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Steven E. Hyman, MD
October 14, 2000
Director, National Institute of Mental Health
6001 Executive Blvd.
Bethesda, Maryland 20892

Dear Dr. Hyman,

Unfortunately, I did not get your letter, stamped September 28, 2000, in time to
consider it in my prepared statement delivered to Committee on Education and the
Workforce, hearing entitled "Behavioral Drugs in Schools: Questions and
Concerns," held September 29, 2000, 9:00 a.m., in Room 2175, Rayburn House
Office Building, Washington, DC, 20515-6100.

Psychiatrists, like neurologists, and all other medical specialists, are
physicians first and specialists second.  All of us are responsible for knowing
that the demonstrable physical abnormality in the patient is the disease. All of
us are responsible, by the time we get our MD degree, for being able to
distinguish those who have disease from those who do not.

You did not respond to question #1 in my letter of September 19, 2000 (with cc to
Representative Robert Schaffer, R-CO):

"Is ADHD a bona fide disease with a confirmatory physical or chemical abnormality
demonstrable within the patient?  Circle ‘yes’ or ‘no’?"

You are aware, I suspect, that no physical or chemical abnormality has ever been
confirmed in children meeting any of the ever-changing criteria, either for ADD (
DSM-III, 1980) or for ADHD (  DSM-III-R, 1987, or DSM-IV, 1994), and that the
answer to question  #1, quite simply, is ‘no’.   As you and I both know, a ‘yes’
or ‘no’ answer is always possible.

Moreover, regardless of what proofs may exist (none do) in the scientific
literature, or in some remote institute, if a physical abnormality has not been
demonstrated in the child/person, by their own physicians, they cannot be said to
be abnormal-diseased.  No child said to have ADD/ADHD can legitimately be said to
be other than normal.  You have said so yourself in paragraph 3 of your letter:

"…there are currently no biological markers that can be used for diagnostic purposes."

For this reason, no child with ADD/ADHD is demonstrably abnormal until their
drugging commences.

You persist, nonetheless, in speaking of the ‘valid’ diagnosis of ADHD and of
manic-depressive disorder, and major depression, and of all psychiatric
‘disorders’--by which you mean ‘diseases’.  It would be legitimate of you to
refer to such diagnoses as ‘valid’ if your only claim or inference was that they
were behavioral problems in physically normal individuals, but that is not
your/psychiatry’s claim or inference.  Rather, without physical evidence, you
make the blanket claim, and broadcast to patients and the populace alike that
these are diseases with validating, physical abnormalities within the
‘patients’--the only kind of validity that applies when claiming disease is
present.  As you and I were taught in medical school, the physical abnormality is
the disease.  In diabetes, the elevated blood sugar and all of it’s attendant
physical complications, is the disease.  ‘Diabetes’ is the name it is given. In
diabetes and in all bona fide medical/surgical diseases, treatment is not begun
until the diagnostic physical abnormality is found.  In ADHD, 6 million are being
treated with addictive, dangerous, at time deadly  drugs, without prior
demonstration of an abnormality—a disease.

Getting back to ADHD and your letter, you state (paragraph 3):

"Scientific studies have shown that there are identifiable differences in the
brains of children with ADHD as compared to normal."

You give two references (your references #4 and #5).  Let us look at these reports.
The first (#4 in your bibliography), authored by Castellanos, et al. (like
yourself, from the NIMH) was entitled:  Quantitative brain magnetic resonance
imaging in attention deficit-deficit hyperactivity disorder.   It appeared in the
Archives of General Psychiatry. 1996;53:607-616.  Castellanos et al,  took
magnetic resonance images (scans) of the brains of 57 boys, 5-18 years of age,
said to have ADHD, and of 55 "healthy" age-matched controls.  Those in the ADHD
group were found to have smaller, atrophic brains than the " healthy" controls.
They concluded that the brain atrophy was due to ADHD, tending to prove, as you
accept,  that ADHD, diagnosed with pencil-paper behavior rating scales (mostly by
teachers), is  a "brain disease" with the brain atrophy, it’s confirming abnormality.

However, under "Subjects with ADHD," it was explained that "Fifty-three of them
(53 of the 57 with ADHD) had been previously treated with psychostimulants, and
56 had participated in a 12-week, double-blind trial of methylphenindate,
dextoamphetamine and placebo…" (and may also have been on medication) as had
been described in a 1991 article.

Under "Comment," is found the brief acknowledgment: "Because almost all (93%)
subjects with ADHD had been exposed to stimulants, we cannot be certain that our
results are not drug related."  This did not, deter Castellanos, et al, from
concluding that the brain atrophy was due to ADHD, not to the brain damaging
(encephalopathic) drugs that 93% to 98% of their ADHD subjects had been on. That
was 1996.

In 1986, Nasrallah, et al, reported "Cortical atrophy in young adults with a
history of hyperactivity in childhood," in Psychiatric Research,
1986;17:241-246.  This was a computerized tomography (CT) brain scan study
(comparable, but not quite as refined as MRI, which came along 5-10 years after
CT).   Scans of 24 hyperactive subjects showed brain atrophy (shrinkage) in more
than 50% leading the authors to conclude: "cortical atrophy may be a long-term
adverse effect of this treatment."

Has the NIMH considered this possibility?  Have they explored it?

Castellanos, still at the NIMH, was interviewed for an article entitled Making
Sense of Ritalin by John Pekkanen, which appeared in the January, 2000, Readers
Digest.  Therein it is stated:

"Some critics claim that such brain differences in ADHD Children might actually
be caused by Ritalin—meaning these smaller areas of the brain could be the result
of the stimulant treatment.  To address this , Castellanos has now embarked on
another study, imaging the brains of ADHD youngsters who have not been treated
with drugs."

With the rate of stimulant prescriptions for ADD/ADHD rising so rapidly (from
approximately 500,000 in 1985, to 1.0 million in 1990 and 6 million today), why
didn’t the NIMH long ago conduct the one experiment necessary to determine
whether the brain atrophy that was being found on the brain scans was due to
so-called ADHD or to the  Ritalin/amphetamine treatment.  Three patient groups
would have been sufficient: (1) a normal control group; (2) ADD/ADHD, treated;
and (3) ADD/ADHD, not treated.  Nasrallah et al suggested the need for such a
study in 1986 and it could well have been initiated, getting an answer to this
all-important question, even with the then-existing, CT technology.  There were,
for that matter, MRI scanners becoming available by that time as well.

Far from confirming that ADHD is a disease, the brain scanning research (CT and
MRI) from 1986 to the present, showing, on-average, 10% brain atrophy (shrinkage)
in ADHD subjects (most all of them on Ritalin or amphetamine treatment) as
compared to normal control subjects, allows no conclusion other than that the
Ritalin/amphetamine exposure, itself, is the only plausible cause of the brain
atrophy.  So much for your reference # 4.

Let us turn now to the second article (your reference # 5, Dopamine transporter
density in patients with attention deficit hyperactivity disorder. Dougherty DD,
Bonab AA, Spencer TJ Rauch SL, et. al.  Lancet. 1999;354:2132-2133, December 18,
1999)  which you claim shows "identifiable difference in the brains of children
with ADHD as compared to normals."

Here, I will be referring not just to the article of Dougherty, et al, but to my
own  (Baughman FA Jr. The Lancet, 2000;355:1460; April 22, 2000) letter to the
editor critiquing the article of Dougherty, et al.

I wrote:

"Dougherty, et. al., state  that  patients were excluded from  "therapy with
drugs which affect the dopamine system within 1 month before participation".
Saying "drugs which affect the dopamine system"  they likely refer to the
amphetamines—methylphenidate (Ritalin), d-, l- amphetamine (Adderall), an
d-amphetamine (Dexedrine).   Brown, [Brown WD, Taylor MD, Roberts AD, et
al.  FluoroDOPA PET shows the nondopaminergic as well as dopaminergic
destinations of levodopa.  Neurology. 1999;53:1212-1218.] have shown such theory
to be simplistic and invalid, accentuating that it cannot be said of any drug, or
class of drugs, that they are known to act exclusively on any one set of
chemical  transmitters, or, that it is known exactly how they act.

Assuming they are speaking, if not of  stimulants, of other types of psychotropic
drugs   it cannot be assumed, with no mention of  what they might have been or
how long the subjects had been on them, that there would be no drug affect
capable of altering the SPECT testing, after just one month off of whatever drug
it was they were on.

Observing that these were 6 adult subjects with ADHD , it is likely that they had
been on chronic, long-term psychotropic therapy, more likely with stimulant
therapy than with other psychotropic drugs.  But again, none of these things are
stated in methods.  Surely, the authors make no claim that their ADHD patients
were wholly drug-naïve, that is, that they had used no drugs at all, any time in
their lives, and that their ADHD (behaviors) were the sole variable.

The fact that they were apparently on some psychotropic medications until one
month or more prior to SPECT scanning means that they—the 6 ADHD subjects--were
not drug-naïve, and that the scan differences between the subjects and controls
were likely drug-induced.  Certainly, it cannot be concluded that the study
defines an ADHD phenotype, pathology, pathological physiology or pathological

Reviewing the neuro-imaging literature at the National Institutes of Health,
Consensus Conference on ADHD, November 16-18,1998, Swanson [Swanson J,
Castellanos FX.  Biological Bases of ADHD: Neuroanatomy, Genetics, and
Pathophysiology.  Program and Abstracts, NIH Consensus Conference on the
Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, November
16-18,1998: pages 37-42] showed that the brains of ADHD subjects were, on
average, 10% atrophic compared to normal controls.  He stated there were no such
studies in which the ADHD subjects were drug-naïve; i.e., virtually all such ADHD
subjects had been on stimulant therapy.  This being the case, stimulant therapy,
not ADHD, is the likely cause of the brain atrophy.

There can be no contention  that having persons off of stimulants, or off of any
psychotropic medication, for a period of 1 month,  a few months, or for any
period at all, entirely rules out the possibility of drug affect.

ADHD has yet to be validated as a disease (with a confirmatory physical or
chemical abnormality), a syndrome, or a phenotype (with a confirmatory physical
or chemical marker)."

To the best of my knowledge, as of today, October 14, 2000:

"ADHD has yet to be validated as a disease (with a confirmatory physical or
chemical abnormality), a syndrome, or a phenotype (with a confirmatory physical
or chemical marker)."

None of the articles that you have cited in your letter of September 28, 2000,
and no article or articles in the peer-reviewed literature, to date, constitute
proof of a physical or chemical abnormality validating ADD/ADHD as a disease, a
syndrome, or as anything whatsoever, physical or organic.

At the November 16-18, 998, ADHD Consensus Conference, Richard Degrandpre, author
of Ritalin Nation [15], commented on the Report of the Panel, as follows:

"… it appears that you define disease as a maladaptive cluster of
characteristics. In the history of science and medicine, this would not be a
valid definition of disease."

Having failed to prove that ADHD is a disease, it appears that the Panel sought
to re-define the word ‘disease’.

It occurs to me, Dr. Hyman, that you would not be seeking so intently to
represent that you have found physical differences in ADHD and in all psychiatric
‘diseases’ were you not convinced of the need to demonstrate abnormalities to
validate them as diseases.

There can be no claim in the US today, or anywhere else in the world, that
children said to have ADD/ADHD are anything but normal.  There is no
justification to make ‘patients’ of normal children/persons and to ‘diagnose ’ and
‘label’ them (in itself invariably damaging) or to, in any way, ‘treat’ them, as
if there were a legitimate need to do so.  There is not.

For lack of proof in every article (including the ones you have just offered as
proof) and in every press release, ADHD is a fraud.  Every normal child thus
‘labeled’ and ‘drugged’ is inevitably injured.  Those who do this, knowing that
the children are normal, must be identified and held accountable.


Fred A. Baughman Jr., MD
1303 Hidden Mountain Drive
El Cajon, CA 92019
phone 619 440 8236
fax 619 442 1932

cc Congressman Bob Schaffer
cc Congressman Pete Hoekstra
cc Congressman Henry Hyde
Senator Teddy Kennedy
Senator Paul Wellstone
Senator Pete Domenici
Senator Harkin
Tipper Gore


1. Letter to Dr. Hyman of September 19, 2000
2. My oral testimony to Committee on Education and the Workforce, hearing
entitled "Behavioral Drugs in Schools: Questions and Concerns," held
September 29, 2000, 9:00 a.m., in Room 2175, Rayburn House Office Building,
Washington, DC, 20515-6100.

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