A few weeks ago I wrote about screening for preschoolers. This touched a nerve as it has had the most comments of any blog I have written. The notion of “screening” children to determine their “fitness” for school together with the proposed “emotional wellness checks” for three year olds has the potential to do considerable harm to children who may be “diagnosed” with “conditions” they do not actually have.
There is another screening and intervention program, which sounds warm and fuzzy but will also do far more harm than good. This is the proposal for early intervention in teenagers to prevent psychosis which is being promoted by certain psychiatrists like Patrick McGorry who seem to have the ear of government.
Sounds lovely until you realize the fundamental flaw is that we do not have the capacity to determine which behaviours are pointers to psychosis and that there is NO evidence that so called “early intervention” actually achieves anything.
More to the point there are no specific behaviours that can be identified in people “at risk” of psychosis that might not be found in other people. The false positive rate could be as high as 90%. In other words nine out of ten people who receive “early intervention” which may include being prescribed potent antipsychotic medication will not need it, as they are NOT at risk. The harm done from prescribing these drugs to teenagers is not insignificant. Yet far worse is the labeling of healthy teenagers as having a disorder.
Just imagine the effect on an impressionable teen of a professor telling them they have a disease, which will be lifelong, and that they need medication. How will that affect the teenager’s view of self? And who is going to unravel the mess and tell them it was all a mistake – sorry!
According to Allen Francis M.D. who chaired the DSM-IV task force this is a “reckless experiment”. Writing on Psychology Today he describes McGorry as …”a false prophet whose visions are offered at least a few decades before their time. Australia, led astray by his impractical hopes, is about to embark on a vast and untried public health experiment that will almost surely cause more harm to its children than it prevents.”
Some $400 million has been allocated to the project over the next five years to roll out Early Intervention Prevention and Intervention Centres. As Allen Francis points out there are a number of steps, which need to be taken before any such program could commence. This includes developing a reliable definition of psychosis risk, using it in ways that has an acceptable false positive rate and demonstrating that the interventions are indeed effective!
Sounds obvious, but not to the government, or the program’s supporters.
A trial of use of antipsychotic medication in children as young as 15 was aborted due to ethical concerns. The trial was to see whether use of drugs like Seroquel (whose manufacturer settled a suit in the USA for A$623 million for failing to warn the drug may cause diabetes) would prevent psychoses like schizophrenia in 15 to 40 year olds. The ethical concern was that children who had not even been diagnosed with a psychiatric illness would be exposed to drugs with significant side effects.
The well-respected Cochrane collaboration found no evidence that early intervention could prevent psychosis.
Francis concludes “McGorry’s intentions are clearly noble, but so were Don Quixote’s. The kindly knight’s delusional good intentions and misguided interventions wreaked havoc and confusion at every turn. Sad to say, Australia’s well-intended impulse to protect its children will paradoxically put them at greater risk. Let’s applaud McGorry’s vision but not blindly follow him down an unknown path fraught with dangers.”
Teens are seen as an “untapped” section of the medical marketplace because by and large they are healthy. The pharmaceutical industry sees market potential as we see above and so do device makers as is witnessed by a push to do lap band surgery in teenagers.
Meanwhile simple things are ignored. Teenagers who get enough sleep are less likely to crash their car or be involved in bullying. Teenagers who talk to their fathers about things that matter to them are less likely to smoke.
Sleep and talk are “interventions” that do not cost millions of dollars and do not have side effects. They also do not come with research dollars for promoters or lucrative government contracts.
Our teenagers need our love, support and guidance. They do not need to be part of an experiment in which they are given potent psychoactive medications and labeled as having a disease, which they do not have.