Pseudoscience

 

When asked for proof of its validity, 'ADHD experts' will often respond that there are thousands of scientific papers that support their claims.  However, when asked which one of these scientific papers has robust methodology, they cannot identify a single, long term, research paper that stands scrutiny.  Good science is not about quantity of research, it is about quality.  None of the thousands of papers cited by the ADHD industry prove that ADHD is a biochemical imbalance or that amphetamines or Strattera are safe and effective treatments.  The ADHD industry makes up for a lack of quality research, supporting their arguments, by producing a mass of short term, poor quality research.  To back up this dodgy research ADHD industry insiders produce consensus statements, where like-minded, self appointed 'experts' agree that ADHD is real and amphetamines are a safe and effective treatment.

 

Oregon Study

 

Compelling evidence of the poor quality of this research was demonstrated in 2005 through the Oregon Health and Science University ADHD Drug Effectiveness Review Project.  The review was commissioned by fifteen U.S. states in order to determine which ADHD drugs were the safest and the most cost effective.[1]  The 731-page report analysed "virtually every investigation ever done on ADHD drugs anywhere in the world."[2] Of the 2,287 studies analysed "the group rejected 2,107 investigations as being unreliable, and reviewed the remaining 180 to find superior drugs." [3] 

 

The review concluded:

• there is "no evidence on long-term safety of drugs used to treat ADHD in young children or adolescents." 
• good quality evidence is lacking that ADHD drugs improve "global academic performance, consequences of risky behaviours, social achievements and other measures." 
• safety evidence is of "poor quality," including research into the possibility that some ADHD drugs could stunt growth. 
• evidence that ADHD drugs help adults "is not compelling,"
• there is little evidence that one drug "is more tolerable than another"
• "the way the drugs work is, in most cases, not well understood". 

Instead of being able to make objective comparisons of the safety and effectiveness of different ADHD drugs the review was "severely limited" by a lack of studies measuring "functional or long-term outcomes." [4] 

 

The ADHD industry's response to this independent report was characteristically dismissive.  The Senior Vice President of the Pharmaceutical Research and Manufacturers of America, Ken Johnson,  refused to comment directly on the Oregon Report, but offered the standard ADHD industry response, that the benefits of ADHD drugs "clearly outweigh the risks." [5]  

 

MTA Study

 

Until the 3-year follow up data was published in 2007 the Multimodal Treatment Study for Attention-Deficit Hyperactivity Disorder (the MTA Study) was frequently quoted by the ADHD industry as supporting the use of stimulants for ADHD.  Early results of the MTA Study found that 14 months of medication worked better than behavioural therapy.  The 3-year follow up to the MTA Study, however, concluded that while drugs such as Ritalin and Dexamphetmine worked in the short term, after three years of medication "that there were no beneficial effects - none".  The MTA study results were entirely in keeping with the joint propositions that nothing affects behaviour as fast as behaviour altering medications and that ADHD medications simply mask symptoms and do nothing to address the causes of dysfunctional behaviours. 

 

Since the publication of the three year data the MTA is rarely mentioned by the ADHD industry. Many other studies unfavourable to the pharmaceutical companies are never publicised.  This ability to bury unfavourable results is an essential tool in the ADHD industry's quest to show that amphetamines are good for ADHD children. 

The Australian public and even the Australian drug safety regulator, the Therapeutic Goods Administration (TGA), are not allowed to know the whole truth about the results of drug trials.  Pharmaceuticals are usually licensed first in the U.S. by the Food and Drug Administration (FDA) and soon after in Australia by the TGA.  In America, pharmaceutical companies are free to determine who conducts their studies and which studies they publish and which they keep quiet.[6]  Obviously the pharmaceutical companies do not choose researchers or set research parameters designed to show their products in a bad light.  When that happens it is often their response is to turn off the lights. 

Another favourite trick of the ADHD industry is confusing cause and effect by arguing that when left un-medicated ADHD causes criminal behaviour or drug abuse.  Identifying dysfunctional populations like criminals and drug addicts as having dysfunctional behaviours (i.e. ADHD) is the equivalent of being able to bet on a horse after the race has finished.

Prevalence Rates 

Yet another tactic of the ADHD industry is to defend claims that ADHD is over-diagnosed and over-medicated by claiming prevalence rates exceed diagnosis and drugging rates, and therefore claim ADHD is under-diagnosed/under-medicated.  Prevalence rates are estimates of the percentage of a population with a disease or disorder.  A prevalence rate is different from a diagnosis rate, which is the percentage of the population diagnosed with a condition.  Not surprisingly estimates of the prevalence vary widely.  A study conducted in 1998 found that prevalence estimates vary between 1.7% and 16%.[7]  The huge range is a consequence of relying on subjective and ill defined diagnostic criteria.  Even if levels of attention could be objectively measured, so that children could be reliably placed on a continuum of ADHD behaviours, that would not make ADHD a legitimate disorder.  ADHD behaviours are not extreme behaviours. They are normal behaviours within a continuum of difference.  

  

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[1] McDonagh MS, Peterson K, Dana T, Thakurta S. Drug Class Review of Pharmacologic Treatments for ADHD: Final Report Update#2, Evidence Tables (Oregon Health and Science University, Portland, Oregon, 2007) http://www.ohsu.edu/ohsuedu/research/policycenter/customcf/derp/product/ADHD_Final%20Report%20Update%202_Evidence%20Tables.pdf (accessed 13 February 2009)  

 

[2]  Alexander Otto, "Are ADHD drugs safe? Report finds little proof." The News Tribune, 13 September 2005   

 

[3] ibid

 

[4] ibid 

[5] M. Alexander Otto, ‘Are ADHD drugs safe? Report finds little proof’, The News Tribune, 13 September 2005. http://www.playattention.com/attention-deficit/articles/are-adhd-drugs-safe-report-finds-little-proof (accessed 12 May 2007)

[6] David Armstrong and Keith J Winstein, 'Antidepressants Under Scrutiny Over Efficacy', The Wall Street Journal Online, 17 January 2008

[7] Goldman, L.S,, Genel, M., Bezman, R.J., & Slanetz, P.J.  (1998) Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of American Medical Association, 279(14), 1100-1107