Is ADHD a Pretext for Selling Speed?

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.

As Schwarz concedes, stimulants help many people, adults as well as children, pay attention and perform better in school and at work. The relevant question is not, as Schwarz seems to think, whether all of these people "really" have ADHD (whatever that means) but whether the benefits of stimulants outweigh their risks. Schwarz tries mightily to magnify those risks:

Psychiatric breakdown and suicidal thoughts are the most rare and extreme results of stimulant addiction, but those horror stories are far outnumbered by people who, seeking to study or work longer hours, cannot sleep for days, lose their appetite or hallucinate. More can simply become habituated to the pills and feel they cannot cope without them.

Notice how Schwarz mixes "rare and extreme...horror stories" with a common, often welcome effect of stimulants, implying that users experience suicidal thoughts, insomnia lasting for days, and hallucinations (presumably due to the aforementioned sleep deprivation) about as often as appetite suppression. His final warning—that people may "become habituated to the pills and feel they cannot cope without them"—is little more than negative spin on a situation he elsewhere describes as taking a "medication" to compensate for a "disability." Schwarz's most laughable attempt to scare people away from stimulants is his grave warning that "these drugs are classified by the government among the most abusable substances in medicine." Yes, and according to the government, marijuana is even more dangerous.

I don't mean to imply that prescription stimulants—or their illegal counterparts, many of which, impurities aside, are chemically very similar or identical (e.g., Desoxyn vs. black-market meth)—carry no hazards at all. But the risks are the same whether or not consumption of the drug has been blessed by a doctor's prescripton, and whether or not Alan Schwarz thinks that prescription should have been written. People should be free to weigh the risks for themselves, without having to obtain the magical piece of paper that transforms crime into medicine.

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  • Irish||

    The White House figures out how to sell Obamacare.

    Sex appeal.

  • ||

    The people into Diaper Play are a large, but silent majority.

  • ||

    If there's one thing everybody loves it's a hipster who spends Christmas lecturing them about Obamacare.

  • ||

    Their desperation and pathetic attempts to fix this are the best Christmas present anyone could have possibly imagined. And they just keep digging the hole deeper. And I wasn't even a good boy this year! Or any year!

  • Sevo||

    "Silicon Valley tech leaders to Obama: “Aggressively” reform NSA"
    [...]
    "the President preferred to talk about his new health care program."...
    Sounds like a laugh a minute!
    http://blog.sfgate.com/nov05el.....eform-nsa/

  • Lady Bertrum||

    Because nothing is sexier than a scrawny nerd in a flannel onesie.

  • ||

    People should be free to weigh the risks for themselves, without having to obtain the magical piece of paper that transforms crime into medicine.

    True, of course. But even absent the current government regime, I'm confident that doctors and the major drug companies would have come up with some kind of prescription/restriction/control system for certain kinds of drugs privately in response to pressure from insurance companies. Although once they reach generic status I doubt such a system would be very effective.

  • Ted S.||

    Unfortunately, Schwarz barely mentions the American Psychiatric Association (APA), the organization that identified ADD, later relabeled "attention deficit hyperactivity disorder" (ADHD), as a disease

    They don't have the profit motive to the extent that the drug companies do. Therefore, by definition they can't be as evil.

  • ||

    Well, also, the APA says they care, and since they said it, that means it is true to TEAM BLUE, regardless of their actual actions or the consequences of their actions.

  • Ted S.||

    Jacob couldn't concentrate long enough to produce alt-text. :-(

  • JeremyR||

    Yes, yes it is.

    Speed should be legal, but this ADHD stuff is just bullshit. It shouldn't be forced on kids.

  • ||

    Those two thoughts are not mutually exclusive. I agree that it shouldn't be "forced" on anyone, but I think you are going to need more evidence to back up your ADHD-is-bullshit claim.

  • HBfromMN||

    There is a specific, testable brainwave pattern associated with ADHD. Please do your research rather than spread misinformation.

  • Invisible Finger||

    And that test is about as scientific as a breathalyzer

    http://www.medscape.com/viewarticle/809079

  • SIV||

    Denier!

  • Locke||

    ..."but those horror stories are far outnumbered by people who, seeking to study or work longer hours, cannot sleep for days, lose their appetite or hallucinate-"

    So you're telling me that I'll be able to stay up late to study, lose weight, and maybe enjoy some hallucinations? I'm not seeing the negatives here.

  • ||

    I'm not seeing the negatives here.

    You might enjoy it.

  • Voros McCracken||

    Alan's a very nice guy by the way.

  • alittlesense||

    NOot if he writes this sort of crap. We all know the ultimate end result of this; some congressfool will push legislation through that makes it almost impossible to get Adderall, and gives the police more excusesto arrest people. And it will all be for the sake of "the children." And the people who need this medication will be screwed.

  • Zombie Jimbo||

    Shire stock is @ $136. I'm good with it.

  • John||

    but those horror stories are far outnumbered by people who, seeking to study or work longer hours, cannot sleep for days, lose their appetite or hallucinate. More can simply become habituated to the pills and feel they cannot cope without them.

    And that is because those people cant cope at all and use the "drugs" as a lame excuse for their own weakness.

  • RishJoMo||

    Kinda crazy when you think about it.

    www.AnonGoes.tk

  • mr simple||

    the organization that identified ADD, later relabeled "attention deficit hyperactivity disorder" (ADHD),

    ADD and ADHD are actually two separate diagnoses. I was diagnosed ADD, but am not hyperactive. My brother was diagnosed ADHD. We never took anything for it, though.

  • HBfromMN||

    The claim that ADHD is not a testable medical condition is false. Yes, many doctors do not know this, few parents know it, and it is likely many medical manuals get it wrong. But there is a specific brainwave pattern associated with true cases of ADHD. A competent physician can show you it on the EKG chart. I have seen it.

    I do believe that it is over-diagnosed; I was a skeptic until I had a child who has it. He has the brainwave pattern, and he has the behavior. We can watch it occur in real time; we can watch the drugs eliminate the negative behavior in 15-20 minutes.

    People who claim it is not a testable condition are just uninformed.

    Having said that, it is definitely not a *discrete* condition. It is a condition that falls on a bell curve -- the brainwave can be normal, it can be way way off, or it can be anywhere in between. That doesn't make it not real or untestable. The fuzzy part is where to draw the line. All kids would benefit from Ritalin, so why not give it to everyone? Where on the bell curve do we draw the line? No matter where we draw the line, the next "worse" kid is now at the bottom. Drug companies want to push it as far as possible; parents want to resist drugging their children. It's a battle that will never be settled.

  • HBfromMN||

    Sorry, I meant EEG above, obviously, not EKG.

  • Invisible Finger||

    All kids would benefit from Ritalin, so why not give it to everyone?

    Sullum's argument is that Ritalin should be available to anyone without having to go through a gatekeeper. If you want a gatekeeper or expert opinion or whatever before taking it or giving it to your child, you may. (People already consult with doctors before taking aspirin.)

  • ||

    I've often wondered how much adderall would cost if all drugs were OTC legal.

    What kind of wonderful amazing drugs would have been created if they didn't have the FDA to contend with?

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