- Gabor Maté
physician and best-selling author of four books, including Scattered: How Attention Deficit Disorder Originates and What You Can Do About It. His latest book is In the Realm of Hungry Ghosts: Close Encounters with Addiction.
- Alan Schwarz
an award-winning New York Times reporter who has extensively written about attention deficit hyperactivity disorder. His most recent article, "The Selling of Attention Deficit Disorder," looks at how the number of diagnoses soared amid a 20-year drug marketing campaign.
In part two of our discussion with physician Gabor Maté and New York Times reporter Alan Schwarz, we discuss how attention deficit disorder manifests in children and adults, and how past abuse of drugs used to treat its symptoms helped lead to the passage of the Controlled Substances Act. Maté notes that medication is not the solution for everyone who shows symptoms, even if they are properly diagnosed.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman. Part two of our discussion about the selling of attention deficit disorder. We’re joined by Alan Schwarz, who is the award-winning New York Times reporter who has extensively written about attention deficit hyperactivity disorder, or ADHD. His most recent article, on Sunday, front-page piece of The New York Times, looks at how the number of diagnoses soared amidst a 20-year drug marketing campaign. Yes, it’s called "The Selling of Attention Deficit Disorder."
And we’re joined in Vancouver, Canada, by Dr. Gabor Maté. He is the physician and best-selling author who, among his books, has written Scattered: How Attention Deficit Disorder Originates and What You Can Do About It.
Let’s start with Dr. Gabor Maté. You have been dealing with this issue for a long time. You see ADHD as a very serious issue for children, as well as adults. In fact, you were diagnosed yourself as an adult. So, how do you reconcile that with the drugging, the massive drugging of America’s children? We don’t even know the numbers. I think it’s 3.5 million between the ages of four and 17, but it’s not counted in the United States beyond that.
DR. GABOR MATÉ: As Alan Schwarz indicated, it’s a genuine problem that does affect a lot of people, myself included. The question is how to understand it and how to deal with it. And the first thing to say is that not everybody who’s got trouble paying attention or has impulse-control issues has ADHD. There’s all kinds of other reasons why people might have various manifestations. So to put them all into the ADHD basket is to ignore the complexity of human behavior.
Secondly, to make the assumption that even if somebody has these traits, and even if they have them over a lifetime, that the significant or the only answer is medication is to ignore, again, the complexity of the human brain and human behavior. So, what we have here is a vast oversimplification of what is a fairly sophisticated problem. And it’s that oversimplification then that the pharmaceutical companies exploit to their great advantage, as Alan has documented.
AMY GOODMAN: Alan Schwarz, how did you get interested in doing this investigative series? I mean, you were the sports guy at The New York Times. You were writing, actually, about concussions.
ALAN SCHWARZ: Yeah, I was a sports guy at the Times. I was lucky enough to be able to cover the concussion issue from the beginning and get to break a lot of stories in that realm. And then, when I was a little tired of that, when I heard that high school kids were snorting Adderall before the SATs, I questioned: How much pressure are we putting on these kids? I don’t think they want to do this. And so the first story that I did was in the context of academic pressure and what some kids will do in order to deal with it.
And after doctors—doctor upon doctor upon doctor—told me that, "Oh, this is not an overdiagnosed condition; this is underdiagnosed," and I looked at the numbers, and it was—it’s a preposterous assertion. I said, "Wait a minute. What are the doctors doing here? What are their motivations? What are their biases? How do they misunderstand probability and statistics?" And so, I looked into it further, and there were so many issues at play here, with regard to why doctors prescribe, how often doctors prescribe.
I think one of my regrets is that I haven’t been able to do a story on the good that Adderall can do. I try to acknowledge it in my stories. But, of course, it’s a good drug. What we have to be careful of is, how do we use it?
AMY GOODMAN: Explain its origins, Alan Schwarz.
ALAN SCHWARZ: Sure. Well, Dexedrine, an amphetamine, were around for a very long time. Benzedrine used to be an inhaler in the 1930s and '40s, straight amphetamine, and people abused it then. They would take out the little soaked gauze pad and put it in their mouths in order to abuse amphetamine. And then Dexedrine became on the market in the ’50s and ’60s. So did Ritalin, by the way. And it was so abused among college students and adults in the late ’60s that that's why we now have the Controlled Substances Act, was because of the Dexedrine epidemic. Now, cocaine took over in the '70s and ’80s. But then, of course, that became—you know, it's obviously illegal, and other issues.
But then, attention deficit disorder became so well known and so accepted among parents, and perhaps even appropriate for a lot of the kids in the '80s and ’90s who got diagnosed—Jamison Monroe notwithstanding—what you see is that there's now a very easy mechanism to get amphetamine if you want it. If you need it, you can get it, yes, but if you just want it, you can get it, too—free amphetamine, because it’s covered by insurance. And so, when a pharmaceutical executive named Roger Griggs, who had his own little—relatively little pharma company, he heard that this diet pill named Obetrol, OK, might have an application to this relatively newly appreciated childhood condition called—what was it?—hyper—I’m sorry, I’m forgetting right now. Oh, minimal brain dysfunction, which is a—
AMY GOODMAN: That’s what it was called at the time.
ALAN SCHWARZ: Yes, a charming—a charming name for it. But, OK, fine. And he said, "Gee, I wonder if this could treat that." And, lo and behold, it could. But, of course, it’s been well known that amphetamines, you know, and diet pills have been abused. Hell, there was a Family Ties episode about it in 1984. And so, this has been a long-standing issue. I think now the main problem is that 15 percent of children, by the time they graduate high school, have been told that there is something basically permanently wrong with their brain chemistry, for which some of the most addictive and abusable substances known to medicine are the primary antidote. Now, a lot of people can take them just fine. It’s not the devil’s drug. We’ve seen a father talk about his son who committed suicide after, and we want to be careful that—
AMY GOODMAN: That was part one of our conversation with John Edwards.
ALAN SCHWARZ: That was, yes, part one of our conversation. But it’s not as if every kid, or even 2 percent—I mean, no, that’s an extremely rare, terrible disintegration of these people’s minds. We have to realize, you can take it safely. Just look out for the signs that things are going wrong.
AMY GOODMAN: Gabor Maté, weigh in here.
DR. GABOR MATÉ: Yes, well, about that particular James Edwards—is that the boy’s name?
AMY GOODMAN: John Edwards, Johnny Edwards.
DR. GABOR MATÉ: You know, the father—part of the issue is how the diagnosis was made. I mean, you don’t make a diagnosis by asking a college kid if he’s got trouble concentrating, because there’s all kinds of reasons why he might. Depression could have been another reason why that kid had all of a sudden trouble concentrating. You have to take a lifelong history. You actually have to talk to the family. You have to have information from the school that he went to as an elementary and a high school student. In other words, it’s a lifelong diagnosis. It doesn’t come along all of a sudden in college. And you don’t take somebody’s word for it. You actually have to do a much more rigorous questioning of the individual and people significantly known to him, and that way you can arrive at a sort of a globally based diagnosis. So, that young man was really badly treated by the medical system. I think, as Alan demonstrates, it’s not untypical. And the end was untypical, but the process was not untypical.
AMY GOODMAN: In the New York Times piece, Alan Schwarz, you write, "Dr. William W. Dodson, a psychiatrist from Denver, stood before 70 doctors at the Ritz-Carlton Hotel and Spa in Pasadena, Calif., and clicked through slides that encouraged them to 'educate the patient on the lifelong nature of the disorder and the benefits of lifelong treatment.' But that assertion was not supported by science, as studies then and now have shown that perhaps half of A.D.H.D. children are not impaired as adults, and that little is known about the risks or efficacy of long-term medication use."
ALAN SCHWARZ: Well, this fellow was paid by Shire to indoctrinate doctors about their new long-acting formulation of Adderall XR. And he told them that it is a lifelong condition, and you should medicate for the rest of the person’s life. And, unfortunately, it’s been known, then and since, that only half, roughly—some say 30 percent, some say 70 percent, whatever, but roughly half of adults are not impaired as adults. I talked to Dr. Dodson about his assertion that day and since, and he said he does not believe that that is true, and that if you have ADHD, you have it for life, and he recommends to all of his patients—hundreds, perhaps even up to a thousand—that they do this. And I think it’s up to us to decide if he’s telling these people the truth.
AMY GOODMAN: Tell us about Dr. Keith Conners’ change of heart.
ALAN SCHWARZ: Well, Dr. Conners was absolutely one of the—
AMY GOODMAN: At Duke.
ALAN SCHWARZ: At Duke, yes—was one of the earliest advocates for recognition of ADHD. I mean, he came along in the late '50s, early ’60s, when kids were just labeled—kids with this condition, severe condition, were just labeled "bad kids" and then thrown aside. What he did is he got a lot of people to realize this is a real issue, and he was one of the primary advocates of the use of Ritalin in the ’60s and ’70s and ’80s. I think that some of the articles—at least he's told us that the articles that we’ve written this year in The New York Times have really woken him up to the fact that what he had evangelized, he did an awfully good job, and now, as we’ve talked about, 15 percent of high school kids graduate having been diagnosed with ADHD. And when he read that, and he read some of the horror stories of young people abusing these medications, I think he decided that he—he realized that he had been part of a problem, and he now wants to be part of a solution.
AMY GOODMAN: And you talk about Dr. Joseph Biederman, the prominent child psychiatrist at Harvard University and Massachusetts General Hospital. A Senate investigation revealed his research on many psychiatric conditions had been substantially financed by drug companies, including Shire, which owns Adderall, which sells Adderall. Those companies also paid him $1.6 million in speaking and consulting fees. He denies that the payments influenced his research.
ALAN SCHWARZ: Well, he is not really that atypical among prominent psychiatrists in the field, the degree to which he participated in pharmaceutical research and public statements about the use of medication for many psychiatric—child psychiatric diagnoses. He has been very involved with Risperdal and other antipsychotics. And, you know, he conducted a lot of studies that came in three flavors: One, ADHD is seriously underdiagnosed; two, it has devastating consequences if left untreated; and three, the medications associated with it—Ritalin, Adderall, Conserta, whatever—are basically harmless. And so, he sort of seeded a lot of the pharmaceutical messages that said, "Hey, look, we’re just relying upon the science of a Harvard University professor, an eminent psychiatrist." And, yeah, they were.
I think that what some people are concerned about was just how one-sided he was. And whenever anyone would say, "Look, I think you’re a little off base here," he would really shut down. And so, some people are concerned that he played such a role with giving pharma the messages that they wanted, that they now question, you know, whether that was appropriate. I certainly wanted to talk with him about the concerns that a lot of people had. And, by the way, this is not new. He is the most controversial figure in child psychiatry—by a lot. He didn’t respond to my requests to talk with him. And that was not unpredictable. And so, you know, I think that one point that we made in this story is that a lot of his critics say that his primary motivation was not financial gain; he was trying to help severely impaired kids. He went to a point that many people think was way too far.
AMY GOODMAN: Gabor Maté, your response?
DR. GABOR MATÉ: [inaudible] all the research, and he was paid all that money. But it only came out afterwards. So, when a guy doesn’t disclose that conflict of interest, you really wonder what’s actually going on. I’m not impugning him personally, but it’s just not appropriate procedure, as we all know.
AMY GOODMAN: Dr. Gabor Maté, talk about that progression from children to adults—
DR. GABOR MATÉ: OK.
AMY GOODMAN: —the expression of attention deficit hyperactivity disorder. And what’s the difference between ADD and ADHD?
DR. GABOR MATÉ: Well, you can have hyperactive—you can have attention problems without hyperactivity, so when you add the H, it’s simply to signify that a child or an adult also has difficulty regulating their body, in the sense of sitting still, not fidgeting, not interrupting, not being able to wait their turn in line, and so on. So it just adds a physical dimension to the hyperactivity that takes place in the brain itself, where too many thoughts follow one another randomly and with no rational progression. So it’s a physical manifestation of the emotional and intellectual dynamics that already occur in the brain of the person with ADHD. Boys, in general, tend to be more the hyperactive kinds. Girls very often have the attention problem, if they genuinely have it, without the physical manifestation.
AMY GOODMAN: And then, adults, the whole issue of—you know, we see it backwards, with children—
DR. GABOR MATÉ: Well, yeah.
AMY GOODMAN: —with the selling of cigarettes. Adults were sold cigarettes, and then they were—the companies wanted to get the kids—I mean, people addicted younger and younger, so you have a longer span of selling cigarettes. This goes the other way: First you got the kids, and now you move on to adults, and telling them that at the time it wasn’t known, and now you diagnose adults, and they take the drug.
DR. GABOR MATÉ: Well, interesting that you mention cigarettes, because cigarettes contain nicotine, and nicotine is a stimulant. And so, actually, a lot of people hooked on cigarettes are self-medicating ADHD, whether they know it or not. But the psychiatrist who Alan Schwarz quoted, who said that you don’t grow out of it, has it completely wrong, because he’s just not aware of the factor of neuroplasticity—neuroplasticity meaning the brain has capacity to develop new circuits even later on in life. So a lot of people actually do grow out of the deficit—that’s the first point—because their brains develop, number one.
Number two, there’s a lot of other reasons why kids might have difficulty paying attention. And the question very often is: Do they grow out of ADHD, or do they grow out of school? In other words, do they just grow out of an artificial environment, where human beings were never meant to sit for eight hours and behind a desk, and not be able to run around and play and not be able to create and express themselves and do art and be noisy? All the things that the human child naturally wants to be, and is, are suppressed, and very often in the school setting. So, we’re creating an artificially induced problem by the environments that kids are reared in. And so, when kids leave those environments, naturally they don’t have those symptoms anymore.
So, there’s all kinds of reasons why that psychiatrist who stands in front of a group of doctors and asserts that once you’re diagnosed, you have it for the rest of your life, is completely scientifically inappropriate.
And finally, not to mention that this isn’t unique. You know, I went to dinners—or one dinner, at least, 15, 20 years ago, a medical dinner, where a high-priced expert, flown in from Australia, was telling physicians that every woman, post-menopausal, should be on hormonal replacement therapy. And, boy, did they rake in the money. Well, of course, then it turned out that in fact those same hormones can cause heart disease and increase the risk of cancer and so on, so that this pharmaceutical propaganda that bewitches the medical profession—and they always find the experts; you can always find an expert to support whatever point of view—it’s unfortunately not unique to the problem that Alan has depicted in his recent article.
AMY GOODMAN: Alan Schwarz, what kind of response have you gotten to this series of articles? You did the piece on Johnny Edwards committing suicide at Harvard after being prescribed Adderall. His family is suing Harvard University. You’ve done this front-page piece, "The Selling of Attention Deficit Disorder." I mean, you were a sportswriter. You certainly get a lot of response for that. How does that compare to this?
ALAN SCHWARZ: I think it’s not dissimilar, because the concussion work that I did in football—football is very good in a lot of settings. It’s very important to people. And so, it’s a real balance between what good can we get from this, while minimizing the bad, the risk. Here, it’s not that dissimilar. In fact, it’s probably accentuated. These medications have done a lot of good for a lot of people. And frankly, they do a lot of good for kids who don’t have ADHD. Who are we kidding? I mean, it does help you perform. I mean, it would help you and me, quite possibly—I’ve never tried it, but I’d probably be hooked in a second. So—
AMY GOODMAN: What about that issue of addiction? Can you get off it?
ALAN SCHWARZ: Well, that was flip, OK. I, by no means, do even more than 10 percent of people who try it.
AMY GOODMAN: Yes.
ALAN SCHWARZ: You know, but—I just—I think I’d like it a lot. The point is, is we have to look at the process, the process through which these diagnoses are made, the process through which we allow pharmaceutical companies to prey upon the fears and needs of, typically, mothers. And it’s pretty adjustable. We can make things better if we just pay a little attention. And I think that people have picked up on that in the stories. They’ve tried not to be hysterical. They’ve tried to just point out, hey, if—perhaps you want to take this into account so that we can do a better job for kids and adults. It doesn’t mean stop doing good by prescribing the medications when necessary. I mean, look, a chainsaw is a really helpful tool, you know? But sometimes, you’ve got to—or, usually, you’ve got to just be really careful with it. No one bans chainsaws. No one should ban Adderall. There’s just a way to handle it a lot better. And we, as human beings, are responsible for that.
AMY GOODMAN: We want to thank you both for being with us. Alan Schwarz, we’ll link to your articles in The New York Times, "The Selling of Attention Deficit Disorder" and the ones before, at democracynow.org. And Gabor Maté, author of Scattered: How Attention Deficit Disorder Originates and What You Can Do About It. This is Democracy Now!, democracynow.org, The War and Peace Report . If you missed part one of this conversation, go to democracynow.org. I’m Amy Goodman. Thanks for joining us.