Fwd: Ritalin: Child Abuse On Prescription?

[Guest guest]

SSRI-Research , JustSayNo wrote:

This article gives general material and opinions for information

only and

is not to be considered an alternative to professional medical advice.

Readers should consult their family doctors or other qualified medical

advisers on any matter relating to their health and wellbeing.

 

 

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Ritalin: Child Abuse On Prescription?

 

 

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Family doctors are these days frequently under pressure (usually

from

teachers and social workers who know nothing about drug therapy and

probably

understand nothing about the way the international drug industry

operates)

to prescribe the drug called Ritalin for children who are accused of

behaving badly behaved, reported as not doing well at school and

`diagnosed'

as suffering from something called Attention Deficit Hyperactivity

Disorder

(known as ADHD).

 

 

For several decades now Ritalin, and other amphetamine type drugs,

have

been prescribed for children diagnosed as suffering from various

types of

brain dysfunction and hyperactivity. (Other psychostimulants which

have, at

one time or another, been regarded as competitors to Ritalin have

included

Dexedrine).

 

 

In my view the first problem is that Attention Deficit Hyperactivity

Disorder (and other variations on the hyperactivity theme) is a

rather vague

diagnosis which is often leapt upon by teachers, social workers and

parents

to excuse and explain any unacceptable or uncontrollable behaviour.

 

 

Parents of children whose behaviour is in any way regarded as

different or

unusual are often encouraged to believe that their child is suffering

from a

disease for two simple reasons. First, it is more socially acceptable

to

give a child a pseudoscientific label than to have to admit that he

or she

may simply be badly behaved.

 

 

Second, when a child has been given a label it is possible to offer

a

treatment. Commonly it will be one, such as a drug, which offers

someone a

profit.

 

ADHD, which is also known as Attention Deficit Disorder (or ADD),

hyperkinetic child syndrome, minimal brain damage, minimal brain

dysfunction

in children, minimal cerebral dysfunction and psycho-organic syndrome

in

children, is a remarkably non specific disorder. The symptoms which

characterise the disorder may include: a chronic history of a short

attention span, distractibility, emotional lability, impulsivity,

moderate

to severe hyperactivity, minor neurological signs and abnormal EEG.

Learning

may or may not be impaired.

 

 

Read that rather nonsensical list of symptoms carefully and you'll

find

that just about any child alive could probably be described as

suffering

from ADHD.

 

 

What child isn't impulsive occasionally? What child doesn't cry and

laugh

(that's what emotional lability means)? What child cannot be

distracted?

 

 

One big worry I have is that Ritalin could be recommended for any

child

who seemed bored and restless or who exhibited unusual signs of

intelligence

or skill. Read the biographies of geniuses and you may wonder what we

are

doing to our current generation of most talented individuals.

 

 

`Is Ritalin a drug in search of a disease?' wrote one author, and

it isn't

difficult to see why.

 

First Used In The 1960s

 

Ritalin has been recommended as a treatment for functional behaviour

problems since the 1960s. When CIBA first suggested this in 1961 they

were

turned down by the FDA but in 1963 approval was given for this use of

the

drug.

 

 

By 1966 the `experts' had come up with a definition of the sort of

child

for whom Ritalin could useful be prescribed. Children suffering from

Minimal

Brain Dysfunction (MBD), the first syndrome for which Ritalin was

recommended, were defined as `children of near average, average or

above

average general intelligence with certain learning or behavioural

disabilities ranging from mild to severe, which are associated with

deviations of function of the central nervous system. These

deviations may

manifest themselves by various combinations of impairment in

perception,

conceptualization, language, memory and control of attention, impulse

or

motor function'.

 

 

Other symptoms which children might exhibit and which could be

ascribed to

MBD included: being sweet and even tempered, being cooperative and

friendly,

being gullible and easily led, being a light sleeper, being a heavy

sleeper

and so on and on.

Given that sort of list to work with it is difficult to think of a

child

who wouldn't benefit from Ritalin - though the official estimate

seemed to

be that only around 1 in 20 children were real MBD sufferers.

 

A Convenient Diagnosis

 

The bottom line is that it has become easy for social workers and

teachers

to define any children who misbehaves or doesn't learn `properly' as

suffering from MBD or ADHD. Its a convenient diagnosis which excuses

parents, teachers and social workers from responsibility or any sense

of

guilt. How can the parents or the teacher be accused of failing when

the

child is ill?

 

 

The head of the task force which identified and labelled MBD

allegedly

subsequently joined the company making Ritalin and produced their

handbook

for doctors on the condition. Commercially Ritalin and MBD became a

huge

success. By 1975 around a million children in the U.S. were diagnosed

as

suffering from MBD. Half of these were being given drugs and half of

those

on drugs were on Ritalin.

 

 

For the sake of completeness I should point out that Ritalin has not

always been used exclusively in the treatment of badly behaved

children.

 

 

When Dr Andrew Malleson wrote his book `Need Your Doctor Be So

Useless' in

1973 he reported that the CIBA Pharmaceutical Company had suggested

`to

doctors the use of their habit forming drug Ritalin for `environmental

depression' caused by `NOISE: a new social problem'.

 

 

Does Ritalin Work?

 

The next question which has to be asked is: `Does Ritalin work?'

 

 

Well, I'm afraid that I can't answer that question. And I honestly

don't

think anyone else can either. Novartis, the drug company which is now

responsible for Ritalin in the UK, admits that `data on...efficacy of

long

term use of Ritalin are not complete'.

With one in twenty children said to be suffering from MBD (or ADHD

or ADD

or whatever else anyone wants to call it), with Ritalin having been

on the

market and used for this condition for over three decades, and with

some

experts saying that a million children a year are given Ritalin in

the U.S.

alone you might find this a trifle disappointing.

 

 

Just how long does it take to find out whether or not a drug works?

Am I

being horribly cynical in suggesting that it might be against the drug

company's interests to find out whether or not Ritalin really works?

After

all, if long term studies found that Ritalin didn't work a very

profitable

drug would, presumably, lose some of its appeal.

Some research has been done. One five year study of hyperactive

children

who were given Ritalin at Montreal Children's Hospital found that the

children did not differ in the long term from hyperactive children

who were

not given the drug. At least one investigator has reported that drugs

like

Ritalin may produce a deterioration in learning new skills at school

and

parents have reported that the symptoms of MBD have miraculously

disappeared

during school holidays.

 

 

The picture is confused by the fact that there may be a short term

improvement in behaviour among children given Ritalin. But is this a

real

improvement? Or is the child simply drugged? Amphetamine type drugs

reduce

the variety of behaviour exhibited by children. A child taking

Ritalin might

have more focused behaviour. But although that might mean less

disruption in

the classroom does it really help the child? And should we give a

child a

powerful and potentially hazardous drug because they it keeps him

quiet?

 

 

There is evidence suggesting that children who are genuinely

hyperactive

may have been poisoned by food additives or by lead breathed in from

air

polluted by petrol fumes. If this is so then is giving another

potentially

toxic drug really the answer to this problem?

 

Potentially Toxic

 

The next problem is that I believe that Ritalin can reasonably be

described as potentially toxic. Ritalin has been described as `very

safe'

but for the record here is a list of some of the possible side

effects which

may be associated with Ritalin: nervousness, insomnia, decreased

appetite,

headache, drowsiness, dizziness, dyskinesia, blurring of vision,

convulsions, muscle cramps, tics, Tourette's syndrome, toxic

psychosis (some

with visual and tactile hallucinations), transient depressed mood,

abdominal

pain, nausea, vomiting, dry mouth, tachycardia, palpitations,

arrhythmias,

changes in blood pressure and heart rate, angina pectoris, rash,

pruritus,

urticaria, fever, arthralgia, alopecia, thrombocytopenia purpura,

exfoliative dermatitis, erythema multiforme, leucopenia, anaemia and

minor

retardation of growth during prolonged therapy in children.

 

 

Doctors who prescribe Ritalin, and who have the time and the

inclination

to read the warnings issued with the drug, will discover that Ritalin

should

not be given to patients suffering from marked anxiety, agitation or

tension

since it may aggravate these symptoms.

 

 

Ritalin is contraindicated in patients with tics, tics in siblings

or a

family history or diagnosis of Tourette's syndrome. It is also

contraindicated in patients with severe angina pectoris, cardiac

arrhythmias, glaucoma, thyrotoxicosis, or known sensitivity to

methylphenidate and it should be used cautiously in patients with

hypertension (blood pressure should be monitored at appropriate

intervals).

Ritalin should not be used in children under six years of age,

should not

be used as treatment for severe depression of either exogenous or

endogenous

origin and may exacerbate symptoms of behavioural disturbance and

thought

disorder if given to psychotic children.

 

 

The company selling it claims that although available clinical

evidence

indicates that treatment with Ritalin during childhood does not

increase the

likelihood of addiction chronic abuse of Ritalin can lead to marked

tolerance and psychic dependence with varying degrees of abnormal

behaviour.

 

 

Ritalin, it is warned, should be employed with caution in

emotionally

unstable patients, such as those with a history of drug dependence or

alcoholism, because such patients may increase the dosage on their own

initiative.

 

 

Ritalin should also be used with caution in patients with epilepsy

since

there may be an increase in seizure frequency.

 

 

And height and weight should be carefully monitored in children as

prolonged therapy may result in growth retardation. (A child might

lose

several inches in possible height - though if treatment is stopped

there is

a generally a growth spurt). It is perhaps worth mentioning here my

view

that if a drug is powerful enough to retard growth it does not seem

entirely

unreasonable to suspect that the chances are high that it may be

having

other powerful effects upon and within the body.

 

 

Doctors are also warned that careful supervision is required during

drug

withdrawal, since depression as well as renewed overactivity can be

unmasked. Long term follow up may be needed for some patients.

 

 

There have also been reports that children have committed suicide

after

drug withdrawal. And one study has shown that children who are

treated with

stimulants alone had higher arrest records and were more likely to be

institutionalised.

Long term use of Ritalin has been said to cause irritability and

hyperactivity (these are, you may remember, the problems for which

the drug

is often prescribed). In a study published in Psychiatric Research and

entitled Cortical Atrophy in Young Adults With A History of

Hyperactivity

brain atrophy was reported in more than half of 24 adults treated with

psychostimulants (though I don't think anyone can say for sure

whether or

not the psychostimulants caused the brain atrophy the possible link

should

make prescribers, teachers and parents who are fans of Ritalin stop

and

think for a moment).

 

 

In Johannesburg a study of 14 children is said to have produced a

response

in only 2 children. One child showed some deterioration and another

showed

marked deterioration.

 

 

The final insult is, surely, the fact that the company selling

Ritalin

tells doctors that `Data on safety and efficacy of long term use of

Ritalin

are not complete.' For this reason they recommend that patients

requiring

long term therapy should be monitored carefully with periodic

complete and

differential blood counts, and platelet counts.

I regard this as an insult because Ritalin is not a new drug.

 

 

I have not, at the time of writing this, been able to find out

exactly

when it was first introduced but I have been able to trace it back to

1961.

 

 

Now, maybe I'm being rather demanding but it does seem to me that

when a

drug has been on the market for well over a quarter of a century it

isn't

entirely unreasonable for the drug company involved to have completed

studying the data on whether or not it works and is safe.

 

Cancer In Mice

 

When early safety tests were done on mice researchers found that

the drug

caused an increased in hepatocellular adenomas and, in male mice

only, an

increase in hepatoblastomas (described as `a relatively rare rodent

malignant tumour type').

`The significance of these results to humans is unknown' say

Novartis, the

company selling Ritalin.

 

Here, once again, is yet more proof of the total worthlessness of

animal

experiments and the ruthless and cynical attitude shown by drug

companies

and those government departments which allegedly exist to protect the

public

from unsafe drugs.

I have frequently argued that when drug companies perform pre

clinical

tests on animals they do so knowing that if the tests show that a drug

doesn't cause any problems when given to animals they can use the

results to

help convince the authorities that the drug is safe.

 

 

On the other hand when a drug does cause a problem when given to

animals

the results can be ignored on the grounds that `the significance of

these

results to humans is unknown'.

 

 

The question here is a very simple one: if the experiments on mice

which

showed that Ritalin causes cancer were of value why is the drug still

available on prescription for children? And if the experiments can

safely be

ignored (on the grounds that animals are so different to human beings

that

the results are irrelevant) why the hell were the tests done in the

first

place?

 

Ignorance And Misplaced Trust

 

My own feeling is that the people who told you that Ritalin

is 'very safe'

are either unable to read or too lazy to do any research into the

safety of

a product which they are recommending with such enthusiasm.

 

 

Years of experience mean that I am not in the slightest bit

surprised to

find such crass stupidity exhibited by social workers. I am, however,

more

surprised to find school teachers showing such a potent mixture of

ignorance

and misplaced trust. Some observers claim that Ritalin can be

considered for

a children when tests and clinical examinations have shown the

existence of

a clear neurological disorder - with abnormal brain wave patterns.

 

 

Psychiatrist, psychologist, health visitor, teachers, GP and parents

should, it is said, all be considered before considering treatment.

 

 

Even the company selling Ritalin says that `Ritalin treatment is not

indicated in all children with this syndrome and the decision to use

the

drug must be based on the physician's evaluation of the child's

history and

the duration and severity of symptoms'.

However, despite this, when a team of researchers from the United

Nationals International Narcotics Control Board examined the records

of

nearly 400 paediatricians who had prescribed Ritalin they found that

half

the children who had been diagnosed as suffering from MBD (or ADD or

whatever) had not been given psychological or educational testing

before

being given the drug. The United Nations concluded that frustrated

parents,

teachers and doctors were too quick to stick a label of ADD onto

children

with behavioural problems (or, to be more accurate, to children whose

behaviour was annoying the parents, teachers and doctors).

 

 

Less Than Enthusiastic

 

I am less than enthusiastic about this drug. In my view, the world

would

be a healthier place if all supplies of this wretched drug were

wrapped in

concrete and buried in the rubble of the headquarters of the company

making

the damned stuff.

 

 

You might have guessed by now that I wouldn't prescribe Ritalin for

anyone - for anything.

 

 

But other doctors clearly don't agree with me. Some observers have

described Ritalin as a drug that can unlock a child's potential. And

although estimates about the number of children taking Ritalin vary

in the

U.S. alone it has been claimed that up to 12 % of all American boys

aged

between 6 and 14 are being prescribed Ritalin to treat various

behavioural

disorders. In 1990 the world wide production of the drug was less

than three

tonnes. By 1994 production of the drug had virtually trebled. It is

now not

unknown for schools to arrange for children to be treated with Ritalin

without obtaining parental permission.

 

 

It is worth remembering that although doctors, parents and teachers

have

for over thirty years now been enthusiastically recommending the use

of

Ritalin (and similar drugs) in the treatment of MBD there are still a

number

of unanswered questions.

 

We still do not know whether the drug works and nor do we know

whether it

causes any permanent long term damage. We do not know whether the

listed

potential side effects do more damage than any possible good the drug

might

do. And, perhaps most astonishing of all, despite the fact that

millions of

children have been diagnosed as suffering from ADHD, ADD or MBD, and

treated

with powerful drugs, we do not even know whether any of these

conditions -

or hyperactivity - really exist.

 

 

Back in 1970 the Committee on Government Operations of the U.S.

House of

Representatives studied the use of behaviour modification drugs on

children.

At that time around 200,000 to 300,000 children a year in the U.S.

were

being given these drugs and the point was then made that

hyperactivity is

considered a disease because it makes it difficult for schools to be

run

`like maximum security prisons, for the comfort and the convenience

of the

teachers and administrators who work in them...'.

Since then the only thing that has changed is that the popularity of

Ritalin has continued to rise and rise and rise inexorably.

 

 

Prescribing Ritalin is, in my view, authorised child abuse on a

massive,

global scale.

 

But it is clear that the prescribing of powerful mind altering

drugs for

small children is big business.

 

 

In the US the use of antidepressants and stimulants among toddlers

aged

between two and four tripled between 1991 and 1995. The period

between birth

and four years of age is a time of great change in the human body.

Most

importantly it is a time when the brain is maturing. Heaven knows what

effect these drugs have on those tiny developing brains.

 

 

Ritalin is now widely prescribed for toddlers. So are many other

antidepressants, stimulants and other powerful drugs. Remember:

typical

symptoms of this alleged disease include `restlessness' and

`inattentiveness'.

 

 

I am delighted that my protests and complaints about these absurd

and

obscene prescribing habits have drawn a number of vicious complaints

from

doctors.

 

In my view every doctor who prescribes such drugs for children with

alleged ADHD should be defrocked, given a good thrashing with

genetically

engineered stinging nettles and forced to emigrate to the USA.

--- End forwarded message ---