hate, wishing they were dead, confusion between reality and fantasy, and may threaten or even become violent. All of these emotions have the potential of increasing as the child gets older. Without intense intervention, many of these young people have little chance of leading an independent life and making a positive contribution to society.
Drug studies on children and adolescents are desperately needed. On this point there is complete agreement yet the unbiased source of funding remains elusive. As our young people continue to turn to us for answers it is our responsibility to come up with viable solutions.