The Selling of Attention Deficit Disorder

[meistersinger]

Posted here without permission from Wrong Planet (wwww.wrongplanet.net)

Ever since my issues with psychiatric drugs, I been advocating for people on the spectrum to think again about using this crap.

 

For instance, there was a 14 year old that recently posted on WP that she was having issues with the 10 medications she was taking each day. Turns out that the psychiatrist had her on 2 SSRI's, 2 antipsychotics, her PCP had her on 2 antihistamines, melatonin, Prilosec, and a drug I never heard of.

 

My first response to her was, no wonder you're a walking zombie!

 

My next response was to have her tell her parents, then her doctors how she was feeling. I also let her know that, by the fact these idiot doctors didn't even bother to check the Physician's Desk Reference for interactions, let alone the pharmacist not advising her parents about the interactions, that she and her parents should have a LONG talk with the parties involved, up to and including changing doctors and filing a complaint with the State medical board charging the involved parties with malpractice.

 

As for me, I'm off Viibryd Completely, since my psychologist sent a strongly worded email to my psychiatrist, regarding the side effects that still exist (mainly tinnitus, which makes it hell Tying to hear pitch. I still have problems with anxiety, which I drink chamomile tea when needed, as recommended by both my psychologist and psychiatrist. I have also been diagnosed now by my psychologist with Seasonal Affective Disorder, which he wanted to put me back on antidepressants. I told him in no uncertain terms what I thought of that idea, having been down that road 6 times before over 20 years.

 

I have been reading up on light box therapy for SAD. Last time I talked to Doc's mother, I asked her if he could build me a light box, which he did. It's up in my room right now, and gets frequent use. My psychologist has seen me in a lot better mood, and was quite surprised I even knew of light therapy.

 

Anyhow, merry Christmas from a cold and snowy Red Lion, PA, the former Cigar capital of the world.

 

I did join back up with the county ecumenical choir, which has their concert on Dec. 29. I'll post a link to a recording of the concert once it has taken place, as well as a link on where to send donations for this group.

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The Selling of Attention Deficit Disorder

The Number of Diagnoses Soared Amid a 20-Year Drug Marketing Campaign

 

By ALAN SCHWARZ DECEMBER 14, 2013

 

After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder, Keith Conners could be celebrating.

 

Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurological problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic A.D.H.D., helping youngsters succeed in school and beyond.

 

But Dr. Conners did not feel triumphant this fall as he addressed a group of fellow A.D.H.D. specialists in Washington. He noted that recent data from the Centers for Disease Control and Prevention 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. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

 

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. 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.”

 

The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

 

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. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.

 

Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. 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.

 

A 2002 ad for Adderall showed a mother playing with her son and saying, “Thanks for taking out the garbage.”

 

The Food and Drug Administration has cited every major A.D.H.D. drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.

 

Sources of information that would seem neutral also delivered messages from the pharmaceutical industry. Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often that discredit growing concerns about overdiagnosis.

 

Many doctors have portrayed the medications as benign — “safer than aspirin,” some say — even though 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. Patient advocacy groups tried to get the government to loosen regulation of stimulants while having sizable portions of their operating budgets covered by pharmaceutical interests.

 

 

Companies even try to speak to youngsters directly. Shire — the longtime market leader, with several A.D.H.D. medications including Adderall — recently 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!”

 

Profits for the A.D.H.D. 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.

 

Even Roger Griggs, the pharmaceutical executive who introduced Adderall in 1994, said he strongly opposes marketing stimulants to the general public because of their dangers. He calls them “nuclear bombs,” warranted only under extreme circumstances and when carefully overseen by a physician.

 

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.

 

Tom Casola, the Shire vice president who oversees the A.D.H.D. division, said in an interview that the company aims to provide effective treatment for those with the disorder, and that ultimately doctors were responsible for proper evaluations and prescriptions. He added that he understood some of the concerns voiced by the Food and Drug Administration and others about aggressive ads, and said that materials that run afoul of guidelines are replaced.

 

“Shire — and I think the vast majority of pharmaceutical companies — intend to market in a way that’s responsible and in a way that is compliant with the regulations,” Mr. Casola said. “Again, I like to think we come at it from a higher order. We are dealing with patients’ health.”

 

A spokesman for Janssen Pharmaceuticals, which makes Concerta, said in an email, “Over the years, we worked with clinicians, parents and advocacy groups to help educate health care practitioners and caregivers about diagnosis and treatment of A.D.H.D., including safe and effective use of medication.”

 

Now targeting adults, Shire and two patient advocacy groups have recruited celebrities like the Maroon 5 musician Adam Levine for their marketing campaign, “It’s Your A.D.H.D. – Own It.” Online quizzes sponsored by drug companies are designed to encourage people to pursue treatment. A medical education video sponsored by Shire portrays a physician making a diagnosis of the disorder in an adult in a six-minute conversation, after which the doctor recommends medication.

 

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.”

 

The idea that a pill might ease troubles and tension has proved seductive to worried parents, rushed doctors and others.

 

“Pharma pushed as far as they could, but you can’t just blame the virus,” said Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek, Calif. “You have to have a susceptible host for the epidemic to take hold. There’s something they know about us that they utilize and exploit.”

 

Selling to Doctors

 

Modern marketing of stimulants began with the name Adderall itself. Mr. Griggs bought a small pharmaceutical company that produced a weight-loss pill named Obetrol. Suspecting that it might treat a relatively unappreciated condition then called attention deficit disorder, and found in about 3 to 5 percent of children, he took “A.D.D.” and fiddled with snappy suffixes. He cast a word with the widest net.

 

All.

 

For A.D.D.

 

A.D.D. for All.

 

Adderall.

 

“It was meant to be kind of an inclusive thing,” Mr. Griggs recalled.

 

Adderall quickly established itself as a competitor of the field’s most popular drug, Ritalin. Shire, realizing the drug’s potential, bought Mr. Griggs’s company for $186 million and spent millions more to market the pill to doctors. After all, patients can buy only what their physicians buy into.

 

As is typical among pharmaceutical companies, Shire gathered hundreds of doctors at meetings at which a physician paid by the company explained a new drug’s value.

 

Such a meeting was held for Shire’s long-acting version of Adderall, Adderall XR, in April 2002, and included a presentation that to many critics, exemplifies how questionable A.D.H.D. messages are delivered.

 

Dr. William W. Dodson, a psychiatrist from Denver, stood before 70 doctors at the Ritz-Carlton Hotel and Spa in Pasadena, Calif., and clicked through slides that encouraged them to “educate the patient on the lifelong nature of the disorder and the benefits of lifelong treatment.” But that assertion was not supported by science, as studies then and now have shown that perhaps half of A.D.H.D. children are not impaired as adults, and that little is known about the risks or efficacy of long-term medication use.

 

The PowerPoint document, obtained by The Times, asserted that stimulants were not “drugs of abuse” because people who overdose “feel nothing” or “feel bad.” Yet these drugs are classified by the government among the most abusable substances in medicine, largely because of their effects on concentration and mood. Overdosing can cause severe heart problems and psychotic behavior.

 

Slides described side effects of Adderall XR as “generally mild,” despite clinical trials showing notable rates of insomnia, significant appetite suppression and mood swings, as well as rare instances of hallucinations. Those side effects increase significantly among patients who take more pills than prescribed.

 

Another slide warned that later in life, children with A.D.H.D. faced “job failure or underemployment,” “fatal car wrecks,” “criminal involvement,” “unwanted pregnancy” and venereal diseases, but did not mention that studies had not assessed whether stimulants decreased those risks.

 

Dr. Conners of Duke, in the audience that day, said the message was typical for such gatherings sponsored by pharmaceutical companies: Their drugs were harmless, and any traces of A.D.H.D. symptoms (which can be caused by a number of issues, including lack of sleep and family discord) should be treated with stimulant medication.

 

In an interview last month, Dr. Dodson said he makes a new diagnosis in about 300 patients a year and, because he disagrees with studies showing that many A.D.H.D. children are not impaired as adults, always recommends their taking stimulants for the rest of their lives.

 

He said that concern about abuse and side effects is “incredibly overblown,” and that his longtime work for drug companies does not influence his opinions. He said he received about $2,000 for the 2002 talk for Shire. He earned $45,500 in speaking fees from pharmaceutical companies in 2010 to 2011, according to ProPublica, which tracks such payments.

 

“If people want help, my job is to make sure they get it,” Dr. Dodson said. Regarding people concerned about prescribing physicians being paid by drug companies, he added: “They like a good conspiracy theory. I don’t let it slow me down.”

 

Many of the scientific studies cited by drug company speakers involved Dr. Joseph Biederman, a prominent child psychiatrist at Harvard University and Massachusetts General Hospital. In 2008, a Senate investigation revealed that Dr. Biederman’s research on many psychiatric conditions had been substantially financed by drug companies, including Shire. Those companies also paid him $1.6 million in speaking and consulting fees. He has denied that the payments influenced his research.

 

Dr. Conners called Dr. Biederman “unequivocally the most published psychopharmacology maven for A.D.H.D.,” one who is well known for embracing stimulants and dismissing detractors. Findings from Dr. Biederman’s dozens of studies on the disorder and specific brands of stimulants have filled the posters and pamphlets of pharmaceutical companies that financed the work.

 

Those findings typically delivered three messages: The disorder was underdiagnosed; stimulants were effective and safe; and unmedicated A.D.H.D. led to significant risks for academic failure, drug dependence, car accidents and brushes with the law.

 

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.”

 

This year, Dr. Biederman told the medical newsletter Medscape regarding medication for those with A.D.H.D., “Don’t leave home without it.”

 

Dr. Biederman did not respond to requests for an interview.

 

Most of Dr. Biederman’s critics said that they believed his primary motivation was always to help children with legitimate A.D.H.D. and that risks of untreated A.D.H.D. can be significant. What concerned them was how Dr. Biederman’s high-profile and unwavering promotion of stimulants armed drug companies with the published science needed to create powerful advertisements — many of which cast medications as benign solutions to childhood behavior falling far short of legitimate A.D.H.D.

 

“He gave them credibility,” said Richard M. Scheffler, a professor of health economics and public policy at the University of California, Berkeley, who has written extensively on stimulants. “He didn’t have a balance. He became totally convinced that it’s a good thing and can be more widely used.”

 

Building a Message

 

Drug companies used the research of Dr. Biederman and others to create compelling messages for doctors. “Adderall XR Improves Academic Performance,” an ad in a psychiatry journal declared in 2003, leveraging two Biederman studies financed by Shire. A Concerta ad barely mentioned A.D.H.D., but said the medication would “allow your patients to experience life’s successes every day.”

 

Some studies had shown that stimulant medication helped some elementary school children with carefully evaluated A.D.H.D. to improve scores in reading and math tests, primarily by helping them concentrate. The concern, some doctors said, is that long-term, wider academic benefits have not been proved — and that ads suggesting they have can tempt doctors, perhaps subconsciously, to prescribe drugs with risks to healthy children merely to improve their grades or self-esteem.

 

“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.”

 

Drug company advertising also meant good business for medical journals – the same journals that published papers supporting the use of the drugs. The most prominent publication in the field, The Journal of the American Academy of Child & Adolescent Psychiatry, went from no ads for A.D.H.D. medications from 1990 to 1993 to about 100 pages per year a decade later. Almost every full-page color ad was for an A.D.H.D. drug.

 

As is legal and common in pharmaceutical marketing, stimulants’ possible side effects like insomnia, irritability and psychotic episodes were printed in small type and dominated by other messages. One Adderall XR brochure included the recording of a man’s voice reassuring doctors: “Amphetamines have been used medically for nearly 70 years. That’s a legacy of safety you can count on.” He did not mention any side effects.

 

Drug companies used sales representatives to promote the drugs in person. Brian Lutz, a Shire salesman for Adderall XR from 2004 to 2009, said he met with 75 psychiatrists in his Oakland, Calif., territory at least every two weeks — about 30 to 40 times apiece annually — to show them posters and pamphlets that highlighted the medicine’s benefits for grades and behavior.

 

If a psychiatrist asked about issues like side effects or abuse, Mr. Lutz said, they were played down. He said he was told to acknowledge risks matter-of-factly for legal reasons, but to refer only to the small print in the package insert or offer Shire’s phone number for more information.

 

“It was never like, ‘This is a serious side effect, you need to watch out for it,’ ” Mr. Lutz recalled. “You wanted to give them more information because we’re talking about kids here, you know? But it was all very positive.”

 

A Shire spokeswoman said the company would not comment on any specific employee and added, “Shire sales representatives are trained to deliver fair and balanced presentations that include information regarding the safety of our products.”

 

Mr. Lutz, now pursuing a master’s degree and hoping to work in mental health, recalled his Shire work with ambivalence. He never lied or was told to lie, he said. He said he still would recommend Adderall XR and similar stimulants for A.D.H.D. children and adults.

 

What he regrets, he said, “is how we sold these pills like they were cars, when we knew they weren’t just cars.”

 

Selling to Parents

 

In September 2005, over a cover that heralded Kirstie Alley’s waistline and Matt Damon’s engagement, subscribers to People magazine saw a wraparound advertisement for Adderall XR. A mother hugged her smiling child holding a sheet of paper with a “B+” written on it.

 

“Finally!” she said. “Schoolwork that matches his intelligence.”

 

When federal guidelines were loosened in the late 1990s to allow the marketing of controlled substances like stimulants directly to the public, pharmaceutical companies began targeting perhaps the most impressionable consumers of all: parents, specifically mothers.

 

A magazine ad for Concerta had a grateful mother saying, “Better test scores at school, more chores done at home, an independence I try to encourage, a smile I can always count on.” A 2009 ad for Intuniv, Shire’s nonstimulant treatment for A.D.H.D., showed a child in a monster suit taking off his hairy mask to reveal his adorable smiling self. “There’s a great kid in there,” the text read.

 

“There’s no way in God’s green earth we would ever promote” a controlled substance like Adderall directly to consumers, Mr. Griggs said as he was shown several advertisements. “You’re talking about a product that’s having a major impact on brain chemistry. Parents are very susceptible to this type of stuff.”

 

The Food and Drug Administration has repeatedly instructed drug companies to withdraw such ads for being false and misleading, or exaggerating the effects of the medication. Many studies, often sponsored by pharmaceutical companies, have determined that untreated A.D.H.D. was associated with later-life problems. But no science determined that stimulant treatment has the overarching benefits suggested in those ads, the F.D.A. has pointed out in numerous warning letters to manufacturers since 2000.

 

Shire agreed last February to pay $57.5 million in fines to resolve allegations of improper sales and advertising of several drugs, including Vyvanse, Adderall XR and Daytrana, a patch that delivers stimulant medication through the skin. Mr. Casola of Shire declined to comment on the settlement because it was not fully resolved.

 

He added that the company’s current promotional materials emphasize how its medications provide “symptom control” rather than turn monsters into children who take out the garbage. He pointed to a Shire brochure and web page that more candidly than ever discuss side effects and the dangers of sharing medication with others.

 

However, many critics said that the most questionable advertising helped build a market that is now virtually self-sustaining. Drug companies also communicated with parents through sources who appeared independent, from support groups to teachers.

 

The primary A.D.H.D. patient advocacy group, Children and Adults with Attention-Deficit/Hyperactivity Disorder, or Chadd, was founded in 1987 to gain greater respect for the condition and its treatment with Ritalin, the primary drug available at the time. Start-up funding was provided by Ciba-Geigy Pharmaceuticals, Ritalin’s primary manufacturer. Further drug company support helped create public service announcements and pamphlets, some of which tried to dispel concerns about Ritalin; one Chadd “fact sheet” conflicted with 60 years of science in claiming, “Psychostimulant drugs are not addictive.”

 

A 1995 documentary on PBS detailed how Chadd did not disclose its relationship with drug companies to either the Drug Enforcement Administration, which it was then lobbying to ease government regulation of stimulants, or the Department of Education, with which it collaborated on an A.D.H.D. educational video.

 

Chadd subsequently became more open in disclosing its backers. The program for its 2000 annual convention, for example, thanked by name its 11 primary sponsors, all drug companies. According to Chadd records, Shire paid the group a total of $3 million from 2006 to 2009 to have Chadd’s bimonthly magazine, Attention, distributed to doctors’ offices nationwide.

 

Chadd records show that the group has historically received about $1 million a year, one-third of its annual revenue, from pharmaceutical company grants and advertising. Regarding his company’s support, Mr. Casola said, “I think it is fair to call it a marketing expense, but it’s an arm’s-length relationship.”

 

“We don’t control what they do,” he said. “We do support them. We do support broadly what they are trying to do in the marketplace — in society maybe is a better way to say it.”

 

Advocates Answer

 

The chief executive of Chadd, Ruth Hughes, said in an interview that most disease-awareness groups receive similar pharmaceutical support. She said drug companies did not influence the group’s positions and activities, and noted that Chadd receives about $800,000 a year from the C.D.C. as well.

 

“One pharma company wanted to get Chadd volunteers to work at their booth to sort of get peer counseling, and we said no, won’t do that, not going there,” Dr. Hughes said, adding, “It would be seen as an endorsement.”

 

A.D.H.D. patient advocates often say that many parents resist having their child evaluated because of the stigma of mental illness and the perceived risks of medication. To combat this, groups have published lists of “Famous People With A.D.H.D.” to reassure parents of the good company their children could join with a diagnosis. One, in circulation since the mid-1990s and now posted on the psychcentral.com information portal beside two ads for Strattera, includes Thomas Edison, Abraham Lincoln, Galileo and Socrates.

 

The idea of unleashing children’s potential is attractive to teachers and school administrators, who can be lured by A.D.H.D. drugs’ ability to subdue some of their most rambunctious and underachieving students. Some have provided parents with pamphlets to explain the disorder and the promise of stimulants.

 

Susan Parry, who raised three boys in a top public school system on Mercer Island, outside Seattle, in the 1990s, said teachers pushed her into having her feisty son Andy evaluated for A.D.H.D. She said one teacher told her that her own twins were thriving on Ritalin.

 

Mrs. Parry still has the pamphlet given to her by the school psychologist, which states: “Parents should be aware that these medicines do not ‘drug’ or ‘alter’ the brain of the child. They make the child ‘normal.’ ” She and her husband, Michael, put Andy on Ritalin. The Parrys later noticed that on the back of the pamphlet, in small type, was the logo of Ciba-Geigy. A school official told them in a letter, which they provided to The Times, that the materials had been given to the district by a Ciba representative.

 

“They couldn’t advertise to the general public yet,” said Michael Parry, adding that his son never had A.D.H.D. and after three years was taken off Ritalin because of sleep problems and heart palpitations. “But somebody came up with this idea, which was genius. I definitely felt seduced and enticed. I’d say baited.”

 

Although proper A.D.H.D. diagnoses and medication have helped millions of children lead more productive lives, concerns remain that questionable diagnoses carry unappreciated costs.

 

“They were telling me, ‘Honey, there’s something wrong with your brain and this little pill’s going to fix everything,’ ” said Micaela Kimball, who received the diagnosis in 1997 as a high school freshman in Ithaca, N.Y., and is now a freelance writer in Boston. “It changed my whole self-image, and it took me years to get out from under that.”

 

Today, 1 in 7 children receives a diagnosis of the disorder by the age of 18. As these teenagers graduate into adulthood, drug companies are looking to keep their business.

 

The New Frontier: Adults

 

The studio audience roared with excitement two years ago as Ty Pennington, host of “The Revolution” on ABC, demonstrated how having adult A.D.H.D. felt to him. He staged two people struggling to play Ping-Pong with several balls at once while reciting the alphabet backward, as a crowd clapped and laughed. Then things got serious.

 

Much more here... graphs, videos, photos and more text>> http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?hp&_r=0

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Everything is falling.