Ritalin (methylphenidate), the drug used to treat
attention-deficit hyperactivity disorder (ADHD), cannot stay out of
the news. Class-action suits
filed recently in New Jersey and California allege a conspiracy between
the pharmaceutical industry, physicians, and the leading ADHD self-help
group to unnecessarily medicate American children with a dangerous drug.
Ritalin is the best known of the stimulant class
of drugs that have been used for more than 60 years to treat childhood
hyperactivity, now called ADHD. Myths abound about Ritalin, and the
debate over the drug quickly verges on hyperbole.
For example, few know that Adderall,
a purportedly "new" concoction of amphetamine, has surpassed
Ritalin
as the most widely prescribed medication for ADHD in annual prescriptions
in America.1 All the stimulants used for ADHD, including methamphetamine,
have essentially the same effects and side effects, differing mainly
in their duration of action.2
Most people continue to think that stimulants, like
Ritalin, work paradoxically on hyperactive kids to calm them down. Many
studies have proved otherwise: stimulants like Ritalin work the same
in children and adults-whether or not they have ADHD-to improve their
ability to focus on tasks that are difficult or boring.3
Therefore, prescribing Ritalin
as a way to diagnose ADHD is absurd because everyone's performance improves
with its use.
What about this civil class-action suit? The attorneys
are modeling their charges on the recent successful litigation against
tobacco companies. But there is a major difference between Ritalin and
tobacco.
Unlike tobacco, the medical establishment-most
notably the American Psychiatric Association along with the main professional
child psychiatry association-solidly backs if not promotes the use of
Ritalin for ADHD.
The vast bulk of scientific literature supports
the short-term effectiveness and safety of the drug. Is the pharmaceutical
industry suppressing information to the contrary?
Only the disclosure that comes with discovery will
determine whether a Ritalin conspiracy exists. But even without a conscious
plan, the influence of pharmaceutical
industry dollars for research support and advertising-first
to physicians and now directly to families-has been profound. The market
forces of Adam Smith's "invisible hand" operate within the
world of childhood mental health and illness.
American psychiatry's infatuation
with the brain coincides with a drug industry more than happy to contribute
funds for research that only counts symptoms and pills.
If only family counseling or special education rewarded
stockholders the same way Ritalin or Prozac [fluoxetine hydrochloride]
does.
Practically every researcher in ADHD
now accepts drug company money, as do the self-help groups for at least
a part of their work and projects.
They would say that they are not influenced by the
source of their funding. However, many worry otherwise, from the physicians
at local hospital grand rounds listening to a lecture "supported
in part by drug company X" to the editors of the New England Journal
of Medicine reviewing the latest research findings.4 And the economics
of managed care drives physicians toward prescribing Ritalin as a "quick
fix" because talking to parents and working with schools simply
take too much time.
The "success" of Adderall,
which was vigorously marketed to physicians, is more a sign of "hype"
activity than any real medical breakthrough.
The advertising for the new stimulant product for
ADHD, Concerta, crosses new marketing boundaries because it is the first
prescription drug for a childhood psychiatric condition marketed
directly to parents.
The picture of a smiling boy holding a pencil surrounded
by his happy parents and sister tells you that they're pleased because
the boy is now being treated for ADHD, a biologic disorder best treated
with a pill. Such presentations can only further promote a brain-based
view of behavior.
They ignore and deny the importance
of the environment - family, school, neighborhood,
and culture - in a child's healthy emotional development.
The NIMH (National Institute of Mental Health) conference
set out a course to specifically study ADHD and Ritalin use in toddlers.
But virtually every researcher
at that conference receives funds from the pharmaceutical industry.
At the Surgeon General's conference, it was clear
that nondrug approaches
to children are egregiously underfunded.
What about taking yet another cue from the tobacco
wars and developing a tax on either pharmaceutical profits or the drugs
themselves that would be directed to other effective interventions for
ADHD, like parent and teacher behavioral management training?
Specific tax incentives and disincentives are the
most likely way that the public, through government action, will be
able to influence otherwise powerful economic forces that push toward
only medicating for children's problems ...
Unfortunately, given the massive
effort to convince America that their children's brains are bad, only
such extreme countermeasures like the Ritalin suit may get the public's
attention.
