Pencil, Pens and Meds. LA Times Editorial Stigmatizing ADHD Get’s Fisked By Gina Pera

I wish more people fisked ADHD stigmatizers.

The term fisking, or to fisk, is blogosphere slang describing detailed point-by-point criticism that highlights errors, disputes the analysis of presented facts, or highlights other problems in a statement, article, or essay.

Karin Klein an LA Times editorial staff writer wrote an editorial in the August 20th, 2007 issue entitled “Pens, Pencils and Meds”, which I thought just piled more unneeded stigma on people with ADHD. It unfortunately, got picked up by many other newspapers, websites, and blogs, further spreading the stigma and ignorance.

I recently got an email from her saying she was on the Pulliam Fellowship, so she can work full time on an in-depth project in ADD and asked me to help her find mothers with ADD to interview.

Being the curious type, I googled her and found this editorial Karin Klein wrote last August. I wrote back saying I declined and citing her article and made a few points about the stigma against ADDers it created, and that I didn’t want to help her create more stigma against ADDers.

However Gina Pera, a journalist and mental-health activist, did a much more thorough job than me rebutting Karin Klein’s editorial, and with her kind permission I’m reprinting Gina’s rebuttal. Karin Klein’s editorial is in blockquotes, Gina Pera’s comments are in regular text.

If you think that this sort of conte, t stigmatizing people with ADD doesn’t belong in the LA Times you might want to let her editor Jim Newton jim.newton@latimes.com know how you feel.

Enjoy.

Pencils, Pens, Meds

As kids head to class, pharmaceutical companies ramp up their drug marketing — and it works.

It works because too many parents don’t realize their children have ADHD — and their doctors don’t, either — until they get to school! It works because many parents themselves have undiagnosed ADHD, and they do not recognize it as such in their children.

It works because our society is in massive denial about ADHD and sometimes the most effective method is appealing directly to the people who know that it is real – and it is significant.

By Karin Klein

August 20, 2007
Back-to-school season is in full swing. Time to pick out a backpack, sneakers and a stimulant medication for attention-deficit hyperactivity disorder.

Disgusting lead. Cheap, cheap shot.

Nearly 2 million children in the United States are diagnosed with ADHD, which is marked by poor concentration, lack of self-control and/or hyperactivity. Besides time off from school, many kids with ADHD get a summer “vacation” from the prescription medications that help them focus in class.

That is outmoded thinking. Experts today recommend no medication “holidays” because ADHD impairments extend far beyond “focusing in class.” They include deficits in social skills and driving/sports safety and vulnerability to substance use, promiscuous sex, STDS, unplanned pregnancies, and many other risky behaviors.

So, not only is she reinforcing old ideas — that there are medication holidays and that medication is used solely for focusing the classroom — but she is also implying that all children receive stimulant medication callously.

Instead, for the vast majority of parents that I know, it is a very painful process of coming to accept the medical nature of their child’s difficulties—-usually after a long process of trying every other alternative–and finding the best way to help them. They don’t need Ms. Klein heaping ignorant blame on their heads.

(Full disclosure: I have no children, and if I did, I know this would be a tough decision. But I have met many, many parents who have helped their children immensely by seeking medical treatment for them. For many, family life can still be quite tough. These parents deserve all the support we can muster, not fear-mongering.)

So August has become a prime time to market the idea that a change in drug for the new school year (Concerta to Adderall?) might help the kids focus better, keep them going longer or have fewer side effects. Direct-to-parent marketing of ADHD drugs — most of which are stimulants — has grown pervasive over the last few years, despite a United Nations treaty banning most of it. Use of such medications increased by more than 60% from 2001 to 2005, according to the International Narcotics Control Board.

Why does Ms. Klein not cite the studies showing that general practitioners aren’t comfortable with their ability to accurately diagnose or treat ADHD — hence the need for the advertisements in the first place?

At least here she does give one useful piece of information, though accidentally, I’m sure: Some people do respond much better to one class of stimulant over another. And, what does she mean.,..”keep them going longer,” as if these parents are trying to create little Energizer bunnies? That is preposterous.

This month’s homemaker-targeted magazines, such as Family Circle, Woman’s Day and Redbook, feature advertising spreads for Vyvanse, Shire US Inc.’s new entry in the growing stable of ADHD medications. The ads show “Consistent Kevin through the day, even through homework,” picturing a well-groomed boy smiling as he wields his pencil through a work sheet, and “Consistent Sarah,” who even at 6 p.m. contentedly pecks away at the piano keys.

Homemaker???? What decade is she living in?

Ms. Klein might deride the benefits of a child being “consistent,” but for many children it is their dearest wish. Instead, they think it is their failing that they cannot be consistent. Consistently do as well as they know they can. Consistently make and keep friends.

Ms. Klein obviously has an agenda. With her education in psychology and linguistics, perhaps she is of the mindset that these children are being forced into mindless conformity. She can’t be bothered with good old shoe-leather reporting. She’s making this up as she goes.

ADDitude magazine, published for people with ADHD, has ads for four medications. One ad touts a flavored, chewable form of methylphenidate with the slogan, “Give me the grape.” (Methylphenidate is best known under the trade name Ritalin, which is not among those drugs advertised.)

Many people with ADHD have sensory sensitivities, including one that precludes swallowing pills. How else do you suggest getting sensory-defensive children surrounded by stigma to adopt a more comfortable relationship with taking a medication?

And, are not children’s eyeglasses made in appealing styles, so that children feel less stigma about wearing them? (And adults’ eyewear as well?) But in truth, this type of flavored medication is in the minority. Again, she is cherry-picking to suit her biased purposes.

Ads for candy-flavored methylphenidate are a far cry from the vision set forth in 1971 by the Convention on Psychotropic Substances. So far, 159 countries, including the U.S., have agreed to ban consumer-targeted marketing of psychotropic medications — which all these ADHD drugs are — that carry the potential for addiction or dependency. For decades, pharmaceutical companies abided by its provisions.

Since when is grape a candy? But, finally a news peg, such as it is. Why not just focus on that, instead of the preceding diatribe? Because that would not suit her bias?

The fact is, in 1971, we knew very little about the brain or that medical disorders related to the brain might not be obvious. Perhaps the true point of the story should be the need for revising this musty convention. There are all kinds of forgotten laws on the books, ones that no longer apply to modern life.

I would have to see which 159 countries want to ban such marketing. Perhaps their worst fear is an educated populace — one that would learn about the possibilities of medication and then start demanding it. How odd that a journalist would be promoting censorship.

But in 2001, one company began buying ads in the September issue of women’s magazines in the U.S. to draw attention to Metadate CD, a long-acting form of methylphenidate. Other companies quickly followed suit.

Called on the carpet by the U.S. Drug Enforcement Administration,

that great arbiter of neuroscience and mental health.

lawyers for the drug companies vowed to defend themselves under the umbrella of 1st Amendment speech rights. According to former DEA officials, the Department of Justice was unwilling to test this one in court.

Perhaps with good reason.

Six years later, the results are dramatic. Doctors and therapists increasingly see parents seeking to change their child’s medication or coming in with their own diagnosis of ADHD and suggestions for medications they have seen advertised. Many of the companies offer coupons for a free trial supply.

HOGWASH. Critical thinking, please! Research, please! Ms. Klein is drawing a clear correlation between ads and an increase in diagnosis? I should tell that to the thousands of volunteers that I know who have worked doggedly to get this issue on the map — and are still doing so: “Folks, it’s nothing you’ve done. It’s all the ads! Gee, we could have all relaxed and gone to the beach.”

Ms. Klein needs to learn the first rule of science ( I think I learned this in journalism school): CORRELATION IS NOT CAUSATION.

Children in the U.S. are 10 times more likely to take a stimulant medication for ADHD than are kids in Europe. In fairness, children in Europe are also somewhat less likely to be diagnosed with ADHD because of a stricter set of criteria. But that doesn’t nearly account for the difference in prescription rates. The U.S., the only nation to violate the U.N. treaty, consumes about 85% of the stimulants manufactured for ADHD.

Well, I’m glad she’s trying to be “fair.”
In the UK alone, alcoholism rates are through the roof—just one of the presumed side effects of untreated ADHD.

Reports from fellow volunteers throughout the rest of the world absolutely bemoan the lack of medications in their home countries and the ignorance of their national health systems.

The ones who can afford it come here, load up on medications, and fly home.

The ones who don’t suffer. Does Ms. Klein know about this? Or does it not fit her paradigm – or the hypothesis for her book?

The medications are very expensive. NHS usually doesn’t want to pay for them. You want stories of the pain and loss of human potential this causes? I can supply them in spades. People in other countries are in awe of our medical advances; they are envious.

Though the drugs do not appear to be habit-forming in children with ADHD, there’s a rising black market for methylphenidate and similar drugs. A report last year by the National Institute on Drug Abuse found that teenage abuse of prescription stimulants was rising.

It is no surprise, when papers like yours stigmatize the use of medication — and the very idea of ADHD — that many people go undiagnosed and instead go “underground” with their need for stimulant medication. Don’t even get me started on the methamphetamine connection to undiagnosed ADHD in our nation’s rural areas.

But again, what is Ms. Klein’s point? That the ads are causing this stimulant abuse? Again, hogwash. In my college days, students abused speed or No-doz.

Drug companies would argue that increased production and use of ADHD drugs are the result of better diagnosis and treatment.

Many medical and epidemiological experts would argue that, too. And as for the people with ADHD, they cheer on Big Pharma, because they know that novel medications and delivery systems mean that each person has a better chance of finding a medication that works best for them.

But the International Narcotics Control Board holds advertising responsible. In a report earlier this year, the board noted that from 2001 — when the ads first appeared — to 2005, medical consumption of methylphenidate increased by 64%.

The International Narcotics Control Board????? You’ve got to be kidding. Is that the best Ms. Klein can do? This is supposed to be some big scoop? Who cares what this “quasi-official” body thinks?

Why don’t you talk to our own National Institute for Drug Abuse (NIDA), where the brilliant scientist Dr. Nora Volkow could set you straight about the ADHD, the brain and substance abuse.

This just gets worse and worse.

“That large increase was mainly a result of developments in the United States, where the substance is advertised in the media, directly to potential customers,” according to the report.

By continuing to cite this report from this very controversial body, she is giving more credence to it. Yet, she has not quoted one authoritative medical expert. Time to enter the 21st Century, Ms. Klein.

Ms. Klein accepted this grant to be an editorial writer at the LAT with this statement, sounding more like a psychodynamic-oriented psychologist with an agenda than a journalist:

“I am so very grateful to the Society of Professional Journalists and the Sigma Delta Chi Foundation for the opportunity to pursue a project that has been of enormous interest to me. The Pulliam Fellowship will allow me to extend our understanding of a population that has in large part been quietly struggling, and to probe our own, unexplored attitudes about normalcy, differentness and isolation,” said Klein.

Back to Karin Klein’s piece

The Food and Drug Administration should move forward with rules to bring the U.S. into compliance — in conjunction with the Justice Department. There’s legitimate debate about Americans’ rush to diagnose and medicate children who fall problematically outside the norm. In some cases, the drugs are the only thing that keeps a child from being expelled for aggressive behavior, or falling into the foster-care system, or believing that he is an impossibly bad or stupid kid. Yet other countries are making do with far less of the medications.

Making do? Making do? People aren’t making do. They are hobbling through – and suffering tremendously. What is Ms. Klein arguing for? Dumbing down the medical care in this country to meet the low standards of the rest of the world?

Oh, and there’s her throw-away line — just so no one can accuse her of being totally ignorant about ADHD. Sorry, that’s not nearly enough to get her off the hook and convince anyone that she has a modicum of knowledge on this condition, especially not coming on the heels of so much drivel.

Powerful psychotropic medications should be an option of last resort and uninfluenced deliberation, not another brand-name product to add to the back-to-school shopping list.

As if that is how parents make this decision? They most certainly don’t, but Ms. Klein will do her best to make them ashamed of their action and reconsider it — against all good reason.

And deliberation uninfluenced by what? Scientific evidence? Medical opinion? A desire for a happy, self-actualized life?

And why a last resort? On whose authority? Should people be denied eyeglasses unless they can’t see but two feet in front of them? Who the heck is she to decide how much access someone has to his or her brain?

Does she have any clue about the comorbid physical conditions often accompanying untreated ADHD? Does she know about the health risks from on-the-job accidents, and all the rest?

Oh, please. This is an embarrassment to a large daily newspaper. Please do better.