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The argument that public skepticism about the Ritalin/Attention Deficit Hyperactivity Disorder (ADHD) explosion is somehow a parochial "conservative" thing is flatly wrong ("Trick Question," by Michael Fumento, February 3). Dissent from yesterday's enthusiasm for the drug is in fact widespread — and growing. "Many parents," in the words of a recent report in the National Journal, "have joined the backlash against Ritalin, and now reject expert advice to use it and related drugs." Many others are part of the well-publicized commercial rush toward non-stimulant alternatives such as Strattera. Doctors, too, are having second thoughts, led by reform-minded physicians such as Thomas Armstrong (The Myth of the ADD Child, 1995) and Lawrence H. Diller (Running on Ritalin, 1998). Across the ideological board, there is growing concern that "(t)oday, fidgety kids are labeled ADD (Attention Deficit Disorder) and dosed with Ritalin until they can sit still in math class," as TNR senior editor Michelle Cottle has written in The Washington Monthly, and many others, left and right, agree.
Skepticism is also entrenched in another place somewhat lacking in right-wing yes-men, namely the black community, including the 20,000 black doctors of the National Medical Association and the National Black Caucus of State Legislators, both of which have publicly questioned the stimulant explosion. The skeptics know what defenders of the status quo ignore: that prescribing stimulants to millions of children is creating more problems than it solves. One such problem is abuse. Like it or not, the chemical similarities between Ritalin/methylphenidate and cocaine are well-established in the medical literature (see, for example, "Pay Attention: Ritalin Acts Much Like Cocaine," Journal of the American Medical Association, August 22/29, 2001). They are also well-established on the street. Every college campus in the country is home to a bustling black market in Ritalin pills, and everybody knows it except for over-40, see-no-evil parents and doctors. Why is there is an upswing in emergency room visits involving Ritalin abuse (271 in 1990 versus 1,727 in 1998)? Why does Ritalin have street names (Rids, Pineapple, Uppers, Vitamin R, Jif, R-Ball)? Why does the drug rank on the Drug Enforcement Administration's (DEA) top-ten list of the country's most-stolen pharmaceuticals? Is there any connection whatever between the staggering number of minors now prescribed methylphenidate and the well-documented rise in its abuse? At the risk of belaboring things: duh.
Abuse is only one of the problems attendant on the pathologizing of so many children (for a detailed discussion, see my "Why Ritalin Rules," Policy Review, April & May 1999). Yes, hard cases do exist, and some parents do swear by stimulant drugs. No one doubts it. But hard cases alone cannot possibly account for the millions of prescriptions now circulating. In January, the Archives of Pediatrics and Adolescent Medicine estimated that more than 6 percent of the child population now takes one or another psychiatric medication. Do defenders of the status quo truly believe that so many children, from toddlers on up, are in so parlous a state as to require chronic psychotropic medication?
Michael Fumento replies:
In her Policy Review article Eberstadt wrote that child prescriptions for adhd drugs have soared, while her present letter decries "the staggering number of minors now prescribed" Ritalin. Yet she contradicts this by claiming, "Dissent from yesterday's enthusiasm for the drug is in fact widespread — and growing." As it happens, there is statistical support for the rapid rise in prescriptions; there is nothing to back her claim of dissent.
For institutional support she cites a small legislative group and a tiny (20,000-member) medical group. Are these supposed to cancel out the positions of the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry, among other esteemed medical associations?
The alleged "rush" to Strattera is a fabrication. Drug companies report sales on a quarterly basis; Strattera only became available in mid-January.
Eberstadt misrepresents Diller's views. He does have serious reservations about possible Ritalin overuse, which he admits puts him clearly in the minority among physicians. He also just finished a paper declaring that he has prescribed the drug for more than 25 years because his "role as a doctor is to ease suffering and Ritalin will make things easier for the child."
Counting nicknames seems a curious way to measure drug abuse, but Eberstadt's "top-ten" assertion is another fabrication. According to DEA spokeswoman Rogene Waite, "We have no such list." The DEA's "Drug Trafficking" page does list ten problem narcotics, but methylphenidate is not among them.
As my article stated, "According to the DEA, (cocaine and methylphenidate) are comparable when 'administered the same way at comparable doses.' But ADHD stimulants, when taken as prescribed, are neither administered in the same way as cocaine nor at comparable doses." Ritalin actually works against drug abuse. The January 2003 issue of Pediatrics reported that, "stimulant therapy in childhood is associated with a (50 percent) reduction in the risk for subsequent drug and alcohol use disorders."
Eberstadt's emergency room visit claim merely shows high percentage growth from a low baseline. By comparison, the Department of Health and Human Services lists 36 different drugs in order of emergency room visits, emergency room mentions, etc. Methylphenidate isn't mentioned.
When Eberstadt finally cites usage data, it's not for ADHD drugs but for all psychotropic medicines. Sticking to the topic, the February 2003 issue of Pediatrics found an average 4.3 percent use of stimulants among insured children ages five to 14, which inflates the numbers because the uninsured get fewer drugs. Stimulant use increased with age to a point, then it started receding. This is hardly the Fourth Horseman of the Apocalypse but rather an indication that children who need medication to counter a crippling mental disorder are getting it.
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