In  medicine there are guidelines, which are essentially a series of suggestions in how to manage certain illnesses. These are not set in stone as it is well known that human disease stubbornly refuses to be 100% predictable and because lawyers spend hours searching for any deviation by the doctor from what is the usual standard of care.

In an ideal world these guidelines would be written by totally unbiased individuals, who would have nothing to gain or lose by recommending one treatment over another. Unfortunately, many of the distinguished physicians who create the recommendations are anything but unbiased.  Many receive grants and other financial assistance from pharmacy companies. Some of their recommendations might boost the sales of the drugs which the companies make.

A recent example of this (and there are sadly many) involves management of children with ADD or attention deficit disorder. Previous recommendations encouraged evaluation and possible treatment of kids from six years and up. However, the two distinguished docs who wrote the new set of guidelines for the American Academy of Pediatrics now advise starting at age four.

What I would love to know is how to diagnose a 4 year old, who by nature is kind of hyper with a disease which could require some serious, expensive treatments. Intense psychological counseling and medications which have dangerous side effects are given to a four year old boy who moves around a lot and perhaps even spits.

I can tell you without a doubt that I, as a parent would be very, very careful about saddling a four year with a diagnosis of ADD. Behaviors which might be annoying for adults including parents and teacher do not necessarily mean your kid has ADD.  As a doctor I would be reluctant to prescribe any behavior altering medication to such a young patient.

And guess what?  Two doctors who wrote these guidelines get money from the very same companies who just happen to make some of the medications used for treating pediatric ADD. Sounds like the fox guarding the hen  coop.

There is a movement afoot which calls for a stop to the practice of using biased researchers to develop national guidelines. These are doctors  whose financial corporate supporters might have something to gain from their supposedly unbiased guidelines. I certainly support such a stance.