Kudos to Maggie Kozel, M.D. for her interesting article in the Huffington Post (Feb 5, 2011) entitled "Little Pharma: the Medication of U.S. Children." Dr. Kozel laments that our health care system has gone off track, because profits of Big Pharma are driving research on the diagnosis and treatment of children's psychiatric disorders. Dr. Kozel points out some statistics that are shocking even to me. She says that twenty-four million American children are on ADHD medications, ten million are taking antidepressants, and a whopping six million are taking antipsychotics. If these numbers are even close to accurate (and I think the numbers are in fact much lower), the plight of our country's children is dire indeed.
Are purported childhood illnesses such as ADHD and bipolar disorder even real, queries the good doctor. She is courageous to ask the question, but her answer of "Absolutely" is a little too glib. Bipolar disorder may be a long established diagnosis for adults, but it is by no means clear that it is an accurate diagnosis for a child. At this point at least, the child psychiatrists who vote on which diagnoses are real and which are not have elected not to include pediatric bipolar disorder in the next edition of their diagnostic bible, the DSM-V. What Dr. Mozel does allow is that diagnostic criteria for ADHD and bipolar disorder in kids are not clear or well established. As most of us are aware, diagnoses of child psychiatrists are notoriously subjective. One doctor may diagnose and treat a child for ADHD, another may diagnose that child with bipolar disorder, and a third might say that same child has oppositional defiant disorder. The same child may be prescribed Adderall or Risperdal or Zoloft, or a cocktail combining all three, depending on which doctor he happens to visit.
I am inclined to answer Dr. Kozel's original question differently. Are ADHD and Bipolar disorder real? Well, I don't mean to sound like Bill Clinton, but that all depends on the meaning of the word "real". Asking the question a little differently may shed more light. What if we ask if ADHD is a real disease like diabetes is a real disease? The answer to this question is "absolutely not."
The moniker ADHD merely describes a cluster of externally observed symptoms: the child often fidgets, makes careless mistakes in schoolwork, often loses his pencils, has difficulty waiting his turn, blurts out answers in class, and so forth. This is like defining diabetes as excessive urination, frequent thirst, lack of energy, and having sweet-smelling urine. Of course doctors do not define diabetes by these observable symptoms because diabetes has a well understood biological cause. Diabetes is a metabolic disorder of the pancreas being unable to produce sufficient insulin. But ADHD and bipolar disorder in children are defined only by externally observable symptoms. No biological cause has been found for them.
So is ADHD a real illness like diabetes is a real illness. Absolutely not, I would counter. Dr. Kozel is more on target when she concludes that the "scientific" information that doctors rely on for diagnosis and treatment of psychiatric disorders of children is not free from bias and conflict of interest. The fact that Big Pharma pays big bucks to many child psychiatrists and even to the authors of the DSM is well-documented and well-investigated. Big Pharma even has their employees ghost-write articles in medical journals, with the articles bearing the names of respected doctors.
Let us take a real life example. A nine-year-old boy--we'll call him Mike--was diagnosed with ADHD because he couldn't sit still in the classroom or focus on his school work. His teacher predicted that Mike would never succeed in anything because he couldn't concentrate on any task for a long enough time. Mike's mother took him to their family doctor, who diagnosed him with ADHD and prescribed Ritalin. The drug helped Mike almost immediately. He became calmer and more focused at school. He paid attention to his teacher and wasn't so jumpy in the classroom. Three years later, Mike decided that he did not want to become dependent on a drug to control his behavior. He felt that it was an unnecessary crutch, and that if he applied his mind to it, he could control his behavior by himself.
Mike's doctor was supportive and believed in the boy's ability, and so he weaned him off the medication. Mike not only improved his behavior at school, but later went on to be the most decorated Olympic athlete ever, with six gold medals in swimming and thirteen world records under his belt. This is a pretty good achievement for a boy who couldn't focus on anything long enough to be successful at it. If Michael Phelps actually had a real disease for which he needed drug treatment, how could he have succeeded without his meds?
People and corporations wielding wealth and power have been able to convince an entire society that the fabric they spin out of thin air is something real. They finance parent "support" groups, which are really propaganda instruments for their products. But slowly the threads are unraveling, as parents and doctors alike are beginning to apply ordinary common sense to the issue of psychiatric disorders in children. Much of what is diagnosed in this country as ADHD or ODD or bipolar disorder in children is much closer to normal childhood behavior than it is to a real disease or impairment of the brain.
Copyright 2010 Marilyn Wedge