• Irony, thy name is ADHD

    Yesterday, I highlighted a NYT piece on “the selling of attention deficit disorder“. In a bizarre piece of irony, WaPo had its own piece, but its focus was on the rising scourge of ADHD in adults.

    The NYT highlighted some of the prominent individuals who have ties to pharma companies who make these drugs. One was Dr. David Goodman, who over saw a video course sponsored by Shire on the website Medscape. Later, Dr. Goodman reconsidered:

    The psychiatrist who oversaw the course, Dr. David Goodman of Johns Hopkins and the Adult Attention Deficit Disorder Center of Maryland, said that he was paid several thousand dollars to oversee the course by Medscape, not Shire directly, and that such income did not influence his decisions with patients. But as he reviewed the video in September, Dr. Goodman reconsidered its message to untrained doctors about how quickly the disorder can be assessed and said, “That was not an acceptable way to evaluate and conclude that the patient has A.D.H.D.”

    The WaPo article, on the other hand, quoted Goodman extensively (mentioning none of these ties):

    The treatment for older adults with ADHD is similar to the protocol for children with the disorder — usually a combination of “pills and skills,” according to Goodman.

    Medications for ADHD include stimulants such as Adderall XR, Concerta, Focalin XR and Vyvanse, or non-stimulants such as Strattera, according to Goodman.

    Shire makes both Adderall and Vyvanase. Then Goodman went on to bemoan that we need to do a much better job getting insurance to pay for these medications:

    Older adults can have difficulties getting insurers to cover ADHD prescriptions, and they sometimes need to get a waiver to have medications covered. Many of these drugs have been FDA-approved and tested in patients only up to age 55 or 65, Goodman said. At age 62, Ecarius had to wait several weeks for preauthorization of his medication.

    Read the NYT piece, and then the WaPo piece. Then think hard about the fact that the latter may be a perfect example of the issues the former describes.


    • Given that nothing in the theory of ADD or ADHD suggests that it is a result of some event, as opposed to an innate brain malfunction, bemoaning the fact that a 62 year old diagnosed with it had to wait a whole two weeks for meds is pretty funny. Presumably, the old geezer has been waiting 50 years to get some relief another two weeks is nothing.

      • Let’s please use more respectful language about older adults.

        In response to z:

        First, the amphetamines are pretty powerful meds with some addiction potential. Second, coping skills are just as important.

        If the net benefit of ADHD meds is positive, then I agree, we as a society can seriously consider if we should use them more widely. The problem is that there are significant negative side effects and that the drug companies’ incentive is to sell more drugs – so they will tend to downplay the side effects. Furthermore, I would posit that people with ADHD need to develop coping skills – but our health system isn’t giving attention to that part of treatment.

    • Adult ADHD medication can be a job-saving wonder. I am not sure that human beings evolved to perform tedious tasks well. Many people find focusing on such tasks rather difficult. If medication can allow people to do their jobs better and with less stress and time, why are so many people fighting the use of such medication?

      Abuse of the drug can happen, but as long as a physician (preferably a well-trained psychiatrist) monitors usage, the benefits should far out-weigh the harms. I suspect that usage has gone up so much because as people try these drugs and find out how much it improves job performance, they tell their friends and family who realize they can benefit from these drugs as well.

      Life is hard. If ADHD medication, taken under doctor supervision, makes life easier, it should be encouraged, not stigmatized. Rather than getting caught up in whether the technical diagnosis is correct (I am not convinced there is a clear line between ADHD and non-ADHD–people are somewhere on a spectrum), we should focus on whether lives are being improved.