Attention deficit disorder is a classic example of the medicalization of mental disorders, where virtually everyone “believes” it is some sort of biochemical or brain disorder and so medications are the appropriate (and wildly popular) treatment choice. Medications are the right and appropriate treatment choice for ADHD; not because it is a medical disease, but because the research base is pretty strong in showing that they are effective.
But if you can’t trust Consumer Reports to report accurately on this disorder (and other mental disorders), I’m not sure who you can trust anymore. A colleague recently referred me to the “Best Buy Drugs” section of Consumer Reports health website. So I took a look around and started at the beginning of the alphabet. Sadly, it didn’t take me more than 10 minutes to find the marketing influence of pharmaceutical messaging to psychiatrists and doctors in the first brochure I read.
The report in question is entitled “Evaluating Prescription Drugs Used to Treat: Attention Deficit Hyperactivity Disorder.” While I recommend the report for anyone who is starting medication for treatment of attention deficit disorder (ADHD), and generally agree with its lukewarm findings (some generics are preferred because they’re cheap and supposed to be just as effective), I found the introduction to the report written as though it came from a pharmaceutical brochure.
Here’s the most offensive paragraph:
What should lead you to suspect ADHD (which is a distinct biologically-based behavioral disorder now widely recognized by doctors) is this: a persistent pattern lasting at least six months of abnormally high levels of physical activity (hyperactivity), impulsivity, and/or lack of ability to pay attention and focus or complete tasks. (See the full list of symptoms on page 7.) The severity of symptoms and abnormal behavior patterns in children and teens with ADHD varies widely. Some children have only mild symptoms while others are severely affected. The range of symptoms among adults has not been well studied.
How many things are wrong with this paragraph?
1. ADHD, like all mental disorders, has only indirect, correlational evidence that suggests it is a “distinct biologically-based behavioral disorder.” The “biologically-based” phrase is one introduced by pharmaceutical companies as a subtle bias to suggest that such disorders are best medically treated (by their drugs, naturally). Mental disorders are complex bio-psycho-social conditions that have multiple and complex etiologies.
2. No mention is made of an important diagnostic component, and the reason ADHD is so often misdiagnosed and overdiagnosed — the hyperactivity or lack of paying attention has to occur in multiple settings. In other words, if you have trouble only paying attention at work or school, but not at home or with friends or family, technically you don’t qualify for an ADHD diagnosis. Why does this clause exist? Because almost everyone can lose attention at repetitive or boring tasks (e.g., work or school) from time to time.
Leave this component out of this brief symptom list (and its mentioned only in passing in the full symptom list), and you get overdiagnosis — great for the medicalization of childhood behavior!
3. The range of symptoms amongst adults has not been well-studied? Huh?? There are hundreds of studies that examine adult ADHD (I found 604 in PsycINFO), and a few validated psychometric objective measures that assess for it (like the Conners’ Adult ADHD Rating Scales). Not only has it been well-studied, but it’s pretty well-accepted and diagnosed amongst clinicians nowadays. Perhaps because most ADHD medications are targeted toward adolescents and children the emphasis is on that group rather than adults?
And of course this classic also made an appearance:
Doctors don’t know exactly what causes ADHD, but one prevailing theory is that it is due to abnormal levels of these chemical messengers and/or how they are used in the brain. Three neurotransmitters predominate, and the drugs used to treat ADHD alter the brain levels of one, two, or all three of those chemicals. Environment may also play a role — with children prone to ADHD having their symptoms triggered by factors in the home or at school.
We don’t know what causes it, and researchers have about a dozen different theories about its cause, but we’re going to pick the one that emphasizes biology. Well, it is, after all, a brochure about medications and its editing overseen only by psychiatrists and other medical doctors. We’ll also throw in a mention about the environment.
What about psychological factors? What about social factors? What about the other theories? They are given short-shrift, because, after all, they don’t really reinforce medication treatment.
The peer reviewers have a long laundry list of competing interests, which at least is disclosed (if you dig for it on the website; it appears nowhere on the actual report).
I commend Consumer Reports in its effort to help consumers make better-informed choices about their treatment options. But c’mon… Get some balance and reviewers in there who are not so well-schooled in the traditional “biologically-based” mental disorder nonsense and, if you’re going to talk about these disorders, talk about them with fairness and appreciation for their complexity (and completely not-understood causes).
Don’t say, “We don’t know what causes them” and then proceed to spit out a pharmaceutical marketing message cloaked in science double-talk. We expect more from Consumer Reports — and so should you.
The full report is here: valuating Prescription Drugs Used to Treat: Attention Deficit Hyperactivity Disorder (PDF)