ReconsiDer Tidbits

October 29, 2000

Commentary: Lawsuits question rising use of Ritalin

By DEBORAH FRISCH
and LINDA SISSON

 Although Americans are supposedly waging a "war on drugs," the practice of
giving mind-altering drugs to children has skyrocketed in the past 10 years.
An estimated 5 million to 6 million children are currently taking Ritalin or
other amphetamine-type stimulants.
Still more astounding is the three-fold increase in prescriptions for 2- to
4-year-olds, even though these drugs have never been approved as safe or
effective for children younger than 5.

How have we come to believe that the best way to help children who are bored,
restless, troubled, daydreaming, highly energetic or performing poorly in
school is to give them drugs? While the answer to this question is
multifaceted, one fruitful area of study is the sometimes unholy alliance
between science and business - in other words, follow the money.

The psychiatric and pharmaceutical industries would have people believe that
Ritalin is a medicine that was invented to treat Attention Deficit
Hyperactivity Disorder. It may be closer to the truth to say that ADHD is a
disorder that was invented to create a market for Ritalin and other drugs.

While this claim might sound far-fetched, four recent lawsuits filed against
the manufacturers of Ritalin allege collusion, conspiracy and fraudulent
business practices. A Sept. 14 article in The Wall Street Journal reports
that "The lawsuits, which seek class-action status, contend that Novartis and
Ciba-Geigy, along with (the American Psychiatric Association) conspired to
create a broad-based definition of hyperactivity disorders ... that the suits
say has had the effect of boosting profits." Novartis and Ciba-Geigy are also
charged with employing false and misleading advertising, which played down
the drug's side effects and oversold the benefits.

Some of the attorneys involved in these drug suits previously worked on the
high-profile tobacco and asbestos class-action cases. Having seen the horrors
of tobacco promotion aimed at children, these attorneys are now turning their
attention on millions of children who they believe have been misdiagnosed
with ADHD and unnecessarily prescribed Ritalin.

There are many reasons to be skeptical of the claim that ADHD is a brain
disease that should be treated with drugs. The symptoms of the disease are
common childhood behaviors such as "often fidgets with hands or feet" or
"often fails to give close attention to details." Many critics have noted
that such symptoms are basically behaviors that disrupt classrooms. In fact,
clinicians are warned not to confuse ADHD with rambunctiousness.

How exactly do clinicians differentiate ADHD from rambunctiousness? ADHD is
identified in the same way as all psychiatric conditions - from a checklist
of symptoms made up by committees of psychiatrists. If the clinician decides
a certain number if items on the list - say six out of nine - are applicable,
a diagnosis is made. No objective medical test can confirm or rule out a
diagnosis.

This process is highly subjective, and, in the case of ADHD, a decision may
be made on the basis of parent and teacher reports rather than the
clinician's own observations. Children suspected of having ADHD often behave
quite well when receiving one-on-one attention from adults and fail to
exhibit the target behaviors in the clinician's office.

The cultural and political aspects of the ADHD diagnosis may explain why this
disorder is much more prevalent in the United States than in other countries.
The United States has earned the concern of the International Narcotics
Control Board for using nearly 90 percent of the world's Ritalin, "a drug
widely used in a controversial way for the treatment of Attention Deficit
Disorder in children and adults" (INCB 1999 Report).

Although parents are usually told that Ritalin is "safe and well-tolerated,"
the fact is that stimulant drugs have multiple adverse effects such as
cardiac problems, disrupted growth, sleeplessness, depression and anxiety.
These drugs are rated Schedule 11 by the U.S. Food and Drug Administration -
drugs with the greatest potential for abuse and addiction. Furthermore, no
scientific studies have documented the safety of long-term Ritalin use (more
than a few months) on developing brains and bodies.

In response to one of the lawsuits, the American Psychiatric Association
issued a statement that there is "a mountain of scientific evidence to refute
these meritless allegations." This is an exaggeration, since the APA has yet
to produce a conclusive study proving that ADHD is a "disease" in any
ordinary sense of the word.

Regardless of the outcome, these lawsuits will provide a very useful public
service. They will force the drug companies and the APA to present scientific
evidence supporting their claim that ADHD is caused by a brain malfunction.
They will focus attention on the inadequately studied long-term safety and
effectiveness of psychostimulant use. The suits will initiate the release of
internal information from drug company files for public scrutiny.

This information will shed light on the question of whether the current ADHD
epidemic is due to a failure of biology or a success in corporate marketing.

Deborah Frisch teaches psychology at the University of Oregon. Linda Sisson
is the director of Support Coalition Northwest.

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