TRUE, COMPLETE, INFORMED CONSENT IN ADHD
(Is Dr. Sinaikos Treatment Worse than any Other?)
by Fred A. Baughman Jr., MD © 8/1/99
The Medical Board of California (MBC) has recently challenged the
practice of an allergist, a Dr. Robert Sinaiko, who, believing that
Attention Deficit Hyperactivity Disorder (American Psychiatric
Association, Diagnostic and Statistical Manual-IV, 1994) is secondary to
systemic fungal infections, has undertaken to treat such cases with the
potent, dangerous, anti-fungal drug, amphoteracin-B.
However, the main problem concerning ADHD is not which treatment works,
is best, most scientific or, least harmful, but whether ADHD exists at
all? Both, the numerator and denominator of the risk/benefit equation
must be fully portrayed. If not, informed consent is lacking, and has
been violated.
On November 16, 1998, Steven E. Hyman, MD, Director of the National
Institute of Mental Health convened the November, 16-18, 1998, NIH,
Consensus Conference on ADHD stating that the rate of ADHD varies from
0-3% in some school systems to 40% in others, “
the reason for which
one needs a consensus conference.” What was needed was adherence to
science, and candor in the dissemination of what is known about ADHD.
Dr. William B. Carey of the University of Pennsylvania (November 16),
reviewed the state of the science and addressed the question Is ADHD as
a Valid Disorder? Nowadays, when psychiatry uses the term disorder it
means disease, and assumes (but never proves) an abnormality of the
brain.
Providing sixty references, Carey concluded:
What is now most often described as ADHD in the United States appears to
be a set of normal behavioral variations that sometimes lead to
dysfunction through dissonant environmental interactions. This
discrepancy leaves the validity of the construct in doubt
diagnosis of
brain malfunction should be substantiated by some objective test
No one presented evidence to counter Carey–evidence that the millions
of children being diagnosed and drugged in the US, and, increasingly,
around the world (1998, Report of the International Narcotic Control
Board), as treatment for ADHD, are other than normal.
How could the mistaken notion, that so many millions of normal children
are “brain-diseased,” “patients,” and in need of “treatment,” have come
about? Here again, Carey appeared to be the only one uttering the
unpleasant truths. He observed:
The ADHD behaviors are assumed to be largely or entirely due to abnormal
brain function. The DSM-IV does not say so, but textbooks and journals
do
The varying contributions of the setting to the problem (environment)
are typically ignored.
But the DSM-IV (1994) does say so. In praise, psychiatrists Marzuk and
Barchas [Barchas JD, Marzuk PM. JAMA 1995 280;961-962] wrote:
the most significant conceptual shift (from DSM-III-R to DSM-IV) was
the elimination of the rubric organic mental disorders (read, disease),
which had suggested improperly that most psychiatric disorders had no
organic basis
Herein, psychiatry excused itself from demonstrating, as throughout
medical science, that what they declared was a disease, had a
confirmatory physical (including chemical) abnormality and was, in fact,
a disease.
Without proof or evidence of an abnormality of a brain, a set of normal,
if troubled, behaviors, arbitrarily selected, and regularly revised,
were declared, by fiat, to be a brain abnormality, “disorder,”
“disease.” Further, it appears that the psychiatric, neurologic,
pediatric and medical hierarchies have colluded–their textbooks and
journals assuming, anti-scientifically, that ADHD behaviors are largely
or entirely due to abnormal brain function.
On the weight of Dr. Careys testimony, the consensus conference panel
concluded (November 18):
However, we do not have an independent, valid test for ADHD, and there
is no data to indicate that ADHD is due to a brain malfunction. Further
research to establish the validity of the disorder continues to be a
problem.
During the discussion and revision of the consensus statement, Wednesday
morning, November 18, Carey pleaded:
we see the statement that there is no diagnostic test for ADHD and
that
the causes of these behaviors called ADHD are entirely speculative.
And yet, out there in the real world, across the real land, parents and
children are being told that these behaviors are due to a brain
malfunction. Can you not please strengthen the statement to discourage
practitioners from making this statement when there is not adequate
proof to support that at this time?
Here, from Carey, was further proof that the ADHD “industry,” leaders of
which dominated this conference, convey to practitioners and public
alike, that ADHD is a disease due an abnormality in the brains of the
children–a willful perversion of the scientific record and of
requirements of informed consent. This is where the nationwide and
worldwide epidemic of so-called ADHD is coming from. The only real
disease these children have, reprehensibly enough, is
Ritalin/stimulant/psychotropic (otherwise) encephalopathy (brain damage)
which automatically, invariably, follows the ADHD diagnosis. In fact,
97% of kids with ADHD who see a psychiatrist end up on drugs; 49% end up
on two or more drugs. (Clinical and Treatment Characteristics of
Children With Attention-Deficit/Hyperactivity Disorder in Psychiatric
Practice, J. Am. Acad. Child Adolesc. Psychiatry, 1998,
37(12):12621270.)
In the April 29, 1999, JAMA (page 1490), I wrote:
Once children are labeled with ADHD they are no longer treated as
normal. Once methylphenidate hydrochloride or any psychotropic drug
courses through their brain and body, the are, for the first time,
physically, neurologically, and biologically abnormal.
In 1968, the APA, in its DSM-II, defined “homosexuality” as a mental
disorder. They categorized it as one of the “Sexual Deviations.” Just
as quickly, they ended the “epidemic,” voting to remove it as a mental
disease in 1973. A story in Time magazine, (April 1, 1974, p. 45)
entitled “An Instant Cure,” took note of the fact that the 1987
edition of The Merck Manual of Diagnosis and Therapy states: “The
American Psychiatric Association no longer considers homosexuality a
psychiatric disease” (p. 1495).
Had their been a forthright confession to the press and public at the
NIH Consensus Conference that ADHD has never been validated as a
“disorder,” a “disease,” or anything abnormal in the child, the ADHD
epidemic, could likewise, with a stroke of a pen, have been brought to a
merciful and fitting end.
In the meantime, there is no validity to any treatment or research that
represents, by way of informed consent, that ADHD is a “disorder,” a
“disease,” or, as anything, neurological, biological, or organic. No
medical association, or state or federal medical board or agency should
be a party to calling things diseases that are not diseases in a true
medical sense, having a confirmatory physical (including chemical)
abnormality.
Cmr1234@aol.com wrote: I am suspicious of the AMA because their CA State Boards are persecuting Dr. Sinaiko whom you probably already know about. And they have persecuted other physicians who never harmed a patient, just for employing "non-approved methods" which happened to help their patients.
[Dr. Baughman: the prob with all
this, all alt med is there is no evid these children have a disease, all is
home-school cause; less than optimal, usually far less than optimal teach,
parent]
Dear Fred: Do I understand that you are writing off ALL “alternative”
health treatment?
There’s a great gray area between optimal health and something that can be
measured as a “disease.” I have met and talked with people who have cured
themselves of conditions/diseases for which their doctors told them there was
no cure. They did it by changing diet and some “lifestyle” practices. I
myself have found beneficial changes in my skin and circulation from
de-toxification and changing to more vegetarian eating habits. Yet no
physician would have pronounced me “diseased” in my original condition.
We’re dealing with a continuum of wellness from optimal homeostasis of all
body systems including immune function, to marginality which defies
measurement but increses vulnerabilities to stresses of all kinds.
Even though the orthodox medical profession does not presently recognize
some of these alternative procedures as “approved,” I submit that there are
subleties that are not presently understood, and may not qualify as
“disease”
in your terms. But they are ranges of vulnerability which ultimately may
be
discernable only by the caring expertise of medical professionals such as
yourself, and colleagues who put finding ways to help the patient as the
top
priority. This is the pursuit of science in the spirit of Arthur Clarke,
in
this case pushing the envelope of understanding of all these cases of
kids
being helped by any of the practices I mentioned.
I remember a student back in my learning center days, a fifth grader who
was
supposed to be on the Feingold Diet. One day when he came in for his
lesson
his motions and efforts were just not as focussed as usual, and was making
a
difference of roughly two grade levels in his ability to perform to our
standards of 90% accuracy. I said, “Andy, are you OK with your diet and
all?” He said, “I had some candy. Don’t tell my mother!” I said,
“She’s
going to know the minute you walk in the door!”
And there were mothers — more than one — who could tell from forty yards
away if their child had violated his diet. But no doctor would have
declared
them “diseased.” There are subleties which medical people have not yet
found
a way to quantify by their present belief systems. But if these
conditions
manifest in visible ways at some level, eventually medical science will
refine its analytical procedures to define what’s happening.
Three years ago, before participating in Gary Null’s de-tox workshop, I
had
some brown “age spots” on my hands and face, also chronic nasal
drip/congestion. These are now all gone. Enzyme replacement therapy and
the dietary changes recommended via the testing of the chiropractor who
practices it have raised my energy levels and improved my Reynaud’s
syndrome
in the fingers of my right hand, and helped with some prostate/bladder
annoyances. (I believe the research on this is from a Dr. Arthur Loomis.)
I know a lady who cured herself of Lupus by careful diet and lifestyle
changes. It took her about three years. And there are many more
stories.
I don’t understand the mechanisms of kinesiology or accupuncture, or
Scotopic
Sensitivity Syndrome (aka “the Irlen Effect”), but of the latter I can
quantify the person’s improvement in performance when I find a combination
of
filters that help him see the print more stably. I don’t understand the
physiology of auditory processing deficits, but I’ve measured them with
the
Lindamood Auditory Test, and know that the Lindamood people have been
treating them for over 40 years. They helped John Corcoran, who spent 100
hours with them and has nothing but praise for their help.
The way I heard it, Dr. Sinaiko got a raw deal from the CA Medical Board,
defense testimonies were arbitrarily rejected without evaluation, etc.
Someday we/you will find a way to quantify the subtleties of immune
functions, and the effects and patterns of various kinds of homeostasis or
lack thereof. There are so many new toxins and irritants in the
environment
and the food chain (plus un-labeled genetic engineering). We owe it to
the
public to keep trying.
Charlie