Psychiatric "Science" Under Heavy Fire
Parents Against TeenScreen
6/19/misguided_standards_of_care>
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/06
/19/misguided_standards_of_care
The Boston Globe
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Boston Globe
Misguided standards of care
By Lawrence Diller
June 19, 2007
AS A doctor, I did the nearly unthinkable at a recent conference on
bipoloar disorder in children. I charged another doctor with moral
responsibility in the death last December of Rebecca Riley, a 4
-year-old girl from Hull. Naming names in medicine is just not done very
often -- and I knew the personal and professional risks I was taking.
Yet I felt compelled to name Joseph Biederman, head of the Massachusetts
General Hospital's Pediatric Psychopharmacology clinic, as morally
culpable in providing the "science" that allowed Rebecca to die.
Rebecca's parents have been jailed and charged in her death. They are
accused of intentionally overdosing her with clonidine, an anti
hypertensive and sedative drug -- one of three psychiatric medications
prescribed by a Tufts-New England Medical Center child psychiatrist.
Rebecca had been treated with these medications since the age of 2 1/2
for the purported diagnosis of bipolar disorder -- the new name for
manic-depression.
While the psychiatrist involved has withheld comment on the case, both
her lawyer and the medical center have defended her actions as "within
the standards of care." Biederman and his colleagues at Harvard are the
professionals most responsible for developing and promoting those
standards of care -- which include diagnosing preschool children as
young as 2 with bipolar disorder and treating them with multiple
medications.
Biederman shocked the child psychiatric world in 1996 by announcing that
nearly a quarter of the children he was treating for attention deficit
hyperactivity disorder also met his criteria for bipolar disorder. Up
until then bipolar disorder was rarely diagnosed in teenagers and
unheard of in prepubertal children. Biederman could justify his findings
by simply broadening the semantic definitions of a previously more
circumscribed condition contained within American psychiatry's bible --
the "Diagnostic and Statistical Manual of Mental Disorders."
Biederman has produced a number of studies and papers purporting to
demonstrate the validity of his diagnosis and treatment. His research
has always epitomized the best of what the DSM model of psychiatry could
expect. But the diagnoses in the manual, in concept, are closely linked
to the medical model of biologically based psychiatric disorders and
focus exclusively on the individual.
While the manual provides helpful clinical guidance in adults, it begins
to unravel with its assumptions about discrete and specific disorders in
children and ignores the families and environments in which children
live. The ultimate absurdity of this scientific model is diagnosing
bipolar disorder in 2 year olds and linking it to the adult disorder
with the same name -- in the process saddling young children as chronic
mental patients condemned to a lifetime of psychiatric drugs.
Even the American Academy of Child and Adolescent Psychiatry -- in its
recent parameters on the diagnosis in children -- eschews the bipolar
diagnosis and its consequent medical treatment in children under 6.
Still there are thousands of potential Rebecca Rileys being treated with
multiple psychiatric drugs because Biederman has said it's OK and
necessary. Supported by millions of dollars of drug industry promotional
funding, Biederman and his colleagues circle the globe offering
professional medical "education" for their singular point of view.
Finally, it's sad but true -- the field of child psychiatry is afraid of
Biederman. One can hear the worries and fears whispered in the academic
halls and clinics over where Biederman has taken the profession. Yet to
politely challenge Biederman in public is to risk public retribution and
ridicule from him and his team. Also academic researchers in child
psychiatry risk losing their funding if they criticize this darling of
the pharmaceutical industry, which provides most of the money these days
for psychiatric research.
The silence was deafening -- and Rebecca's death pushed me over the edge
-- because for over a decade I've have been uncomfortable about these
practices in young children. I am not against psychiatric drugs for
children. I've written prescriptions for children for 30 years in a
clinical practice not tied to the drug industry.
I risk personal censure and loss of credibility in an advocacy for a
broader concept and treatment for children with behavior problems in
naming this doctor. But this time, Dr. Biederman, you have gone far.
Dr. Lawrence Diller practices behavioral/developmental pediatrics in
Walnut Creek, Calif., and is the author of "The Last Normal Child:
Essays on the Intersection of Kids, Culture and Psychiatric Drugs."
_____
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