Why are unnecessary and inappropriate drugs being prescribed for perfectly healthy infants?

Baby, don’t cry

“Disturbing” hardly begins to describe the article I just read.

Medicating infants with a drug for adults? Absolutely disturbing.

And doubly disturbing: It involves a medication that’s been so commonly used for so long that the newly emerging evidence of potential dangers haven’t really sunk in with most consumers.

But what may be MOST disturbing is that an experienced pediatrician should be aware that in the vast majority of these cases, no medication is needed at all.

How in the world did we get to this point where innocent babies are put in harm’s way with drugs they don’t even need?

The new normal

Acid reflux — also known as gastroesophageal reflux disease (GERD) — is over-diagnosed in infants less than a year old.

That’s the opinion of Dr. Eric Hassall, a pediatric gastroenterologist at San Francisco’s Sutter Pacific Medical Foundation.

Dr. Hassall says that when infants’ unexplained crying leads to spitting up, doctors are jumping too quickly to a GERD conclusion.

Many of these infants are treated with acid-suppressing drugs — primarily proton pump inhibitors (PPIs). But Dr. Hassall points out that there is no research that would support the common use of these drugs in very young children.

So much for “gold standard” and “science-based” pharmaceutical use!

What the research DOES show is that PPIs are no more effective than placebo for infants with symptoms of irritability, unexplained crying, and spitting up.

As we’ve seen over the past couple of years, PPI drugs control stomach acid, but can also set up other problems. And Dr. Hassall notes this, explaining that gastric acid plays an important role in nutrition and fighting infections such as pneumonia and gastroenteritis.

Repeating my earlier question: How did we get to this point of medicating infants for symptoms that clearly don’t call for drugs? And Dr. Hassall offers an answer: “We are medicalizing normality.”

Dr. Hassall: “It is recognized that more advertising leads to more requests by patients for advertised medicine, and more prescriptions; the term ‘acid reflux’ as used in the marketing of PPIs to adults, has simply trickled down to infants.”

I agree completely with Dr. Hassall, but I believe there’s one more part to the puzzle that is just as important: young pediatricians.

Virtually all medical students today are immersed in a pervasive drug culture from day one of med school. You think you’re bombarded with drug commercials on TV? That’s nothing. Drug company sales reps start calling on students long before they receive their degrees. And they approach students bearing many of the same perks they use to entice doctors — gifts, meals, free textbooks, golf outings, and more.

So you take a young pediatrician who’s pre-conditioned to believe that medicating is a reasonable response to nearly any symptom, then match him with a parent who’s seen all the ads on TV, and you’ve got a pharmaceutical executive’s dream come true.

And that’s how we got to this point where babies are receiving unnecessary and inappropriate drugs to “treat” crying and spitting up.

If you know anyone with a brand new baby in the house, share this message with them. They’ll have a much better chance of calming a crying baby with swaddling combined with a vacuum cleaner’s white noise than with any stomach acid drug.

Sources: 
“Over-prescription of Acid-suppressing Medications in Infants: How It Came About, Why It’s Wrong and What To Do About It” Eric Hassall, The Journal Of Pediatrics, October 2011, jpeds.com

“Acid-Suppressing Drugs Being Over Prescribed in Infants” California Pacific Medical Center press release, 10/14/11, newswise.com