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The Lazy Doctor and the Drunk Electrician

April 2, 2013

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Around one in every five high school age boys in the United States have received a medical diagnosis of attention deficit hyperactivity disorder, the US Centers for Disease Control and Prevention has discovered.

ADHD is being grossly overdiagnosed for a range of commercial and social reasons. For millions of children to be taking powerful drugs which can have dangerous side effects is an example of the sort of pharmaceutical scandal that emerges every few decades, usually as a result of lazy and lax prescribing habits by doctors.

In the 1950’s for instance, amphetamines were being used successfully to augment recovery of brain damage following stroke, due to their ability to accelerate plastic reorganization of the brain.

British Prime Minister Sir Winston Churchill suffered a speech-destroying stroke in June 1953 during dinner with the Italian Prime Minister, and was prescribed amphetamines by his physicians to help accelerate his recovery. He went on to give a brilliant speech at the Conservative Party Conference in Margate in October of that year.

Yet amphetamine was eventually banned in many countries, including USA and UK, because of its widespread abuse, including in the sort of blanket prescription for weight loss which we are now seeing with respect to ADHD drugs for minor problems of concentration and forgetfulness.

A similar sort of problem arose with benzodiazapines which came to be prescribed by doctors in pandemic proportions for anxiety in the second half of the twentieth century, leading to very bad problems of addiction, aggression and other problems far worse than the original presenting difficulties which the physicians sought to combat. Most countries have had to greatly limit the prescription of these drugs.

But what is so worrying about the ADHD scandal is the age of the people upon whom these legal drugs are being pushed.  The adolescent brain is wonderfully – and therefore frighteningly – malleable. We spend so much time and money educating our adolescents precisely because of this fact – their ultra-receptive brains soak up skills and knowledge, embedding it in a network of brain cells that will remain with them for life.

Yet exactly the same fact pertains if you pump brain-changing drugs into their blood at this age: these can wreak permanent changes which also last a lifetime. We have seen this in a New Zealand study of marijuana use, where adolescent heavy users were found to lose as many as eight points of IQ in their late thirties.

We do not know what the long term effects of mass brain-medication of our adolescents will be. But the human brain is the most complex entity in the known universe, and we tamper with it – above all in childhood and adolescence – at our peril.

Of course there are a small proportion of children and adolescents who can benefit from an ADHD diagnosis and appropriate pharmaceutical treatment: research in my laboratory has shown that we can even predict which children are likely to respond to it [i].

While the long term benefits of this are uncertain, I am certainly not saying that no young people should receive medication for severe ADHD. But we are talking low single figure percentage incidence of severe ADHD, not the sort of mass medication of a fifth of the population which the recent CDC report has revealed.

Imagine you are renovating a house and the time comes to electrically rewire it. The electrician turns up …. drunk. Of course you send him away because the long term consequences of having your house rewired by an intoxicated tradesman could be devastating.

But long-term medication of our adolescents’ developing brains with drugs, legal or illegal, could be like letting a drunk electrician rewire your house. Beware.

@ihrobertson


[i] Bellgrove MA, Barry E, Johnson KA, Cox M, Dáibhis A, Daly M, Hawi Z, Lambert D, Fitzgerald M,  McNicholas F, Robertson IH, Gill M and Kirley A  (2008) Spatial attentional bias as a marker of genetic risk, symptom severity and stimulant response in ADHD. Neuropsychopharmacology 33, 2536–2545

 

 

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One Comment leave one →
  1. April 3, 2013 10:08 am

    Great analogy Ian, of the drunk electrician. It does seem extraordinary how willing doctors and parents seem to be to latch onto a diagnosis and cure, as if they’ve fulfilled their responsibilities to put children on powerful drugs. Ken Robinson calls it a ‘modern epidemic’ and talks about how kids are penalised for getting distracted from the boring stuff of traditional educational models while living in the most stimulating environment that has ever existed. (For anyone interested, check out http://www.ted.com/talks/ken_robinson_changing_education_paradigms.html, 3m40s in). I don’t know, but I hope we don’t see similar levels of medication creeping into Ireland.

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