The New York Times published an article on December 31st 2011 entitled “FDA Finds Short Supply of Attention Deficit Drugs”.
Since Ritalin and Adderall are addictive, the Drug Enforcement Administration sets manufacturing quotas designed to control supplies and thwart abuse. The article went on highlight some important facts:
1) The American Academy of Child and Adolescent Psychiatry told the more than 8,000 doctors in its membership that shortages seem to be “widespread across a number of states” and are “devastating” for children.
2) The article stated, “Doctors wrote 51.5 million prescriptions for ADHD. drugs in 2010, with a total sales value of $7.42 billion — an increase of 83 percent from the $4.05 billion sold in 2006, according to IMS Health, a drug information company.”
3) Approximately 8% of our children have ADHD.
Another article entitled “Ritalin Gone Wrong” by Dr. Alan Sroufe, Professor of Psychiatry at the University of Minnesota and one of the world’s leading authorities on ADD.
After reading these articles, I wanted to address a pattern of medical thinking that we all need to be aware of, whether or not we have a special interest in ADD & ADHD.
The Scope of the Problem
Three million children in this country take drugs for problems in focusing. In the past 30 years there has been a 20-fold increase in the consumption of drugs for attention-deficit disorder.
When I first began practicing medicine in the late 1970s, we experienced an explosion of new knowledge in neuroscience. At that time, it was believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Dr. Sroufe writes, “Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs.”
In 1973, Dr. Sroufe reviewed the literature on drug treatment of children for The New England Journal of Medicine. Dozens of well-controlled studies showed that these drugs immediately improved children’s performance on repetitive tasks requiring concentration and diligence. He writes, “I had conducted one of these studies myself. Teachers and parents also reported improved behavior in almost every short-term study. This spurred an increase in drug treatment and led many to conclude that the ‘brain deficit’ hypothesis had been confirmed.”
The emergence of brain imaging also began showing impressive studies with acute changes in brain activity and brain metabolism with the use of these drugs in children with ADD.
But, how could these results be reconciled with other experiences with amphetamines? Many dieters who have used similar drugs to lose weight, abandon them as effects fade. College students abandon chronic use for increased focus once effects wear off.
Long-term use of amphetamines for attention deficit disorder
Some experts have argued that children with attention deficit disorders wouldn’t develop tolerance because their brains were somehow different. But in fact, they apparently develop a tolerance to the drug, and thus its efficacy disappears. It turns out, after 30+ years of experience that when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.
Dr. Stroufe writes:
Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs. What gets publicized are short-term results and studies on brain differences among children. Indeed, there are a number of incontrovertible facts that seem at first glance to support medication. It is because of this partial foundation in reality that the problem with the current approach to treating children has been so difficult to see…. To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.
Lessons Learned:
We think we know more than we do
We are very early in the scientific renaissance of understanding of neuroscience. It is very unlikely that genetics explains the majority of the increase in ADD over the past 30 years. Rather, studies have more clearly demonstrated the impact of “experience” in the development of ADD (i.e., increased stress, conflict, lack of community support…).
Studies on long-term use of any therapy are rarely performed, rarely publicized and receive scant attention
Policy makers are often looking for quick fixes and, in this case, are still convinced that children with attention deficits have an organic disease. There are very few studies funded by The National Institute of Mental Health studying the role of experience in ADD. Scientists, aware of this orientation, tend to submit only grants aimed at elucidating the biochemistry – thus creating a cycle – more studies showing biochemical abnormalities, more drugs developed to address the biochemical abnormalities.
Safety concerns and long-term implications of treatment are not often studied as well as we would like
Many parents take their children off the drugs find that behavior worsens. In the past, this was used as confirmation that the drugs work. But the behavior worsens because the children’s bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking. The impact of withdrawing these medications on these children and their parents are not well studied.
The concept of a magic pill as a long-term strategy for most conditions is not viable
In this case, putting children on these drugs does nothing to change the conditions that impacted on their development in the first place. As Dr. Sroufe eloquently writes, “… the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone — politicians, scientists, teachers and parents — off the hook. Everyone except the children, that is”.
So, what can we do?
We must increase our medical awareness (medical consciousness), and focus on practicing a systems approach towards treatment and prevention and towards educating our families and friends. We must take a more holistic view and address the impact of the increasingly negative impact of experience on our children and teenagers. Nutrition, stress, societal and school pressures, lack of quality family time, 24/7 distractions, pharmaceutical medications – all need to be carefully thought through. Putting generations of children and young adults on amphetamines to increase their focus, or on anxiety/depression medications to address other mental stresses is not the answer.
We at Anatara Medicine have a uniquely powerful holistic perspective on health, whether for adults or for children. In my opinion, the future of medicine requires individualized care and relies on a real proactive and comprehensive strategy, rather than on quick fixes.