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The Business of Attention Deficit Disorder
Hugh Pickens DOT Com writes "Alan Schwarz writes in the NYT that the rise of ADHD diagnoses and prescriptions for stimulants over the years have coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. 'The numbers make it look like an epidemic. Well, it's not. It's preposterous,' says Dr. Keith Conners, a psychologist who has led the fight to legitimize attention deficit hyperactivity disorder for more than fifty years. Few dispute that classic ADHD, historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. But recent data from the CDC show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990." (Read on for more.)
"Behind that growth has been drug company marketing that has stretched the image of classic ADHD to include relatively normal behavior like carelessness and impatience, and has often overstated the pills' benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in 'schoolwork that matches his intelligence' and ease family tension. The FDA has cited every major ADHD drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times. And although many doctors have portrayed the medications as benign — 'safer than aspirin,' some say — they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction. Meanwhile profits for the ADHD drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health. 'This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels,' concludes Conners."
Wait... what was I doing?
The pharmaceutical industry won't be happy until everyone is on a handful of medications. One that supposedly "cures what ails you" and the rest to address the many side effects of the other drugs.
Get 'em early. Get 'em hooked. Get 'em for life.
See also https://www.ted.com/talks/ken_robinson_says_schools_kill_creativity.html . Watching that video will be one of the best 20 minutes you've ever spent.
The ACA is something, and something is better than nothing, but the medical industry is saturated with greed and gouging. Take the obscene profits out of medical care and there is no incentive for mass misdiagnosis.
Happiness in intelligent people is the rarest thing I know.
Ernest Hemingway
...aside from the big push by the drug companies is that they allow family doctors to diagnose ADHD and prescribe the meds at all. The docs, parents, and teachers get handed a checklist and if the kid (or adult) meets a certain number of criteria on the checklist then they're told meds are the answer. Some doctors who work for the big PPOs and HMOs are expected to see 6 or more patients an hour so they are taught to rely on the checklists to give them answers. Sometimes it comes down to the fact that a few parents and teachers have lost the ability to set and hold limits with their kids. Sometimes a kid is just being a brat. I'm simplifying so I'm hoping someone can expand on my idea more, but ADHD is serious and needs to be diagnosed by a psychiatrist. Attention problems and hyperactivity can be symptoms of things other than ADHD too.
I did a quick search to see how many children there are in the United State. The first number I found was 74 million (total of all children under 18, as of 2013).
5% of 74 million is 3.7 million. Since I doubt they are giving Ritalin to toddlers (yet), this estimated number of children with ADHD is amazing close to the number who are on a prescription.
In other words, those are probably not two independently-derived numbers. They're one. There is no independent estimate of what percentage of kids have ADHD: there's only a count of how many are on the meds. This is a classic trick from _How to Lie with Statistics_: when you don't have the number you want (how many kids actually have ADHD), use the number you have (how many are on the meds) and pretend there is no distinction.
This has the side effect of "showing" (with numbers!) that the diagnostic methods for ADHD are nearly perfect. By circular logic, QED.
[Sir Garlon] is the marvellest knight that is now living, for he destroyeth many good knights, for he goeth invisible.
I'm not american, lived and visited several parts of the world. Love to talk and fit in with the locals and socialize.
Of course it's all anecdotal, but I'm pretty sure that something odd is going on in American culture. The times i've been there I couldn't help but finding amazing how such large parts of the population take behavioral related medication. I mean, even most TV commercials I saw were for anti depressants, or even complenents to them.
But it's not the medication itself what caught my attention but how people itself claims to be unwell, not feeling like what people should feel or not behaving as people should behave. It's as if there was some sort of strong "need to be normal" or "need to be well" (whathever tha means), and that not being like that is not fitting in society.
It's not that where I am from (South America) people won't get depressed or have panic attacks, but you see such symptoms by far much, much less often. It's not misdiagnose either or that people chooses to put up with it instead of taking medication , I mean, it's very clear when someone is going through depression. In contrast, people here are more "unpolite", intimate,cares less about rules and socialize a lot more. I'm sure there has to be a relationship somehow, but I am no expert on the matter. As I said, it's just what I see, but I can't connect the dots.
So, I think that even if pharmaceutical companies capitalize on this stuff, I'm not that sure they created the situation, I believe it's more akin to a side-effect.
I can't help agree with a poster above, who recommended the Ken Robinson video.
I also wanted to add that I think the way that our modern education system works has a lot to do with parents seeking a diagnosis for little Bobby "who just can't sit still".
I used to work in the environmental education field for quite a few years. I can say that I loved to have kids with "ADHD" in my group, because they were the ones turning over rocks and logs and activity searching for things. What is seen as a detriment in one setting, seemed to be an advantage in another setting.
An interesting thing to note is often how I would find out about their conditions. Since I did do some work at overnight facilities, I would sometimes would be told ahead of time medications and conditions a child had. But most of the time, I found out about it by a teacher saying something like: You know, so-and-so has a ADD/ADHD and he is just doing SO well out here.
Is it big pharma pushing doctors to prescribe more? Is it doctors too lazy/busy to do a proper diagnosis? Is it mothers, fathers and teachers who seek to explain bad behavior and poor discipline (which is largely their fault) on medical conditions? Is it our foods which have changed over to GMO based content over the same period of time?
The basic cause of this is simple: lack of physical activity causes kids to be fidgety. They can't concentrate. Kids that fidget in class are disruptive. They are marked as "trouble".
Crap. My son was diagnosed in the early 90's. We resisted the diagnosis at first, then balked at medication. In the end, the medications did help him succeed in school and at such activities as soccer, where the difference in his ability to pay attention was easiest to observe.
The counter-intuitive thing about ADHD medications is that they are typically stimulants, hardly something you would think of giving to a hyper-active child. Our doctor described the symptoms as something more akin to the restlessness that can come with drowsiness than an over-active mind or metabolism.
Maybe some parents diagnose and treat to make life easier, but I'm here to tell you that we specifically did not medicate my son during weekends and vacations, partly to minimize the medication, and partly to be able to observe his baseline behavior to see whether it changed over time.
As for teachers, my wife has taught first and second grade for about 20 years, and in her school system, teachers are prohibited from offering a diagnosis or even acknowledging the possibility when asked; that is the domain of medical professionals, not teachers. YMMV, of course.
All that said, ADHD is certainly over-diagnosed, and that was almost certainly the case back when my son was diagnosed, at the early end of the chart in TFA. I have to say I was shocked at how much more prevalent the diagnosis has become. I tend to lay the blame at the feet of Big Pharma marketing treatments to lay people; the lengths they go to in advertising in magazines (with pages of fine print that few read or understand) and television, carefully staying within the guidelines of regulations (that clearly aren't helping) is absurd.
Well kind of.
This was originally brought up as a problem 20 years ago, give or a take a few years; ADD, a substype of ADHD, was commonly used.
At that time it was teachers and schools pushing it and it is still is, if the kid was causing distruptions it was a standard solution to get the kid on a pill.
Companies are just responding to the need. Companies are coming up with better drugs with less side affects or are cheaper or better in other ways. Since they now have this better drug they are putting out information about it. So now people are pointing to the drug companies and saying how they are to produce a better drug that schools are pushing.
I have ADD myself, and I take meds to treat it. I can honestly say that I make smarter decisions when on my medications. I focus better, get things done, my social life improves, and I'm just generally better at living. And when I reflect back on days when I was not on my meds, I often just shake my head at myself in embarassment for all the dumb things I did that day. So glad to have a treatment. I think before ADD was clinically diagnosed, people were just called "less intelligent". And who wants to be dumb? Certainly not me.
Is it big pharma pushing doctors to prescribe more? Most likely, there are so many regulations and public pressure to lower the costs of their drugs, so they will make up the difference with increase volume. I mean we have TV adds full of commercials pushing superscription medicine, even if 80% of the commercial is about the side effects, to cure a minor condition.
Is it doctors too lazy/busy to do a proper diagnosis? Lazy, no. Over worked yes. In an attempt to try to get health care cheaper doctors usually take the brunt of the cost cuttings, insurance companies pressuring them to lower their rates, so they make it up by double/triple booking patients. Because they cannot afford to see 12 patients a day at 45 minutes apiece.
Is it mothers, fathers and teachers who seek to explain bad behavior and poor discipline (which is largely their fault) on medical conditions? Not necessarily their fault, society has changed the role of the traditional family. With both parents working full time, or a single parent family the norm, it makes it quite difficult to raise their children. Teachers have their hands tied behind their back on what they can do to discipline children. Then you combine media fear about strangers wandering suburban streets waiting to abduct your child, so they try to keep them safe by locking them indoors where they can only play indoor, without burning off the energy that kids have. Then if you kid is allowed outside and gets hurt or worse caused an other kid to get hurt, you are under pressure to explain yourself.
We have gotten to litigious in many areas, while the intent is honorable, it creates side effects much like the drugs do, that is sometimes worse then the cure they are trying to fix.
You can jump up and down and complain how greedy these people are, but that is the problem if you take people/corporations in the Macro sense, their main trends will be following going towards greed. However each individual has virtues too, however they are quite varied, and tends to get washed out when you calculate the overall trend.
If something is so important that you feel the need to post it on the internet... It probably isn't that important.
Is it big pharma pushing doctors to prescribe more? Is it doctors too lazy/busy to do a proper diagnosis? Is it mothers, fathers and teachers who seek to explain bad behavior and poor discipline (which is largely their fault) on medical conditions? Is it our foods which have changed over to GMO based content over the same period of time?
The basic cause of this is simple: lack of physical activity causes kids to be fidgety. They can't concentrate. Kids that fidget in class are disruptive. They are marked as "trouble".
Let them burn off all that energy they get from the sugars and carbs and mass market garbage foods they have shoved down their gullets by the schools and parents who don't have time to cook because a 40 hour week never really means that, and their commutes usually are longer than the time they spend with their kids.
This ADHD problem is a byproduct of the fast paced world we've created to "stay competitive, stay on top, and keep up with the Joneses".
You sir are full of shit.
Lack of physical activity? Are you serious? I was training in gymnastics for sixteen hours a week when I was diagnosed. I was winning state and regional medals until I was fifteen.
It's always fucked up to me how all the people who have never had ADD are always first to know exactly everything about it. You've never had to struggle with academics and social skills because the only things you could focus on were the ones that were rewarding to you. It's not a cut and dry case of being 'fidgety' and rarely is it a case of discipline on part of the parents.
ADD made my elementary school days hell for me. It was almost impossible to get along in regular social situations with exception to times I was with other kids that had ADD. It was hard for me to pay attention to what I was reading when all I could focus on were INTRUSIONS into my focus from say, the sound of the kid behind me wheezing. The ticking of someone's watch. Hearing the hum of a fan turning on and off at regular intervals and noticing it always happens every 4 minutes. The way a cute girl across the room wore her hair differently today or maybe she got her ear pierced and I'm distracted by how red it's made her earlobe and how she's scratching it often. Maybe today I've noticed the teacher got a new watch and it's super shiny. He asks if there are any questions and I raise my hand and ask about the watch. Everyone laughs at me since the question had nothing to do with the lecture but I can't understand why no one else was so interested in the cool looking timepiece.
ADD is not an inability to focus. It is a deficit with the ability to filter out the intrusions into your senses that make focusing on what others seem to find important nearly impossible at times. Let's face it, it's hard to have perspective about how important it is to know about the revolutionary war when you're 10 years old.
Don't be so quick to have all the answers when your understanding of the issue is clearly incomplete.
ADD is STILL affecting my life. I struggle with it every day. This morning is a perfect example. I WAS trying to sleep. I woke up to pee and decided to read slashdot in bed while I let sleep take over again. But I read your retarded comment and it has made it impossible for me to go to sleep. Why? Because I can't seem to filter out your bullshit. Your asinine opinion on the matter has intruded into my focus on getting a healthy night's sleep. I tried to let it go and just lie down but I couldn't stop focusing on your stupidity and I won't be able to until I post this. Hell, even after I hit submit I'm still going to toss and turn for a half hour while I try to divert my attention to happy butterflies and fluffy sheep to count.
The Blade Itself
What you're describing is a lack of discipline. Yes, speed does help with that (short-term). But, as with any drug, there's a down-side, too.
I don't respond to AC's.
I've got ADD. I was diagnosed with it in 5th grade. My parents refused medications and instead demanded the school address it via teaching techniques. Right or wrong that decision lead to me being who I am. They used to tell me in my special ed class that I was the only one in there that actually had ADD, the rest were just lazy. lol. It does bother me how many people I meet that claim to have ADD and clearly do not. Just about everyone self diagnoses themselves with it at a whim. It's not a joke, it's a real and debilitating disease.
My teachers taught me how to focus despite my disability. Today's shrinks (at least the ones I see) call it "Hyper focus" which has it's pluses and negatives. I can be given a task and plow through it in an almost machine like manner. I could be at a rock concert, it doesn't matter. If the planes going down and you need someone to work on fixing the autopilot before we crash without being distracted by imminent death and everyone screaming, I'm your man. I'd still be stripping wires as we plowed into the ground.
The downside is, I'm not in many plane crashes or doing work at rock concerts so often. More routinely I'm at my desk focused on some code or SQL, and I miss a fire drill... or someone comes up to me, needs my attention and keeps bugging me until I finally turn around in a rage and say WHAT?!?!?!? then feel very embarrassed. Luckily I've explained my condition and my co-workers understand why it happens. Like any mental health condition it becomes a lot easier to deal with when you have a shrink give you tools that you can teach to those around you. Now my friends and co-workers know there is value in me being a bit off and put up with me getting cranky when torn away from my work. They also tap me on the shoulder for fire alarms now. :-)
And, I always like to state that being open about mental health issues is good. We need to stop shunning people who have them... We ALL have them.
If they have truly made a pill for carelessness and impatience, imagine how many factors more richer they could be if they made a pill to cure idiocy.
What do you mean, "if?"
I have the cure for idiocy right here. Just send your life savings to P.O. Box 732, Ripoff City, USA, 66601, and I'll ship it out the second your check clears. Better hurry, though, demand is high and supply is low. Order Now!
An enigma, wrapped in a riddle, shrouded in bacon and cheese
I feel your pain. I was diagnosed around 1991. Multiple tests involving psychologists, most finding I had a very high IQ (137+) but I had ADD. I was put on medication, Ritalin and then Dexedrine. My mother did not like the side effects and in order to avoid the side effects, I had to be drugged up all day long. the worse side effect was loss of appetite. My mother said to hell with that and took me off the medication and decided to dedicate a lot more of her time to helping me with my homework (along with my father) and well to be honest, do some of it for me. It helped and got my through grade school and high school but not without lots of summer school and help to prevent me from being left behind. I even lost my father the first month of high school which was a huge blow in life but thankfully the SPARK program in school had an amazing woman who helped me get through school (and life) by bargaining with my teachers to give me special assignments I could focus on to pass classes.
Of the few things I have learned over the years, hyperfocus and its addictive cycle is what has been crippling me. Its very detrimental and it's only recently, in my 30's, that I learned that I suffer from it. And how bad is hyper-focus overall? It takes over your thought and pushes things to the back burner. Important things like clean up, pay bills, remember appointments, basically the important small things in life. Hell it gets so bad, I hate to say this but screw it: I have actually wandered off in the middle of masturbating and 20 minutes later realize I am holding my flaccid dick in my hand. All of my friends know I have ADD and many time they have had to get my attention my shaking me or shouting my name. Your mind literally focuses so sharply on something that everything else is simply background noise that doesn't register. I even have problems processing sentences people speak to me as I am half in thought and half trying to pay attention to them. I have lost every girlfriend, the few I managed to hook up with, by forgetting dates, and important occasions. l lost one girl I was with for three years after she had enough of my shit. I forgot her birthday, I couldn't even remember the month. After that I couldn't stay in a relationship for more than a few months, I gave up and have been single for quite a while (I tried again last year but it didn't work out because of our work schedules, a bit of progress I suppose.). Hell, I have on a few occasions forgot my own birthday and received calls from friends asking "what are you doing tonight?" to which my reply was "why, what's going on tonight?" the reason isn't that I have a bad short term memory, its that those things aren't important, they get pushed aside in my head and forgotten.
It used to confuse me because I kept thinking to myself: "why the fuck can I come up with a good idea, lay out a blueprint but never even get around to "breaking ground"?" And I realized the hyperfocus mechanism in my brain created an addiction. The Hyperfocus addiction cycle that works like this: you get a "great idea" (for me, usually some electronics project) in your head and your mind runs away with it. I then spend hours/days/weeks researching, designing and then when it comes to the actual phase of implementing it - BOOM - brick wall. I can lay out a hardware/software project, even start laying out schematics, bits of code and even some PCB prototyping in CAD but almost never beyond that. You see its the research/design part that gets me so enthralled as it must trigger chemicals in my brain that causes euphoria. It makes me "high" so to speak. Its the challenge to solve a problem which gets me going. Its the "actual work" part that is the brick wall for me as it's no longer a "cheap thrill" and now becomes work. I have stayed up for hours, on work nights, causing me to suffer the next day. But I didn't care as long as the high was achieved. I knew I had to stop, kept telling myself "go to sleep, go to fucking sleep". But I couldn't stop. It wasn't until I was exhausted, delirious and a