Monday, December 16, 2013

Attention Deficit Disorder Wins Media Attention: Thanks to the drug industry?

Consider it a gift this holiday season, the appearance of a nuanced children's health article on the front page of the New York Times. It tops the news heavy-weight's Most Emailed list today too with over a 1,200 comments and counting. The Selling of Attention Deficit Disorder. It's a multi-page examination of how the  pharmceutical business has sold doctors, parents, teachers, kids (but aparently not journalists) on the notion Attention Deficit Disorder (ADD) is a common lifelong disease that leads to school failure, divorce and a life of crime if left untreated. Oh and it's easily diagnosed and totally treatable with very effective drugs with very few side effects.

Not much of the ADD news in the article surprises me except for the fact this blessedly fact-based piece on children and health earned the above-the-fold spot along side Syria and leaker Edward Snowden.  Remarkable. The cynical media observer might wonder whether this investigative article would have been so prominently featured if it hadn't involved a hugely profitable international industry. Would it have merited the top spot if it couldn't have appeared in the business section too?  

When is the last time children's health landed on the front page? 

Now for some highlights sure to please parents attuned to the ridiculousness that often passes as parenting news.

On rising rates of ADD and studies showing 15% of high-school students have been diagnosed at some point in their young lives:
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. (Keith) Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
On experts promoting the disorder in the media. Here, Joseph Biederman, a child psychiatrist at Harvard University and Mass General Hospital, author of many studies on the safety of ADD drugs, who was also investigated by the Senate in 2008 and found to have earned $1.6 million in speaking and consulting fees from pharmaceutical companies:
Dr. Biederman was frequently quoted about the benefits of stimulants in interviews and company news releases. In 2006, for example, he told Reuters Health, “If a child is brilliant but is doing just O.K. in school, that child may need treatment, which would result in their performing brilliantly at school.”
On doctors dispensing accurate evidence-based advice on ADD drugs:
“There are decades of research into how advertising influences doctors’ prescribing practices,” said Dr. Aaron Kesselheim of Brigham and Women’s Hospital in Boston, who specializes in pharmaceutical ethics. “Even though they’ll tell you that they’re giving patients unbiased, evidence-based information, in fact they’re more likely to tell you what the drug company told them, whether it’s the benefits of the drugs or the risks of those drugs.”
Not many organizations get a free pass here. In addition to the usual suspects, the ones under scrutiny for their role in promoting the disorder and its pharmaceutical treatment, however indirect or well-intended include but are not limited to:

The American Psychiatric Association (ADD criteria, drug $$$)
Medical/Academic journals (drug ads)
Parent advocacy groups (drug $$$)
Magazines (drugs ads targeting kids)
Health websites (Do You Have ADD? quizzes, drug ads)

The reporter, Alan Schwartz gets credit for writing such claim-busting phrases as "no science, ""not supported by science," and "no credible national study" in reference to the incidence of the disorder among adults, the educational benefits of stimulant medications,  the lifelong benefits, the prognosis for untreated ADD (i.e. prison), etc. 

The New York Times also got in on the quasi-science action. They pestered more than 1,100 adults to take the same 6-question quiz that appears on a webpage sponsored by Shire, maker of ADD meds. A quiz sure to zap too many minutes of your day. Anyhow 33% scored "A.D.H.D. Possible" and 16% "A.D.H.D. May Be Likely" but only 5% were ever diagnosed by a professional. I scored a "Possible" though I most definitely do not have A.D.H.D. Not even during this holiday season.

Are some kids diagnosed who probably don't have it? Yes. Do I doubt the existence of ADD or attentional issues in children? No. Nor do I doubt the efficacy of medications like Ritalin and Adderall. In fact I don't discount automatically good research showing a drug's safety simply because it was sponsored by a pharma company and I'm surprised this article didn't get into that research a touch more. Then again it focused on the"selling" and not so much the "studying." I would have preferred more detail there because it would be easy to conclude from this piece there is no reliable information that these drugs are safe or effective when used to treat ADD and that's not the case. 

2 comments:

Barbara TherExtras said...

Not.even.a.whisper on other environmentally-related causes?

BIGpharma takes the hit, again.

Not that I defend that industry but, heck, tv, online video, video gaming, reduction of physical activity in childhood and side-effects of asthma medications also bear some of the statistical relatedness, do they not?

Oh, and what about formula feeding, hormones in meat, GMOs and bad parenting? Ahem.

Happy New Year, Polly!

Polly Palumbo, Ph.D. said...

.... increasing academic demands, high fructose corn syrup, artificial food coloring, sleep disruptions, Instagram, Snap Chat, constant instant gratification, modernization, urbanization...

Howdy, Barbara! Should we have a cause-off? A cause-a-thon?

Someone at the NY Times has taken a special interest in psychology/mental health over the past few months. I wonder, can we attribute it to the new intern popping Adderall?