About 15-20 years ago or so, when I was still Director of Psychiatric Residency Training at the University of Tennessee Medical School, I went to a grand rounds (a teaching conference involving the whole department) to hear a talk by a doctor about adult ADHD. It turned out to be more of a drug commercial for some or other stimulant the sponsor of the talk was selling.
The guy basically said that this pseudo-diagnosis was in fact incredibly common – up to 14% of the adult population – and all of them should be taking significant doses of one of the most dangerous and addictive class of drugs that are available by prescription – classified by the FDA in the same category of abuse potential as opiates like morphine. Wow.
During the Q&A at the end of the talk,
the subject of ADHD in children came up. Someone asked him why so many kids
diagnosed with the disorder could go to a video game arcade (which had at the
time only recently gone the way of the dinosaurs) and concentrate with
tremendous focus on the game they were playing despite all sorts of buzzers and
bells going off, flashing lights everywhere, and scores of people milling all around
talking to each other. The speaker opined that this was “not concentration.” I’ve
heard that sentiment many times before and since from Pharma shills. Well if it
isn't concentration, I wondered, then WFT is
it?
Another skeptic in the audience from child
psychiatry asked him about the high incidence of alcoholism in the parents of
ADHD patients. His response: “If you had a kid like that, you’d probably drink
too!” Oh, I see. Alcoholism is caused by having rambunctious children.
I should have gotten up and cussed the dude
out for saying heinous stuff like this, but my boss in the department might
have frowned on it.
All this reminds me of another talk I once
heard from someone from the National Institute for Drug Abuse during an outside
medical meeting. He was going on and on about how cocaine, another stimulant
BTW, depletes a chemical in the brain called Dopamine, which makes it nearly
impossible for abusers to enjoy anything but the drug. Someone (again, not me) got
up and asked, “But aren’t we doing that when we prescribe stimulants to our
kids?” The speaker’s answer, “But the drugs work
so well.”
So I’m guessing that the answer to the
question that was actually asked, which the speaker completely avoided, was, “Yes.”
Spot on as usual, David. One can't help wondering if early exposure to stimulants leads to addiction in adults, though there is a dearth of online literature supporting this position. Most so-called ADHD experts claim the opposite; ie, that failure to treat ADHD with stimulants in childhood increases the addiction risk as adults.
ReplyDeleteRegarding the corrupting influence of academic psychiatry on impressionable physicians, it was recently reported to me by a psychiatrist fresh out of residency that he was required during his addiction rotation to prescribe Suboxone, which is widely embraced as appropriate medication-assisted therapy for opiate addicts, and an apparent cash cow now for funding psychiatry residency programs. Great idea...prescribing a drug that's 40X the potency of Morphine and calling it treatment. That's comparable to treating someone addicted to Bud Lite with Jack Daniels. In my practice, I have observed the rise of first-time heroin users in patients who were addicted to hydrocodone or oxycodone and treated in an inpatient rehab facility with Suboxone. Unable to afford it following discharge, they discontinued it, quickly relapsed, but were unable to manage their withdrawal with pre-"treatment" dosages of their less potent opiates of choice. Next logical course for an addict?...HEROIN!
Dr. Allen's piece on ADHD, and reply by commenter "doctor z", should be quite disheartening to anyone even casually familiar with the science on this subject.
ReplyDeleteHow would Dr. Allen respond to the following excerpt, from "International Consensus Statement on ADHD" (January 2002, _Clinical Child and Family Psychology Review_) which is devastating to the opinions expressed in his piece?
From the article...
Occasional coverage of the disorder [ADHD] casts the story in the form of a sporting event with evenly matched competitors. The views of a handful of nonexpert doctors that ADHD does not exist are contrasted against mainstream scientific views that it does, as if both views had equal merit. Such attempts at balance give the public the impression that there is substantial scientific disagreement over whether ADHD is a real medical condition. In fact, there is no such disagreement—at least no more so than there is over whether smoking causes cancer, for example, or whether a virus causes HIV/AIDS
The U.S. Surgeon General, the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, and the American Academy of Pediatrics, among others, all recognize ADHD as a valid disorder. … Among scientists who have devoted years, if not entire careers, to the study of this disorder there is no controversy regarding its existence.
I would respond by pointing out that for decades a strong international consensus was that gastric ulcers were caused by stress and that the inside of the stomach is too acidic for any organisms to survive.
DeleteAnd then some doctors discovered heliobacter pylori.
Yes, David, as well as the international consensus of experts that thought cholera was transmitted through the air.
ReplyDeleteWhile the US only represents 5% of the world's population, we consume 80-85% of the global opiate and stimulant production, so Houston, we've got a problem. Here are 2 well-researched NCBI papers, one from 2005 and another from 2011, that explain the unreliability of subjective rating scales in diagnosing ADHD and ease of malingering a diagnosis for the purpose of obtaining stimulants. Continuous performance tests are objective indicators for revealing nonspecific attentional problems, but are rarely done in a typical clinical setting. In the last 16 and 10 years since the publication of these articles, things have only gotten worse regarding the overprescribing of stimulants. Sadly, the genie has long left the bottle on this one...
ReplyDeletehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173757/
An even bigger problem with this dx is that acting out behavior and distractibility are caused by parents who don't know how to set boundaries or limits, or who subject children to adverse childhood experiences, and the clinicians making the diagnosis don't even ask about it - let alone observe how the family operates (like Supernanny did. Yeah, I know, it's just a TV show).
DeleteNot to mention they let their kids get sleep deprived by staying up half the night playing videogames or posting on Twitter. Because anyone can concentrate so well in that state.
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