Regarding your series on foster care needs, Steven Goldsmith and the Post-Intelligencer editorial writer are articulate advocates for bettering foster care for children; however, in their collective enthusiasm, they succeeded in nailing several innocent scapegoats to the cross. As a physician member of the "independent group" that the Department of Social and Health Services asked to investigate Domico Presnell's death, I rapidly concluded that it represented only the very tip of the iceberg of the whole "attention deficit disorder" controversy - as well as the plight of DSHS.
Let's clarify one point: The unfortunate child died, not from cumulative amitriptyline, but from a one-time excessive ingestion. Moreover, amitriptyline is but one member of a class of drugs, any one of which in overdose can prove fatal. Most are not FDA-approved for children under 6, but a number are widely used without problems, even for bed-wetting. Your readers don't realize that it costs a bundle to get FDA approval for use in children - and that it is not needed once a drug is released.
We in the United States are seeing an epidemic of what our society calls either "attention deficit disorder" or "youthful exuberance." Frankly, it's an international embarrassment. Pill pushers are ecstatic; therapists and counselors see their professional nirvana; schools get "financial bonuses" for ever-increasing diagnostic rates of the ephemeral malady. But in a society ever searching for the proverbial "quick fix" for obesity or for insomnia, for high cholesterol or for simply smoking cigarettes, is anyone surprised that a pill - amitriptyline, clonodine, Ritalin, Cylert and now Prozac- is seen as the solution? Will using only FDA-approved pills help one iota? I doubt it. Moreover, is there any real evidence that expanding the proverbial "health care team" to include the juvenile judge has bettered the world? And does it really take $6.6 million to replicate the system of portable medical records for foster children employed successfully by the military for more than a century? The suggested cost works out to more than $600 per foster child.
Foster children have far more than their fair share of real problems. Capitalizing on an erroneous interpretation of what caused one single fatality to promote quick fixes for the overall system is to me utter nonsense. Such is especially true in your editorial, which totally overlooked any efforts at "preventing" the need for foster care in the first place.
William O. Robertson, M. D.
Medical Director, Washington Poison Center
Professor of Pediatrics, UW School of Medicine