The Selling of ADHD: Diagnoses, Prescriptions Soar After 20-Year Marketing Effort by Big Pharma

TRANSCRIPT:

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AMY GOODMAN: Taken at face value, the latest figures on attention deficit hyperactivity disorder, ADHD, suggest a growing epidemic in the United States. According to the Centers for Disease Control, 15 percent of high school children are diagnosed ADHD. The number of those on stimulant medication is at 3.5 million, up from 600,000 two decades ago. ADHD is now the second most common long-term diagnosis in children, narrowly trailing asthma.

But a new report in The New York Times questions whether these staggering figures reflect a medical reality or an over-medicated craze that has earned billions in profits for the pharmaceutical companies involved. Sales for ADHD drugs like Adderall and Concerta topped $9 billion in the U.S. last year, a more than 500 percent jump from a decade before. The radical spike in diagnoses has coincided with a 20-year marketing effort to promote stimulant prescriptions for children struggling in school, as well as for adults seeking to take control of their lives.

The marketing effort has relied on studies and testimonials from a select group of doctors who have received massive speaking fees and funding grants from major pharmaceutical companies. Dr. Keith Conners, a leading expert on ADHD, told The New York Times he questions the preponderance of ADHD diagnoses in the U.S., saying, quote, “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

Well, to discuss this issue, we’re joined by four guests. Alan Schwarz is with us, award-winning reporter who wrote the New York Times piece, Sunday cover story, called “The Selling of Attention Deficit Disorder.” He has written extensively about ADHD in a series of New York Times articles over the past year.

Jamison Monroe is with us, a former teenage Adderall addict who now runs Newport Academy, a treatment center for teens suffering from substance abuse and mental health issues. He’s also the executive producer of the recent documentary, Behind the Orange Curtain, which looks at the prescription drug epidemic.

Dr. Gabor Maté is with us from Vancouver, Canada. He is a physician and best-selling author. Among his books, Scattered: How Attention Deficit Disorder Originates and What You Can Do About It. His most recent book is called In the Realm of Hungry Ghosts.

And we’re joined by John Edwards. His son, Johnny Edwards, committed suicide in 2007, just months after he was prescribed Adderall and antidepressant medications at the Harvard University Health Services clinic.

We’re going to start right there, with our guests, talking about your son, talking about what happened to your son, John Edwards, at Harvard University.

JOHN EDWARDS: Good morning. Hi. So—

AMYGOODMAN: It’s good to have you with us.

JOHN EDWARDS: Thank you. So, Johnny was a—went into Harvard in 2006. And between his freshman and his sophomore year, I discovered he was on Adderall during the summer, when he was home. And, you know, I kind of questioned. I thought Adderall was—from what I understood, was for attention deficit disorder. And I had some questions. It didn’t seem—Johnny was a class valedictorian at his high school, a top high school in Massachusetts, 4.0, a brilliant kid. He was a—I think he was about a 4.0, a straight-A student at Harvard. And he was also doing stem cell research and working on grants between his freshman and sophomore year. And he was just a brilliant kid, which paled in comparison to what a wonderful human being he was. And it seemed rather odd that he would be on a drug for attention deficit disorder. He seemed like the last person that would be on drugs, how you could achieve what he’s achieved and have that type of issue. But, you know, from what he shared with me and what I understand, that it seemed as though in his particular case it may have—he may have been given it to somehow boost his confidence or for some other reason. And I found it all a bit odd.

And I noticed during the summer, when we were on summer vacation in New Hampshire, he was having these huge effects with—best way I can describe, these woosh effects, where he’d get these [inaudible] bouts of anxiety, and he said it was due to the time-released product he was on, and his doctors were paying attention to it and working it all out. And, you know, the problem is, when your kids go off to college and they turn 18, you’re no longer involved in their care, even though I requested—I made a request. I said, you know, “Would you mind if I spoke with the person who’s treating you?” And then he checked into it, and they said, “No, that’s not really necessary.” That’s what he told me. So I assumed he was under great care. I mean, he’s at Harvard, you know, wonderful, leading institution in the country.

And, you know, he then was prescribed a couple of additional medications, as well, which happened to be stimulants, as I learned later. And as part of that, he was feeling—over the coming months, I guess he had significant anxiety or concerns about it, even wrote an email to the person who had—he had been seeing, the nurse practitioner, and, you know, indicated, “Should I continue to take these?” And she said, “Yes, just make an appointment to come in and see me when you have a chance.” And, unfortunately, two days after that email, he committed suicide at Harvard Medical School, completely out of the blue. And, you know, I—none of us in the family had any idea that something like this was—he had just been home for Thanksgiving. And it was just—it’s obviously devastated myself, my family, my daughter, in particular, Julia, and been a very, very difficult time for us, the last six years.

AMY GOODMAN: Alan Schwarz, how typical is Johnny’s story, that you wrote about in The New York Times?

ALAN SCHWARZ: Excuse me, you know, Mr. Edwards, hi. I’m sorry about—about everything.

It’s very atypical, OK, in terms of the ending, in terms of how despondent he became and how he acted upon it. I think what most people are particularly concerned about is the process through which Johnny received what is technically, I guess, medical care. He went to the student health center at Harvard, probably faked his ADHD symptoms, or at least exaggerated them, in order to receive Adderall and other stimulant medications. It happens all the time. The problem is, is that the procedure through which the diagnosis is made is really quite sloppy, in many cases. If you read the deposition in the Edwards case, because there are some legal proceedings going on, the nurse practitioner involved in the diagnosis and care said that one of the reasons that she put Johnny on stimulants is because he drank a lot of Red Bull, and that’s always a sign that somebody needs more attention help.

AMY GOODMAN: Didn’t Marianne Cannon—this is the nurse who made the prescription for Adderall—noted that beyond his general inability to focus, he had received two minor traffic citations, further suggesting impulsiveness?

ALAN SCHWARZ: Well, it is known that peopleADHD do get in more traffic accidents because of their lack of attention, or perhaps the impulsivity of just taking a right turn when you kind of shouldn’t, OK? But there’s a big difference between knowing that ADHD folks get in more traffic accidents or working backwards and saying that people who get in traffic accidents have ADHD.

AMY GOODMAN: This is all, this diagnosis, made within an hour of meeting him.

ALAN SCHWARZ: Yeah, exactly. I mean, the misuse of conditional probability, if I may, in this case and many others, is just laughable—or “laughable” perhaps not the right word here. But what you see is the misuse of the science. The nurse practitioner—and we are not dissing nurse practitioners. There are a—I mean, really, a lot of people think they’re better than doctors, so, you know, nurse practitioners, don’t send me hate mail. The thing is, is that, you know, she had heard about the science, ADHD being—having 80 percent heredity. But that’s not what that statistic means. She thought that 80 percent of kids with ADHD have a parent with ADHD. And because Johnny told the nurse practitioner that his father might have had it—and, Mr. Edwards, you can certainly testify to that—you know, she took all these little signs as meaning ADHD. And this happens every day, hundreds of thousands of times across a year, of people just not really paying attention to what is a real diagnosis and causes real people real problems, and for which Adderall and other stimulant medications are an appropriate remedy. But we’ve gone way past that to the more recreational, cosmetic use.

AMY GOODMAN: Why would Johnny want the Adderall? You’re saying that he, you know, knew the language, very smart kid, and he wanted this drug, as so many high school and college kids are taking.

ALAN SCHWARZ: Well, please forgive me, because of course I didn’t know Johnny personally. And, Mr. Edwards, you’re on the line, so I hope—would it—Mr. Edwards, is it OK if I—if I guess here?

JOHN EDWARDS: Yeah. No, no, this—and I’m also very open, so—

ALAN SCHWARZ: OK.

JOHN EDWARDS: —about talking about Johnny, so feel free. And I would say that I agree with everything that you’ve said up to now. And, no, I don’tADHD, as well—never been diagnosed.

ALAN SCHWARZ: OK, I just—I just wanted to make sure it was OK I talk about your son.

JOHN EDWARDS: OK. Thank you.

ALAN SCHWARZ: Hundreds of thousands of college kids go to student health wanting Adderall, because it helps them stay up at night and study. There is a lot of conflicting evidence over whether you actually perform better on these drugs, whether kids perform better on average. But the problem is, is that a lot of kids really do benefit. And so they get seduced by the idea that I can stay up really late, I can do all sorts of great things, and sometimes it blows up in their face.

AMY GOODMAN: Jamison Monroe, you call yourself a former Adderall addict, and you now are running the Newport Academy rehabilitation center and participated in this documentary calledBehind the Orange Curtain that looks at the prescription drug epidemic. Why did you get Adderall when you were young?

JAMISON MONROE: Johnny’s story sounds very familiar to mine, actually, just a little bit further on in time. So, I went to private schools, prep schools. I graduated number one in my class out of eighth grade and then went to a very competitive high school, extremely competitive high school, and, you know, was making decent grades. I had a C in an honors biology class. And, you know, people were talking. Counselors, parents were concerned. And, you know, it was just life was happening. High school was happening. There were girls, many more distractions. The courses were arguably tougher in high school than they were in junior high.

And—but my lab partner was taking Adderall, and so were some of my friends. And so, you know, I tried it. I got a few. And I took one, and it worked. It worked really well. I could stay up. I could go to sports practice. When I got home, I could study. I could do my homework. I could wake up early, take an Adderall, be right on target, be ready to rock ‘n’ roll. And so, I took it to get ahead, to get that advantage, to make better grades, to be able to study longer. And as we’ve alluded to a little bit here, it was that competitive nature. You know, I was just trying to keep up. And it’s—it is a performance-enhancement drug. And that’s what I see.

And so, what happened was, then I realized that it worked, and so I went to my parents, and I said, “I think the reason why my grades are kind of falling from the past is that I have ADD, or I have ADHD.” And as any parent would say when a child comes to you saying that they have this clinical diagnosis that may hinder their ability to perform, especially academically, they took me to a doctor. And so I went to a doctor. And I love what Alan said, because I did exactly that. I completely faked my symptoms and acted like I was distracted during the 45-minute-or-so test that the doctor gave me. And sure enough, when I walked out of there, I got a prescription for Adderall. That was in 1995. I had that prescription in various forms for the next nine or 10 years.

AMY GOODMAN: And then what happened?

JAMISON MONROE: Well, so, what we see—what happened to me and what we see in a lot of kids that come through Newport Academy is that, in fact, the first drug they do take is Adderall or some sort of stimulant study drug. And then, you know, the next year, when I was offered a Vicodin or a Valium or some other type of pharmaceutical drug, my perceived harmfulness of these drugs was low. And what’s the difference between one and another? And that’s what happened to me and what was see in other kids.

I developed a substance abuse problem, and then Adderall became just one of the many drugs that I was abusing and addicted to. I couldn’t—I couldn’t sit down and study, write a paper or study for an exam, without taking an Adderall. And so—and then, near late high school and early college, my peers and I, we would crush them up and snort them, and so we were drinking and using the stimulant as a recreational stimulant, as well as a study drug. And then that developed into, you know, cocaine and other drug abuse. And Adderall was always there for the all-nighters in the library. You know, it was absolutely necessary in order to get by and in order to study.

AMY GOODMAN: I wanted to bring Dr. Gabor Maté into this conversation, joining us from Vancouver, from Canada. You have written and spoken extensively about this—one of your books, Scattered: How Attention Deficit Disorder Originates and What You Can Do About It. You talk about the drugging of America’s children.

GABOR MATÉ: Alan Schwarz’s article is very significant, I think, because it points to a major dynamic in American medicine, which is—there’s an article—he quotes Lawrence Diller, who’s a psychiatrist, or at least a child’s pediatrician, in California. And Diller says—Dr. Diller says that they, the pharmaceutical companies—referring to their success in inducing doctors to prescribe medications, Diller says that for an epidemic to take hold, there has to be a susceptible host—in this case, the medical profession. And then Dr. Diller says, quoted by Alan Schwarz, that they must know something about us that they can exploit. And what the pharmaceutical companies know about the medical doctors is that we’re in the grips of this ideology that reduces everything to brain biology and everything to genetics, so that it’s not just a question of ADHD, it’s a question of millions of kids being on medications of all kinds—ADHD drugs, the stimulants. There’s half-a-million children in the States on antipsychotics, who are not even psychotic; there are kids getting SSRI antidepressants for OCD, for depression, for anxiety—so that this template of the medical profession reducing everything to questions of brain biology and then thinking that they can solve problems by handing out pills is what has given the pharmaceutical companies the foothold, which they’ve exploited so brilliantly, as demonstrated in Alan Schwarz’s article.

And I’ll just add to that that absent from that awareness in the medical profession is the science, which is not even controversial, but most physicians are not aware of it, that the brain biology actually develops in interaction with the environment, beginning in utero and in early childhood, number one; and number two, that an individual’s physiology, including brain physiology, is in lifelong interaction with the environment. So when we have lots of children in trouble, when in Canada you have the number of prescriptions for ADHD going up 45 percent in the last five years, when you have the kind of figures that Alan has accumulated and demonstrated in his article, what are we looking at? We’re looking at the huge impact of the environment on the troubled functioning of many, many young people and children. And to reduce that to a question of brain biology and to try and smooth it out by medications is an abdication of medical responsibility.

AMY GOODMAN: Alan Schwarz, what you write about in this piece, “The Selling of Attention Deficit Disorder,” is the selling of it. Explain the interests of the pharmaceutical companies and how they influence the doctors.

ALAN SCHWARZ: Well, let’s remember that the pharmaceutical companies are capitalistic organizations whose not only interest is making money, their legal responsibility is to make money for their shareholders. It is not to take great care of America’s children. Now, hopefully those two things can be aligned, but when push comes to shove, they want to sell product. And so, the story that I wrote, and I think that the whole concept of the selling of attention deficit disorder, is more a story—is perhaps less a story of what Pharma did and more a story of what we let Pharma do. We have theFDA, that can’t check for advertisements ahead of time, that completely distort what ADHD is and what ADHD drugs do. Again, they’re very good for a lot of kids, but a lot of times—and a majority of times, I would attest—they do not get prescribed to kids with ADHD. I can prove that. Anyway—

AMY GOODMAN: What do you mean?

ALAN SCHWARZ: Well, if you look at the numbers—I’m a math guy at heart, and if you look at the numbers with a real—a bit of a keen eye, it’s clear as day. We can talk about that later, perhaps on another program.

But, you know, what you see is that they prey upon, typically, mothers’ fears that their kids are going to be friendless, that their kids are going to have substance abuse problems later on, that their kids are not going to succeed academically. And what the pharmaceutical industry does—and it ain’t no secret that this is what they do—is they take a study, that’s been funded with their dollars, OK, by “independent” researchers, that find a slight improvement on how many math questions get answered and how many math questions get answered correctly—a tiny, little immediate effect. And then they put in the ad: “improves academic performance.” And then, in one other ad for Adderall, there is a mother hugging her child, who’s holding a paper with a B+ on it, and the line is: “Finally, schoolwork that matches his intelligence.” Now, what mother thinks that their child’s schoolwork matches their intelligence? And it’s a shame, because the pharmaceutical industry could make a lot of money absolutely legitimately, OK? And God bless them. But it appears as if they’ve gone well past what ADHD is, and they are preying upon the fears of the population.

AMY GOODMAN: Can you talk about the amount of money that the companies are putting into the advertising and the promotional campaigns and reaching out to the doctors? I mean, as you just pointed out, Alan Schwarz, it’s not about what they do; it’s what society lets them do, what the doctors let them do. But the funded research, that isn’t cited as their research, the doctors who go out and speak, being paid by the pharmaceutical companies.

ALAN SCHWARZ: I think that a lot of doctors do mean well. I really believe that. I think that they just lose sight of how they’re human beings and that when they’re paid to say things, they begin to believe it. Now, there are also doctors who get paid by the companies to go out and talk to other doctors and, for that matter, prescribe to real people, who, frankly, have just lost their minds, who don’t know what these drugs do. They don’t care what these drugs do; they just want to give it out, in part because they believe in it, and in part because it keeps the business coming in. And now, with the insurance company rules—rules, that’s a little strong—but, you know, you can get paid for a five-minute med check, and so that’s all it takes. You prescribe medication, you get your med checks every three months. And I know psychiatrists—there’s one a couple blocks from here—where, literally, it will take you longer to fill out the paperwork in the waiting room than it will for him to diagnose youADHD and give you a prescription for stimulants. And that is not uncommon.

AMY GOODMAN: We’re going to break and come back to this discussion. Our guests are Alan Schwarz—he’s the New York Times award-winning reporter. His latest piece, Sunday front page, “The Selling of Attention Deficit Disorder.” Jamison Monroe is with us, former teenage Adderall addict, runs Newport Academy rehabilitation center. And John Edwards is on the phone with us. His son, Johnny Edwards, committed suicide. He had recently been prescribed Adderall, which he was taking. And we’re joined by Dr. Gabor Maté from Vancouver, Canada. He is a physician, best-selling author, wrote Scattered: How Attention Deficit Disorder Originates and What You Can Do About It. We’ll be back in a minute.

[break]

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman. As we look at the selling of attention deficit disorder, I want to play for you a TV ad featuring music celebrity and singer Adam Levine, produced by Everyday Health Media.

ADAM LEVINE: I couldn’t organize my thoughts. And it was my ADHD. And like many kids with ADHD, I didn’t outgrow it. I remember very distinctly not being able to focus, so that was right around the time when I actually saw a doctor.

NARRATOR: If you were diagnosed with ADHD as a kid, you might still have it. Take a quiz at OwnYourADHD.com to recognize your symptoms. Then talk with your doctor.

ADAM LEVINE: Looking into it is really important. It’s your ADHD. Own it.

AMY GOODMAN: Everyday Health Media produced that. That’s Adam Levine who’s speaking. Alan Schwarz, you wrote a series of pieces in The New York Times. What about this?

ALAN SCHWARZ: Well, hey, it’s fair enough. If you had ADHD as a child, you might still have it. About 50 percent of adults will retain their symptoms, and perhaps even impairment, as adults. So it’s a fair message.

But if you take the quiz at OwnYourADHD.com, and you look up in the top right-hand corner, it’s sponsored by Shire, the maker of Intuniv, Vyvanse and, in the past, Adderall XR. Now, if you take the quiz—we gave the quiz to 1,100 Americans, scientifically, over the phone. It was legitimate. Forty-eight percent of them took this six-question quiz and were told, through the algorithm, thatADHD was either possible or possibly likely, which is a curious diagnosis. Anyway, it’s—the test is rigged to get people to think they have the disorder. And that’s very powerful.

AMY GOODMAN: I mean, I’ve got it right here. In your piece in The New York Times, you lay out these six questions in: “How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done? How often do you have difficulty getting things in order when you have to do a task that requires organization? How often do you have problems remembering appointments or obligations? When you have a task that requires a lot of thought, how often do you avoid or delay getting started? How often do you fidget or squirm with your hands or feet when you [have to] sit down for a long time?” And “How often do you feel overly active and compelled to do things, like you were driven by a motor?”

ALAN SCHWARZ: But again, I don’t blame the test for human beings’ misuse of it. It is our fault. What they don’t say in there is that these symptoms are supposed to be severe, and they’re supposed to impair your daily life and functioning. And if they meet that standard, then you really do have ADHD.

AMY GOODMAN: We have very little time. Jamison Monroe, who is coming to you at your clinic—you, who are a recovering, as you describe it, Adderall addict—, the Newport Academy rehabilitation center?

JAMISON MONROE: So, one thing that I want to highlight real quick is, in one of Alan’s previous pieces, he had a great quote from a pediatrician, and this is something that I love that Dr. Maté addresses, as well. And a pediatrician, quote, said, “I don’t have a whole lot of choice. We’ve decided as a society that it’s too expensive to modify the kid’s environment—the school environment, parenting—so we have to modify the kid.” So, you know, like we’re saying here, we’ve kind of been pushed into a corner. We need to develop, you know, parenting skills. We need to expand the school offerings, creative arts, creative outlets, things like that.

So, what we see at Newport Academy and in the filming of Behind the Orange Curtain, which highlights mainly prescription drug overdoses, primarily opiates, is that all of those kids—not all, but almost all of the kids that are highlighted in the documentary, and many of the kids we see coming into Newport Academy, the first drug they took was an ADHD stimulant medication. We see about 60 percent of kids that come through Newport Academy are on one, mostly multiple, medications, as Dr. Maté was alluding to, is that they’ll be put on an Adderall, and then they’ll be put on an antidepressant, and then it just compounds each other. And so, we see about two-thirds of our kids that come to Newport Academy are on pharmaceutical medications for one diagnosis or another, and about half of those have some sort of Adderall diagnosis, whether it’s legitimate or not. What we do is we’ll typically take kids off of these medications, because there is no baseline and there is no real test that has been done to give a proper diagnosis, and then we’ll be able to have a baseline to see if we need—these kids do in fact need medications. And only about 30 percent of kids leave Newport Academy on medications.

AMY GOODMAN: We only have 10 seconds, but I want to go back to John Edwards. You’re suing Harvard University. What do you want to see happen?

JOHN EDWARDS: Well, for me, and particularly to the question—the questions being asked today, I want to get the answer to the question if—you know, I agree with what Alan said exactly. On one level, these medications do have a purpose, that they’re to address serious issues. And one of the questions I have, related to Johnny, that I’ve not had answered is: How do you have a 4.0 or very close to that at Harvard and be considered to have something like attention deficit disorder? I would think that’s all you need to know, and you don’t need to be hunting for [inaudible]—

AMY GOODMAN: John Edwards, we have to leave it there. And I want to thank Gabor Maté and Alan Schwarz, as well as Jamison Monroe.