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Ritalin Doesn’t Show Long Term Effectiveness for ADHD

Posted on February 2, 2012  Comments (0)

From the New York Times opinion piece, Ritalin Gone Wrong, by L. Alan Sroufe is a professor emeritus of psychology at the University of Minnesota’s Institute of Child Development:

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.
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To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear… At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

As I have written before I am skeptical of the amount of drug use our health care system encourages: Lifestyle Drugs and Risk.

Related: Long Term ADHD Drug Benefits Questioned (2009) – Nearly 1 million Children Potentially Misdiagnosed with ADHD in the USA – Diet May Help ADHD Kids More Than Drugs – Over-reliance on Prescription Drugs to Aid Children’s Sleep? – Epidemic of Diagnoses

Diet May Help ADHD Kids More Than Drugs

Posted on March 13, 2011  Comments (2)

Diet May Help ADHD Kids More Than Drugs

Kids with ADHD can be restless and difficult to handle. Many of them are treated with drugs, but a new study says food may be the key. Published in The Lancet journal, the study suggests that with a very restrictive diet, kids with ADHD could experience a significant reduction in symptoms.

The study’s lead author, Dr. Lidy Pelsser of the ADHD Research Centre in the Netherlands, writes in The Lancet that the disorder is triggered in many cases by external factors — and those can be treated through changes to one’s environment. “ADHD, it’s just a couple of symptoms — it’s not a disease,” the Dutch researcher tells All Things Considered weekend host Guy Raz.

The way we think about — and treat — these behaviors is wrong, Pelsser says. “There is a paradigm shift needed. If a child is diagnosed ADHD, we should say, ‘OK, we have got those symptoms, now let’s start looking for a cause.’ ”
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According to Pelsser, 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food. Researchers determined that by starting kids on a very elaborate diet, then restricting it over a few weeks’ time. “It’s only five weeks,” Pelsser says. “If it is the diet, then we start to find out which foods are causing the problems.”

Teachers and doctors who worked with children in the study reported marked changes in behavior. “In fact, they were flabbergasted,” Pelsser says.

Related: Nearly 1 million Children Potentially Misdiagnosed with ADHD in the USA – Lifestyle Drugs and Risk – Over-reliance on Prescription Drugs to Aid Children’s Sleep? – Epidemic of Diagnoses
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Monarch Butterflies Use Medicinal Plants

Posted on October 14, 2010  Comments (6)

Monarch butterflies eat toxic plants (that they have evolved to tolerate and make the butterflies themselves toxic to predators). They use medicinal plants to treat their offspring for disease, research by Emory biologists shows. When the butterflies are infected by certain parasites the butterflies have a strong preference to lay their eggs on a plant (tropical milkweed) that will help the caterpillar fight the parasite when it eats those leaves (it serves as a drug for them). Their experiments may be the best evidence to date that animals use medication.

Related: Monarch Migration Research – Monarch Butterfly Migration – Evolution at Work with the Blue Moon Butterfly

Scientific Illiteracy Leaves Many at Risk in Making Health Care Judgements

Posted on September 8, 2009  Comments (5)

Scientific literacy is important for many reasons and that importance has increased greatly over the last century. Medical research is often difficult to interpret. Often various studies seem to contradict each other. Often the conclusions that are drawn are far too broad (especially as the research conclusions are passed on and people hear of them overly simplified ways).

Many health care options are not obviously all good, or all bad, but instead a mix of benefits and risks, both of which include interactions with the individuals makeup. So we often see contradictory (and seemingly contradictory) advice. Without a level of scientific literacy it is very difficult for people to know how to react to medical advice.

We have numerous posts on the scientific inquiry process showing that acquiring scientific knowledge is complex and can be quite confusing in many instances. While understanding things are often less clear cut than they are presented it is still true that most often strategies for healthy living have far better practices that will provide far better results than alternatives.

The scientific illiteracy that has some think because their are risks no matter what is done that means there is no evidence some alternatives are far superior is very dangerous. As you can see in action now with those that risk their and others lives and health by doing things like not vaccinating their children, or driving when drunk, or driving when talking on a cell phone.

Without a scientifically literate society even completely obvious measures like not using antibiotics on viral infections are ignored.

Related: Long Term ADHD Drug Benefits Questioned – How Prozac Sent Science Inquiry Off Track – Lifestyle Drugs and Risk – Correlation is Not Causation: “Fat is Catching” Theory Exposed
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Long Term ADHD Drug Benefits Questioned

Posted on March 27, 2009  Comments (0)

Debate Over Drugs For ADHD Reignites by Shankar Vedantam

New data from a large federal study have reignited a debate over the effectiveness of long-term drug treatment of children with hyperactivity or attention-deficit disorder, and have drawn accusations that some members of the research team have sought to play down evidence that medications do little good beyond 24 months. The study also indicated that long-term use of the drugs can stunt children’s growth.
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One principal scientist in the study, psychologist William Pelham, said that the most obvious interpretation of the data is that the medications are useful in the short term but ineffective over longer periods but added that his colleagues had repeatedly sought to explain away evidence that challenged the long-term usefulness of medication. When their explanations failed to hold up, they reached for new ones, Pelham said.
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Peter Jensen, one of Pelham’s fellow researchers, responded that Pelham was biased against the use of drugs and was substituting his personal opinion for science.

Jensen said Pelham was the only member of the team of researchers who took away “the silly message” that the study raised questions about the long-term utility of drugs, but interviews and e-mails show that Pelham was not alone.
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In a telephone interview, Jensen denied that the researchers had misled the public, pointing out that some children getting the drugs did do better over the long term. Looking at overall results was not as useful as studying how particular groups of children fared, he said.

Jensen and another co-author, L. Eugene Arnold at Ohio State University, who are both psychiatrists, emphasized the importance of individualizing treatment — and warned parents against abruptly terminating drug therapy.

The subgroup analysis found that children in homes that were socially and economically stable did the same in the long term with or without medication. Children from troubled or deprived backgrounds slid backward as soon as the intensive therapy stopped and they went back to their communities. About one-third — those with the least impairment to begin with — continued to improve over the long term.

Jensen and co-author Benedetto Vitiello at the NIMH said drugs may not have shown an overall long-term benefit because the quality of routine care that children received may have been inferior to the care they got during the initial part of the study. Jensen said the take-home message is that community care needs improvement.

I have said I believe we too frequently reach for drug solutions. In the right situations drugs are wonderful tools. But they also have consequences and risks and it seems to me those negatives are given far too little weight.

Related: New Antipsychotics Old Results – Lifestyle Drugs and Risk – Over-reliance on Prescription Drugs to Aid Children’s Sleep? – How Prozac Sent Science Inquiry Off Track

Mental Pick-Me-Ups: The Coming Boom

Posted on February 25, 2009  Comments (0)

I am not a fan of lifestyle drugs. People seem to forget that drugs have side effects that are quite large. Being surprised when a drug has adverse consequences shows a failure to understand the risks. You should assume adverse effects and take them only when that risk is outweighed by significant tangible benefits. A Boom in Memory-Enhancing Drugs?

A whole generation has come of age using attention-deficit drugs such as Adderall and Ritalin, a category valued at nearly $4.7 billion in 2007. A lot of teenagers have used them casually as study aids, often buying them on the Internet. And now, overworked professionals are seeing the appeal.

And when they almost certainly have significant adverse effects on many people, then people will get upset. Granted the drug companies pushing sales for negligible benefits do deserve condemnation. However, the larger problem is people that choose to risk their health as though they don’t have the ability to learn and can just ignore evidence of risks.

Related: Over-reliance on Prescription Drugs to Aid Children’s Sleep? – Marketing Drugs – New Antipsychotics Same Old Bad Results – How Prozac Sent Science Inquiry Off Track

Searching for More Effective Tuberculosis Drugs

Posted on February 1, 2009  Comments (1)

In India: A Search for More Effective Tuberculosis Drugs

The multi-drug regimen is a major problem for several reasons. It requires TB patients to manage taking four drugs exactly as prescribed over six to nine months. If patients don’t take the full course of the medicines, the TB bacteria may develop resistance to the drugs and become even more difficult to treat. To reduce that risk, many countries require that patients go to a clinic so a healthcare professional can watch them take the medication and ensure they are complying with their drug-treatment regimen. This is both expensive and time consuming. Gokhale said that a single drug that targets multiple pathways could save time and money by eliminating the need to take so many drugs over such a long period of time.

To create their new compound, Gokhale and his colleagues exploited an evolutionary quirk in the way Mycobacterium tuberculosis builds the lipid layer that coats its surface. Unlike other organisms, M. tuberculosis displays a suite of complex lipids on its outer membrane. Some scientists have suggested that these long lipid molecules contribute to the bacteria’s ability to maintain long-term infections by confusing the host’s immune system.

Related: Fighting Tuberculosis – TB Pandemic Threat – Extensively Drug-resistant Tuberculosis (XDR TB) – Virtually untreatable TB found

New Antipsychotics Old Results

Posted on September 16, 2008  Comments (2)

Risks Found for Youths in New Antipsychotics

A new government study published Monday has found that the medicines most often prescribed for schizophrenia in children and adolescents are no more effective than older, less expensive drugs and are more likely to cause some harmful side effects. The standards for treating the disorder should be changed to include some older medications that have fallen out of use, the study’s authors said.
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“I think the reason the use of these newer drugs has gone up so fast is that there was this widespread assumption that they were safer and more effective than what we had before,” Dr. McClellan said. “Well, we’re seeing now that that’s not the whole story.”

Related: Lifestyle Drugs and Risk – How Prozac Sent Science Inquiry Off Track – Overuse of Antibiotics

How Prozac Sent Science Inquiry Off Track

Posted on July 7, 2008  Comments (4)

I post often on examples of scientific inquiry in action. I think it is an important way to see how science works while searching for answers. The process is not a simple one, but after a solution is found it can often be presented as obvious. But while trying to find answers it is quite difficult.

How Prozac sent the science of depression in the wrong direction

But the success of Prozac hasn’t simply transformed the treatment of depression: it has also transformed the science of depression. For decades, researchers struggled to identify the underlying cause of depression, and patients were forced to endure a series of ineffective treatments. But then came Prozac. Like many other antidepressants, Prozac increases the brain’s supply of serotonin, a neurotransmitter. The drug’s effectiveness inspired an elegant theory, known as the chemical hypothesis: Sadness is simply a lack of chemical happiness. The little blue pills cheer us up because they give the brain what it has been missing.

There’s only one problem with this theory of depression: it’s almost certainly wrong, or at the very least woefully incomplete. Experiments have since shown that lowering people’s serotonin levels does not make them depressed, nor does it does not make them depressed, nor does it worsen their symptoms if they are already depressed.
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In this sense, Prozac is simply a bottled version of other activities that have a similar effect, such as physical exercise.
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It is jarring to think of depression in terms of atrophied brain cells, rather than an altered emotional state. It is called “depression,” after all. Yet these scientists argue that the name conceals the fundamental nature of the illness, in which the building blocks of the brain – neurons – start to crumble. This leads, over time, to the shrinking of certain brain structures, like the hippocampus, which the brain needs to function normally.

Related: Lifestyle Drugs and Risk – Overrelience on Prescription Drugs to Aid Children’s Sleep?

Big Drug Research and Development on Campus

Posted on June 9, 2008  Comments (1)

Big Drug R&D on Campus

Merck and Harvard just signed an agreement to develop treatments for the bone disease osteoporosis. On Apr. 25 rival Pfizer (PFE) invested $14 million in an alliance with four universities to study diabetes and obesity.

Drugmakers are counting on these deals to solve a persistent problem: underperforming product pipelines. Merck, Pfizer, and others have been losing sales of one blockbuster drug after another as patents expire and competitors charge in with generics. Big drug companies have fought back by spending more on research, yet the number of new medicines approved each year is falling. In the last week of April alone, the U.S. Food & Drug Administration rejected two of Merck’s experimental drugs, prompting the company to lay off 1,200 salespeople.
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Past deals between industry and academia have been hampered by patent disputes and tussles over publication rights, as companies tried to thwart academics who want to share their discoveries with colleagues around the world. So now the companies have devised policies allowing their Ivory Tower partners to patent and publish their discoveries, even as they draw the professors more deeply into corporate affairs.

Funding university activities this way can lead to conflicts and problems but realistically huge amounts of funding are entangled with possible conflicts of interest. The biggest concern I is that universities will bow to the almighty dollar instead of their missions. And inadequate oversight can damage their credibility (not one failure, most likely, but if a pattern emerges). For example: Researchers Fail to Reveal Full Drug Pay (“The Harvard group’s consulting arrangements with drug makers were already controversial because of the researchers’ advocacy of unapproved uses of psychiatric medicines in children.”). Then find out the companies were paying them well, the professors failed to disclose that and the advocacy is rightfully questioned.

Related: From Ghost Writing to Ghost Management in Medical Journals – Funding Medical Research – Medical Study Integrity (or Lack Thereof) – Marketing Drugs

Marketing Drugs

Posted on May 17, 2008  Comments (1)

Melody Petersen, author of Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines on Bill Moyer’s Journal:

I actually thought that they were a lot about science. That’s what they tell the public. They are all about science and discovering new drugs. But as I started to follow their daily activities and talk to executives, I learned that really it was marketing that drove them.

According to Petersen, the rewards have been large. America has become the top consumer of prescription drugs in the world, with nearly 65% of the population on physician-prescribed medication. In 2005, Americans spent $250 billion dollars on such drugs. This consumption made pharmaceuticals the most profitable business sector in America from 1995-2002.
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We’ve come to a time when decisions on how to treat a disease have as great a chance of being hatched in a corporate marketing department as by a group of independent doctors working to improve the public’s health.

Unfortunately patients are driven more by marketing than medicine. Much worse though, doctors seem to bend to these patients marketing driven desires. Plus the corrupting influence of money on research and marketing to doctors seems likely a significant reason for the poor performance and high cost of USA health care.

Related: Lifestyle Drugs and Risk – Overrelience on Prescription Drugs to Aid Children’s Sleep? – Drug Price Crisis – Lack of Medical Study Integrity

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