The Diagnostic Statistical Manual (DSM) is considered the bible of American psychiatry. It provides diagnostic criteria to assist qualified clinicians in making mental disorder diagnoses in order to treat clients whose symptoms and behaviors meet the criteria for those disorders.
The American Psychiatric Association (APA) published its first diagnostic manuals in 1952 and 1968 which were spiral bound booklets comprised of 130 pages. In 1980 the DSM-III was a 494 page hardbound book and reflected an emerging revolution in the field of American psychiatry.
The DSM-III discarded the psychoanalytical approach of the DSM-I and DSM-II which relied primarily on theories of unconscious conflict being the cause of most expressions of psychopathology. The DSM-III wanted to achieve greater diagnostic reliability by creating a new approach to identifying mental disorders based solely on observable signs and symptoms. Prior to the DSM-III, disorders ranged along a spectrum from ‘normal’ to ‘severe’. The DSM-III organized ‘observable’ signs and symptoms into discrete categories outlining the criteria for a particular disorder. By 2000, the DSM-IV had expanded to almost 1,000 pages and in 2013 the DSM-V was published after 6 years in the making amid much criticism and controversy.
Among those who challenged the DSM-V were Robert Spitzer, the editor of the DSM-III and Allen Frances, the editor of the DSM-IV. Their two primary complaints were the secrecy surrounding the process that determined what would be included in the new edition and the belief that by lowering thresholds for particular disorders, the APA was pathologizing behaviors that were previously considered appropriate or normal in response to the circumstances. They referred to this paradigm shift as the ‘medicalization of normal human emotions’. In other words, in the absence of using a spectrum to assess symptoms and behaviors on a scale from ‘normal’ to ‘severe’, we now run the risk of pathologizing and subsequently medicating what might not have previously met the criteria for ‘severe’ but is, instead, developmentally or situationally appropriate.
Having worked for several years with at-risk, under-served populations in my community, I have witnessed first-hand their extreme vulnerability and the significant impact that the DSM and the field of psychiatry can have on their lives. In order for insurance companies, including Medicaid, to be willing to pay mental health professionals so that individuals can receive treatment and services there must be a documented diagnosis with a corresponding numerical code for billing purposes. Unfortunately, these diagnoses can negatively impact the lives of millions of people in the United States every day by influencing where they can live, what jobs they can hold, and how their children will be educated. Because the DSM is also utilized by public housing authorities, school officials, lawyers, judges, and prison officials, a mental disorder diagnosis could end up causing more harm than good.
While helping at-risk youth transition back into the community from correctional facilities, I was deeply disturbed to discover that all juveniles in the state of Virginia who are incarcerated are initially processed at the “Reception and Diagnostic Center” for psychiatric evaluation. Every kid I worked with, without exception, had been given a diagnosis for a mental disorder and medicated before being assigned to a correctional facility. One can only conclude that containing a large population of adolescents within an over-crowded prison setting must be much more manageable if that population has been heavily medicated.
Since the first DSM was published in 1952, psychiatric diagnoses have increased significantly leading to speculation by many experts in the field of psychology and psychiatry that many diseases are now being promoted by large pharmaceutical companies in their marketing campaigns in an attempt to increase sales.
Shyness made its debut in 1980 in the DSM-III as a psychiatric disorder now referred to as ‘Social Phobia’. By 1994, the DSM-IV was referring to it as ‘Social Anxiety Disorder’. Five years later the FDA approved Paxil for said disorder and sales soared into the billions of dollars for GlaxoSmithKline. On July 2, 2012 Glaxo pled guilty to criminal charges and was fined 3 billion dollars for marketing Paxil for unapproved uses and failing to report drug safety information to the U.S. Food and Drug Administration (FDA). The settlement covers improper Glaxo practices from the late 1990s to the mid-2000s in which Glaxo offered kickbacks to doctors and sales reps to push the drug and helped publish a paper on Paxil in a medical journal that misrepresented clinical trial data.
As reported by Time Magazine on July 5, 2012:
- Although the antidepressant Paxil is not approved for patients under 18, Glaxo illegally marketed the drug for use in children and teens, offering kickbacks to doctors and sales representatives to push the drug.
- A government probe was launched in 2002, and it was discovered that Paxil, as well as several other antidepressants, were no more effective than placebo in treating depression in kids. Indeed, between 1994 and 2001, Glaxo conducted three clinical trials of Paxil’s safety and efficacy in treating depression in patients under 18, and all three studies failed to pass muster.
- One clinical trial, known as Study 329, found that teens who took the drug for depression were more likely to attempt suicide than those receiving placebo pills. Glaxo hired a company to prepare a medical journal article that downplayed Paxil’s safety risks, including increased risk of suicide, and misrepresented data to trump up the positive results of the study. The article was published in 2001, falsely reporting that Paxil was an effective treatment for child depression.
- Prosecutors accused Glaxo sales representatives of then using the article to promote the use of the drug for depressed youth. Sales reps invited prescribing psychiatrists to luxury resorts for “Paxil forum meetings” where they were treated to fancy dinners and free entertainment like sailing trips, spa treatments, and balloon rides.
- Reports of teens committing suicide while taking Paxil began surfacing in 2003, and the FDA discovered that 10 of the 93 Paxil patients in Study 329 had attempted suicide or thought about it, versus one out of the 87 patients on placebo. In 2004, the FDA added a black-box warning on the drug’s label about the increased risk of suicidal thoughts in teens who take it.
In 2006, a research paper out of the University of Massachusetts was published in the journal “Psychotherapy and Psychosom” entitled “Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry.”
The following is the Abstract:
Background: Increasing attention has been given to the transparency of potential conflicts of interest in clinical medicine and biomedical sciences, particularly in journal publishing and science advisory panels. The authors examined the degree and type of financial ties to the pharmaceutical industry of panel members responsible for revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Methods: By using multimodal screening techniques the authors investigated the financial ties to the pharmaceutical industry of 170 panel members who contributed to the diagnostic criteria produced for the DSM-IV and the DSM-IV-TR.
Results: Of the 170 DSM panel members 95 (56%) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies. The leading categories of financial interest held by panel members were research funding (42%), consultancies (22%) and speakers’ bureau (16%).
Conclusions: Our inquiry into the relationships between DSM panel members and the pharmaceutical industry demonstrates that there are strong financial ties between the industry and those who are responsible for developing and modifying the diagnostic criteria for mental illness. The connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders. Full disclosure by DSM panel members of their financial relationships with for-profit entities that manufacture drugs used in the treatment of mental illness is recommended.
The following paragraphs are transcribed from “Shrinks for Sale: Psychiatry’s Conflicted Alliance”, an article published by the Citizens Commission on Human Rights (CCHR), an international mental health industry watchdog:
- In July 2008, the U.S. Senate Finance Committee requested that the APA provide accounts for all of its pharmaceutical funding. In March 2009, the American Psychiatric Association announced that it would phase out pharmaceutical funding of continuing medical education seminars and meals at its conventions. Despite its announcement, within two months, the APA accepted more than $1.7 million in pharmaceutical company funds for its annual conference, held in San Francisco.Within a month of the APA’s announcement, its conflicts came under criticism again with the release of a study that found that 18 of the 20 members overseeing the revision of clinical guidelines for treating just three “mental disorders” had financial ties to drug companies. The three diagnoses generated some $25 billion a year in pharmaceutical sales.
- In June 2007, The New York Times reported that psychiatrists in Vermont and Minnesota topped the list of doctors receiving pharmaceutical company gifts and that this financial relationship corresponds to the “growing use of atypicals [new antipsychotics] in children.” From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than six-fold to $1.6 million.During those same years, prescriptions of antipsychotics for children under the state’s insurance program rose more than nine-fold.
- With the U.S. prescribing antipsychotics to children and adolescents at a rate six times greater than the U.K., and with 30 million Americans having taken antidepressants for what psychiatrists admit is a pharmaceutical marketing campaign, it is no wonder that the conflict of interest between psychiatry and Big Pharma is under congressional investigation.
Nada Stotland: The 2008 APA President, Stotland serves on the Board of the National Mental Health Association (now called Mental Health America), a group that received over $3 million in pharmaceutical company funding in one year alone. In 2008, Pfizer donated at least $500,000 to Mental Health America while Eli Lilly donated $600,000. Stotland is on the speakers’ bureau for Pfizer and GlaxoSmithKline (GSK).
David Kupfer: A member of the DSM-IV Task Force and Chair of the DSM-V Task Force. He has been a consultant to Eli Lilly & Co., Johnson and Johnson, Solvay/Wyeth, Servier and also sat on the advisory boards of Forest Labs and Pfizer. In 2008, Kupfer also disclosed that he had been a consultant for Forest Pharmaceuticals, Pfizer Inc., Hoffman La Roche, Lundbeck and Novartis.
Dilip V. Jeste: APA Trustee and Member of the DSM-V Task Force is a consultant to Bristol-Myers Squibb, Lilly, Janssen, Solvay/Wyeth and Otsuka; honoraria from Bristol-Myers Squibb, Janssen and Otsuka; received “supplemental support to NIMH-funded grants” from Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, and Janssen in the form of donated medication for the study, “Metabolic Effects of Newer Antipsychotics in Older Patients.” Jeste’s 2008 APA disclosure for the DSM-V Task Force stated he received honorarium from Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly Janssen, Pfizer-Eisai, Solvay-Wyeth and Otsuka. He also received consulting fees from nine pharmaceutical companies.
Steven Sharfstein: Former APA president who sat on the Board of Directors of the American Psychiatric Foundation (APF), an organization formed by the APA that lists 17 major pharmaceutical companies as its corporate adviser. Since 1992, he has been President and CEO of Sheppard Pratt Health System and in 2002, he signed on 6 pharmaceutical companies to test their products at Sheppard Pratt. He signed contracts with Eli Lilly & Co., Merck and Janssen Research Foundation.
Joseph Biederman: Chief of the Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Biederman has received research funds from 15 pharmaceutical companies. The New York Times exposed how Joseph Biederman earned $1.6 million in consulting fees from drug makers between 2000 and 2007 but did not report all of this income to Harvard University officials. His marketing of the theory that children have “bipolar” was attributed to the increase in antipsychotic drug sales for pediatric use in the United States—today 2.5 million children. Following exposure of his conflicts, he stepped down from a number of industry-funded clinical trials. In March 2009, in newly released court documents, Biederman was reported to have promised drug maker Johnson & Johnson in advance that his studies on the antipsychotic drug Risperidone would prove the drug to be effective when used on preschool age children.
Melissa DelBello: Research psychiatrist, University of Cincinnati was cited for her failure to disclose to the university much of what she had earned from pharmaceutical companies. In 2002, she was the lead author of a study that reported some patients benefited from the antipsychotic drug Seroquel, which is manufactured by AstraZeneca, which paid her $100,000 in 2003 and $80,000 in 2004. DelBello disclosed that she’d received $100,000 from the company between 2005 and 2007, but federal investigators discovered it was more than double that—$238,000.
Frederick Goodwin: Former National Institute of Mental Health (NIMH) director, Goodwin earned at least $1.3 million between 2000 and 2007 for giving marketing lectures to physicians on behalf of drug makers—a fact he did not reveal to the audience, broadcaster or producers of “The Infinite Mind,” that he hosted on the National Public Radio during its 10-year run.
Charles Nemeroff: Professor and Chairman of Psychiatry and Behavioral Sciences, Emory University School of Medicine in Atlanta. From 2000 through 2006, Nemeroff received just over $960,000 from GlaxoSmithKline (GSK), but only disclosed no more than $35,000 to Emory. Between 2000 and 2007, Charles Nemeroff earned more than $2.8 million from various drug makers but failed to report at least $1.2 million. He signed a letter in 2004 promising Emory administrators that he would earn less than $10,000 a year from GSK but on the same day he was at a hotel earning $3,000 of what would become $170,000 in income from the company—17 times greater than the figure he agreed upon. He was the principal investigator for a five-year $3.9 billion grant financed by the NIMH for which GSK provided the drugs, during which he received more than the annual $10,000 threshold allowed from the company. In 2003, he coauthored a favorable review of three therapies in Nature Neuroscience failing to mention his significant financial interests in these, including owning the patent for one of the treatments—a lithium patch. Nemeroff has consulted for 21 drug and device companies simultaneously. In 1991 Nemeroff testified before the FDA on behalf of Eli Lilly in hearings into Prozac, saying that the drug did not cause suicidal acts of ideation—yet 13 years later, the FDA concluded the opposite and issued a black box warning about suicide risks.
Martin Keller: Professor of Psychiatry and Human Behavior at Brown University, chairman of the psychiatry department at the Alpert Medical School, Keller’s study (329) on GSK’s Paxil use in children and adolescents and its authors have been fiercely criticized in medical journals for allegedly misrepresenting data, suppressing information linking the drug to suicidal tendencies and reaching a conclusion unsupported by the relevant data. There are also claims that a GSK-affiliated employee ghostwrote Study 329, while Keller et al. made huge sums of money from the antidepressant manufacturer. In 1999, it was disclosed that while serving as chief of the psychiatry department at Brown University, Keller earned more than $842,000 from Pfizer, Bristol-Myers Squibb, Wyeth-Ayerst and Eli Lilly, makers of antidepressants he “lauded in a series of medical research reports.” After a three-year criminal investigation by the Attorney General’s Office, Brown University “agreed to return $300,170” of taxpayer money to the state of Massachusetts for psychiatric research Keller’s psychiatry department never performed. Additionally, Keller did not disclose the extent of his financial ties with companies to the medical journals that published his research—this included $93,199 in 1998. In the same year that Keller authored a review article in Biological Psychiatry, and concluded that the newer antidepressants were more effective, he received $77,400 in personal income and $1.2 million in research funding from the makers of two of these drugs.
Alan Schatzberg was appointed APA President in May 2009, despite the exposure of his conflict of interest. As exposed in The New York Times and other media, Schatzberg owned $6 million equity in drug developer Corcept Therapeutics at the same time that he was principle investigator in an NIH-funded, Stanford-based study of Corcept’s drug mifepristone. Schatzberg had initiated the patent application on mifepristone to “treat psychotic depression” in 1997. He co-founded Corcept in 1998, and in 1999, extended the NIH grant for the study of psychotic depression to include mifepristone.
Thomas Spencer: Assistant Director of the Pediatric Psychopharmacology Unit at Massachusetts General Hospital and Associate Professor of Psychiatry, Harvard Medical School, he is under Senate investigation for reportedly failing to disclose at least $1 million in earnings from drug companies between 2000 and 2007.
Karen Wagner: Professor, University of Texas Medical Branch at Galveston reportedly failed to disclose more than $150,000 in payments from GSK. Between 2000 and 2008, Wagner had worked on NIH-funded studies on the use of Paxil to treat teenage depression and was a co-researcher on Study 329 (See Keller). In 2001, when study 329 was published, the company reportedly paid her $18,255. Between 1998 and 2001, she was one of several researchers participating in more than a dozen industry-funded pediatric trials of antidepressants and other drugs. In her Zoloft study, Wagner said she had received “research support” from several drug makers, including Pfizer, but did not disclose she had received “sizeable payments” from Pfizer for work related to the study. Between 2000 and 2005 GSK paid her $160,404, but only $600 was disclosed to the university. In 2002, Eli Lily also paid her over $11,000, which was not disclosed.
Timothy Wilens: Associate Professor of Psychiatry at Harvard Medical School in Boston allegedly failed to report that between 2000 and 2007 he had earned at least $1.6 million from drug makers. Federal grants received Dr. Joseph Biederman (above) and Wilens were administered by Massachusetts General Hospital, which in 2005 won $287 million in such grants. He is under Congressional investigation.
The Citizens Committee on Human Rights further reported that:
The Senate Finance Committee also requested the financial records of NAMI, a group long accused of being a covert marketing arm of the pharmaceutical industry. The mental health alliance, which is hugely influential in many state capitols, has refused for years to disclose specifics of its fund-raising, saying the details were private. But according to documents obtained by The New York Times, drug makers from 2006 to 2008 contributed nearly $23 million to the alliance, about three-quarters of its donations.”
While the National Alliance on Mental Illness (NAMI), claims to be an advocacy organization for people with “mental illness,” its actions indicate otherwise. The group opposed the black box warnings on antidepressants causing suicide for under 18 year olds in 2004, and black box warnings on ADHD drugs causing heart attack, stroke and sudden death in children in 2006, when you look at their biggest source of funding: Pharma.
From the previous article “What is Normal”:
As a mental health professional advocating for children, adolescents and their families within the legal, academic, and social institutions for a number of years, I have observed a growing intolerance within our society to behavioral presentations and patterns that do not conform to an increasingly narrow perception of what is 'normal'. Simultaneous to this increasing intolerance is a continuous breakdown within the institutions themselves which limits their ability to respond effectively to the needs of the individual. Unprecedented cutbacks in education, arts, and social programs which assist our most vulnerable citizens; the young, the elderly, the impoverished and the disabled, is creating a new culture of 'normal'; one in which our ability to respond to the 'troubled' or 'maladapted' individual is becoming more and more limited to chemical restraints. In our public schools physical exercise, creative expression, and critical thinking skills have been replaced with educational strategies such as "No Child Left Behind" and Standards of Learning requirements that entrain our children to focus primarily on test-taking and grade percentages. The results of which appear to directly correlate to their developing sense of self-worth or lack thereof. Policies such as "Zero Tolerance" has created a fear-based culture of reactivity within our academic institutions, resulting in extreme, irrational consequences for what was previously recognized as falling within the realm of developmentally appropriate behaviors.
For the first time in history we are engaged in the largest social experiment in which we have agreed on a scale never before seen that it makes perfect sense to chemically restrain our children when their behaviors and achievements do not conform to our expectations. Consequently, one in four children in this country between the ages of 13 and 18 has now been identified as suffering from an anxiety disorder. In 1985, half a million children in the United States met the diagnostic criteria for ADHD. Today it is estimated that 5 to 7 million children in this country now have this diagnosis. Three and a half million children have met the criteria for a diagnosis of depression and a recent study showed a 600 percent increase in the diagnosis of pediatric bipolar disorder in children under the age of 13 in the last 10 years. Most of these children are receiving pharmacological interventions despite the absence of longitudinal studies that have not been funded by pharmaceutical companies excluding long-term, negative consequences on a developing brain still in its most critical stages of development.
One of the most concerning expressions of this particular social experiment that I’ve witnessed during the past eleven years is the increasing vulnerability of children to be diagnosed with Attention Deficit Disorder(ADD) and prescribed amphetamines because of their inability to conform to rigid and unrealistic expectations within the classroom.
In my opinion, this phenomenon has been perpetuated by a fear-based culture that took root in response to the Columbine school shootings that occurred in 1999. Prior to this unprecedented and unimaginable event, there was a greater willingness to assess child and adolescent behaviors on a scale that provided a context for what would be considered developmentally and situationally appropriate.
It is also my opinion that the pharmaceutical companies have knowingly taken advantage of this and contributed to this culture of fear by manipulating parents, teachers, administrators, and pediatricians into believing that medicating a brain with stimulants during its most critical stages of development is the wisest course of action when academic excellence becomes difficult for the child to achieve.
The following are excerpts from the New York Times published on December 14, 2013 on “The Selling of Attention Deficit Disorder” by Alan Schwarz:
- Recent data from the Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990.
- Profits for the A.D.H.D. drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health.
- Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
- The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.
- Even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.
- Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.
- The Food and Drug Administration has cited every major A.D.H.D. drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and non-stimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.
- Insurance plans, increasingly reluctant to pay for specialists like psychiatrists, are leaving many A.D.H.D. evaluations to primary-care physicians with little to no training in the disorder. If those doctors choose to learn about the diagnostic process, they can turn to web-based continuing-education courses, programs often subsidized by drug companies.
- Many doctors have portrayed the medications as benign — “safer than aspirin,” some say — even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction.
- Companies even try to speak to youngsters directly. Shire — the longtime market leader, with several A.D.H.D. medications including Adderall — recently subsidized 50,000 copies of a comic book that tries to demystify the disorder and uses superheroes to tell children, “Medicines may make it easier to pay attention and control your behavior!”
- Even Roger Griggs, the pharmaceutical executive who introduced Adderall in 1994, said he strongly opposes marketing stimulants to the general public because of their dangers. He calls them “nuclear bombs,” warranted only under extreme circumstances and when carefully overseen by a physician.
- Adderall quickly established itself as a competitor of the field’s most popular drug, Ritalin. Shire, realizing the drug’s potential, bought Mr. Griggs’s company for $186 million and spent millions more to market the pill to doctors. After all, patients can buy only what their physicians buy into.
- As is typical among pharmaceutical companies, Shire gathered hundreds of doctors at meetings at which a physician paid by the company explained a new drug’s value.
- Such a meeting was held for Shire’s long-acting version of Adderall, Adderall XR, in April 2002, and included a presentation that to many critics, exemplifies how questionable A.D.H.D. messages are delivered.
- 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.
- The PowerPoint document, obtained by The Times, asserted that stimulants were not “drugs of abuse” because people who overdose “feel nothing” or “feel bad.” Yet these drugs are classified by the government among the most abusable substances in medicine, largely because of their effects on concentration and mood. Overdosing can cause severe heart problems and psychotic behavior.
- Slides described side effects of Adderall XR as “generally mild,” despite clinical trials showing notable rates of insomnia, significant appetite suppression and mood swings, as well as rare instances of hallucinations. Those side effects increase significantly among patients who take more pills than prescribed.
- Another slide warned that later in life, children with A.D.H.D. faced “job failure or underemployment,” “fatal car wrecks,” “criminal involvement,” “unwanted pregnancy” and “venereal diseases”, but did not mention that studies had not assessed whether stimulants decreased those risks.
- Dr. Conners of Duke, in the audience that day, said the message was typical for such gatherings sponsored by pharmaceutical companies: Their drugs were harmless, and any traces of A.D.H.D. symptoms (which can be caused by a number of issues, including lack of sleep and family discord) should be treated with stimulant medication.
- Like most psychiatric conditions, A.D.H.D. has no definitive test, and most experts in the field agree that its symptoms are open to interpretation by patients, parents and doctors. The American Psychiatric Association, which receives significant financing from drug companies, has gradually loosened the official criteria for the disorder to include common childhood behavior like “makes careless mistakes” or “often has difficulty waiting his or her turn.”
- Drug company advertising also meant good business for medical journals – the same journals that published papers supporting the use of the drugs. The most prominent publication in the field, The Journal of the American Academy of Child & Adolescent Psychiatry, went from no ads for A.D.H.D. medications from 1990 to 1993 to about 100 pages per year a decade later. Almost every full-page color ad was for an A.D.H.D. drug.
- When federal guidelines were loosened in the late 1990s to allow the marketing of controlled substances like stimulants directly to the public, pharmaceutical companies began targeting perhaps the most impressionable consumers of all: parents, specifically mothers.
- A magazine ad for Concerta had a grateful mother saying, “Better test scores at school, more chores done at home, an independence I try to encourage, a smile I can always count on.” A 2009 ad for Intuniv, Shire’s nonstimulant treatment for A.D.H.D., showed a child in a monster suit taking off his hairy mask to reveal his adorable smiling self. “There’s a great kid in there,” the text read.
- “There’s no way in God’s green earth we would ever promote” a controlled substance like Adderall directly to consumers, Mr. Griggs said as he was shown several advertisements. “You’re talking about a product that’s having a major impact on brain chemistry. Parents are very susceptible to this type of stuff.”
- The Food and Drug Administration has repeatedly instructed drug companies to withdraw such ads for being false and misleading, or exaggerating the effects of the medication. Many studies, often sponsored by pharmaceutical companies, have determined that untreated A.D.H.D. was associated with later-life problems. But no science determined that stimulant treatment has the overarching benefits suggested in those ads, the F.D.A. has pointed out in numerous warning letters to manufacturers since 2000.
- Shire agreed last February to pay $57.5 million in fines to resolve allegations of improper sales and advertising of several drugs, including Vyvanse, Adderall XR and Daytrana, a patch that delivers stimulant medication through the skin.
- However, many critics said that the most questionable advertising helped build a market that is now virtually self-sustaining. Drug companies also communicated with parents through sources who appeared independent, from support groups to teachers.
- The idea of unleashing children’s potential is attractive to teachers and school administrators, who can be lured by A.D.H.D. drugs’ ability to subdue some of their most rambunctious and underachieving students. Some have provided parents with pamphlets to explain the disorder and the promise of stimulants.
- Today, 1 in 7 children receives a diagnosis of the disorder by the age of 18. As these teenagers graduate into adulthood, drug companies are looking to keep their business.
“The very vocabulary of psychiatry is now defined at all levels by the pharmaceutical industry.”