Part 1

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 Part 2

Published on Dec 17, 2013 – Taken at face value, the latest figures on Attention Deficit Hyperactivity Disorder (ADHD) suggest a growing epidemic in the United States. According to the Centers for Disease Control, 15 percent of high school children are diagnosed with ADHD. The number of those on stimulant medication is at 3.5 million, up from 600,000 two decades ago. ADHD is now the second most common long-term diagnosis in children, narrowly trailing asthma. But a new report in the New York Times questions whether these staggering figures reflect a medical reality, or an over-medicated craze that has earned billions in profits for the pharmaceutical companies involved.

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Sales for ADHD drugs like Adderall and Concerta topped $9 billion in the United States last year, a more than 500 percent jump from a decade before. The radical spike in diagnoses has coincided with a 20-year marketing effort to promote stimulant prescriptions for children struggling in school, as well as for adults seeking to take control of their lives. The marketing effort has relied on studies and testimonials from a select group of doctors who have received massive speaking fees and funding grants from major pharmaceutical companies. We are joined by four guests: Alan Schwarz, an award-winning reporter who wrote the New York Times piece, “The Selling of Attention Deficit Disorder”; Jamison Monroe, a former teenage Adderall addict who now runs Newport Academy, a treatment center for teens suffering from substance abuse and mental health issues; Dr. Gabor Maté, a physician and bestselling author of four books, including “Scattered: How Attention Deficit Disorder Originates and What You Can Do About It”; and John Edwards, the father of a college student who committed suicide after he was prescribed Adderall and antidepressant medications at the Harvard University Health Services clinic.

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Is ADHD A Pretext For Selling Speed?

Jacob Sullum, Contributor

New York Times reporter Alan Schwarz, who for the last year or two has been wondering what’s up with all the speed kids are taking these days, has a long article in Sunday’s paper on “The Selling of Attention Deficit Disorder.” Unfortunately, Schwarz barely mentions the American Psychiatric Association (APA), the organization that identified ADD, later relabeled “attention deficit hyperactivity disorder” (ADHD), as a disease that can be treated with prescription stimulants such as Adderall, Ritalin, and Vyvanse. Instead he focuses on the companies that make those stimulants, which he accuses of encouraging “overdiagnosis” to maximize sales.Schwarz surely is right that companies such as Shire, which sells Adderall, and Ciba-Geigy, which makes Ritalin, have a financial interest in pushing as broad a definition of ADHD as possible. But none of this would be possible without the APA’s blessing, and Schwarz pays scant attention to the problem of saying whether someone does or does not have a disease for which there is no objective test. Here is the sole reference to the APA in his 5,300-word story:

Like most psychiatric conditions, A.D.H.D. has no definitive test, and most experts in the field agree that its symptoms are open to interpretation by patients, parents and doctors. 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.”

ADHD, like every other condition listed in the APA’s Diagnostic and Statistical Manual of Mental Disorders, is whatever the current edition of the DSM says it is. Since the official definition is broad and “open to interpretation,” it is hard to know what Schwarz means by “overdiagnosis.” Here is his best stab at explaining:

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.

But even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication.

Evidently Schwarz accepts the legitimacy of Classic ADHD while turning up his nose at New ADHD. But since neither purported disease can be objectively verified, it is not clear on what basis Schwarz prefers the narrower definition. It seems to me that Schwarz, who started his career as a sports reporter, is making a moral judgment about when it is acceptable to use performance-enhancing drugs: If you have a “legitimate disability,” it’s OK, but not if you are merely trying to turn a B+ into an A. He dresses up this moral judgment in the language of medical science, but it remains a moral judgment, and a questionable one at that.


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