More ADHD Diagnoses; Can Parental Interventions Trump Drugs?

By Joe Elia

Over 10% of U.S. school-age children have received a medical diagnosis of attention-deficit/hyperactivity disorder, according to an analysis of federal data by the New York Times. The prevalence is almost 20% among high school boys.

One concern is that an estimated two thirds of those with ADHD receive prescriptions for stimulants. CDC Director Thomas R. Frieden told the Times: "The right medications for ADHD, given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate." Sales of those drugs have more than doubled since 2007, to $9 billion in 2012.

Another concern is that, according to one expert, "we have kids out there getting these drugs to use them as mental steroids - that's dangerous."

Meanwhile, a review in Pediatrics concludes that training parents to help address children's behavioral problems has "greater evidence of effectiveness than methylphenidate for treatment of preschoolers at risk for ADHD.

First Published in Physician's First Watch April 2, 2013

RELATED LINKS:
New York Times story (Free)
Pediatrics article (Free abstract)
AAP clinical practice guidelines on ADHD (2011) (Free PDF)

Swapping the ER for an e-visit:

“Modern-day house call” startup gets $3 million investment

by Deanna Pogorelc

More than 136 million Americans visit an emergency room each year, but fewer than 13 percent of them are admitted to the hospital. In fact, a company called Stat Health Services estimates that two of three ER visits are for minor medical conditions that could be treated via telemedicine.

Aimed at relieving crowded ERs, saving time and reducing the cost of emergency care, Stat Health Services created a virtual ER portal where patients can go for on-demand attention from a doctor without leaving their home.

The company, founded by emergency physicians, appears to have just landed a $3 million investment as disclosed in a recent U.S. Securities and Exchange filing. CEO Dr. Alan Roga was not available to comment.

Stat Health Services’ customers are employers and insurance carriers who offer its e-visit service, STAT DOCTORS, to people as a supplement to a health or wellness plan. The company and its network of medical groups provide members with 24/7 access to board-certified emergency physicians. Patients can use a webcam, a cellphone or a landline to connect with a physician instead of visiting the ER or an urgent care clinic for common, minor medical issues like respiratory infections, colds, pink eye, sports injuries and rashes. Prescriptions are sent electronically to the patient’s pharmacy of choice.

More healthcare providers are starting to offer e-visits, and more health plans are covering them too. But there are also other, third-party telemedicine companies including Teladoc and virtuwell by HealthPartners that offer generalized e-visits. The telehealth market as a whole is expected to double by 2016.

Aside from the new equity investment, STAT DOCTORS also won $250,000 from the Arizona Innovation Challenge last fall. Formed in 2009, it’s based in Scottsdale, Arizona. Clients that the company has made public include the Arizona Small Business Association and Scottsdale Healthcare.

Published in Business Insider, January 29, 2013

WHO Issues New Guidelines

on Sodium and Potassium Intake for Adults and Children

By Cara Adler

Most children and adults worldwide should consume less sodium and more potassium to reduce risk for cardiovascular disease, according to a pair of new guidelines issued by WHO (the World Health Organization) late last week.

WHO recommends that adults consume less than 2 grams of sodium (5 grams of salt) and more than 3510 mg of potassium from food daily. For children older than 2 years, these amounts should be lowered proportionately to account for children's lower energy requirements.

This is the first time WHO has recommended limits on sodium intake for children and the first time WHO has offered dietary potassium recommendations.

LINK(S):
WHO guideline on sodium intake (Free PDF)
WHO guideline on potassium intake (Free PDF)
Published in Physician's First Watch February 4, 2013

Drowned in a Stream of Prescriptions

By Alan Schwarz

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Read the entirety of this original article, published February 2, 2013 in the New York Times