Faulty Reporting on ADHD
Newspaper of record criticized for its tardy response to overmedicalization.
Posted Apr 11, 2015
“It is certainly heartening that the Times has turned a more skeptical eye on mental health reporting in general, and ADHD in particular,” write Jonathan Leo and Jeffrey Lacasse in a recent essay on “The New York Times and the ADHD Epidemic.” Yet “if during the past two decades the Times’ readership had been exposed to the broader debate about ADHD, would the epidemic that the Times is now writing about be as severe?” (8).
With the CDC reporting that more than 10,000 U.S. toddlers, aged 2 to 3 years, are currently medicated for ADHD and that, in some parts of the country—the South, for instance—"23% of school-age boys have received an ADHD diagnosis" (Leo & Lacasse 3), it’s a question badly needing to be asked. Is the Times—and the U.S. media in general—partly to blame for insufficiently investigating what's been driving the supposed ADHD epidemic?
Despite the Times’ decision recently to publish several high-profile critiques of disease-mongering, including “The Selling of Attention Deficit Disorder” by Times reporter Alan Schwarz, the newspaper of record is faulted for citing the same “Key Opinion Leaders” (KOLs) over and again, even after they’ve been widely discredited. It’s also criticized for inadequately sourcing earlier critiques of psychiatric overdiagnosis and for its belated recognition of the hyping of diagnostic rates. As if that weren't enough, the newspaper is taken to task for its long-standing presumption that medication remains superior to other forms of treatment and that ADHD was an underdiagnosed problem afflicting now-skyrocketing numbers of American children, teens, and adults.
The blistering article, appearing in Social Science and Modern Society, argues that the Times “has a long history of giving preferential treatment to the idea that ADHD is a fundamental flaw in a person’s biology. Only recently,” the authors assert, “can one sense skepticism of this idea within” the newspaper (3). Yet by echoing what critics "have in fact been saying for decades" while rarely acknowledging earlier, justified concerns about the risks of overdiagnosis and overmedication, the Times’ revised emphasis unintentionally calls attention “to the belated nature of [its] current reporting.” Worse, “even with [its] new-found skepticism," the newspaper "still turns to the original proponents of ADHD for commentary” (3).
One of several cited examples is Dr. Harold Koplewicz, a high-profile child and adolescent psychiatrist who was, Leo and Lacasse note, “one of the authors of Study 329, a ghostwritten article which claimed that Paxil was safe and effective for children by selectively reporting the data." "The study is inarguably the most infamous study in child psychiatry,” they add, “and was the cornerstone of the Department of Justice’s (DOJ) three-billion dollar fine against GlaxoSmithKline (GSK) for research fraud and illegal advertising,” because it exaggerated the benefits and downplayed the risks of prescribing Paxil to children (4).
For many years a go-to figure for the Times, Dr. Koplewicz wasn’t even asked about his role as coauthor of the study in a 2004 article in the Times on the controversy surrounding Study 329 itself—a striking failure of investigative journalism. Six years later, he was in fact featured in a Times article entitled “Ask a Psychiatrist.” Subsequently, in 2012, Leo and Lacasse note, the Department of Justice “issued the largest health care fraud settlement in U.S. history against GSK. The DOJ’s complaint stated that Study 329 misstated facts and made false claims about Paxil’s efficacy for children” (5).
The Times' ongoing failure to acknowledge earlier critiques of overmedication is equally baffling and remiss. Why, for instance, in his lengthy piece on “The Selling of Attention Deficit Disorder,” could Schwarz find no space to acknowledge the high-profile article Leo had earlier published in Skeptic entitled “ADHD: Good Science or Good Marketing?” Or the book chapter he and Lacasse released in 2009 entitled “The Manipulation of Data and Attitudes about ADHD: A Study of Consumer Advertisements,” which they followed-up with a piece in Psychiatric Times entitled “Consumer Advertisements for Psychostimulants in the United States”?
Instead, though no definite test exists for ADHD and “the rate of diagnosis varies from one doctor’s office to another, from one state to another, and from one country to another” (7), Times reporter Schwarz will still contend, seemingly for balance, but in fact editorializing egregiously: “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. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.”
On several counts that first sentence is quite incorrect. The “five percent” figure, Leo and Lacasse insist, is pure fiction—and even on its own terms raises many more questions than it answers, as basic rumination on the figures makes clear: “If 20% of high school aged boys are taking a medication when only 5% ‘really have’ the condition, then 15% of them, under a doctor’s direction, are presumably abusing stimulants” (7).
Leo and Lacasse’s essay does not pull any punches. Its principal focus is Times reporting on ADHD, rather than, say, depression or anxiety disorders; and it ignores Times investigative journalists such as Duff Wilson, who has written quite extensively about overmedicalization. (Disclosure: the Times Op-Ed department in 2007 solicited from me a piece on the making of Social Anxiety Disorder entitled "Shy on Drugs," and it reprinted a follow-up op-ed from the Boston Globe on diagnostic inaccuracy entitled "Shyness or Social Anxiety?," both tied to my 2007 book on medicalization, Shyness: How Normal Behavior Became a Sickness.)
In documenting the newspaper’s weaknesses in reporting on ADHD and other hyped disorders—including its continued bias toward biological psychiatry and protracted failure to ask what was driving massive increases in psychiatric diagnoses—the article helps us wonder if the Times is not partly responsible for the mental health crisis we face today: “It did not take the Times long to acknowledge that their reporting of the Iraq war was biased,” Leo and Lacasse conclude; “for ADHD, and mental health in general, there has been no similar introspective view” (3-4).
Lacasse, J.R., & Leo, J. (2015). “The New York Times and the ADHD Epidemic.” Social Science and Modern Society 52:3-8: DOI 10.1007/s12115-014-9851-5
Lacasse, J.R., & Leo, J. (2009). “Consumer Advertisements for Psychostimulants: A Long Record of Misleading Promotion. Psychiatric Times 26(2). Available at http://tinyurl.com/ LacLeoPT
Lane, C. (2007). Shyness: How Normal Behavior Became a Sickness. New Haven: Yale University Press.
Leo, J., & Lacasse, J.R. (2009). “The Manipulation of Data and Attitudes about ADHD: A Study of Consumer Advertisements, in S. Tamimi & J. Leo (eds.), Rethinking ADD: From Brain to Culture (pp. 287- 312). New York: Palgrave Macmillan.
Schwarz, A. (December 29, 2013). “ADHD Experts Reevaluate Study’s Zeal for Drugs.” New York Times. Available at http://www.nytimes.com/2013/12/30/health/adhd-experts-re-evaluate-studys-zeal-for-drugs.html
Schwarz, A. (December 14, 2013). “The Selling of Attention Deficit Disorder.” New York Times. Available at http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html