An Open Letter to the Editor of the New York Times from Thomas E. Brown, Ph.D.

Sent December 16, 2013

The front page of the New York Times on Sunday, December 15, 2013 featured an article “The Selling of Attention Deficit Disorder” by Alan Schwarz announcing that the number of diagnoses of ADD soared amid a 20-year drug marketing campaign. This lengthy article acknowledged that “classic ADHD, historically estimated to affect 5% of children, is a legitimate disability that impedes success at school, work and personal life.” It also acknowledged that “medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.”

In his piece, Schwarz describes in detail how several pharmaceutical companies have waged extensive campaigns to educate physicians and parents about ADHD and to promote their medications used to treat ADHD. He also provides a number of examples where pharma advertising or physicians have made excessive claims for the potential benefits of these medications, have minimized potential risks of treatment, and have made inadequately supported statements about the disorder. Many of these examples warrant criticism.

Yet, this Schwarz article is seriously flawed in 4 important ways:

1)     It seems to assume that the substantial increase in ADHD diagnoses over the past 20 years is due simply to pharma companies seducing doctors and parents into medicating many children needlessly for problems that are trivial or non-existent. It shows no real grasp of how science-based understanding of ADHD has substantially changed over the past 20 years from the “classical”  focus on young children with disruptive behavior. Schwarz does not recognize that this disorder is now understood as developmental impairment of the brain’s management system, its executive functions. And he sees efforts to address these problems in adolescents and adults as just a search for more people to medicate rather than as recognition that many, though not all, who have ADHD in their childhood continue to suffer from these impairments throughout adolescence and, in some cases, much of their life.

2)     Schwarz claims that ADHD now is understood as including “relatively normal behavior like carelessness and impatience.” While it is true that all of the characteristics of ADHD occur for most people some of the time, legitimate diagnosis of ADHD requires that these problems significantly impair the functioning of the individual in ways that are inconsistent with usual expectations for the person’s age and negatively impact the person’s functioning, not just occasionally, but persistently for more than half a year.

3)     The article begins with an alarmist quote from Keith Conners, a retired researcher in ADHD, who recently lamented that the rising rates of diagnosis are “a national disaster of dangerous proportions…a concoction to justify giving out of medications at unprecedented and unjustifiable levels.”  Both Conners and Schwarz apparently assume that the incidence rate for ADHD should remain forever set at that earlier level. They do not allow for the possibility that the earlier estimate may have been incorrect or that the more recent science-based understanding of ADHD may describe a problem that actually impairs a larger number of children and adults.

4)     In this article and several earlier articles in the Times, Schwarz correctly emphasizes that medications used to treat ADHD can have serious adverse effects. This is true of any medication, including such common over-the-counter medications as Tylenol. Yet he tends to exaggerate the risk of severe adverse effects, e.g. “cannot sleep for days, lose their appetite or hallucinate” by not mentioning that hallucinations due to these medications are quite transient and extremely rare; nor does he note that problems with sleep or appetite can almost always be alleviated without any significant or lasting harm. If prescribed medications are not effective or cause any significant adverse effects, any responsible prescriber will correct it with dose adjustments, medication change, or discontinuation.

It is quite reasonable for the Times for make readers aware of problems such as Alan Schwarz described in his article, but it seems irresponsible for such a reputable newspaper to present such information without more careful attention to underlying assumptions of the piece that may be inaccurate, outdated, and, for many readers who may be struggling with this disorder, unnecessarily frightening.

 

Thomas E. Brown, Ph.D.
Clinical Psychologist
Associate Director of Yale Clinic for Attention & Related Disorders
Dept. of Psychiatry
Yale University School of Medicine
www.DrThomasEBrown.com

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7 Responses to An Open Letter to the Editor of the New York Times from Thomas E. Brown, Ph.D.

  1. Gina Pera says:

    Thank you, Dr. Brown, for correcting those four points.

    I found many more, but those will suffice.

    The NYT long ago discovered that they could pander to the public’s lowest common denominator and create much-needed web traffic.

    Many in the ADHD community also flocked to such stories to voice dissent and ask for better coverage in the future. To no avail.

    So, the NYT won on both counts: Telling the public what it wanted to hear and creating a frenzied series of link-sharing among the outraged ADHD community.

    I no longer link to the NYT. And, as a journalist, I am saddened that that the former “paper of record” has sunk to the lowest of yellow journalism standards. Sensationalistic reporting and lax editing does not a good paper make.

    Gina Pera

  2. Dorothy Avery says:

    Thank you Dr. Brown. I so appreciate your writing to the editor. I feel so attacked by the NYT every time they run these negative pieces…and then I start second guessing my diagnosis…and my mind goes through the entire can of worms again and again!!! You are one of the people those of us with ADHD can rely on in these situations and it is so appreciated.

  3. Ted Vaughan says:

    Dr. Brown
    I met you at several CHADD national conferences in the early 90’s early in our quest to understand and ameliorate in our two children. I am heartened to see that you continue to advocate for legitimate ADHD diagnosis and legitimate medical mitigation. The truth like history needs to be continually evaluated and concomitantly validated. With that validation forward understanding is then possible and necessary through research. This is not whack a Mole! Thank you for your valuable and professional attention to ADHD! Our children have progressed well into adulthood! Merry Christmas!

    Ted Vaughan

  4. Dr. Brown:

    Your Open Letter hits on all cylinders. Our organization, CHADD, has recently addressed the article in our Board meeting and in our Editorial Advisory Board meeting (for our publication, ‘Attention’ magazine). All spoke very highly about the article.
    Thank you for writing it.

    M. Jeffry Spahr*
    Norwalk, Ct.
    CHADD – National Secretary/Board of Directors;
    CACLD – President

    *Proud father of a young boy first diagnosed by Dr. Brown.

  5. Jay Little says:

    Mr. Brown,

    While I can appreciate your response to the NY Times article, there is a problem here and the drug companies (BIG PHARMA) know it. As a life time suffer of ADHD, I know the effects of ADHD all to well.

    I think there is way too much use of drugs to control disease versus using natural things such as exercise (note during my teens and twenties I ran in excess of 85 miles a week maxing at 157 miles a week when attempting to qualify for the Olympic Trials in the Marathon, I ran a 2:23;50 in 1991, I also taught swimming lesson to handicpped and normal persons during that time spending as many as 10 hours a week in the pool swimming with my students, as self medication). By your answers I’ll guess you have read NEITHER “Spark” by John Ratey, MD NOR “Cracked” by James Davies.

    The NY Times article does talk about the abuses by Big Pharma and unfortunately the article does not talk about giving people SPEC and PET tests to see what activity is taking place in the brain to reveal an accurate diagnosis rather than guess work on the part of medical professionals. The drug companies certainly don’t want SPEC and PET tests being used as these would cut into their profits.

    Also the article does not even begin to address the way the DSM manuals have been done since the first in the 1950’s. The way the spectrum of mental illness is a joke and has been and still is about money and NOT patients well being. I also believe you were interviewed in the book “Cracked” and Mr. Brown, you of all people should know the problems associated with DSM – V.

    From personal experience where I was misdiagnosed and for a period of about 10 ten years had to fight for my sanity. I only got some of what I should have gotten when I threatened a provider of treatment with legal action as they told the insurance company I had at the time that I was NOS as if they would have said I was ADHD, I would have only received 10 VISITS a year. By saying I was NOS, I received treatment amounts to the effect of being cart-blanch.

    If anyone would like to discuss this in greater detail – email me at jaylittle66@gmail.com.

    Jay Little
    Elkhart, Indiana

  6. Sarah Hammond says:

    Dear Dr. Brown,

    Thank you for your outstanding letter to the NYT on behalf of all who suffer from ADHD, and/or have relatives with the disorder.

    It is astonishing to me that in the 21st century there continues to be so much controversy and misinformation about ADHD proliferating. Articles such as this series in the NYT contribute to the fear of medications that could significantly improve quality of life for ADHD patients. While the implication is that ADHD medications are over-prescribed, in fact medication is usually the LAST choice of treatment for desperate parents; and sadly many undiagnosed adults unwittingly self-medicate through drugs, alcohol, or other addiction first, before figuring out that ADHD medication may help them.

    I was also distressed to hear an interview with Stephen Hinshaw by Michael Krasny on public radio about two months ago. He and his co-author Richard Sheffler alternated between truth and false implications in their interview; I was appreciatively noticed that many of the audiences comments were so astute that they corrected these distinguished researchers lapses. Astonishing that the truth is still so prevalently manipulated when it comes to ADHD treatment and diagnosis. While I am a big believer in using alternative approaches such as exercise, dietary changes, supplements and other complementary therapies–as well as structure and limits–in many instances they do not replace the appropriate use of medication.

    Again thank you for your cogent Letter to the Editor. In addition, I want to thank you for your years of research and your well-written, thoughtful books.

    Warm regards,
    Sarah

  7. Rebecca says:

    Amen! Thank you so much for writing this.

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