attention deficit disorder

the NY times had a front-page story on "the selling of attention deficit disorder", one of a recent series of health care expose-type articles (see http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?nl=todaysheadlines&emc=edit_th_20131215&_r=0). their basic points:

--dramatic increase in diagnosis (made in 15% of high school aged children!! -- second only to  asthma -- with # of kids on meds increasing from 600K to 3.5M in past 20 years)

--increase in meds coincides with intensive drug company campaign to publicize syndrome and promote pills as therapy, including widespread advertising to parents/kids: using celebrities on TV to promote diagnosis, defining ADHD to include "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", "subsidized 50,000 copies of a comic book that tries to demystify the disorder and uses superheroes to tell children, 'medicines may make it easier to pay attention and control your behavior'".

--(my comment): part of issue is that DSM-5 has broadened diagnosis of ADHD, expanding the age of diagnosis (used to be that dx had to be made by age 7, now it's 12), and lowering the definition of when a kid is "impaired" but without specifics on the definition of degree of impairment, eg mild, moderate, severe). BMJ has a good editorial comment on DSM-5, noting that many more people diagnosed, lack of specific definitions of severity though 87% of those diagnosed in 2010 ended up on meds (though per DSM-5 those with only mild to moderate sx should have nonmedication behavioral approach), and 78% !!!! of the work group advisors for DSM-5 redefinition of ADHD had links to drug companies (see adhd DSM-5 critique bmj 2013 in dropbox, or http://dx.doi.org/10.1136/bmj.f6172)

--drug company now targeting "adult ADHD" for publicity blitz, using popular musicians and the campaign: "it's your ADHD -- Own It", and an on-line instrument which NY Time poll found that 1/2 of 1000 participants got result of either "ADHD possible or ADHD may be likely". the Times comments on a psychiatrist promoting concept that ADHD is a lifelong disorder requiring life-long therapy (he received $45K from drug companies from 2010-2011). also, part of ad campaign is that since ADHD runs in families, parents of ADHD kids may need therapy. as an aside, there was a funny comment in the lancet several years ago in an editorial about adult ADHD (which they saw as basically a credible diagnosis in the U.S. and not the U.K.), where a U.S. med student was asked what was "normal" for patient, with the response that that happened when the physician did not look hard enough.....

--dr. joseph biederman, a child psychiatrist at harvard and MGH whose studies were frequently cited by drug companies, was involved in 2008 senate investigation on his research, which was subsidized by drug companies, and he was paid $1.6M in speaking and consulting fees.

--and, by the way, the name "Adderall" comes from ADD for all"

so, there are clear cases of ADHD in kids -- i have treated many kids with severe dysfunction from ADHD with some pretty remarkable results.  the point is not to deny the existence or appropriate therapy to those kids in need. but there are clear adverse effects (not a benign drug as promoted by drug companies, but with potential for addiction and, though unusual, can have very severe adverse effects, such as psychosis/hallucinations, suicide). the extensive drug company blitz clearly led to dramatic profits for the drug company, akin to the drug-company sponsored "pain as the fifth vital sign" helped promote the widespread use of opiates, as per prior emails/blogs.