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According to One Doc, The New York Times has Successfully Ostracized all the Mental Health Docs we want to Talk!

The New York Times recently posted an article titled, “Thousands of Toddlers are Medicated for ADHD,”  which mentions that around 10,000 2-3 year olds are on medication for ADHD outside of proper pediatric guidelines.  The article was written by Alan Schwarz who has been writing about ADHD in the Times for a while now.  He also happens to be biased and biased in the same direction as me.  One of his earlier articles in 2013, titled, “The Selling of ADHD,” should make his bias evident.  It is not exactly a neutral headline.

I am the chief editor for a mental health newsletter that promotes alternatives over medications for treating mental illness. I had a terrible experience on anti-depressants myself. I think medicating two to three year olds for any sort of mental condition is ludicrous, and on some days, you might even hear me call it child abuse.  I do not believe there is a two or three year old crazier than the act of medicating a two or three year old with amphetamines, the drugs commonly prescribed for ADHD.  So I side with Schwarz most of the time.

That said, I have been steadily working to keep my own bias in check when it comes to controversial topics like medicating children for mental disorders.  Through my wellness endeavors I have met parents who have a child on medication and explain to me that it was a last resort, that they felt helpless and that their child is doing better on the medication.  For example, I recently talked to a mom who had a defiant child with ADHD who was now on medication and doing a lot better.  Now her child is able to sit still and do his homework and is no longer failing out of the first grade.  I am Irish, extra stubborn and hotheaded, and let me tell ya: It is a humbling experience to recognize and muzzle your bias on tough issues you feel so strongly about. The reactive part of me wanted to yell at her, “How could you give your 6 year old an amphetamine? What about the long-term side effects?  Maybe he is just being a kid?  Kids go through a million and one awkward and weird phases, just let them be!”

I went away from that conversation thinking to myself, “There is no way she tried everything. There is now way medication was her last resort, she is just saying that.”   So, yes. It is a struggle to muzzle your own bias.  Recognizing that fact, however, and just being open and honest about it with myself and others, I think ( I hope)  has made me a better scientific investigator.  I am now better at investigating an issue and keeping my bias to a minimum before preemptively jumping in and calling someone an idiot.   But, it is always a struggle, and I still may call them an idiot just for the heck of it.

Realizing I continually have to hear all sides of a story, I recently reached out to a psychologist, Dr. Russ Barkley of South Carolina, who is one of the premier researchers on a possible new pediatric mental disorder, Sluggish Cognitive Tempo. Sluggish Cognitive Tempo is still being defined, but it has been described as an attention-deficit disorder that is unique from ADHD. Barkley is a big believer in Sluggish Cognitive Tempo and has a large evidence base for it.  He has also been criticized for being paid over 100,000 dollars by the drug company giant,  Eli Lilly, for giving lectures on their behalf.  Eli Lilly has funded research on Sluggish Cognitive Tempo, and specifically research that tests one of their drugs, Strattera, as a possible treatment.

I am biased against doctors like Barkley, but of course I would be: He is a doctor who is trying to create a new mental disorder for kids and he’s a doctor who gets paid by a massive drug company to speak on their behalf.  Still, and always, a responsible and thoughtful investigator should hear all sides of an issue to have the best possible picture of a complicated, controversial issue, even if that means punching your punching bag a few times before sitting down to talk to him.

I found his email, wrote a thoughtful letter explaining who I was AND my bias, and asked him if he would be willing to do an interview on Sluggish Cognitive Tempo and how one could distinguish it from normal childhood behavior.  He wrote me back the following email:

  “Sorry but I am not available for such an interview.  You can find all of the information on SCT that is known in the research literature in the Fact Sheet on this condition on my website under the Fact Sheets directory.  Here is the article of mine that led the NYTimes sports journalist to contact me for an interview, which I and other clinical scientists working in this area refused to do given his past sensationalized articles on ADHD. I hope you find these informative.

    Best wishes,

   Russell A. Barkley, Ph.D.

   Clinical Professor of Psychiatry and Pediatrics
   Medical University of South Carolina
 
 I was disappointed he declined since I have nothing to do with the NYT and would have presented his side as he presented it to me.  I also found it extremely discouraging that, according to him, not only is he refusing to do all interviews, but EVERY clinical scientist doing research on Sluggish Cognitive Tempo is refusing to talk.  If what he says is true, that is if the New York Times writer has sensationalized  his articles on ADHD to the point of all mental health doctors in the field now refusing to do interviews, well that is a darn shame.  Because then we, the public, are surely only getting one side of the issue, even if we think that one side is the absolute correct one.  If Barkley is, perhaps, the one being sensational in his email to me, and not all clinical researchers on SCT have sworn to silence, then I hope the ones who haven’t speak up about their research and why they feel it is necessary to create another pediatric mental illness. If those researches choose to keep quiet, then such behavior gives credence to the theory that money-hungry doctors and drug companies are definitely conspiring to put young kids on medication, thereby increasing the probability of having life-long customers.  If people refuse to talk, money always will.
  I replied the following to Dr. Barkley:
    “Okay, Doctor Barkley, and thank you for the information. I do appreciate it, and I will look it over.  I’m especially interested if, such a disorder exists, there are alternatives approaches that parents/ guardians can try first, rather than immediately choosing a medication route  My greatest concern, as a doctor and a compassionate citizen, is the unknown long-term side effects of amphetamine-like drugs on children.  I’m also interested in how doctors can distinguish a passing phase from an actual problem– especially as the NIMH director is about to wipe out the DSM.  ( I know this disorder is not yet in the DSM, but it appears as if the entire diagnostic approach is going to change.)
  I completely understand your reluctance to do the interview, but in my humble opinion, the media portrays anyone who refuses to do an interview in the worst possible light.  It also makes the clinicians/individuals who refuse to do an interview more suspicious.  I think people are losing confidence in psychiatry, because without understanding the science/research behind newly proposed disorders, especially ones involving children, it only fuels the conspiracy that doctors are in cahoots with drug companies to invent new disorders to be treated by a specific company’s drugs. I’m guessing that is why you were criticized for being a paid speaker for Eli Lilly.  ( For the record, I’m not criticizing you. While I think relationships as such between drug companies and doctors can breed corruption, I’d much rather see direct-to-TV drug commercials nixed.)” 
I also find it odd that the NYT would have a sports writer interview you. I do not know which writer you are referring to, but that’s bizarre.   I’ll have to see which one.
Thanks again for the paper.
Best wishes as well,
Erin”
 Dr. Barkley replied with a short and sweet, “Be Well.”  
 I’m sure his “Be Well,”  is code for “F off,” but I can’t say I blame the man. After all, I called him out.

 

 

One Response to “According to One Doc, The New York Times has Successfully Ostracized all the Mental Health Docs we want to Talk!”

  1. Hi Erin.

    You and I have discussed much of this before, quite extensively. I completely agree with your approach – and I also agree with your interpretation of the good doctor’s “be well” message.

    You can tell that one side of the debate team is offside when they stop engaging. Fear is a big factor – and as far as I’m concerned, where there’s money involved….well, you get the picture.

    I like and appreciate your approach to the whole question. It’s got to be tough – and hard on the tongue, what with all that biting going on – to keep still and listen to what the other side has to say. Of course it would help if the other side actually *said* something, rather than be so righteously dismissive of any other views than their own.

    The notion of a three year old getting medication alarms me as well, and I have very little medical knowledge. Just the thought of one of these little ones gulping down amphetemines brings a chill. I think, as time goes on, we’re learning more and more about conditions like ADHD – and we’re discovering that medication is only one of a myriad of tools that can be used to manage it. My hope is that doctors and lay people will gravitate away from the idea that medication is the first stop in treating it.

    Juxtaposed against this hope is the vision of my nephew who, yet to be diagnosed, is simply a non-stop windup doll. I’ve grown up with unruly kids, kids who can’t keep still and kids who get into trouble all the time. Never have I seen a kid like this. My sister, knowing my own diagnosis of ADHD, asked me about it. She wondered if I thought he had it. Internally, I was shouting “YES. OH GOD YES. If he doesn’t have it, I’ll eat my shirt”. Outwardly I said, quite rightly “where there’s a possibility, you should have him tested by a professional. That’s what I did, despite the fact that everything pointed to it.”

    The reason I was so inwardly confident he has it, involves more than just his non-stop hyper behaviour. It’s the fact that there’s a family history of it. The concensus among professionals right now is that it’s an inherited condition. Medical professionals also agree that, absent testing, wrong conclusions can be reached quite easily. The testing I went through was extensive, and was designed to ensure that other possibilities were ruled out first.

    People are way too quick to label each other. Whenever I hear someone say that “so and so” has ADHD, I’ll respond with “really?” and then I’ll ask them two questions.
    1) When was he medically diagnosed?; and
    2) “Which one of his parents has ADHD?”

    There is a lot of talk about the condition being merely mislabelled, and that with kids in general eating copious amounts of sugared products, it’s no wonder they’re flying around the way they do. So, how does one determine whether his child should be tested for ADHD, versus having his diet looked at?

    A good indicator: if your child flies around, and then abruptly crashes or even falls asleep, chances are high that sugar is the culprit.

    An ADHD child does not have an “off” switch, and even has trouble falling asleep at night.

    One other thing: ADHD doesn’t always manifest in hyperactivity. The other version of it – the one I have called the “inattentive type” – doesn’t have a hyper component at all. It shows up as an inability to complete projects because of an inability to focus. (That’s the simple one-note version. The more complex answer would take too much space here.)

    Probably a good way to describe it is like this. Think of a map of a maze. The average person will tackle it, trying to find the best way to get from point “A” to point “B”. They can focus on that little dot as they work their way through the maze.

    The inattentive ADHD person has no choice but to see the whole thing at once, and can’t help noticing all of the turns and lines. He notices patterns and, just when he goes to start somewhere on the map, he realizes he’d KILL to have an orange right now.

    Getting back to the original point: I honestly can’t see how anyone can diagnose much of anything in the mental arena in a kid who’s three years old. Other than the parents’ histories, there’s just not enough data yet to go on. I mean, it took me a few decades before I realized I should get tested. (Of course, they didn’t know much, if anything about ADHD back when I was a child).

    I don’t know if I’ve contributed much to what you’ve said, Erin. I dislike that doctor for not holdling up his side of the conversation though.

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