Earlier this week, the nation’s leading pediatric group issued guidelines suggesting that some high-risk children be given cholesterol-lowering statin drugs that are typically prescribed for middle-aged men. The news shocked many pediatricians, who predicted a backlash from the public and doctors.
I spoke with Dr. Darshak Sanghavi, a pediatric cardiologist at the University of Massachusetts School of Medicine, about the move to put children on adult drugs.
“Children’s bodies are very different in how they metabolize or handle drugs,” he said. “Their livers are different, their kidneys are different. In many cases it’s about the same if they’re taking Tylenol or asthma medication. But for other drugs like statins that might have some impact on their endocrine system, we just really don’t know. I, for one, feel unsafe simply saying children are little adults in this case.”
To read the original story about the new guidelines, click here. Dr. Sanghavi also answered readers’ questions about the issue here.
And to listen to the rest of my conversation with Dr. Sanghavi about kids, drugs and cholesterol, listen to the podcast below.
Listen to the Podcast (mp3)
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From 1 to 25 of 55 Comments
If the guidelines are followed properly, this should not be an issue. The problem will come when boarderline cases are placed on statins or parents with a family history of heart disease demand to have their child placed on a statin for “prevention”. Also, only MD’s should be making this decision, not schools or other non-medical areas. I have seen schools recommend that children be placed on meds for ADD, prozac or antibiotics. Most parents then demand this from ther MDs.
It is a shame that we have become a nation of pill-poppers for every problem, not just adults, but kids as well. The PBS Frontline documentary on “the overmedicated child” should be a must watch for all clinicians.
— Janice NelsonRNOvermedicated kids, yes, — and now, pets, too.
See NYTimes article on July 13.
http://www.nytimes.com/2008/07/13/magazine/13pets-t.html?scp=1&sq=pill%20popping%20pets&st=cse
— leahJust becauase something is on Frontline doesn’t make it true. I don’t believe in “pill-popping for every little problem,” but many of the problems that come under attack are actually serious problems. For instance, some children really do have neurochemical disorders, and often for these children, medication is an important part of their treatment. The more severe the problem, the more willing most doctors and parents are to use drugs that some might find controversial.
However, there is a large body of research on many of these drugs in children (and yes, I know how to tell who paid for the research). This simply isn’t true of statins.
To me this means that the problem had better be pretty darned severe.
I’m not opposed to trying meds in children for the first time. My cousin is alive because they took a chance and gave her ACTH (around 1950) — one of the first five children in the country to receive it — rather than see her die from Rheumatic Fever. She recovered completely, was a champion swimmer in high school and was able to have a child.
But they didn’t try it first in either her brother or her sister, who had much milder cases of Rheumatic Fever.
Until we have research, we should not be using statins except in the most severe cases of pediatric cholesterol. Children’s livers, just for starters, are not the same as adults’.
But as for watching Frontline, only a very foolish parent would gather important medical information from any TV show — even from PBS. Without a bias, it doesn’t go on TV. Parents need unbiased information.
— Gail PerryWe have pediatricians for a reason. No, their primary function is not to wear a stethescope with a teddy bear on it. Kids are not little. Peds are kid specialists!
That is why it is appalling for these ivory tower Peds to recommend, without any evidence of efficacy, statins in obese kids with high cholesterol.
It would be understandable if they did this only with famililial hypercholesterolemia, a desperately devastating disease that, unlike run-of-the-mill high cholesterol *severely* clogs arteries and causes heart attacks by young adulthood.
But this blanket recommendation is so unbelievable so as to call into question either the panel’s competence, or their motives.
— jackThis ABSOLUTELY is an issue–guidelines or not; most doctors have NO IDEA how this is going to affect children. When this news broke, I almost laughed in disbelief: here we go again. We are a nation addicted to the idea of medication (besides oil). We are putting our kids on anti-depression medication without fully knowing what the long-term effects are. I agree w/#1 above me: watch Frontline’s “Overmedicated Child.”
— Alex M. Pruteanutrust the doctor? don’t trust the doctor? sorry state of “medicine”.
— american…I dont believe that everything was good in the good old times but I do believe that there were things much better than today.In order to change things for the better regarding childrens health,go back to the time when the family eat dinner together and the food was healthy,mostly home cooked and there was a conversation at the table.Dont tell me that it cant be done.If it is for thew future of the children and their health it MUST be done.I dont live in the states and have never lived there before but you all have to change the way you live even if there wont be all the latest gagets in the home and you will have only one car in the garage.Something has to give and the lifestyle has to change for families like it or not.Otherwise you will have medicated kids from an early age and what will it do for their life and future.I can go on and on but I do hope that somehow there will be a lightbulb lightened in the minds of some,and I do hope,many parents that things will have to change otherwise it will get worse and worse.
— m.nadlerForget the kids. The most immediate need is to treat each member of The American Academy of Pediatrics. Caster oil should do it.
— rrinardvanTypical American (cheap)response to problem: give ‘em a pill.
— I am DubiousGet those kids on the treadmill…ooops, they can’t reach the hand-holds…
— Uncle SidTo the poster who said some children actually do have a neurochemical disorder–guess what? That is not proven when it comes to ADHD or depression. Scientists and physicians have no idea how these medications even work, let alone much about the “disorders” themselves. All they know is that sometimes, and I must emphasize the word “sometimes”, the drugs cause behavior to change. As for unbiased studies proving safety and efficacy, that’s bunk. Studies are biased 100% of the time. Most people are not clean slates who never take other drugs or don’t have different health issues. It’s foolish to think any information out there is unbiased or tainted in the least. It just isn’t. I’m sure there is still useful information to be gleaned from scientific studies, but picking out the gems from the junk is nearly impossible, even if you know who funded the study.
Anyway, I’m glad to hear an expert speaking out against the use of statins in children. Thanks for posting this.
— SSAChildren are not little adults indeed, although I’m not sure statins for big adults are the best idea either.
Kids can’t consent to a medication that might have devastating effects on them in later life, which is particularly egregious when we don’t know what half those effects might be. We should be feeding kids well and caring for them responsibly, paying attention to the foods that have nourished kids well for generations. We should also be noticing when diet guidelines don’t work and rethinking them as necessary. But risky adult drugs… we shouldn’t go there.
Thanks for continuing to cover this, and for highlighting those who are voicing deep concern about the idea of putting kids on statins.
Food Is Love
— DebsI find this proposal frightening. I find the idea that some “authority figures” by which I mean American Academy of Pediatrics and the Food and Drug Administration, which apparently is going to go along with this, terrifying.
Is there any evidence whatsoever that this will work? No.
Has there been any testing with follow-thru, and I mean large scale testing, to see what, if any “collateral damage” this might have? None.
Did the FDA go along with this, and on whose sayso? Apparently YES, and on the SaySo of Big Pharma.
Will the manufacturers of these drugs, which may or may not be effective, and which may or may not have major, potentially life threatening side effects, be able to re-label them and keep them “on patent” (which means no generic competition)? because of this?
You’d better believe it.
I see this as George Bush’s last big gift to one of his biggest supporters, Big Pharma.
I wouldn’t believe a word any of them said, absent outside, large scale, verifiable testing.
But then again, we won’t see that either, because under the Bush Administration, the private sector can do no wrong, and can be trusted to police itself.
IF you believe that, I’d like to talk to you about your possibility of enriching your retirement by purchasing shares in a bridge. A big one.
— Judy from Fairfax, VAI’m 70 and have been on statins since my kidney transplant in 1998. The side effects of the immunosuppressants I have to take to prevent rejection of my donor kidney include high cholesterol. I eat a very low-fat diet, lots of fish and vegetables, and recently have been able to reduce my immunosuppressant dosage. My cholesterol is good–HDL high, LDL low, triglycerides on the high side but within normal range. So, good for me, at 70–but, I have muscle aches, diarrhea, peripheral neuropathy (can’t feel my fingertips, button buttons, thread a needle although I can see the buttonhole and thread clearly, fasten most of my hoop earrings, etc.) Who would want to put a developing kid through such disabilities–I can tolerate it at my age, but what kid could? Or should?
— TempThis is insane. Stop eating fast foods, packaged crap and cheap fillers. An apple a day would be a start. Then pedal for the electicity it takes to run a TV. Take the dog for a walk and maybe poochie won’t need prozac either.
— pill a wayExcellent. My ‘5% rule’ is validated. Yet again.
For those of you who may be unfamiliar with the 5% rule…
It postulates that on any provocative NY Times article that allows comments by readers - dealing with ANY subject, of any kind - as long as there is a decent sample size (say, at least 50-100 comments) at least 5% will blame George Bush and/or the Bush administration for whatever is wrong. Child prescriptions, the weather in Bulgaria, the price of sorghum in Cameroon. You name it.
I see that comment number 13 broke the ice for this particular article. And since my comment will be number 16 or 17 (if I hit ’submit’ in time) the rule is validated again. Harder to repeal than the law of gravity.
My all-time favorite was the article about the alcoholic woman from New York who was arrested, handcuffed and died in the Phoenix airport. The Times website had to shut down the comments after a few days because so many poured in. If I remember correctly, that article clocked in at about a 7% ‘It’s Bush’s fault’ hit rate.
I’ll be interested to see what the numbers are for the Obama or McCain administration.
Matt
— MatthewSSA, *nothing* is “proven” in research, but children (and adults) can and do sometimes have neurochemical disorders for which medication can be an important part of treatment. Most likely no one will ever be able to prove it to you. That’s OK. Go visit http://www.alaska.net/~clund/e_djublonskopf/Flatearthsociety.htm
They don’t accept strong evidence either. You might fit right in! :)
— Gail PerryThe kid are fat. Don’t put them on statins. Stop them from eating so much. Of course, their parents are fat too, so that might not be so easy.
— BarryWhen an incompetent administration has been in power for almost 8 years it stands to reason that they are somewhat to blame for a wide spectrum of societies ills. Probably much more than 5%, so the nyt readers are being kind.
In my upstate local news, disgruntled readers blame democrats for the problems 100% of the time, so be thankful that at least here you are dealing with a more educated readership.
— akThere is, in fact, a growing body of scientific literature that shows that children (and young of other species) are biochemically not little adults. These findings indicate that drug metabolism, hormone synthesis, and cholesterol usage are very different in children, and change as they develop towards adulthood. Without specific studies in children (very difficult because of the informed consent issue) it is impossible to know what to expect with any drug - witness the FDA’s recent banning of cough medicines for infants and toddlers.
— Jed GThe doctor who developed the criteria for childhood bi-polar disorder did not disclose the extent of his financial earnings from pharmaceutical companies. (NYT, June 8, 2008) This suggests a significant conflict of interest and one I suspected after learning the extent of the divide among child psychiatrists, specifically the legitimacy of diagnosing children with bi-polar disorder and the long term use of psychotropic medication never tested on children.
This recommendation appears similar. The reality is, this recommendation may create a life long patient/customer for the manufacturer of cholesterol lowering medication. Similar with bi-polar disorder, once you are diagnosed, you take medications for life.
We have obviously reached the point where research is only as good as full disclosure of funding sources and physician financial connections to study sponsors. We should strongly advocate increased funding to the National Institute of Health so un-biased researchers are not dependent on funding from an industry riddled with conflict of interest.
Can anyone confirm that Pfizer, the manufacturer of Lipitor, had nothing to do with the research behind this recommendation?
— AnneI think some NYT investigative reporting is in order to look for any ties these Academy members may have had to Big Pharma.
— jackAnne, your ignorance about bipolar in children is showing. Doctors have been talking about it for DECADES, and no one doctor developed the diagnostic criteria — which will continue to evolve for some time as more and more is learned about it.
Untreated, four out of five people with bipolar will have *serious* substance abuse problems, usually starting in early teens if the bipolar is prominent by then (alcohol included). Untreated, one out of five people with bipolar *successfully* commit suicide. Untreated their personal relationships are often in complete ruins, along with their finances. I personally know someone with bipolar, who — before he was diagnosed — made millions of dollars but still put his family into bankruptcy with his wild and relentless spending. Their garage is packed literally to the top with all sorts of things he doesn’t recall buying and they don’t need. At the bottom of that pile is a boat that fills half the garage, on a trailer. That by itself cost a great deal.
I’ve seen children who were so out-of-control that it appeared that residential care would be the only option for them. One boy got irrationally mad and tried to push his baby sister out of the car, still in her car seat — while the car was going about 40 mph. Fortunately the parents had “child locks” and he couldn’t get the door open. On medication, within a matter of days, he had significantly improved. Not only did he not go to residential setting but (with professional support) stayed in his home, with his family, and even in his regular classroom.
But even if the thing you said was true it wouldn’t mean that children can’t have bipolar. But it isn’t true. No one doctor makes up the criteria for anything in DSM.
The group promoting your view is the CCHR, an arm of scientology, a group opposed to all psychiatric care for all people. And why? They want people to use THEIR method, which is far more expensive, over a lifetime, than psychiatry. In other words, their view is tainted by money in a far more direct way.
— Gail PerryGail, no reason to be ugly. Equating someone who is skeptical of American medicine, an industry plagued by constant conflict of interest, with someone who thinks the Earth is flat is a low blow. And if you can’t agree that the number of diagnoses of all these neurochemical disorders is so high that it seems unlikely all of these people actually suffer from them, then you’ve bought into the flawed system a little too confidently.
— SSAPfizer (and other cholesterol drug makers) funded research by the Dr. that wrote the guidelines.
The FDA has not approved cholesterol drugs for children, but “off-label” prescribing is frequent, though mostly (I hope) done for adults.
see
http://junkfoodscience.blogspot.com/2008/07/is-it-for-real-cholesterol-screening-in.html
The research and details are there.
— Donna