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.
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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.
