PRESIDENT’S BIOETHICS COUNCIL AFFIRMS MULTIMODAL TREATMENT FOR AD/HD News From CHADD 10/21/03 - Commentary by Fred A. Baughman Jr., MD

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.

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