Amidst all the recent tragedy, you may have noticed what appeared to be some good news. A Senate Committee last week called for more support for Australians with ADHD (attention-deficit/hyperactivity disorder).
Following submissions and hearings, the committee recommended better access to ADHD diagnosis and treatments. It also made a specific call to implement guidelines for health professionals.
So far, so uncontroversial, right? Well, maybe.
Controversial disorder
ADHD can be seen as a ‘highly controversial disorder’ as it’s been described in The Conversation.
A once rare childhood phenomenon, the boundaries have been pushed wider and wider. Symptoms have blurred with aspects of ordinary life, and now it’s promoted as an adult condition as well, with claims one-in-ten people are affected.
Central to that promotion have been pharma companies, cashing in on expanding markets for their meds – largely amphetamines – often funding patient and professional associations to help frame ADHD as widespread, severe, and treatable.
Today, social media makes dissemination infinitely easier. A recent analysis of 100 ADHD TikTok videos found they’d had 280 million views, yet half were classified as misleading and potentially contributed to an ‘increased risk for overdiagnosis or misdiagnosis’.
The number of ADHD prescriptions, and the numbers being prescribed, are skyrocketing in Australia, rising more than ten per cent annually. Following the money doesn’t explain the whole story, but it’s a start.
Follow the money
The Senate Committee last week recommended implementing guidelines from the ‘ADHD Professionals Association’. The president, vice-president and past-president of that association have all taken speaking fees from drug-makers, such as Novartis, Lilly, and Shire.
Their conference sponsorship is dominated by drug companies, including Takeda, which famously bought Shire recently for almost A$100 billion.
Similarly, the ADHD professionals’ association in the US is entangled with industry, where drug companies also sponsor conferences.
The US association president – a Las Vegas psychiatrist – has accepted research, speaking and consultant fees from more than 20 companies, totalling almost A$6 million in the past 7 years alone.
Close to 50 per cent of authors of a recent ‘ADHD International Consensus Statement’ disclosed receiving money from drug companies.
The problem here is the assumption that long-term treatment is safe and effective, according to Jon Jureidini, University of Adelaide professor and child psychiatrist.
‘There is very little good evidence to support long-term treatment, and the guidelines do not engage sufficiently with potential long-term harms’, says Jureidini.
A quick look at the product information for Takeda’s blockbuster ADHD amphetamine, Vyvanse, reveals potential harms can include supressed growth, aggressive and psychotic behaviour, higher blood pressure, and dependence.
Much of the evidence for ADHD treatments, whether drugs or talking therapies, shows modest improvements in symptoms, with minimal side effects, but studies tend to be short-term.
Complex causes
Professor Jureidini is part of the Critical Psychiatry Network. It’s Senate submission made clear there’s a cluster of symptoms known as ADHD – across inattention, overactivity, and impulsivity – and these disturbances clearly occur.
Unlike other groups they don’t see ADHD primarily as a neurobiology problem, but instead point to multiple dimensions including learning disabilities, grief, trauma, abuse, family dysfunction, bullying, hunger, poor eyesight, incompetent teaching, and poverty.
‘The ADHD label should not be conceptualised as an explanation for children’s distress and/or dysfunction,’ said their submission. ‘ADHD is more a diagnostic question than a conclusion.’
Jureidini’s submission also pushed back against moves to add ADHD to a list of conditions commonly covered by Australia’s NDIS disability scheme.
‘The label of ADHD can be applied so broadly that it could overwhelm the NDIS system and people with severe physical and intellectual disabilities may miss out.’ It seems this argument won the day, as the Senate committee fell short of recommending that change.
The ADHD debate is part of a wider one.
‘We’re taking everyday experiences that are part of the human condition and we’re overdiagnosing them as mental disorders,’ says Dr Allen Frances, the US psychiatrist who once oversaw the writing of the psychiatrists’ manual DSM (Diagnostic and Statistical Manual of Mental Diseases), before becoming its harshest critic.
On ADHD: ‘I think we’re doing a massive worldwide experiment on immature brains, bombarding them with very powerful chemicals without any knowledge whatever about what the long-term outcome will be and without informed consent,’ Frances told me a few years back.
No doubt doctors who run professional associations, and senators calling for better access to treatment, are motivated by goodwill.
Witnessing and acting to help another who is suffering, defines what it means to be human.
Yet surely offering sympathy and support does not mean we suspend our critical skills, or our need – acute in medicine – to follow the money.
A former Harkness fellow at Harvard and columnist with the British Medical Journal, Dr Ray Moynihan is author of four books on the business of medicine.
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