http://www.nationalpost.com/home/story.html?f=/stories/20010402/519885.html
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SPECIAL SERIES
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April 2, 2001
200,000 guinea pigs
It has been prescribed for children for 40 years, but some doctors say the
long-term effects of Ritalin are anyone's guess. One father admits doubts
of his own: 'The teachers are happy. But there's something about all those
pills that scares me.'
Brad Evenson
National Post
Newscom
Thousands of Canadian children begin every morning with a Ritalin pill.
But some doctors say clinical trials of the drug have been inadequate and
its negative side effects have been kept from public view.
Colin Price, The Province
Photo of a pharmacist counting pills.
More Canadian children are taking Ritalin than ever before, even as
critics of the drug grow more wary of its potential side effects. In an
exclusive five-part series on the drug, the National Post examines how
Ritalin works, its enduring mysteries, potential dangers, and alternative
approaches to helping children with attention deficit/hyperactivity
disorder.
- - -
There is one in every class -- the clown, the trouble maker, the shy kid
or the dreamer. Ritalin kids do not conform to a stereotype, but they are
everywhere -- at least 200,000 in Canada alone.
Every day they wake up, get dressed and swallow a powerful pill with
breakfast. Ritalin and its stimulant cousins have fallen from the
headlines, but their use in treating attention deficit/hyperactivity
disorder (ADHD) in children is soaring. Sales rose 9% last year, according
to the research firm IMS Health Canada, bringing the sheer weight of
Ritalin absorbed into the bloodstream of Canadian boys and girls to 1,300
pounds a year.
If medical science could say this presents a benefit to society, the
acrimonious debate over using drugs for ADHD would fall silent. Instead, a
major new study has found the lifetime risks of taking Ritalin have been
concealed and its benefits exaggerated.
"Anyone who gives this drug to their children is sending them out into the
dark," says Dr. David Moher, an epidemiologist at the CHEO Research
Institute in Ottawa.
Within weeks, Dr. Moher and psychologist Dr. Howard Schachter will publish
the largest-ever systematic review looking at the effectiveness and safety
of methylphenidate, the active chemical in Ritalin. It is to appear in the
Canadian Medical Association Journal.
They conclude the quality of science assessing methylphenidate has been
perilously low.
To start, it is unclear whether Ritalin works better than giving children
sugar pills. Although the drug has been used for 40 years, the Ottawa
scientists say clinical trials comparing Ritalin to a placebo -- a sugar
pill -- were ludicrously short. The longest was 28 weeks. "That, by no
stretch of the imagination, can be considered long-term," says Dr. Moher.
"If you're a mother or a father and you go to a doctor, you will [be
prescribed] Ritalin for a year, not 28 weeks. This is stupid. It's basic
stupidity," he says. They also say studies that detail Ritalin's negative
side effects, including insomnia and suppressed appetite, have been kept
from public view.
"It's called publication bias," says Dr. Moher. "If little Johnny takes
Ritalin as part of a study, and those study results are not nice, then
little Johnny's contribution is not used. And that's wrong."
The findings, which draw the drug's overall benefits into doubt, come at a
time when Ritalin is under attack in the courts and by governments.
Several U.S. states have recently made it illegal for teachers or school
staff to recommend, demand or insinuate a child should take psychiatric
drugs as a condition of attending school. Three class-action lawsuits have
been filed in U.S. federal courts against the company that makes Ritalin
in the past two years. One is being handled by Richard Scruggs, a lawyer
who became prominent by helping win a billion-dollar settlement against
the U.S. tobacco industry in the 1990s.
The lawsuits allege the Swiss drug manufacturer Novartis Pharmaceuticals
Corporation conspired with the American Psychiatric Association and others
to boost sales of Ritalin by creating an overly broad definition of ADHD.
"I am not saying it doesn't exist," Mr. Scruggs said last year."I am
saying the definition is inappropriately broad. Under [those] criteria,
there's not a child in America that's not ADHD. And everybody makes money
on the diagnosis: the shrinks, the drug company and the schools." The
lawsuits claim this collusion has led to people taking Ritalin when they
did not need it, putting them at unnecessary risk. No such legal actions
have been launched in Canada.
The drug company calls these "conspiracy" claims preposterous. "Science
has clearly spoken on these issues, and it has spoken again and again," it
stated in a court document filed March 5 in California. "Ritalin has been
marketed for more than 40 years, and is well-established as a safe and
effective treatment."
Scientists also wonder what the cumulative effects of Ritalin use may be,
since many begin taking it as children, while their brains are still
developing.
Caught between the colliding trains of Ritalin's critics and champions are
the worried parents of boisterous children. Is Ritalin a safe drug? Will
taking it ensure a child a successful life? What will happen to the
generation of boys and girls now taking a daily stimulant drug? No one can
say.
"I have two sons taking Ritalin because I don't want them to end up like
me," says Sandy Jones, a Regina father. "My childhood was a mess. In and
out of school, a stint of reform school, and no steady job for years.
They're doing OK. They get good marks and they don't miss [days of
school]. The teachers are happy. But there's something about all those
pills that scares me."
Like many parents, Mr. Jones found his sons, once heavy sleepers, now need
sleeping pills to get them through the night. He is also worried the boys,
aged 8 and 10, no longer eat enough at mealtimes. "I hear stories [that]
kids on these drugs don't grow as fast," he says. Until long-term studies
are complete, children who take Ritalin may indeed be facing an unknown
risk. But most experts say nothing they have seen suggests a serious
potential problem.
"I don't think anybody's uncovered anything about Ritalin that should make
a clinician afraid or reluctant to prescribe it under the right
circumstances," says psychiatrist Dr. Russell Schachar, head of the
research institute at the Hospital for Sick Children in Toronto.
Dr. Schachar cites several major studies, which have followed children who
took Ritalin for over seven years, as evidence of its efficacy and safety.
Perhaps the most meticulous of these is the Multimodal Treatment Study of
Children with ADHD (MTA), published in 1999, which followed 579 children
at various U.S. centres for 14 months. It compared four approaches -- drug
therapy alone, behavioural therapy alone, community care and a combination
of drugs and behavioural therapy. For ADHD symptoms, it found medication
was the best approach.
However, critics point out studies like this contain a built-in bias,
since many children with ADHD improve simply by virtue of being in a
study. They say one group of children should have been tested with a
placebo, to prove that stimulant drugs were the sole reason for their
improvement.
The first doctor to describe the modern condition known as ADHD was the
English physician George Frederic Still in 1902. Dr. Still described a
group of 20 children in his practices as "aggressive, defiant and
dishonest." However, he rejected the belief this was caused by bad
parenting or training. He attributed it to a hereditary factor in some
children and injuries in the womb or during infancy in others.
Many of Dr. Still's ideas remain central to modern thinking about ADHD.
The first use of stimulants to treat these children occurred in the 1930s,
when Dr. Charles Bradley prescribed benzedrine -- also known as speed --
to calm them down. This may seem paradoxical, but it makes sense. The
brain system that is stimulated by the drug acts to inhibit behaviour. In
other words, stimulants make the brakes work better.
In 1961, the U.S. Food and Drug Administration approved Ritalin for use in
treating "behaviour syndromes in children," including hyperactivity.
Eleven years later, Virginia Douglas, a Canadian researcher, delivered a
paper to the Canadian Psychological Association that changed the way
children were diagnosed. She argued the problem with hyperactive kids was
their inability to pay attention. The term "Attention Deficit Disorder"
(ADD) was born. In 1980 the new disease was included in the Diagnostic and
Statistical Manual-III, a physician's reference book.
In 1994, the diagnosis was refined. It drew a distinction between
inattentive kids whose minds seem to wander endlessly and kids who are
hyperactive and impulsive. Either way, the medical community's answer was
the same: more Ritalin.
This new diagnosis has come under heavy fire, notably in two bestselling
books: Running on Ritalin by Dr. Lawrence Diller and Talking Back to
Ritalin by Dr. Peter Breggin. These books accuse busy teachers, parents
and doctors of pushing children to take drugs as a "chemical straitjacket"
so they are easier to handle.
"What if Tom Sawyer or Huckleberry Finn were to walk into my office
tomorrow?" wrote Dr. Diller. "Tom's indifference to schooling and Huck's
oppositional behaviour would surely have been cause for concern. Would I
prescribe Ritalin for them too?"
In a provocative defence of Ritalin use, New Yorker writer Malcolm
Gladwell pushed Dr. Diller's quote to its breaking point. "Huck Finn and
Tom Sawyer lived in an age where difficult children simply dropped out of
school, or worked on farms, or drifted into poverty and violence," he
wrote. "The 'childhood' Diller romanticizes was a ruthlessly Darwinian
place, which provided only for the most economically -- and genetically --
privileged."
The theory that ADHD has genetic roots remains unproven. It is also
unclear how many kids have ADHD. Epidemiological studies using the DSM-IV
criteria say 3% to 6% of school-age children in North America have the
disorder. This percentage has led such medical authorities as U.S. Surgeon
General David Satcher to argue not enough children are being treated,
especially in black, Asian and aboriginal communities. By contrast,
studies show the children of affluent white parents are far more likely to
be taking Ritalin.
What is beyond dispute is that Ritalin, dextroamphetamine, Adderall and
other stimulants have a sudden and distinct effect on ADHD. They reduce
the core symptoms of inattentiveness, hyperactivity and impulsiveness.
They improve classroom behaviour, reduce "acting out" and promote better
interaction with teachers, family and peers.
But some experts doubt the importance of these results. "It's telling you
a little bit about how the kids are more manageable, that's about all,"
says Dr. James Wright, managing director of the B.C. Therapeutics
Initiative, an advisory agency.
"It doesn't tell you about whether they're learning more, or are
healthier. So if I was a parent and I had a kid, before I would use a drug
like this I would demand a trial showing that this would improve my kid's
chances of learning and graduating and also that there wouldn't be a
significant down side in terms of possible other serious adverse
outcomes."
Dr. Wright, whose agency is planning to publish a critical look at Ritalin
by the summer, compares the behavioural approach to measuring the drug's
effects to using only blood sugar to test diabetes. While some diabetes
pills do a good job of controlling blood sugar, patients tend to get
sicker and die more often on these pills than on other drugs.
"The proper outcome for these [stimulant] drugs is, 'How do these kids do
in terms of their ultimate success in life, in their education?'" asks Dr.
Wright.
"Do they make it through university? And also, what about the risks of
these drugs and the serious adverse events, hospitalizations and all those
things? I think we aren't getting the data."
DIAGNOSIS:
Displaying six or more of the following symptoms for six months or longer
is defined by the Diagnostic and Statistical Manual-IV as consistent with
the disorder ADHD:
INATTENTIVE SUB-TYPE:
1 Often fails to pay attention to details, makes careless mistakes.
2 Has difficulty sustaining attention in work or play.
3 Often does not seem to listen.
4 Often fails to follow instructions.
5 Often has difficulty organizing tasks and activities.
6 Often reluctant to do tasks that require sustained effort.
7 Often loses things.
8 Easily distracted.
9 Often forgetful in daily activities.
HYPERACTIVE SUB-TYPE
1 Often fidgets with hands or feet or squirms in seat.
2 Often leaves seat in classroom or in other situations in which remaining
seated is expected.
3 Often runs about or climbs excessively in inappropriate situations.
4 Often has difficulty playing quietly.
5 Is often "on the go" or often acts as if "driven by a motor."
6 Often talks excessively.
7 Often blurts out answers before questions are completed.
8 Often has difficulty awaiting turn.
9 Often interrupts or intrudes on others.
OTHER STORIES IN THIS SERIES
» 200,000 guinea pigs (April 02, 2001)
More Canadian children are taking Ritalin than ever before, even as
critics of the drug grow more wary of its potential side effects. In an
exclusive five-part series on the drug, the National Post examines how
Ritalin works, its enduring mysteries, potential dangers, and alternative
approaches to helping children with attention deficit/hyperactivity
disorder.
» Scientology leads backlash (April 03, 2001)
In a lavish ceremony, Priscilla Presley -- Elvis's widow -- recently
presented a human rights award to a "courageous" New York mother, Patricia
Weathers. Mrs. Weathers had fought a long battle with her son's school to
get her 11-year-old son Michael off Ritalin, which she said caused him
mental harm.
» How Ritalin affects the human brain (April 03, 2001)
During the Second World War, when doctors in the British, German and
Japanese armies issued more than 100 million amphetamines to combat
"battle fatigue," soldiers noticed a paradoxical effect: the pills calmed
them down.
» 'I'm a devil when I don't take it' (April 04, 2001)
More Canadian children are taking Ritalin than ever before, even as
critics of the drug grow more wary of its potential side effects. In an
exclusive five-part series on the drug, the National Post examines how
Ritalin works, its enduring mysteries, potential dangers and alternative
approaches to helping children with attention deficit/ hyperactivity
disorder.
» Schoolteachers poorly informed, survey shows (April 04, 2001)
For many parents, the news their child may need medical help for
behavioural problems -- code for Ritalin or similar drugs -- comes from a
teacher. But Judith Wiener, a clinical psychologist, is not impressed with
what teachers know about ADHD or the drugs so often used to treat it.
» The way of the brainwave (April 05, 2001)
More Canadian children are taking Ritalin than ever before, even as
critics of the drug grow more wary of its potential side effects. In an
exclusive five-part series on the drug, the National Post examines how
Ritalin works, its enduring mysteries, potential dangers and alternative
approaches to helping children with attention deficit/ hyperactivity
disorder.
» Alternative treatments profit from fear of drug (April 05, 2001)
Type the words "Ritalin alternatives" into a Web search engine and prepare
to be overwhelmed.
» A school of their own (April 06, 2001)
At a private school in Toronto devoted to children with attention
deficit/hyperactivity disorder, teachers focus on the students' learning
problems rather than their problem behaviour: 'These are very bright kids.
They may have a learning disorder, but that doesn't mean they can't
learn.'
http://www.channelvip.com/philosophy/drugs1.html
"...This elementary fact makes the child psychiatrist one of the most
dangerous enemies not only of children, but also of adults who care for
the two precious and most vulnerable things in life - children and
liberty. Child psychology and child psychiatry cannot be reformed. They
must be abolished." - Thomas Szasz M.D., Cruel Compassion.
"The pediatrician's wanton prescription of powerful drugs indoctrinates
children from birth with the philosophy of 'a pill for every ill'."...
"Doctors are directly responsible for hooking millions of people on
prescription drugs. They are also indirectly responsible for the plight of
millions more who turn to illegal drugs because they were taught at an
early age that drugs can cure anything - including psychological and
emotional conditions - that ails them. " - Robert S. Mendelsohn, M.D., How
to Raise a Healthy Child...In Spite of Your Doctor.
Fred A. Baughman, M.D. - Immunize Your Child Against ADD Peter R. Breggin,
M.D. - Toxic Psychiatry
Peter R. Breggin, M.D. - Talking Back to Ritalin Ann B. Tracy, PhD -
Psychiatric Drugs
Fred A. Baughman, M.D. - What You Should Know About ADD If You Need Help
A Dose of Sanity, by Sydney Walker III, M.D.
"A brilliant expose of the scandalous failure of modern psychiatry...If
your doctor recommends Prozac, Xanax, Ritalin, or psychotherapy for your
"mental" problems, read this book first. It justmight save your life."
- Bernard Rimland, PhD., Director of the Autism Research Institute
If you are currently being treated for depression, anxiety or panic
disorder, attention deficit disorder, a sleeping disorder, or any of a
wide array of common behavioral disorders, this book could save your life.
If you are being given psychiatric SSRI drugs, prozac, paxil, zoloft,
luvox, effexor, serzone, anafranil, fenfluramine, fen-phen & redux, you
must read this book.
In A Dose of Sanity, Sydney Walker III, M.D. takes us inside the big
business of contemporary psychiatry and reveals how, by sacrificing sound
medical principals in favor of labeling-by-convenience and brain-damaging
quick-fixes like prozac, paxil, zoloft, luvox, effexor, serzone,
anafranil, fenfluramine, fen-phen, redux, and ritalin, psychiatrists cause
untold suffering and destroy the physical and mental health of millions of
people.
Reading like a detective novel, A Dose of Sanity, tells the story of
dozens of men and women, many of whom suffered needlessly for years,
simply for lack of a sound medical diagnosis. You'll meet the concert
musician whose lifelong bouts with "psychosis" were actually due to
undiagnosed typhus; the widow who was treated for "panic attacks" that
turned out to be a thyroid dysfunction; the "hyperactive" boy whose
symptoms were caused by exposure to carbon monoxide; and many others saved
by the intervention of Dr. Walker and like-minded colleagues.
The Myth of the A.D.D. Child, by Thomas Armstrong, Ph.D.
The Myth of the A.D.D. Child exposes the mislabeling of millions of
children as A.D.D./A.D.H.D., and the use of powerful mind-altering drugs
such as Ritalin in treating children's hyperactivity. Not long ago,
children who behaved in certain ways were called "bundles of energy",
"daydreamers," or "fireballs." Now they're considered "hyperactive,"
"distractible," or "impulsive"-victims of the ubiquitous Attention Deficit
Disorder. Tragically, such labeling can follow a child through life.
Worse, the mind-altering drugs prescribed for A.D.D./A.D.H.D. are
unnecessary-and they are harmful.
By tackling the root causes of a child's attention and behavior problems -
rather than masking the symptoms with drugs - parents can help their
children begin to experience fundamentally positive changes in their
lives.
The Myth of the Hyperactive Child & Other Means of Child Control, By Peter
Schrag and Diane Divoky
Millions of children have been "diagnosed" as "hyperactive" or having
"attention deficit disorder" and millions are now taking brain-damaging
amphetamine-type medication, in many cases by order of school officials.
Millions of other children have been labeled predelinquent, found to have
"deviant" tendencies, or said to exhibit "maladaptive behavior." Can these
illnesses be in fact so widespread, or is this a new way the schools have
found to deal with healthy children who seem, to parents or teachers, to
present some form of difficulty?
This meticulously documented book covers all aspects of the rapidly
spreading ideology of "early intervention," demonstrates how common
problems become medical ones, and exposes the shoddy research that
underlies those practices. Examining the "scientific" literature as well
as searching out the underlying causes of this new and frightening trend,
Peter Schrag and Diane Divoky document in telling detail the ways in which
old-fashioned punishment and control are being replaced by new forms of
medical and social treatment, teaching the younger generation that it must
trust the state and its new "science" to define and manage the ways it
grows up. The information and ideas they examine are critically important
and profoundly disturbing.
Psychiatry - The Ultimate Betrayal, By Bruce Wiseman for the Citizens
Commission on Human Rights
There are reasons why today's high school graduate cannot read, why our
elderly are dying prematurely, why racial conflict persists and families
are shattering. Something penetrated every aspect of our lives -- our
schools, our courts, our homes - doing so without most of us even knowing
it. Authoritative and compelling, Psychiatry - The Ultimate Betrayal
unmasks those who have betrayed in the name of help. It tracks the
destructive bent compelling psychiatry, right from its historical
beginnings. It lays bare psychiatry's web of influence, but most
importantly lays out a plan of action we must take to survive as a
society.
Toxic Psychiatry, by Peter R. Breggin, M.D.
In Toxic Psychiatry, Peter R. Breggin, M.D. exposes the hype and false
promises surrounding psychiatry, and shows how dangerous and
brain-damaging psychiatric drugs are. He demonstrates that: psychiatric
drugs such as ssri's, prozac, paxil, zoloft, luvox, effexor, serzone,
anafranil,fenfluramine, fen-phen and redux are spreading an epidemic of
long-term, permanent brain damage; that mental illnesses have actually
never been proven to be genetic or even physical in origin, and that
millions of Americans are being incorrectly labeled with medical diagnosis
and treated with mind altering drugs, rather than being patiently listened
to, understood, and helped.
"Much of today's psychiatric science is based on wish, myth, and politics.
Breggin addresses this self-serving pseudoscience head-on." - Loren
Mosher, M.D., Former Chief of the Center for Studies of Schizophrenia, The
National Institute of Mental Health.
Other Sites
The Life Extension Foundation
International Advocates for Health Freedom
The Merrow Report - Attention Deficit Disorder
Rising Use of Ritalin on Teens Sinks Plans for Military Career
Yahoo: Health: Alternative Medicine
Yahoo: Business and Economy: Companies: Health: Alternative
Yahoo: Business and Economy: Companies: Books: Health: Titles: Alternative
Medicine
Pseudoscience and Psychobabble Page
John M. Friedberg, M.D., Board Certified Neurologist
Support Coalition & Dendron News
Center for the Study of Psychiatry and Psychology
National Foundation for Gifted and Creative Children
United States Drug Enforcement Administration
Training Children To Be Drug Addicts
Important note: When trying to withdraw from many psychiatric drugs,
patients can develop serious and even life-threatening emotional and
physical reactions. It is dangerous not only to start taking psychiatric
drugs, but also it can be dangerous to stop taking them. Withdrawal from
psychiatric drugs should be done gradually and under medical and clinical
supervision.