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News From CHADD Volume 3, Number 56 October 21, 2003 PRESIDENT'S BIOETHICS COUNCIL AFFIRMS MULTIMODAL TREATMENT FOR AD/HD Multiple Concerns Raised About Medication Use On Thursday, October 16, the President's Council on Bioethics issued a 320-page report examining the ethical and social implications of using biotechnology on a wide range of medical topics. According to Council chair Leon Kass, M.D., the document is not a research report, but an ethical inquiry. The document, "Beyond Therapy: Biotechnology and the Pursuit of Happiness," can be accessed at http://www.bioethics.gov/reports/beyondtherapy/index.html. [Fred A. Baughman Jr., MD: an ethical inquiry] Several case studies are featured in the report, including the treatment of AD/HD. The AD/HD case study can be found in Chapter 2, "Better Children," Section III, pages 71 - 97. Note to readers: The most definitive review of published scientific research on mental disorders and AD/HD remains the December 1999 Surgeon General's Report on Mental Health at http://www.surgeongeneral.gov/library/mentalhealth/home.html In the report, the Commission states that biotechnology has "been produced largely for the purposes of preventing and curing disease, reversing disabilities, and alleviating suffering" (page 12). However, the Commission's report also emphasizes that biotechnology is used for "enhancement," defined as targeted not on "disease processes but the normal workings of the human body and psyche, to augment or improve their native capacities and performances" (page 13). [Fred A. Baughman Jr., MD: this may be what they say they do but with regard to ADHD and all psychiatric entities, they tell patients/parents, without exception, that the condition the have is a disease, and this, of course is a violation of informed consent--malpractice.] MULTIMODAL TREATMENT OF AD/HD VALIDATED The Council relied significantly on December 2000 testimony to the Council from Lawrence Diller, M.D., as well as a presentation by Steven Hyman, M.D., former director of the National Institute of Mental Health. The Commission acknowledges that "the rapid expansion of both AD/HD diagnosis and Ritalin prescriptions has raised troubling questions in some quarters" (page 75). [Fred A. Baughman Jr., MD: as it should with no proof ADHD is a disease--anything but normal behaviors in normal children] The Council affirms the legitimacy and reality of AD/HD, as well as the importance of multimodal treatment of AD/HD. [Fred A. Baughman Jr., MD: Most so-called bioethicists are on the "take" from industry. Whether ADHD is a disease or not is a medical determination not an ethical one. It is surely not ethical to lie to patients/parents by way of informed consent or routinely violate the Controlled Substances Act by giving normal children addictive, dangerous, Schedule II drugs.] Multimodal treatment for children and adolescents with AD/HD consists of parent and child education about diagnosis and treatment, specific behavior management techniques, stimulant medication, and appropriate school programming and supports. Treatment should be tailored to the unique needs of each child and family. "None of us on the Council questions the reality of Attention-Deficit/Hyperactivity Disorder. [Fred A. Baughman Jr., MD: Nor is whether a condition a disease or not a matter of consensus] All of us believe that children suffering from its depredations should receive the best treatment available, including prescription stimulants. Though we worry about misuse and abuse, [Fred A. Baughman Jr., MD: this is not a matter of misuse or abuse of an otherwise legitimate practice, without disease validation we have the drugging of normal children, which, based on lies and the violation of informed consent is assault and battery] we are not opposed in principle to using behavior-modifying drugs in children, even very young children, if circumstances require it" (page 76). [Fred A. Baughman Jr., MD: "even very young children" ...they have sold their souls.] The Commission further states "when behavior of children who are inattentive, impulsive, or hyperactive to an abnormal degree is sufficiently severe, chronic, and early in its onset, such children are held to suffer from Attention-Deficit/Hyperactivity Disorder....In the great majority of children diagnosed with AD/HD, stimulant drugs (frequently used in combination with non-medical efforts to alter behavior) have apparently succeeded in enhancing focus and attention, calming disruptive behavior, and improving performance at school. Moreover, their use by children also appears to be safe, non-addictive, and free of major side-effects" (page 74). "When prescribed for children suffering from properly diagnosed and clear-cut cases of AD/HD, stimulants are not only an acceptable but a necessary treatment of choice and until now, better than all other available alternatives" (page 74). [Fred A. Baughman Jr., MD: Here the PRESIDENT'S BIOETHICS COUNCIL infers that ADHD is a disease...a diagnosable disease, and, in so doing, violates the public's right to informed consent.] "The preponderance of the evidence shows a remarkably low incidence of side-effects when stimulants are used, in low doses, in the treatment of AD/HD and allied conditions...While some have expressed the concern that children who use stimulants when young might be more likely to become drug abusers in their teens and beyond, there is evidence that the opposite is true" (page 86). [Fred A. Baughman Jr., MD: This is the consensus of poorly structured research, all of it industry-sponsored, meant to debunk the largest prospective controlled study, that of Nadine Lambert of UC Berkley which leaves no doubt of the highly addictive nature of the Schedule II stimulants routinely urged on normal children said to have the bogus, fraudulent "disease" ADHD.] CRITICISM OF "MEDICALIZATION" While the Council clearly acknowledges the legitimacy of AD/HD and its treatment, [Fred A. Baughman Jr., MD: repeating it is legitimate time and again does nothing to make it so. The children who's drugging they subborn are no less normal] it also criticizes what its calls the "medicalization" of behavior and self-understanding. According to the report, "medicalization," a term coined by sociologists, means in the first instance a way of thinking and conceiving human phenomena in medical terms, which then guides ways of acting and organizing social institutions. [Fred A. Baughman Jr., MD: medicalization is just what they do, then, having "diagnosed" them they medicate them, which, because they are normal--and they know it--is poisoning] By medicalizing key elements of our life through biotechnical interventions, we may "weaken our sense of responsibility," the Council said in the report (page 92). CHADD is concerned that these criticisms will lead to public confusion regarding the reality of AD/HD and its treatment. [Fred A. Baughman Jr., MD: CHADD is concerned about nothing be making ever more "patients" out of normal children and seeing to it they are drugged with products of their paymasters, paymasters of all in the industry even those who right legislation assuring this wholly--100%--fraudulent diagnosis and treatment. From Methyphenidate (A Background Paper) October, 1995, DEA, p 4: 'In fact, a spokesman for Ciba-Geigy (now Novartis) stated that "CHADD is essentially a conduit for providing information to the patient population". The relationship between Ciba-Geigy (Novartis) and CHADD raises serious concerns about CHADD's motive in proselytizing the use of Ritalin.' It is obscene to speak of CHADD as a patient advocate groups when they are far more akin to an illicit drug cartel. What they do is illicit but should be illegal and prosecuted. ] The Council claims that the term "medicalization" is used as a "neutral description, without any implied judgment" (page 305) and yet it defines medicalization as "the tendency to conceive an activity, phenomenon, condition, behavior, etc., as a disease or disorder or as an affliction that should be regarded as a disease or disorder" (page 305). Those who deny the existence of AD/HD will likely use this section of the report to bolster their arguments, which are based solely on ideology and not science, that AD/HD is a non-existent, fraudulent disorder. [Fred A. Baughman Jr., MD: In medicine it is very simple: physical abnormality = disease; no abnormality = normal = no disease. Pure and simple the Council lies exactly as they were commissioned to do] The Commission's solution to the medicalization, including going "beyond therapy", is to think of "humans not in material or mechanistic or medical terms but in psychic and moral and spiritual dimensions" (page 308). The Commission concludes that the "causes of medicalization are many, among them, the power of modern biological explanation and techniques; the growth in medical knowledge and competence; the expanding domain of psychiatry, the 'doctoring of the psyche'; increased success using medical interventions; and rising patient expectations of cure, relief, and salvation coming from health care professionals. It is also driven by deep cultural and intellectual currents..." (page 305). PREVALENCE OF STIMULANT USE IN CHILDREN In its report, the Council clarifies the estimated number of children reported to be using stimulant medication as approximately three to four million (page 82). This is an important issue that CHADD continues to monitor, particularly as it relates to inaccurate data cited in media reports. Beginning at the September 2002 hearing on AD/HD by the House Committee on Government Reform, the organized movement that denies the existence of AD/HD has used increasingly exaggerated numbers to describe the extent of stimulant medication use among school age children. [Fred A. Baughman Jr., MD: Whether ADHD is an actual disease or not is not a matter of anyone's opinion but whether or not an objective physical abnormality has been and can be adduced individual by individual. If it can not, there is no disease. ADHD is not a disease; the children who's lives psychiatry, mental health and the Council would medicalize and invariably drug, are, according only to science and the legitimate application of medicine, wholly normal. Further, the burden of proof rests only with those saying they are abnormal/diseased and who would "treat" them medically in any way.] At that hearing, this group claimed that six million school-age children used such medications, although the generally accepted prevalence was between two to three million. These public claims have increased since September 2002 to eight million, to ten million, and most recently tens of millions. Disturbingly, the media has frequently reported these unsubstantiated claims. REPORT IDENTIFIES ADDITIONAL CONCERNS WITH THE TREATMENT OF AD/HD IDENTIFIED The Council acknowledged that an increase in the diagnosis of AD/HD and in the number of prescriptions for stimulants raises troubling questions. The Council outlined its concerns with the treatment of AD/HD in the report: 1. "Even when stimulant drugs are properly used to treat a recognizable disorder, they are acting as agents of behavior modification and control, applied by adults to children" (page 75). 2. "There are ambiguities in the set of behaviors being treated...which can and do exist separately and in varying degrees of severity, and they are always targets of possible corrective intervention, regardless of diagnosis" (page 75). 3. "The very safety of these drugs in children increases the temptation of parents to seek and physicians to consider prescribing these agents as remedies for the undesirable behaviors" (page 76). 4. "Growing socio-economic pressures - from schools, clinics, advertising, and health insurance reimbursement arrangements - are encouraging people to consider such pharmacological approaches to controlling the behavior of children" (page 76). 5. "These drugs have the capacity to enhance alertness and concentration in children without any symptoms whatsoever" (page 76). Referred to as "universal enhancers," "Ritalin has similar effects on all children, regardless of whether they meet the criteria for AD/HD." In a groundbreaking NIH study, "stimulants brought the performance of the AD/HD patients up to normal or near normal levels, and brought those of the normal subjects to above normal levels... Herein lies the rub, and a chief source of our interest in this subject in the present report. The fact that Ritalin and similar stimulants can be, and quite possibly are being, used to mollify or improve children who suffer no disorder..." (page 83). 6. "Vagueness in diagnosis where the symptoms are less clear-cut and less severe tends to create uncertainty with regard to appropriate treatment" (page 81). 7. "Although the DSM criteria are carefully set forth by pediatric psychiatrists, many of the actual diagnoses are made by family physicians lacking specialized training in these disorders, often on the basis if brief visits and incomplete work-ups" (page 81). 8. "We have no doubt that, in most cases, parents, teachers, and physicians are acting in what they sincerely deem the best interest of the child. But anecdotes abound of schools and teachers pressuring parents to medicate their children...of doctors, pushed by hectic schedules and distorted insurance rules, prescribing stimulants to children they have not fully examined, and of parents seeking a quick way to calm their unruly child or pressuring their doctors to give their son the same medication that is helping his schoolmates" (page 84). 9. "What should concern us most are the implications of inserting the novel and precedent-setting use of drugs into child-rearing and educational practices, and what it means for the character of childhood and the nature of responsible parenting" (page 86). 10. "The biotechnical capacity to modify children's behavior threatens to introduce into rearing children an element into the mix that is so powerful as to be very difficult to moderate" (page 88). 11. "Behavior-modifying drugs offer us an unprecedented power to enforce our standards of normality...This enhanced ability to make children conform to conventional standards could also diminish our openness to the diversity of human temperaments" (page 90). [Fred A. Baughman Jr., MD: full financial disclosure should be required of all on the Council. Further, given that their claim is that ADHD is neurobiological disorder, which translates to brain disease, the neurological qualifications of all members of the Council who, as we have seen, have repeatedly butressed the claim that this is a legitimate disorder/disease/brain disease] CHADD will continue to monitor these and other issues and provide routine updates to subscribers of News from CHADD. News From CHADD is a free electronic newsletter providing the latest federal action alerts, legislative and policy updates, and CHADD press releases. Contributions to support CHADD are welcomed and can be made online http://www.chadd.org or via mail.
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