The leading U.S. pediatrician group recommends its members ignore an FDA warning

Rough Ride

I’m going to start by saying something nice about the American Academy of Pediatrics (AAP).

Then I’m going to lock the AAP in the trunk of a car and drive it off a cliff.

First the nice: Nine years ago the AAP and the U.S. Public Health Service petitioned drug companies to remove thimerosal from vaccines intended for children. Thimerosal, of course, is the controversial mercury-based vaccine preservative that may have triggered autism in thousands of children.

So my hat is off to you, AAP. Because of your 1999 petition, most vaccines no longer contain thimerosal. Well done! Take a bow!

Now get in the trunk.

Burn after reading

A couple of months ago in the e-Alert “Generation Lipitor” (7/7/08) I ranted long and loud over an AAP recommendation that children should routinely be tested for cholesterol problems. The recommendation applies to children as young as eight, and even younger if there are weight issues or a family history of heart problems.

As you might suspect, the AAP also recommended that these very young kids receive statin drugs to address elevated cholesterol. One AAP rep told the New York Times: “The risk of giving statins at a lower age is less than the benefit you’re going to get out of it.” That rep sounds pretty confident, doesn’t he? Where exactly that confidence comes from I have no idea because he also admitted that there is not “a whole lot” of data on pediatric use of cholesterol-lowering drugs.

We can only hope that most pediatricians immediately dismissed this insane recommendation.

But what does the recommendation tell us about AAP executives? Does it mean they’re way too comfortable with the idea of giving drugs to kids? Or does it mean they’re simply hyper-diligent when it comes to protecting the heart health of our nation’s youth?

Judging from a controversy about how stimulant ADHD drugs affect the heart, we get the picture. Apparently they’re all about the drugs.

Clarifying statements

This past May, the American Heart Association (AHA) released a statement that called for cardiovascular monitoring of children to assess heart disease risk before stimulant drugs (such as Ritalin) are prescribed to address ADHD.

That seems reasonable. After all, these ADHD drugs can increase blood pressure and heart rate while boosting risk of sudden death in kids with heart problems.

But the AHA statement also recommended that doctors consider electrocardiogram testing. And to that the AAP said, “No you didn’t!” AAP execs imagined parents far and wide rejecting ADHD drugs after doctors scared them to death with all this talk about heart risks and ECGs. Heavens! We can’t have THAT!

So the AAP issued a policy statement noting that an ECG shouldn’t be considered routine when an ADHD drug is prescribed. Then AHA officials finally got on board and issued a “clarifying” statement, stating that their recommendation didn’t actually call for routine ECGs.

And then up steps Cleveland Clinic cardiologist Dr. Steven Nissen to put the AAP statement into sharp perspective. Here’s what he told Heartwire (the WebMD news service): “It suggests that as many as 8% of children should be treated with amphetamines or related stimulant drugs. These drugs increase blood pressure and have not been studied in long-term trials. The statement asserts that sudden death is not more common in children receiving these drugs. However, the FDA has issued a warning for all of the ADHD drugs that states that they can cause sudden death at usual doses.”

And here’s Dr. Nissen’s slammer: “It is irresponsible for a professional medical society to recommend to its members that they ignore an FDA-mandated warning.”

Well done, Dr. Nissen! Take a bow!

What WOULD be a responsible recommendation? They might start with omega-3 fatty acids, which have been shown to help impulsive kids get a handle on their hyperactivity. And how’s THIS for a wild coincidence: Omega-3s also provide excellent heart health support. You can read all about it in the e-Alert “Oil Change” (5/2/07).

Sources:
“AAP and AHA Differ on ECG/ADHD Advice” Sue Hughes, Heartwire, 8/1/08, medscape.com
“Pediatricians Nix Heart Tests Before ADHD Drugs” Lindsey Tanner, Associated Press, 7/29/08, ap.org
“Cholesterol Screening is Urged for Young” Tara Parker-Pope, The New York Times, 7/7/08, nytimes.com