Drugs for ADHD: Too Good

The December 14th edition of The New York Times included an article titled “The Selling of Attention Deficit Disorder”. Predictably, the pharmaceutical industry came in for a roasting for promoting overdiagnosis of the disorder and overstating the benefits of the stimulants used to treat it. Well, yes, pharmaceutical manufacturers might do those things. They are in business to make money for their stockholders.

There may be many reasons why a drug, or a class of drugs, is overprescribed. Antibiotics are overprescribed because they are relatively safe and a prescription for one is remarkably effective at getting a patient with a cold out of your office. Acetylcholinesterase inhibitors are widely prescribed for Alzheimer’s in spite of their questionable benefits because they are also relatively safe and the pressure to treat Alzheimer’s with something can be overwhelming. The reason for overprescribing of the stimulants used to treat attention deficit disorder, in my opinion, is that they work. For children who have ADHD (attention-deficit/hyperactivity disorder), they can be close to a miracle. “He’s like a different child” is a common response from the parents of treated patients. For young adults with ADHD who have always struggled academically out of proportion to their intelligence, stimulants can change their lives.

The problem is, people who do not have any discernible diagnosis may also respond to these drugs in one way or another: improved work productivity, better test results, more energy, etc. We do have some safeguards in place. These are controlled substances. The FDA does monitor their promotion as best it can. And there are well-standardized tests for making a diagnosis of ADHD. So let’s not be too quick to discourage prescribing of drugs that have important benefits. For more details about their efficacy and safety, take a look at our most recent article on this subject: Drugs for Treatment of ADHD in the May, 2011 edition of Treatment Guidelines from The Medical Letter.

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  1. Clifford Dacso, MD says:

    I usually do not disagree with Dr. Abramowicz but I think he is a bit soft here. The scheduled nature of a drug is not a sufficient barrier to over prescribing. The pressures of office practice too often lead to assent to patient requests as rational discussion pointing out benefits and risks, takes more time than many clinicians have. I interpret the Times article as a cautionary tale to educate the public. Overprescribing of antibiotics, my personal bete noire, has had dreadful societal consequences. We have not yet seen the effect of chronic prescription of amphetamines on a generation that is still young. Such agnosticism should be accompanied by caution.

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