Kids who take Ritalin and Adderall for ADHD are much more likely than their drug-free counterparts to die suddenly, according to scientists at Columbia University.

Still, the number of deaths in the drug-taking population was small, and limitations in the study prevented the scientists from concluding the popular medicines were causing kids to drop dead.

Physicians have long wondered whether such a link could exist because the drugs are stimulants: they increase heart rate and blood pressure and occasionally precipitate abnormal heart rhythms.

About 2.5 million children take these drugs in the US.

“This study reports a significant association between sudden unexplained death and the use of stimulant medication, specifically methylphenidate (Ritalin),” wrote the authors. Our findings draw attention to the potential risks of stimulant medications for children and adolescents.”

To reach these conclusions, Madelyn Gould and colleagues undertook a matched case-control study involving 564 US children that died suddenly and inexplicably between 1985 and 1996.

The scientists determined which children were taking the stimulants through interviews with parents and a review of medical records.

While kids taking the stimulant medications had a much higher risk of sudden death, the tragic event occurred in less than 1 in 10,000 kids taking the drugs. And it remained possible that ADHD itself might have increased the risk for sudden death.

For those reasons, FDA officials said it would not be necessary to change the warning labels on the drugs and urged parents to take up any concerns with doctors rather than stopping their kids’ drugs cold turkey.

The new safety concerns regarding ADHD drugs come on the heels of an unsightly public dust-up involving co-authors on a scientific paper that appeared to show the drugs had no beneficial effects in the long term.

This post first appeared on the Practice Fusion Blog.

Last week, the venerable Institute of Medicine released a list of 100 research priorities designed to provide a roadmap for the comparative effectiveness agenda mandated by the Big O’s January Hail Mary otherwise known as ARRA.

At the top of the list are treatment strategies for common conditions like obesity and back pain and the prevention of falls in hospitalized patients. The list also includes mechanisms by which  medical research findings are disseminated to the bedside and to the public.

The full list is here.

Congress allocated $1.1 billion of its $787 billion stimulus package to comparative effectiveness research, assuming such research can improve the quality of health care, though such an impact would be years away.

This “is a program about improving decisions for patients,” Harold Sox told the Wall Street Journal. Sox co-chaired the IOM committee that established the list.

Sox’ team distilled the final 100 from more than 2,600 suggestions submitted by professional groups, policy experts and the public.

Although the products of medical device and pharmaceutical companies will be the primary focus of the research, the former contributed only 11 suggestions and the latter managed just 17. “For whatever reason, we didn’t get many suggestions from them,” Sox understated.

“Right now, the winners and losers (among the various drugs and devices in extant) are based on which company has the best marketing department, rather than who has the best product,” said University of Pennsylvania professor Brian Strom.

“If we show that in certain drugs, the more expensive one is better than the cheaper one, the answer is use the expensive one,” added Strom. “The focus of comparative effectiveness research is that it leads to better care, not cheaper care.”