HJNO Jul/Aug 2025

MAHA REPORT 46  JUL / AUG 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   395 Amato, P. R., Patterson, S., & Beattie, B. (2015). Single-parent households and children’s educational achievement: A state-level analysis. Social Science Research, 53, 191-202. 396 Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24-31. 397 Louv, R. (2005). Last child in the woods: Saving our children from nature-deficit disorder. Algonquin Books of Chapel Hill. 398 Bozaslan, H., & Karakaş, G. Liu, J., & Green, RJ. (2023). The effect of exposure to nature on children’s psychological well-being: A systematic review of the literature. Urban Forestry & Urban Greening, 81, 127856 127846 . 399 Kuo, F. E., & Faber Taylor, A. (2004). A potential natural treatment for attention-deficit/hyperactivity disorder: Evidence from a national study. American Journal of Public Health, 94(9), 1580-1586. 400 Bratman, G. N., Anderson, C. B., & Berman, M. G. (2019). Nature and mental health: An ecosystem service perspective. Science Advances, 5(7), eaax0903. https://doi. org/10.1126/sciadv.aax0903. 401 Faber Taylor, A., & Kuo, F. E. (2009). Children with attention deficits concentrate better after walk in the park. Journal of Attention Disorders, 12(5), 402-409. 402 Kaiser Family Foundation. (2024, February 6). Recent trends in mental health and substance use concerns among adolescents. https://www.kff.org/mental-health/ issue-brief/recent-trends-in-mental-health-and-substance-use-concerns-among-adolescents/. 403 Curtin, S. C., & Garnett, M. F. (2023). Suicide and homicide death rates among youth and young adults aged 10–24: United States, 2001–2021 (NCHS Data Brief No. 471). National Center for Health Statistics. https://dx.doi.org/10.15620/cdc: 128423. 404 Centers for Disease Control and Prevention. (2023). Data and statistics on children’s mental health. https://www.cdc.gov/children-mental- health/data-research/ index.html. 405 Kazda, L., Bell, K., Thomas, R., McGeechan, K., Sims, R., & Barratt, A. (2021). Overdiagnosis of attention-deficit/hyperactivity disorder in children and adolescents: A systematic scoping review. JAMA Network Open, 4(4), e215335. 406 Merten, E.C., Cwik, J.C., Margraf, J., & Schneider, S. (2017). Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child and Adolescent Psychiatry and Mental Health, 11, 5. 407 Frances, A., & Batstra, L. (2013, August 20). Why are so many children being diagnosed with mental disorders? Psychiatric Times. https://www.psychiatrictimes . com/view/why-are-so-many-children-being-diagnosed-mental-disorders. (2013). Why so many epidemics of childhood mental disorder?. Journal of developmental and behavioral pediatrics : JDBP, 34(4), 291–292. https://doi.org/10.1097/DBP.0b013e31829425f5. 408 Foulkes, L., & Andrews, J. L. (2023). Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis. New Ideas in Psychology, 69, 101010. https://doi.org/10.1016/j.newideapsych.2023.101010. 409 Shrier, A. (2024). Bad Therapy: Why the Kids Aren’t Growing Up. Penguin. reap handsome profits when publishing successful studies of drugs. 489 • More than half of top medical journal editors have been paid directly by drug companies, often as funding for research; though most payments were modest there were two notable outliers who received general payments of greater than $1M in 2014. 490 • Despite incentives to favor industry, some of the world’s most respected medical journal editors have publicly expressed disgust and loathing for industry’s impact on the content and nature of medical journals, including: 491 • Richard Horton, editor of The Lancet: “Journals have devolved into information laundering operations for the pharmaceutical industry.” • Marcia Angell, former editor of the New England Journal of Medicine: Criticized industry for becoming “primarily a marketing machine” and co-opting “every institution that might stand in its way.” • Richard Smith, former editor of the BMJ: “Medical journals are an extension of the marketing arm of pharmaceutical companies.” • Arnold Relman, former editor of the New England Journal of Medicine: “The medical profession is being bought by the pharma- ceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institu- tions of this country are allowing themselves to be paid agents of the pharmaceutical industry. I think it’s disgraceful.” One of the world’s most prestigious journals published an article critiquing pharmaceutical advertisements, and lost an estimated $1-1.5 million in advertising revenue, revealing “the true colors of the pharmaceutical industry, which was willing to flex its considerable muscles when it felt its interests were threatened.” 492 2. Exerting Potentially Undue Influence Evidence suggests that pharmaceutical money strongly influences congressional legislation through lobbying and the manipulation of patient advocacy groups, and exerts considerable financial control over the FDA and its employees: • From 1999 to 2018, the pharmaceutical industry spent $4.7 billion on lobbying expenditures at the federal level, more than any other industry. 493 • Industry-funded patient advocacy groups often present as independent entities, pressuring regulatory bodies to prioritize rapid access to new treatments over safety. 494 • Between 2010 and 2022, industry provided $6 billion to over 20,000 patient advocacy organizations. 495 • 9 of 10 past FDAcommissioners have gone on to work in the pharmaceutical industry; 496 similarly, roughly 70% of FDAmedical exam- iners ultimately find employment in the industry. 497 3. Widening Markets and Influencing Clinical Practice The pharmaceutical, device, and related healthcare industries have used a broad range of tactics to maximize profits, many of them explicitly untethered to improvements in child health. Such tactics typically have the impact of distorting and widening markets for indus- try product sales. Examples include: • In prior studies, 80% of clinical departments at U.S. medical schools and teaching hospitals are funded directly by the pharmaceuti- cal industry. 498 • Industry sponsorship of education for medical students and physicians typically promotes drugs, encourages off-label prescribing, and contributes to polypharmacy in kids. 499