The Selling of Attention Deficit Disorder – NYTimes.com.
The Number of Diagnoses Soared Amid a 20-Year Drug Marketing Campaign
By ALAN SCHWARZ – DECEMBER 14, 2013
Hello all. Just a quick update to my December 11th, 2013, blog post on how we should add desirable care to our focus on affordable care. In my earlier blog post I talked about how feeding our kids copious amounts of behavioral drugs more potent than cocaine—such as Ritalin and Adderall—was not a desirable form of care. Well, a mere few days after my blog post went hot, the New York Times published an article by Alan Schwarz entitled The Selling of Attention Deficit Disorder. The information Schwarz presents tracks the information that Gary Greenberg covers in his book The Book of Woe: The DSM and the Unmaking of Psychiatry. I frame the information that both authors present using the following question: “Is this desirable care?” Taken a step further I could ask, “Is this ethical and moral care?” Here are a few quotes and bullet points from Schwarz’s article (which I recommend that you read in its entirety):
The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.
• “Profits for the A.D.H.D. drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health.”
• “The American Psychiatric Association, which receives significant financing from drug companies, has gradually loosened the official criteria for the disorder to include common childhood behavior like ‘makes careless mistakes’ or ‘often has difficulty waiting his or her turn.’ ” Again, for more on this theme, see Greenberg’s The Book of Woe. Simply, powerful groups like the APA are medicalizing every burp and hiccup of normal childhood development as a way of opening the door for psychopharmacology companies to unfairly target children (and, increasingly, adults).
Some studies had shown that stimulant medication helped some elementary school children with carefully evaluated A.D.H.D. to improve scores in reading and math tests, primarily by helping them concentrate. The concern, some doctors said, is that long-term, wider academic benefits have not been proved—and that ads suggesting they have can tempt doctors, perhaps subconsciously, to prescribe drugs with risks to healthy children merely to improve their grades or self-esteem.
As I have blogged about before (including my December 11th, 2013, post), ADHD expert, Russell Barkley, writing in his book Executive Functions, tells us that, yes, stimulant drugs can control behavior, but, in what can only be called a cruel paradox, they tend to keep children from the Executive Function skills that they would need in order to move past ADHD such as focusing attention, appropriately shifting attention, planning, delaying gratification, impulse control, etc. Barkley calls the current ADHD epidemic an epidemic of EF deficiencies. Simply, behavioral drugs control behavior; they do little if anything as far as developing EF skills, the same skills needed to move past and heal from ADHD. Is this desirable care?
• “When federal guidelines were loosened in the late 1990s to allow the marketing of controlled substances like stimulants directly to the public, pharmaceutical companies began targeting perhaps the most impressionable consumers of all: parents, specifically mothers.”
• “[M]any critics [of questionable advertising practices by psychopharmaceutical companies] said that the most questionable advertising helped build a market that is now virtually self-sustaining [my emphasis]. Drug companies also communicated with parents through sources who appeared independent, from support groups to teachers.”
In my March 13th, 2012, blog post, I touch on this idea that pushing stimulant drugs on kids has left the rails and is no longer about therapy. It has taken on the form of “stimulant haves vs. stimulant have nots.” Here’s what I wrote back in March, 2012:
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1) On one side, the system [which includes doctors, teachers, administrators, counselors, etc.] is sending the not-so-subtle message that if mothers do not comply and put their children (some as young as three and four years old) on behavioral drugs like Ritalin and Adderall, the system may begin viewing these “oppositional mothers” as being unfit. Yeow! Are we looking at ODMD—oppositional defiant mother disorder?
2) On the other, children are putting pressure on their mothers. In both anecdotal stories mentioned [in the original March, 2012, post], the form this pressure takes is the same. Children apparently are telling their mothers that most of their classmates are taking behavioral drugs as a form of “study enhancement.” Children are giving their mothers the following “bottom line”: If we (children) do not take behavioral drugs to enhance study, we will be potentially marginalized with respect to those classmates who are taking study enhancing drugs. Again, yeow!
— o O End Excerpt O o —
There is huge pressure now from doctors, teachers, administrators, counselors, etc., for parents to put their kids on stimulant drugs as a way for these kids to stay academically competitive through a program of cognitive enhancement. In effect, as far as performance enhancing drugs are concerned, we’re asking our kids to study dirty (in school) as we ask them to play clean (on the athletic field). This is a cruel societal double message for kids to internalize. Is this desirable care? Is this care at all? Here’s how Schwarz describes the situation in his article:
• “The idea of unleashing children’s potential is attractive to teachers and school administrators, who can be lured by A.D.H.D. drugs’ ability to subdue some of their most rambunctious and underachieving students. Some have provided parents with pamphlets to explain the disorder and the promise of stimulants.”
Here’s one last quote from Schwarz’s article:
Insurance plans, increasingly reluctant to pay for specialists like psychiatrists, are leaving many A.D.H.D. evaluations to primary-care physicians with little to no training in the disorder. If those doctors choose to learn about the diagnostic process, they can turn to web-based continuing-education courses, programs often subsidized by drug companies.
As we make our care system more affordable, I would suggest that we spend some time making our care system (and care providers) desirable. Give Schwarz’s article a read. You may wish to watch the following video by Schwarz entitled How Drug Companies Sell A.D.H.D.
