Chronicles Magazine, June 2003, pp. 44-45
MAKING A KILLING
by
Fred A. Baughman Jr., M.D.,
and
B. K. Eakman
Pediatrician T. Barry
Brazelton, like many big names in the child development field,
is breathing new life into the popular perception of Attention
Deficit/Hyperactivity Disorder (ADHD) as a "disease"--a chemical
imbalance that requires a stabilizing, "counter-balancing"
agent, such as Ritalin, Adderall, Concerta and other name-brand
amphetamines, to correct a defective brain. An example of this
dogma can be found in Brazelton's recent column: "Managing
ADHD once it's diagnosed" (March 9).
On the positive side,
Dr. Brazelton does allow that "[o]verdiagnosis is a major
problem with ADHD" and that "many children so labeled are merely
anxious, resulting in overactivity and short attention spans."
His argument breaks
down, however, when he points to children who are "overfocused."
Brazelton claims that the severity of the disorder boils down to
the "quality of [a child's] attention" coupled to an "ability to
control" it. The classic scenario of ADHD is nonstop activity,
combined with the inability to sustain attention
on any particular project (ADD). To characterize its precise
opposite--intense concentration (i.e., "overfocusing") --
as the same illness is nonsense.
All medical researchers
as well as practicing physicians (psychiatrists included), study
the normal, disease-free status of human beings along with the
abnormal, which we label "disease" or "illness." They are
responsible for telling one from the other. When no
abnormality/disease is present, there is nothing to make normal;
therefore, there is no need for medical treatment.
A growing chorus of
professionals is daring to challenge the conventional wisdom on
ADHD. There is still no proof ADHD is a disease and no
objective means exists for diagnosing it. We are left with only
a hodge-podge of subjective phenomena. And a whole lot of that
-- particularly as it relates to concentration and focus --
amounts to perfectly normal behavior.
One-third to one-half
of patients seeking help for psychological/psychiatric symptoms
simply have no abnormality. The lure of pills and/or talk
therapy for unhappiness, personal failings (real or imagined),
emotional hang-ups and just plain quirkiness is understandable,
and the pharmaceutical industry, along with many ethically
challenged clinicians, have capitalized on it. Scrupulous
professionals know, however, that making diseases out of things
like too much or too little concentration, aversion to crowds,
and frequent shopping sprees is overkill, if not downright bogus
medicine.
Many of those described
by mental health workers as "hypersensitive" and "obsessive,"
for example, are not only not mentally ill, but possess
incredible genius. It is their very hypersensitivity and
obsessive dedication that allow them to create what
others do not, even if they happen to have the raw talent to do
so.
Psychiatry and
neurology were formally separated in 1948: Psychiatry was to
deal with emotional and behavioral problems of
physically/medically normal individuals; neurology with
physical/medical abnormalities of the nervous system.
The latter can be verified with medical tests; the former
cannot.
With the advent of
psychotropic (mind-altering) drugs in the 1950's and 60's, a
psycho-pharmaceutical industry was born. It has since morphed
into a kind of legal drug cartel pitching "chemical imbalances."
The American Psychiatric Association's bible, the Diagnostic
and Statistical Manual of Mental Disorders
(DSM) grew from 112 mental
"diseases" in 1952, to 374 in the 1994. Virtually none of the
new categories are scientifically. For example, in a 1970
congressional hearing, psychiatry insisted that "hyperkinesis"
(a.k.a. ADHD) was a disease, and ADHD became the field's
prototypical "biologically-based" mental illness. Psychiatrist
John Peters, University of Arkansas, insisted: "... it has to do
with some dysfunction of the brain." The FDA's Ronald Lipman
echoed Peters' determination: "hyperkinesis is a medical
syndrome."
Chairman Cornelius
Gallagher tried to inject some common sense, asking: "Who makes
a decision ... as to whether a child has hyperkinesis, or is
just a bored, bright, creative, pain-in-the-neck kid?"
Nevertheless, ADHD was
institutionalized, though never validated, as a bona fide
disease in the mid-1980's. Now, inexplicably, we have an
epidemic of some half a million "sufferers."
In 1990, Alan Zametkin
of the National Institute of Mental Health (NIMH), using PET
(Positron Emission Tomography) scans, reported that the brains
of individuals diagnosed as ADD used eight percent less glucose
than "normal" people. The diagnoses, however, were based on
parent-teacher interviews. No one could duplicate Zametkin's
findings. But this did not stop pharmaceutical giant
Ciba/Novartis; or high-profile mental health activist
organization Children and Adults with Hyperactivity
Attention-Deficit Disorder (CHADD); or the psychiatric community
in general from chanting "disease!" at every opportunity.
In a widely publicized
1994 piece aimed originally at professional audiences in the
field, "Driven to Distraction," Edward M. Hallowell and John J.
Ratey proclaimed: "... there is enough evidence that
neurochemical systems are altered in people with ADD."
Turning their attention
to CT (computed tomography) scans for support, Hallowell and
Ratey noted that, in 1986, H. A. Nasrallah, et al., had
found brain atrophy (shrinkage) in 58 percent of young adults
diagnosed as ADHD. However, they added a caveat that was
subsequently forgotten by the pro-disease faction: "[S]ince all
of the patients had been treated with psycho-stimulants,
cortical atrophy may be a long-term adverse effect of this
treatment."
This caveat was largely
ignored until a few renegades in the field recently took the
trouble to point it out. From 1986 to1998, nine MRI (Magnetic
Resonance Imaging) brain scans were performed on psychostimulant-treated
groups diagnosed with ADHD. The professional bigwigs concluded
that since all showed brain atrophy, the culprit must be
ADHD. The possibility that the "treatment" itself was causing
the atrophy was dismissed.
Had the
behavioral-science community and the NIMH been interested in the
truth, researchers would have been eager to confirm those
results by conducting MRI scans on untreated symptomatic
individuals. Over the course of those 12 years of brain-scan
research, however, the medical community failed to commission a
single such study.
By the time the
Consensus Conference convened on November 18, 1998, the ADHD
"epidemic" had swelled to between four and five million cases.
Dr. Fred A. Baughman, a pediatric neurologist, attended the
conference as an invited participant. At one point in the
proceedings, NIMH's James Swanson and F. Xavier Castellanos
announced that there is "converging evidence that ... ADHD ...
is characterized by reduced size in specific neuroanatomical
regions of the frontal lobes and basal ganglia." They did not
mention that all of the ADHD subjects has been treated with
stimulants.
So, Dr. Baughman
brought up the subject himself: "Dr. Swanson, why didn't you
mention that virtually all of the ADHD subjects ... have been on
chronic stimulant therapy, and that this is the likely cause of
their brain atrophy?"
Dr. Swanson replied: "I
understand that this is a critical issue and in fact I am
planning a study to investigate that. I haven't done it yet."
The University of
Pennsylvania's
William B. Carey later
testified: "What is now most often described as ADHD in the
United States appears to be a set of normal behavioral
variations.... This discrepancy leaves the validity of the
construct [ADHD] in doubt." Vindicating Dr. Baughman's
professional heresy, the Consensus Conference Panel concluded:
"[W]e do not have an independent, valid test for ADHD, and there
are no data to indicate that ADHD is due to a brain
malfunction."
Four MRI studies have
since been published. Though all of them utilized
stimulant-treated subjects, the researchers found that
"treatment" using Ritalin and other amphetamines was causing
brain atrophy, not that ADHD is a disease. If this stands, we
could see class-action suits in this country that make the
tobacco settlement look like a parking fine.
Only a paper by F.
Xavier Castellanos, published last year in the Journal of the
American Medical Association, claimed to have proof that
ADHD, not amphetamine "treatment," is the cause of brain
atrophy. Castellanos cited "the first neuro-imaging study to our
knowledge to include a substantial number ... of previously
unmedicated children and adolescents with ADHD."
While the study in
question did include 49 ADHD-labeled non-medicated subjects,
it also included 103 amphetamine-medicated subjects.
Furthermore, the 49 non-medicated subjects (mean age, 8.3 years)
were not compared to a matched control group. Instead, the
control group was a full 2.6 years older than the
non-medicated group -- which means larger, less vulnerable
brains! This alone should have invalidated the study.
This sleight-of-hand is
never exposed in the popular press, so parents and teachers
never see it. How is the average parent to make an informed
decision concerning an ADHD diagnosis and the medication of his
child?
In an April 15, 1998,
letter to then-Attorney General Janet Reno, Dr. Baughman wrote
that "the single, biggest heath care fraud in U.S. history [is]
the misrepresentation of attention deficit hyperactivity
disorder (ADHD) as an actual disease, and the drugging of
millions of entirely normal American children."
Psychiatric research
has yet to prove him wrong.
___________________________________________
Dr. Fred A. Baughman
Jr., M.D., Neurology, Pediatric Neurology (board certified) is a
Fellow of the American Academy of Neurology. B. K. Eakman, a
former teacher-turned speechwriter and science writer is
executive director of the National Education Consortium,
columnist and author of Cloning of the American Mind.
