ADHD & Why It’s a “Fictitious” Disorder

[Deleted]

I think ADHD is real but I also think it's easy for a child to be misdiagnosed just because they're a little hyperactive or easily distracted. It's possible that half of the people out there with ADHD diagnoses do not actually have it, but I do believe it's real.

Kids are fidgety and easily distracted by default, because they are kids. That's kind of their deal. They don't want to sit still at a desk and pay attention to something that they find boring. They want to go outside and climb on things and kick footballs around. That's not a disorder, that is just children acting like children.

That's why lessons for young kids need to be interactive and more activity focused, to keep their minds engaged. Telling them to copy from a blackboard or just droning on and on about a subject while they listen is going to result in very little knowledge being absorbed. Good teachers are very valuable for that reason. I learned so much more when the teacher was able to tell good stories (relative to what we were learning).

Shit like ritalin should only be given in most extreme cases where it's obvious the kid has ADHD and isn't just bored/fidgety at school. It's an amphetamine after all and you can't just hand it out like candy.

[starlord]

This outrage is about 10 years behind the curve. Physicians long ago realized ADHD diagnoses were being slapped around too liberally and have walked back dramatically on both prescription and diagnosis. It isn't fictitious, but it does require far less medicating of kids than previously practiced.

Also, just to clarify some misinformation on page 1, we don't get paid to prescribe anything. Not saying it's never happened, but when it does, it's a monstrous ethics violation and gets fixed right quick. The exception rather than the rule. You try spending 15 minutes locked in a tiny exam room with a parent at their wits end and a nightmare of a child bouncing off the walls. The temptation to just medicate them is strong, especially since it works. The non-amphetamine solutions are way harder. Not justifying it, but I 100% understand why it was overdone. Thankfully, this is already heading back in a healthy direction.

doctors who recieve more money/gifts etc from pharmacutical companies prescribe those products at a higher level. they are not *technically* getting paid to prescribe, it *just so happens* that the more $ they recieve, the more they prescribe that drug.

it is considered a form of bribery in other areas, i dont see why doctors should be exempt from that.

[Detritivores]

doctors who recieve more money/gifts etc from pharmacutical companies prescribe those products at a higher level. they are not *technically* getting paid to prescribe, it *just so happens* that the more $ they recieve, the more they prescribe that drug.

it is considered a form of bribery in other areas, i dont see why doctors should be exempt from that.

We aren't. I'd love to hear why you think we are though. What you're describing is widely acknowledged to be unethical.

There are all sorts of blurring of lines however. If I'm receiving food or whatever from a rep that happens to be repping the best drug for a particular problem, am I still wrong to prescribe it more? Do I need to prescribe the competitor's less effective drugs equally to make myself "unbribed?" Obviously not. The clear answer is that no doctors should receive anything from any company. The unfortunate reality is that doctors are incredibly busy people, so if you want us to listen to your spiel on drug x, you need to at the very least feed us. Because lord knows we won't find time to eat otherwise. Alternatively, you could wait until we find time to get caught up on the literature regarding your drug...

Again, I'm not trying to defend this situation exactly. I'm just trying to give you some shades of grey to contemplate from your black and white "bringing Dr. Det a turkey sandwich so he'll read your clinical trial = bribery!" high horse. This is all falling by the wayside any how. No one at my practice is allowed within 50 yards of a drug rep.

[Noogai131]

doctors pushing meds on people who dont need them is what you get with privatized healthcare.

We have a public healthcare system in Australia, and a lot of my friends were diagnosed with ADHD or ADD and fed Ritalin. I stopped taking them 4 years after I was prescribed them, and I actually calmed down when I stopped taking them, ate properly and developed normal friendships and bonds.

Privatization CAN lead to pushing meds. That doesn't mean a publicized healthcare system is any different.

[starlord]

We aren't. I'd love to hear why you think we are though. What you're describing is widely acknowledged to be unethical.

There are all sorts of blurring of lines however. If I'm receiving food or whatever from a rep that happens to be repping the best drug for a particular problem, am I still wrong to prescribe it more? Do I need to prescribe the competitor's less effective drugs equally to make myself "unbribed?" Obviously not. The clear answer is that no doctors should receive anything from any company. The unfortunate reality is that doctors are incredibly busy people, so if you want us to listen to your spiel on drug x, you need to at the very least feed us. Because lord knows we won't find time to eat otherwise. Alternatively, you could wait until we find time to get caught up on the literature regarding your drug...

Again, I'm not trying to defend this situation exactly. I'm just trying to give you some shades of grey to contemplate from your black and white "bringing Dr. Det a turkey sandwich so he'll read your clinical trial = bribery!" high horse. This is all falling by the wayside any how. No one at my practice is allowed within 50 yards of a drug rep.

in government any "gifts" above $20 is considered bribery. doctors recieve thousands of dollars, which has been shown to influence their practices.

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We have a public healthcare system in Australia, and a lot of my friends were diagnosed with ADHD or ADD and fed Ritalin. I stopped taking them 4 years after I was prescribed them, and I actually calmed down when I stopped taking them, ate properly and developed normal friendships and bonds.

Privatization CAN lead to pushing meds. That doesn't mean a publicized healthcare system is any different.

the difference is one provides a direct benefit, the other may simply be a failure on their part.

[Detritivores]

We have a public healthcare system in Australia, and a lot of my friends were diagnosed with ADHD or ADD and fed Ritalin. I stopped taking them 4 years after I was prescribed them, and I actually calmed down when I stopped taking them, ate properly and developed normal friendships and bonds.

Privatization CAN lead to pushing meds. That doesn't mean a publicized healthcare system is any different.

The problem you guys are railing against is overdiagnosis. It's more complicated that us nefarious doctors pushing pills. For the record, we have entire groups of docs devoted to addressing this issue. Here's a short list of good reads from our organization on the topic:

http://www.preventingoverdiagnosis.net/?page_id=12

I haven't read it all by any means, but plenty of good stuff in there. "Selling sickness" was good and is particularly applicable to this thread.

[Danuru]

I wouldn't bother trying to explain anything to Orlong. He lives in a weird bubble where he's the smartest person alive and anyone or anything that disagrees with him is some sort of liberal agenda trying to sabotage his existence.

I agree on very little with you, Nixx, but I imagine you're right about this (Which is both a little funny, and a little humbling, since I consider myself conservative.)

[Detritivores]

in government any "gifts" above $20 is considered bribery. doctors recieve thousands of dollars, which has been shown to influence their practices.

What doctors are we talking about exactly? I've never personally received a dime. I am once again not saying it doesn't exist, but you are painting with way too broad a brush here. Overdiagnosis is not a product of direct bribery. And direct bribery like what you're describing is not acceptable. See above. Lots to learn about this issue.

[Noogai131]

in government any "gifts" above $20 is considered bribery. doctors recieve thousands of dollars, which has been shown to influence their practices.

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the difference is one provides a direct benefit, the other may simply be a failure on their part.

Deals, contracts and the like still happen within a public healthcare system. Just because something is public does not mean it isn't also subject to the same levels of cronyism and bad capitalism.

ADHD exists, I know it does and I accept it. I also believe it is over-diagnosed within many different healthcare systems. I would be interested to see the comparison of diagnosis rates between a public system and a private system, though.

I also feel that the over diagnosis in public systems exists for a separate reason to capitalism or cronyism. I've noticed my local GP/doctor's offices are flooded with patients and it's basically a revolving door system where the doctor tries to get as many people "treated" as possible. It's anecdotal evidence, so don't take it as gospel, but a lot of my friends and people I know admit the healthcare system we have in terms of public or "bulk billed" doctors (places that don't charge you if you are on public healthcare, we still have private doctors) will often just prescribe you with either anti-biotics or some form of medication and put you out the door, even if you have something like an abcess or cyst that needs operation, because they just want you gone and somebody else to come in.

[starlord]

The problem you guys are railing against is overdiagnosis. It's more complicated that us nefarious doctors pushing pills. For the record, we have entire groups of docs devoted to addressing this issue. Here's a short list of good reads from our organization on the topic:

http://www.preventingoverdiagnosis.net/?page_id=12

I haven't read it all by any means, but plenty of good stuff in there. "Selling sickness" was good and is particularly applicable to this thread.

what do you think are the causative factors of overdiagnosis?

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What doctors are we talking about exactly? I've never personally received a dime. I am once again not saying it doesn't exist, but you are painting with way too broad a brush here. Overdiagnosis is not a product of direct bribery. And direct bribery like what you're describing is not acceptable. See above. Lots to learn about this issue.

apparently there are lots of them. there's a list - https://projects.propublica.org/docdollars/

Deals, contracts and the like still happen within a public healthcare system. Just because something is public does not mean it isn't also subject to the same levels of cronyism and bad capitalism.

ADHD exists, I know it does and I accept it. I also believe it is over-diagnosed within many different healthcare systems. I would be interested to see the comparison of diagnosis rates between a public system and a private system, though.

I also feel that the over diagnosis in public systems exists for a separate reason to capitalism or cronyism. I've noticed my local GP/doctor's offices are flooded with patients and it's basically a revolving door system where the doctor tries to get as many people "treated" as possible. It's anecdotal evidence, so don't take it as gospel, but a lot of my friends and people I know admit the healthcare system we have in terms of public or "bulk billed" doctors (places that don't charge you if you are on public healthcare, we still have private doctors) will often just prescribe you with either anti-biotics or some form of medication and put you out the door, even if you have something like an abcess or cyst that needs operation, because they just want you gone and somebody else to come in.

you are right that it could still happen via contracts, however that is less beneficial to the individual.
i suppose the VA is rather notorious, but that is mostly an oversight problem imo.

[Detritivores]

what do you think are the causative factors of overdiagnosis?

That link is a listing of a pile of books exploring the answer to this question. It's multifactorial and far more complicated than I have the time to explain to you here. But grab a book by all means and learn more about this. You seem to think that widespread direct bribery of physicians is a significant factor. I'm trying to tell you that's just not the case. And vilifying doctors for their small part in a horrendous system that encourages overdiagnosis is not particularly helpful.

[starlord]

That link is a listing of a pile of books exploring the answer to this question. It's multifactorial and far more complicated than I have the time to explain to you here. But grab a book by all means and learn more about this. You seem to think that widespread direct bribery of physicians is a significant factor. I'm trying to tell you that's just not the case. And vilifying doctors for their small part in a horrendous system that encourages overdiagnosis is not particularly helpful.

well so far people have argued that it is more due to laziness than greed, which doesnt do doctors any favors either. i think they deserve scrutiny when people's lives are at stake.

[MatadorMedia]

In a DER SPIEGEL interview with retired Harvard psychologist, Dr. Jerome Kagan ...

There's your problem. He's a psychologist, not a psychiatrist. He has a theory but he's not the expert here.

[Detritivores]

apparently there are lots of them. there's a list - https://projects.propublica.org/docdollars/

I'm beginning to wonder if you're actually interested in a discussion here. Surely, from our interaction thus far, you've deduced that I'm a practicing physician with an interest in the phenomenon of overdiagnosis. Do you not think I've seen and made extensive use of this list? Do you understand that the overwhelming majority of people diagnosing ADHD are not on that list? And that the majority of people on that list are not receiving direct bribes?

We are on the same side here. I think any payment given to doctors by pharma or device manufacturers is a bad idea. So do you. But it's far more complicated than that.

Example: I have a friend who's a pain management doctor. He's implanted 100s of stimulators which can help people with their pain. Over the years, he identified the company that makes the best stimulator product, and started using them exclusively because their device gave his patient's the best results. The company noticed him using more of their devices and asked him to speak on their behalf to other doctors, which he agreed to (for a fee), because he had determined they made the best device. If I gave you his name, you'd find him on that list you linked me. And yet, can you argue that his actions are terribly unethical? He's getting compensated to share his experience regarding a device he has found to be superior in his practice.

Now again, I would say that's still a bad idea. But I would also say that that isn't a nefarious direct bribe effecting his practice in any way. Am I making sense here?

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well so far people have argued that it is more due to laziness than greed, which doesnt do doctors any favors either. i think they deserve scrutiny when people's lives are at stake.

I'm saying blaming doctors is short sighted and ignoring the bigger issues.

[Flatspriest]

Doctors aren't receiving payment for prescribing drugs.

Actually, yes they do receive payments from the pharmaceutical companies for prescribing the drugs produced by said companies. The psycho-active drugs are especially pushed by those companies to the doctors to prescribe.

[DesMephisto]

Years ago, if a kid was bored and didn’t listen well in class, he was considered lazy, a daydreamer or perhaps a bit rambunctious. These days, he’s labeled with a mental disorder.

In fact, the CDC says 6.4 million kids ages 4-17 have been “diagnosed with ADHD” since 2011. And that stat doesn’t even include the 198,000 kids under age five who are taking ADHD drugs. Besides that, I guarantee you, these numbers are a lot higher today – because every year the rates continue to skyrocket.

In a DER SPIEGEL interview with retired Harvard psychologist, Dr. Jerome Kagan, he explains why he is critical of “fuzzy diagnostic practices” and the “over-prescription of drugs such as Ritalin for behavioral problems in children.” When SPIEGEL asked Dr. Kagan if he actually thought ADHD was just an invention, he said –

“That’s correct; it is an invention. Every child who’s not doing well in school is sent to see a pediatrician, and the pediatrician says: “It’s ADHD; here’s Ritalin.” In fact, 90 percent of these kids don’t have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they’ll make the corresponding diagnosis.”

Source

Its not entirely based around an abnormal dopamine metabolism, in fact the actual mechanism behind ADHD has not been fully hammered out, similarly to autism (note, they're both on the same spectrum, and if you claim ADHD isn't real, you start pushing into Autism isn't real).

Welbutrin is often prescribed as a way of treating ADHD as well, you know what it is? Its a selective reuptake neuroepinephrine inhibitor, meaning guess what, something other than dopamine. In fact, NE is critical in our signal to noise ratio, IE if its out of wack, you get more noise than signals in your PFC which, I'm gonna let you take a wild guess and figure affects the ability to pay attention.

But sure, lets call it a fictitious disorder.

Sincerely, someone with severe ADHD.

[starlord]

I'm beginning to wonder if you're actually interested in a discussion here. Surely, from our interaction thus far, you've deduced that I'm a practicing physician with an interest in the phenomenon of overdiagnosis. Do you not think I've seen and made extensive use of this list? Do you understand that the overwhelming majority of people diagnosing ADHD are not on that list? And that the majority of people on that list are not receiving direct bribes?

We are on the same side here. I think any payment given to doctors by pharma or device manufacturers is a bad idea. So do you. But it's far more complicated than that.

Example: I have a friend who's a pain management doctor. He's implanted 100s of stimulators which can help people with their pain. Over the years, he identified the company that makes the best stimulator product, and started using them exclusively because their device gave his patient's the best results. The company noticed him using more of their devices and asked him to speak on their behalf to other doctors, which he agreed to (for a fee), because he had determined they made the best device. If I gave you his name, you'd find him on that list you linked me. And yet, can you argue that his actions are terribly unethical? He's getting compensated to share his experience regarding a device he has found to be superior in his practice.

Now again, I would say that's still a bad idea. But I would also say that that isn't a nefarious direct bribe effecting his practice in any way. Am I making sense here?

so, we both agree that it is a bad thing. this is because it can be easily abused. i'm not saying all doctors are "nefarious", only that the temptation is there. i have seen it in my family where doctors will prescribe uneeded medication, to the detriment of my family's health. the only way we knew was by changing doctors when things became worse. doctors are in a position of public trust imo.

[Detritivores]

so, we both agree that it is a bad thing. this is because it can be easily abused. i'm not saying all doctors are "nefarious", only that the temptation is there. i have seen it in my family where doctors will prescribe uneeded medication, to the detriment of my family's health. the only way we knew was by changing doctors when things became worse. doctors are in a position of public trust imo.

Again, I would push back against this whole blame the doctors tendency. There seems to be this perception that doctors are in a position of power, when in reality, we are peons is the larger health care system, at the mercy of administrators who grade us on how many of our patients with diagnosis x are on drug y, regardless of any extenuating circumstances like the patient's wishes or our own clinical judgement. In times gone by, it would have been more than fair to lay this all at the feet of doctors who ran the show and were generally not questioned. That's no longer the case.

Today, there are so many reasons for overdiagnosis and overprescription, some doctor-drive, some patient-driven, some culture-driven, some system-driven. And the question of whether or not a medication is "needed" is in most situations much less black and white than the general public seems to think. Ideally the doctor explains risks and benefits or any medication choice and they and the patient make the decision together.

Edit: To the original point,there should be 0 money changing hands for any reason between any parties, no matter how innocent it seems. We do agree.

[schwarzkopf]

So how is ADHD "fictitious?"

Well fictitious is untrue, and we live in a post fact world - so given anything can be true, anything can be untrue.

Welcome to the Brave New World

[starlord]

Again, I would push back against this whole blame the doctors tendency. There seems to be this perception that doctors are in a position of power, when in reality, we are peons is the larger health care system, at the mercy of administrators who grade us on how many of our patients with diagnosis x are on drug y, regardless of any extenuating circumstances like the patient's wishes or our own clinical judgement. In times gone by, it would have been more than fair to lay this all at the feet of doctors who ran the show and were generally not questioned. That's no longer the case.

Today, there are so many reasons for overdiagnosis and overprescription, some doctor-drive, some patient-driven, some culture-driven, some system-driven. And the question of whether or not a medication is "needed" is in most situations much less black and white than the general public seems to think. Ideally the doctor explains risks and benefits or any medication choice and they and the patient make the decision together.

i agree that the larger healthcare framework is also to blame, influencing doctors way of treating people. they also benefit from such things. my father had to go to the ER because his bloodpressure medication was incorrect, and my grandmother suffered from unnecessary surgeries and also had problems with incorrect and over medication prior to her death.
they didnt know any better than to just take what the doctor said at their word.