[Fred A. Baughman Jr., MD:
Consider this about all research into psychiatric "diseases"-- not a single one a disease. Just as in this WSJ article, positing that the brain changes due to Ritalin/amphetamine "treatment" for ADHD, are due to ADHD--the "diseases"--so it goes throughout research in all of biological psychiatry. They always "discover" report and have press conferences and releases about brain abnormalities in one and all of the "diseases" of biological psychiatry. However, just as in ADHD/Ritalin, there is no such thing as an actual psychiatric disease (having a demonstrable physical abnormality).
Ritalin Shows Unexpected Effect in Back of Brain, Study Finds Thu Aug 1,12:18 AM ET In research that may help improve diagnosis and treatment of attention deficit hyperactivity disorder
, researchers found that the widely used treatment Ritalin ( news - web sites) had a surprising effect on a critical but little-studied portion of the brain, Thursday's Wall Street Journal reported
. But the effect was seen only on extremely fidgety
children. Previously, research into ADHD had mostly focused on the front portion of the brain, responsible for higher-level thinking. But in the study, published today in the American Journal of Psychiatry, researchers found evidence of unusual activity toward the back of the brain, in a part of the cerebellum known as the vermis. The vermis is associated with emotional regulation; moreover, defects in the broader cerebellum are tied to learning disabilities
, which occur disproportionately in people with ADHD. Using functional magnetic resonance imaging, a technology that measures blood flow in the brain over a period of time, the researchers found that the vermis was extra-active
in fidgety kids with ADHD. Administering methylphenidate, a stimulant sold under the brand name Ritalin, made by Novartis AG of Switzerland , decreased the activity of the vermis in these children, but had little effect, or even a slight increase in activity, on the vermis of children who were diagnosed with ADHD but who weren't demonstrably fidgety
The study involved 10 children with ADHD, and six children without ADHD who weren't given Ritalin.
Wall Street Journal Staff Reporter Robert McGough contributed to this report. .............................................
Editor (mailed 9/15/98) September 14, 1998 Scientific American 415 Madison Avenue NY, NY 10017 Re: Barkley RA. Attention-Deficit Hyperactivity Disorder. Scientific American. September, 1998:66-71. firstname.lastname@example.org (sent 9/14/98) To the Editor, Barkley , weaves illusions of disease and biology. The definition of ADHD changes with each edition of the DSM. Thus, we have ADD [DSM-III type, 1980], ADHD [DSM-III-R type, 1987], and, ADHD [DSM-IV type, 1994]. From 1950-1980, there were names and acronyms galore, none with a confirmatory physical abnormality. In a review of the neuro-imaging research, Ernst , laments, "The definition of ADHD has changed over time ...children with ADHD who were diagnosed according to DSM-III-R (1987) criteria include children who do not meet DSM-III (1980) criteria." I have elicited "confessions" from several researchers that ADHD has not been validated as an actual disease. Swanson (American Society of Adolescent Psychiatry, March, 7, 1998): " I would like to have an objective diagnosis for the disorder (ADHD)... psychiatric diagnosis is completely subjective." Castellanos ( personal correspondence, May 13, 1998): "...we have not yet met the burden of demonstrating the specific pathophysiology that we believe underlies this condition." Barkley, implies that brain atrophy characterizes ADHD. He cites MRI studies by Castellanos, et al. In the first , "Subjects with ADHD had a 4.7% smaller total cerebral volume." The second  showed: "Vermal (cerebellar) volume was significantly less...with ADHD." Not mentioned were the facts, acknowledged in the original report , that 93% of ADHD subjects had been on chronic stimulant therapy and, that the same, treated, cohort was used in the second study. Stimulant therapy caused the brain atrophy. The children were normal prior to stimulant therapy. The Nuremberg Code does not allow the abrogation of informed consent (calling ADHD a disease) and the drugging of normal children. Fred A. Baughman Jr., MD 1303 Hidden Mountain Dr. El Cajon, CA 92019 fax 619 442 1932 References 1. Barkley RA. Attention-Deficit Hyperactivity Disorder. Scientific American. September, 1998:66-71. 2. Ernst M. Neuroimaging in Attention-Deficit /Hyperactivity Disorder (p. 95-117). In Nadeau, KG (ed), A Comprehensive Guide to Attention Deficit Disorder in Adults. Brunner and Mazel, Inc. New York. 1995. 3. Castellanos FX, et al. Quantitative Brain Magnetic Resonance Imaging in Attention-Deficit Hyperactivity Disorder. Arch Gen Psychiatry. 1996;53:607-616. 4. Castellanos FX, et al. Cerebellum in attention-deficit hyperactivity disorder. Neurology. 1998; 50:1087-1093. Kristin Leutwyler August 26,1997 Board of Editors Scientific American 415 Madison Avenue New York, NY 10017 Dear Ms/Dr Leutwyler, It was good to visit with you by phone today to revisit the ADHD/Ritalin issue as below. I take it from your comments that there has been no subsequent exploration of the crux of the controversy, which is, whether ADHD is a disease with a characteristic, confirmatory abnormality or is merely an illusion of a disease. An ally, concerned, as I am, just sent me a copy of Paying Attention (by yourself, Scientific American, August, 1996, page 12-14). I was shocked and surprised, not to find the ADHD media juggernaught/misinformation campaign rolling on, but to find it in the pages of Scientific American. That the "scientists" of the National Institutes of Health (NIH) National Institutes of Mental Health (NIMH) and National Institute of Child and Human Development (NICHD) deceive the public making of ADHD the #1 pandemic of the land before it has been validated as a disease, a medical syndrome a phenotype (all require an objective abnormality--pathology) or anything organic or biologic should no longer surprise us. That Scientific American, checking both scientific method and scientific questioning at the door, should be seduced, is truly shocking. It is really very simple. The controversy that the usual cast of ADHD "experts" with their pre-scripted, anti-scientific defenses, say exists, can be cleared up in no time at all. We have an estimated 10 percent of US schoolchildren (5.23 million) on dangerous, addictive psycho-stimulants and other mind-altering drugs for this dread "disease" with its dread "prognosis" (pg 7 of NIH Publication 94-3572 from the NIMH alludes to those with ADHD as having a "disease"). What if ADHD was not a disease at all, or a medical syndrome or anything organic or biological. What if, after 17 years of ADD (and ADHD) it was still "theoretical" with it's biological basis still "about to be elucidated." This would mean, would it not, that the 5 million plus, ADHD schoolchildren are medically, biologically normal--that they have no disease with no prognosis. It means instead, as all of their research is carefully designed not to show, that their grim prognosis, including educational, social and vocational failure, psychoactive substance abuse, and all of the "co-morbidities, are not the prognosis of ADHD at all, but rather, the result of the thorough, permanent medicalizing of the children: the stigmatizing labels, the preempting of literacy and an education, their "disability" designation and the near-mandatory use of quiescence-assuring medication throughout their school-days. Consider the NIMH-Castellanos research on MRI brain scanning in ADHD, considered at some length in your article. What did it actually show? The authors found "significantly" smaller (4.7%) cerebral and cerebellar volume (as well as loss of normal right left caudate asymmetry and reduced right caudate volume) in the 57 with ADHD, than in the 55 "healthy" control subjects (Arch Gen Psych. 1996;53:607-616). Castellanos, et al, concluded " This first comprehensive morphometric analysis is consistent with hypothesized dysfunction of the right sided pre-frontal-striatal systems in ADHD." However, buried within the "Comment" section of their report, was the only plausible conclusion, given that ADHD is not a disease, a medical syndrome, a phenotype or anything organic or biological: "Because almost all (93%) subjects with ADHD had been exposed to stimulants, we cannot be certain that our results are not drug-related." For the past three years I have been asking NIMH, ADHD experts, Castellanos, Zametkin, Rapoport, Jensen and others, to "refer me the article or articles in the peer-reviewed literature that establishes that ADHD has a confirmatory, characteristic physical abnormality (pathology) validating it as a disease, a medical syndrome, a phenotype, or anything organic or biologic." Although I have written each of them more than one time, the last time by registered mail, I have yet to get an answer from any one of them. Since when can scientists, worthy of the name, decline to answer fundamental questions. Perhaps you can get an answer to this fundamental question. However, the FDA and the DEA were responsive. On December 12, 1994, Dr. Paul Leber of the Division of Neuropharmacological Drug Products of the FDA, wrote "We acknowledge that the condition currently known as ADHD has been historically controversial and that as yet no distinct pathophysiology for the disorder has been delineated. The same acknowledgement came from Gene R. Haislip of the Office of Diversion Control of the DEA in a letter dated October 25, 1995: "We are also unaware that ADHD has been validated as a biologic/organic syndrome or disease." Having given coverage to the controversy, you have a duty to science and medicine to ask the hard questions. There cannot be a different standard of science for biopsychatry. What we have, it seems, is millions of normal children having their schooling and lives medicalized, for profit. Moreover they are being made to take drugs known to be addictive, and, as strongly suggested by the Castellanos research, brain damaging, otherwise, as well. Please join me in trying to garner the answers to fundamental questions necessary to get to the bottom of the US, ADHD/Ritalin controversy. The US consumes 90% of the world's supply of Ritalin with 90% of it given to our children. Ritalin use here is rising 75-80% per year, Dexedrine (d-amphetamine) 100% per year. There is no shortage of hard questions to be asked. However, the "ADHD: Is it a disease, a syndrome of anything biologic or organic?" remains the most fundamental of all, and the most difficult to get a straight answer on. Sincerely yours, Fred A. Baughman Jr., MD 1303 Hidden Mountain Drive El Cajon, CA 92019 619 440 8236 (p) 619 442 1932 (f) PS Their credentials and mine which they regularly try to make the issue, do not change the need for answers to these questions. CC Xavier Castellanos MD 10 Center Drive Room 6N240 Bethesda, MD 20892-1600 enclosure: Future of Mental Health (3) What Every Parent Needs to Know About ADD (2)