HEALTH CARE ISSUES IN UK

Health Care Issues in UK



Health Care Issues in UK

Ethical Issues in Psychosocial Treatment Research With Children and Adolescents

Psychosocial treatment research of child and adolescent mental disorders is a relatively young field, but it presents long-standing and at times formidable challenges to investigators. (Caring for children and adolescents with mental disorders, 2004)

Although participation in psychosocial treatment research might be thought of as presenting less of a risk than other forms of treatments, because such treatments are not physically invasive, the risks may, in fact, be substantial for children with mental disorders. The psychosocial researcher often must base his or her design on theories of development and of psychosocial functioning that are less well established than are medical principles of physiology or pathology(Wilens, Biederman, Baldessarini, Puopolo & Flood, 1992, 691-698).

Research based on unsubstantiated theories may bias the investigator's assessment of the morality of research questions and experimental procedures and place the subjects at risk.

The challenges arise in part because the relationship between clinical responsibility for the well-being of clients and scientific objectivity present competing demands to the researcher.

Toward a Science of Scientific Ethics in Research on Child and Adolescent Mental Disorders

Evidence of social dysfunction is on a massive scale, too obvious to bear enumeration. Media accounts of "ethical" transgressions in political, professional, and business practices abound. The sheer number of articles on "professional ethics" listed in psychology journals rose from 25 in 1988 to 224 in 1993 a 900% increase! During this same period, ethics has become associated with intraprofessional specialization:

Ethical guidelines have been developed by most major professional organizations, both within and outside of scientific disciplines. Major medical institutions have established guidelines to delineate mandatory practices (Korenman & Shipp, 1994). The fact that this historical moment the last decade of the century, a period usually characterized by decadence has witnessed such a surge in attention to issues of "morality" deserves a moment's reflection(Wilens, Biederman, Geist, Steingar, 1993, 343-349).

Perhaps contemporary moral discourse and attention to ethical practices are signs of underlying trouble in the functions of institutions whose work has become increasingly questionable.

Ethical Issues in Psychopharmacological Treatment Research With Children and Adolescents

It has become increasingly clear that there is little, if any, safety and efficacy data in the pediatric age group for the majority of prescription medications. In a recent review, the Committee on Drugs of the American Academy of Pediatrics(AAP; 1995) cited data from an FDA report that 80% of the new medications approved from 1984 to 1989 did not contain labeling for use in children. Additionally, the AAP noted that of the medications reviewed in the 1991 Physician's Desk Reference (PDR), 81% had descriptions that either disclaimed their use in children or restricted them to specific age groups (National Research Council, 1993, 50-199).

This paucity of safety and efficacy data in the pediatric age group raises immediate and important clinical concerns about pharmacologic treatment of this age group. Essentially, this absence results in children being left as "pharmacologic ...