European View on ADHD

http://www.iht.com/articles/2004/10/26/news/health.html





MILTON KEYNES, England While most parents collect pictures and essays as
mementos of their children's school days, Tanya French instead totes around
her 9-year-old's behavior chart, on which teachers document the ways in
which her boy has misbehaved.
..
"Pushing another child," "disruptive and rude," "swearing," "calling out,"
"jumping out of his chair," it reads.
..
Shane spends long periods of his school day sitting in the corridor as
punishment.
..
Four years ago, French became convinced that Shane was suffering from
Attention Deficit Hyperactivity Disorder and sought to get him help. But it
was not until last year that he was finally diagnosed, and he has just been
started on medications.
..
In the meantime, teachers and counselors told French that Shane's problems
stemmed from her lack of discipline, or because she is a single parent.
..
Shane, who reads poorly in part because of all the class time he has missed,
is a pariah and has never been invited to a birthday party.
..
"I am at the end of my tether," French said. "Hardly anyone at the National
Health Service knows about it, and neither do the educational authorities.
People here just don't want to recognize it. They think ADHD is just an
American version of being a naughty boy."
..
In the United States, 3 percent to 5 percent of school-age children carry
the diagnosis of Attention Deficit Disorder or its subgroup, Attention
Deficit Hyperactivity Disorder, generally receiving support and treatment
for the condition.
..
In England, well under one percent carry the diagnosis, although recognition
is growing. In countries like France and Italy, many if not most doctors do
not believe the condition exists.
..
In Italy, where a recent study found that the lag time from referral to
diagnosis was more than three years, medicines to treat ADD were not
licensed until this year.
..
While many leading scientists believe there is excess diagnosis and
overmedication in the United States, they concur that the condition has been
seriously neglected in Europe - although that trend is changing.
..
"The rate of the condition is probably the same everywhere, but there is big
undertreatment here," said Dr. Eric Taylor of the Institute of Psychiatry at
Kings College in London. "Gatekeeping in schools and by doctors filters out
90 percent of these children, and tells them they don't have a disorder."
..
If treatment rates varied this much for appendectomies or Caesarean
sections, it would be a considered a medical scandal. But mental health
diagnosis depends not just on science, but also on doctors' paradigms of
psychiatry and on society's attitudes toward children.
..
Attention Deficit Disorder is characterized by a complex of symptoms where
children are unusually impulsive, lack organizational and social skills, and
cannot follow even simple sequential instructions or commands. They tend to
fight or be slow at learning, have tantrums like toddlers, and are
notoriously disruptive in class.
..
It is often compounded by hyperactivity, so that affected children cannot
sit still for story time; in the playground, they are risk takers, always on
the go.
..
People shy away from the diagnosis of ADD in Britain "because it feeds into
panic about the traditional family breaking down," Taylor said. "In Italy,
with its family focus, it is blamed on the upbringing. French psychiatry is
very Freudian, so it is all about psychoanalysis. Many doctors basically
don't recognize ADD. There are many very desperate families."
..
Also, the condition is difficult to treat within public health systems in
which access to child psychiatrists is limited by the financial resources
available. Diagnosis requires a specialist, and optimal treatment involves
both medicine and behavior-training therapy.
..
In contrast, in the United States, ADHD provides lucrative business for drug
companies and therapists, an incentive for diagnosing the condition.
..
Studies have shown that the fallout of undertreatment is dire and
longstanding. Among teenagers with untreated ADD, 40 percent need special
education, 40 percent of girls with the condition end up pregnant, 20 to 25
percent end up arrested and 20 percent have serious problems with drugs,
according to Dr. Russell Barkley, a professor of psychiatry at the
University of South Carolina Medical School.
..
"I don't want to oversell this disorder, but its not benign - not just about
a little too much energy, or too much chocolate or caffeine," Barkley said.
"Treated early in childhood, these kids do well. But there are irreparable
consequences from not taking it seriously."


[My comment: This is exactly what the anti-science know-nothings want to
have happen.]


This is a lesson that has been learned the hard way by some British parents.
By the time Monica Harris's son was diagnosed with ADD at age 12 and started
on Ritalin, he had been suspended many times, sometimes for months on end.
Teachers told Harris, who is black, that he was rebelling against his
parents' mixed-race marriage.
..
On medicine, the boy did better. But his pills were stopped when he turned
16, since it is British national policy to stop treatment at this age for
what is considered a childhood disorder. Within six months he was committing
petty crimes and is now serving time in prison.
..
"By the time my son was in junior school, it was really too late - there was
little left to do for him," said Harris from her postage-stamp-sized office
in Milton Keynes, where she runs the all-volunteer local support group.
"Then they stopped his medicine. That's why my kid is in prison."
..
A very high percentage of teenagers in British prisons suffer from
undiagnosed ADD, said Dr. Quentin Spender, a psychiatrist in Chichester,
England. "It's tragic," he said. "If they are not treated they can't succeed
at school and they get oppositional. Then their self-esteem goes into their
boots. They get labeled as antisocial. They lose school time. They fall in
with the wrong crowd. It's a downward spiral."
..
Most mainstream American doctors believe that children inherit a
predisposition to the disorder than probably stems from a biochemical
imbalance of brain transmitters. But that line of thinking has only slowly
moved across the Atlantic, despite the recent growth of parent groups and
efforts to market ADHD drugs to Europeans.
..
While American psychiatry has been strongly influenced by biochemical
factors in mental health and behavior-modification theories, French
psychiatrists have clung to Freud as their muse and mentor.
..
"Most primary care clinics are very psychoanalytic and don't see this as a
problem of the child that has to do with biology," said Dr. Véronique
Gaillac of the Ste-Anne psychiatric hospital in Paris. "Some of these
children go through years of psychoanalysis, which to me is not at all
effective. Many doctors are passionately, angrily against the idea of ADHD.
They think it is an American invention."
..
That is starting to change, she said, as parents and some doctors try to
increase awareness. Still, the disorder is diagnosed only at a handful of
university research hospitals in France, and the wait is often long for an
appointment. Schools and teachers, who know little about ADHD, are often
vehemently opposed to medication and offer "nothing" in the way of therapy
or behavior modification, Gaillac said.
..
The first line of treatment for ADHD is Ritalin, a medicine that helps
children with the disorder focus but lasts for only several hours.
Longer-acting forms of the drug, standard care in the United States, are
more expensive and are available in only a handful of European countries.
..
At the offices of the Milton Keynes ADHD support group, an hour north of
London, a stream of women come and go, telling of their battles.
..
Harris is a tornado of activity, running an expansive Web site and fielding
calls and queries: Which psychiatrists can handle a diagnosis in Cambridge?
How to cope with a 7-year-old who runs into the street? How to fast-track a
referral?
..
Rachel Begg was horrified to learn that her son Macauley, then 4, was being
"cello-taped" to his seat during assemblies at his preschool to make sure
that he sat still. For four years she repeatedly sought psychological
assessments from nurses and school counselors, all of which concluded that
he was of average intellect but poorly disciplined.
..
Last year, when the boy was 9, Begg insisted he get referred to a child
psychiatrist, who told her it was "obvious" that the boy had ADHD.
..
Begg is relieved that Macauley is now receiving therapy - he is easier to
handle at home. But she is uncertain it will be enough to compensate the bad
habits and the bad reputation he has acquired at school.
..
"If they'd caught this earlier, his social skills would have had a chance to
develop, he would have learned lots more, and these bad behavior patterns
wouldn't have developed," she said.
..
Ironically, the same systems that are slow to treat the children are often
all too happy to medicate the parent. The system that was slow to treat
Shane French gave his mother antidepressants because she couldn't cope with
him.
..MILTON KEYNES, England While most parents collect pictures and essays as
mementos of their children's school days, Tanya French instead totes around
her 9-year-old's behavior chart, on which teachers document the ways in
which her boy has misbehaved.
..
"Pushing another child," "disruptive and rude," "swearing," "calling out,"
"jumping out of his chair," it reads.
..
Shane spends long periods of his school day sitting in the corridor as
punishment.
..
Four years ago, French became convinced that Shane was suffering from
Attention Deficit Hyperactivity Disorder and sought to get him help. But it
was not until last year that he was finally diagnosed, and he has just been
started on medications.
..
In the meantime, teachers and counselors told French that Shane's problems
stemmed from her lack of discipline, or because she is a single parent.
..
Shane, who reads poorly in part because of all the class time he has missed,
is a pariah and has never been invited to a birthday party.
..
"I am at the end of my tether," French said. "Hardly anyone at the National
Health Service knows about it, and neither do the educational authorities.
People here just don't want to recognize it. They think ADHD is just an
American version of being a naughty boy."
..
In the United States, 3 percent to 5 percent of school-age children carry
the diagnosis of Attention Deficit Disorder or its subgroup, Attention
Deficit Hyperactivity Disorder, generally receiving support and treatment
for the condition.
..
In England, well under one percent carry the diagnosis, although recognition
is growing. In countries like France and Italy, many if not most doctors do
not believe the condition exists.
..
In Italy, where a recent study found that the lag time from referral to
diagnosis was more than three years, medicines to treat ADD were not
licensed until this year.
..
While many leading scientists believe there is excess diagnosis and
overmedication in the United States, they concur that the condition has been
seriously neglected in Europe - although that trend is changing.
..
"The rate of the condition is probably the same everywhere, but there is big
undertreatment here," said Dr. Eric Taylor of the Institute of Psychiatry at
Kings College in London. "Gatekeeping in schools and by doctors filters out
90 percent of these children, and tells them they don't have a disorder."
..
If treatment rates varied this much for appendectomies or Caesarean
sections, it would be a considered a medical scandal. But mental health
diagnosis depends not just on science, but also on doctors' paradigms of
psychiatry and on society's attitudes toward children.
..
Attention Deficit Disorder is characterized by a complex of symptoms where
children are unusually impulsive, lack organizational and social skills, and
cannot follow even simple sequential instructions or commands. They tend to
fight or be slow at learning, have tantrums like toddlers, and are
notoriously disruptive in class.
..
It is often compounded by hyperactivity, so that affected children cannot
sit still for story time; in the playground, they are risk takers, always on
the go.
..
People shy away from the diagnosis of ADD in Britain "because it feeds into
panic about the traditional family breaking down," Taylor said. "In Italy,
with its family focus, it is blamed on the upbringing. French psychiatry is
very Freudian, so it is all about psychoanalysis. Many doctors basically
don't recognize ADD. There are many very desperate families."
..
Also, the condition is difficult to treat within public health systems in
which access to child psychiatrists is limited by the financial resources
available. Diagnosis requires a specialist, and optimal treatment involves
both medicine and behavior-training therapy.
..
In contrast, in the United States, ADHD provides lucrative business for drug
companies and therapists, an incentive for diagnosing the condition.
..
Studies have shown that the fallout of undertreatment is dire and
longstanding. Among teenagers with untreated ADD, 40 percent need special
education, 40 percent of girls with the condition end up pregnant, 20 to 25
percent end up arrested and 20 percent have serious problems with drugs,
according to Dr. Russell Barkley, a professor of psychiatry at the
University of South Carolina Medical School.
..
"I don't want to oversell this disorder, but its not benign - not just about
a little too much energy, or too much chocolate or caffeine," Barkley said.
"Treated early in childhood, these kids do well. But there are irreparable
consequences from not taking it seriously."
..
This is a lesson that has been learned the hard way by some British parents.
By the time Monica Harris's son was diagnosed with ADD at age 12 and started
on Ritalin, he had been suspended many times, sometimes for months on end.
Teachers told Harris, who is black, that he was rebelling against his
parents' mixed-race marriage.
..
On medicine, the boy did better. But his pills were stopped when he turned
16, since it is British national policy to stop treatment at this age for
what is considered a childhood disorder. Within six months he was committing
petty crimes and is now serving time in prison.
..
"By the time my son was in junior school, it was really too late - there was
little left to do for him," said Harris from her postage-stamp-sized office
in Milton Keynes, where she runs the all-volunteer local support group.
"Then they stopped his medicine. That's why my kid is in prison."
..
A very high percentage of teenagers in British prisons suffer from
undiagnosed ADD, said Dr. Quentin Spender, a psychiatrist in Chichester,
England. "It's tragic," he said. "If they are not treated they can't succeed
at school and they get oppositional. Then their self-esteem goes into their
boots. They get labeled as antisocial. They lose school time. They fall in
with the wrong crowd. It's a downward spiral."
..
Most mainstream American doctors believe that children inherit a
predisposition to the disorder than probably stems from a biochemical
imbalance of brain transmitters. But that line of thinking has only slowly
moved across the Atlantic, despite the recent growth of parent groups and
efforts to market ADHD drugs to Europeans.
..
While American psychiatry has been strongly influenced by biochemical
factors in mental health and behavior-modification theories, French
psychiatrists have clung to Freud as their muse and mentor.
..
"Most primary care clinics are very psychoanalytic and don't see this as a
problem of the child that has to do with biology," said Dr. Véronique
Gaillac of the Ste-Anne psychiatric hospital in Paris. "Some of these
children go through years of psychoanalysis, which to me is not at all
effective. Many doctors are passionately, angrily against the idea of ADHD.
They think it is an American invention."
..
That is starting to change, she said, as parents and some doctors try to
increase awareness. Still, the disorder is diagnosed only at a handful of
university research hospitals in France, and the wait is often long for an
appointment. Schools and teachers, who know little about ADHD, are often
vehemently opposed to medication and offer "nothing" in the way of therapy
or behavior modification, Gaillac said.
..
The first line of treatment for ADHD is Ritalin, a medicine that helps
children with the disorder focus but lasts for only several hours.
Longer-acting forms of the drug, standard care in the United States, are
more expensive and are available in only a handful of European countries.
..
At the offices of the Milton Keynes ADHD support group, an hour north of
London, a stream of women come and go, telling of their battles.
..
Harris is a tornado of activity, running an expansive Web site and fielding
calls and queries: Which psychiatrists can handle a diagnosis in Cambridge?
How to cope with a 7-year-old who runs into the street? How to fast-track a
referral?
..
Rachel Begg was horrified to learn that her son Macauley, then 4, was being
"cello-taped" to his seat during assemblies at his preschool to make sure
that he sat still. For four years she repeatedly sought psychological
assessments from nurses and school counselors, all of which concluded that
he was of average intellect but poorly disciplined.
..
Last year, when the boy was 9, Begg insisted he get referred to a child
psychiatrist, who told her it was "obvious" that the boy had ADHD.
..
Begg is relieved that Macauley is now receiving therapy - he is easier to
handle at home. But she is uncertain it will be enough to compensate the bad
habits and the bad reputation he has acquired at school.
..
"If they'd caught this earlier, his social skills would have had a chance to
develop, he would have learned lots more, and these bad behavior patterns
wouldn't have developed," she said.
..
Ironically, the same systems that are slow to treat the children are often
all too happy to medicate the parent. The system that was slow to treat
Shane French gave his mother antidepressants because she couldn't cope with
him.
..

On Fri, 29 Oct 2004 13:38:12 GMT, "Mark Probert" Mark
wrote:
.
Also, the condition is difficult to treat within public health systems in
which access to child psychiatrists is limited by the financial resources
available. Diagnosis requires a specialist, and optimal treatment involves
both medicine and behavior-training therapy.
.
In contrast, in the United States, ADHD provides lucrative business for drug
companies and therapists, an incentive for diagnosing the condition.

Complete, utter bull****. This, friends, is why so many people believe
so many stupid, incorrect things about the nature and practice of
medicine -- irresponsible journalism. Nonsense like this is taken by
many otherwise knowledgeable people to be truth, and is repeated
without attribution, becoming "common knowledge" to some when it is
completely wrong.

I didn't know "drug companies" can diagnose ADHD. What states allow
that, hmm?

PF

"PF Riley" wrote in message
...
On Fri, 29 Oct 2004 13:38:12 GMT, "Mark Probert" Mark
wrote:
.
Also, the condition is difficult to treat within public health systems in
which access to child psychiatrists is limited by the financial resources
available. Diagnosis requires a specialist, and optimal treatment
involves
both medicine and behavior-training therapy.
.
In contrast, in the United States, ADHD provides lucrative business for
drug
companies and therapists, an incentive for diagnosing the condition.

Complete, utter bull****. This, friends, is why so many people believe
so many stupid, incorrect things about the nature and practice of
medicine -- irresponsible journalism. Nonsense like this is taken by
many otherwise knowledgeable people to be truth, and is repeated
without attribution, becoming "common knowledge" to some when it is
completely wrong.

I didn't know "drug companies" can diagnose ADHD. What states allow
that, hmm?

So you're saying that the millions (billions?) of dollars that the drug
companies spend marketing to doctors is just money thrown down the drain?
That the availability of a drug to treat a particular condition has never
influenced a doctor in making a diagnosis of that condition? That we would
have exactly as many diagnoses of ADHD if Ritalin et al had never been put
on the market?

"Jess Askin" wrote in message
...

"PF Riley" wrote in message
...
On Fri, 29 Oct 2004 13:38:12 GMT, "Mark Probert" Mark
wrote:
.
Also, the condition is difficult to treat within public health systems
in
which access to child psychiatrists is limited by the financial
resources
available. Diagnosis requires a specialist, and optimal treatment
involves
both medicine and behavior-training therapy.
.
In contrast, in the United States, ADHD provides lucrative business for
drug
companies and therapists, an incentive for diagnosing the condition.

Complete, utter bull****. This, friends, is why so many people believe
so many stupid, incorrect things about the nature and practice of
medicine -- irresponsible journalism. Nonsense like this is taken by
many otherwise knowledgeable people to be truth, and is repeated
without attribution, becoming "common knowledge" to some when it is
completely wrong.

I didn't know "drug companies" can diagnose ADHD. What states allow
that, hmm?

So you're saying that the millions (billions?) of dollars that the drug
companies spend marketing to doctors is just money thrown down the drain?
That the availability of a drug to treat a particular condition has never
influenced a doctor in making a diagnosis of that condition? That we would
have exactly as many diagnoses of ADHD if Ritalin et al had never been put
on the market?

Now you are catching on. You see, methylphenidate is often prescribed in the
generic form. Thee is virtually no marketing that I am aware of for
generics. Many pharmacies get their generics based on which manufaturer is
available at the moment their order goes in.

Now, can you explain why a doctor would say to himself something like this,
"That rep has a nice sales pitch, so I will diagnose the next three patients
with something that I can prescribe their drug for." In essence, that is
what you are saying.

On Sun, 31 Oct 2004 15:34:19 GMT, "Mark Probert" Mark
wrote:

"Jess Askin" wrote in message
...

"PF Riley" wrote in message
...

Complete, utter bull****. This, friends, is why so many people believe
so many stupid, incorrect things about the nature and practice of
medicine -- irresponsible journalism. Nonsense like this is taken by
many otherwise knowledgeable people to be truth, and is repeated
without attribution, becoming "common knowledge" to some when it is
completely wrong.

I didn't know "drug companies" can diagnose ADHD. What states allow
that, hmm?

So you're saying that the millions (billions?) of dollars that the drug
companies spend marketing to doctors is just money thrown down the drain?
That the availability of a drug to treat a particular condition has never
influenced a doctor in making a diagnosis of that condition? That we would
have exactly as many diagnoses of ADHD if Ritalin et al had never been put
on the market?

Now you are catching on. You see, methylphenidate is often prescribed in the
generic form. Thee is virtually no marketing that I am aware of for
generics. Many pharmacies get their generics based on which manufaturer is
available at the moment their order goes in.

Now, can you explain why a doctor would say to himself something like this,
"That rep has a nice sales pitch, so I will diagnose the next three patients
with something that I can prescribe their drug for." In essence, that is
what you are saying.

That's exactly the foolishness these conspiracists are implying. As a
physician, I do not find diagnosing and treating ADHD to be
"lucrative." Certainly it is rewarding in the end since it is actually
usually easily treated and pleasing to everyone involved greatly
(there is a high yield of benefits compared to minimal to nonexistent
side effects), but I am not turning a pretty penny from it. In fact,
the money is not incrementally worth it to me.

When I am seeing a kids for a check-up, there's always that sigh of
relief when, after I ask, "How's Johnny doing in school?" the parent
says, "Great! Excellent student! No problems!" (*WHEW*) I can get on
with the check-up and see the next patient. If instead the parent
says, "Actually, we've noticed he has a lot of trouble settling down
to do his homework, and the teachers suggested we see you too because
he can't concentrate in school and his grades are no where near where
the could be." Great. Now I have to embark on that long road of
excluding mood problems, sleep problems, drug problems, etc.,
communicating with the school to obtain results from validated
diagonistic tools (for which I get paid nothing -- unlike lawyers,
doctors don't charge for phone calls or reviewing correspondence),
making the diagnosis, handing out pamphlets, talking my mouth dry to
explain to a skeptical parent that all the bull**** he's heard on the
Internet is just that: bull****. It gets me at most one more office
visit at first which pays less than the check-up I could have done in
that slot.

I wouldn't care if I never encountered another kid with ADHD again. So
how, exactly, is ADHD so "lucrative" that I have "incentive" to
diagnose (and, by the journalist's implication, OVERdiagnose) it? Of
course, the journalist does say that it's lucrative only to drug
companies and therapists, so would you suggest there's a hidden
message in there that somehow I'm getting a kick-back from them?

PF

Jess Askin wrote:
"PF Riley" wrote in message
...
On Fri, 29 Oct 2004 13:38:12 GMT, "Mark Probert" Mark
wrote:
.
Also, the condition is difficult to treat within public
health
systems in which access to child psychiatrists is
limited by the
financial resources available. Diagnosis requires a
specialist, and
optimal treatment involves both medicine and
behavior-training
therapy. .
In contrast, in the United States, ADHD provides
lucrative business
for drug companies and therapists, an incentive for
diagnosing the
condition.

Complete, utter bull****. This, friends, is why so many
people
believe so many stupid, incorrect things about the nature
and
practice of medicine -- irresponsible journalism.
Nonsense like this
is taken by many otherwise knowledgeable people to be
truth, and is
repeated without attribution, becoming "common knowledge"
to some
when it is completely wrong.

I didn't know "drug companies" can diagnose ADHD. What
states allow
that, hmm?

So you're saying that the millions (billions?) of dollars
that the
drug companies spend marketing to doctors is just money
thrown down
the drain?

No - He said drug companies can't diagnose ADHD. Try to keep
up.



That the availability of a drug to treat a particular
condition has never influenced a doctor in making a
diagnosis of that
condition? That we would have exactly as many diagnoses of
ADHD if
Ritalin et al had never been put on the market?

Ritalin and other stimulants had been on the market for a
long time before the relatively recent increase in
diagnoses.

--
00doc

PF Riley wrote:

Complete, utter bull****. This, friends, is why so many
people believe
so many stupid, incorrect things about the nature and
practice of
medicine -- irresponsible journalism. Nonsense like this
is taken by
many otherwise knowledgeable people to be truth, and is
repeated
without attribution, becoming "common knowledge" to some
when it is
completely wrong.

I just read a report of a study showing that people who
research their chronic medical conditions ont he web fare
far worse (it is or will be appearing in a psych journal I
believe). Turns out they start to feel empowered and make
their own treatment decisions - and - guess what? They don't
do as well as their doctors.

--
00doc

00doc wrote:


I just read a report of a study showing that people who
research their chronic medical conditions ont he web fare
far worse (it is or will be appearing in a psych journal I
believe). Turns out they start to feel empowered and make
their own treatment decisions - and - guess what? They don't
do as well as their doctors.

I personally think that is the result of shoddy science education in
American schools. Anyone can go to a library and become fluent enough in
medical jargon and scientific method to read and understand journal
articles. Most people lack the scientific background to do so effectively,
however. You'd have to be pretty obsessive to become expert this way, but
it's pretty easy to learn enough to understand what your doc is doing and
if they know their stuff or not.

--
Autumn wins you best by this its mute
Appeal to sympathy for its decay.

-Robert Browning

"Jess Askin" wrote in message ...
"PF Riley" wrote in message
...
On Fri, 29 Oct 2004 13:38:12 GMT, "Mark Probert" Mark
wrote:
.
Also, the condition is difficult to treat within public health systems in
which access to child psychiatrists is limited by the financial resources
available. Diagnosis requires a specialist, and optimal treatment
involves
both medicine and behavior-training therapy.
.
In contrast, in the United States, ADHD provides lucrative business for
drug
companies and therapists, an incentive for diagnosing the condition.

Complete, utter bull****. This, friends, is why so many people believe
so many stupid, incorrect things about the nature and practice of
medicine -- irresponsible journalism. Nonsense like this is taken by
many otherwise knowledgeable people to be truth, and is repeated
without attribution, becoming "common knowledge" to some when it is
completely wrong.

I didn't know "drug companies" can diagnose ADHD. What states allow
that, hmm?

So you're saying that the millions (billions?) of dollars that the drug
companies spend marketing to doctors is just money thrown down the drain?
That the availability of a drug to treat a particular condition has never
influenced a doctor in making a diagnosis of that condition? That we would
have exactly as many diagnoses of ADHD if Ritalin et al had never been put
on the market?


Drug reps detail me on an extensive array of drugs all the time. I
tell them *all* some version of the following: "Thank you for
sharing. If it is clinically indicated for my patients, I will
consider using your company's product, provided I can see evidence
that it works, that it has an acceptably low incidence of side
effects, and that it is the cheapest drug that fulfills the first two
criteria."

Drug companies **** away a lot of marketing money, IMNSHO, and I wish
they'd quit with the direct-to-consumer advertisement and the drug
reps. On a smaller scale, I suppose you could say that they waste a
lot of money marketing to me because I don't blindly write a
prescription based on the desires of any drug rep.

As to the number of diagnoses made, I guess the fact that there are
drugs available and awareness of the condition combine to make the
condition in question an identifiable point in one's differential
diagnosis. However, it doesn't make me more likely to actually make
that diagnosis.

Mark, MD

401 10-31-04 20:05
(Mark, M.D.)
Ml Drug reps detail me on an extensive array of drugs all the time. I
Ml tell them *all* some version of the following: "Thank you for
Ml sharing. If it is clinically indicated for my patients, I will
Ml consider using your company's product, provided I can see evidence
Ml that it works, that it has an acceptably low incidence of side
Ml effects, and that it is the cheapest drug that fulfills the first two
Ml criteria."

How about telling the drug rep before using their drug, you will
FIRST use diet modification and/or nutrient addition if that is
more appropriate than a pharm drug?

.... End of message 31 Oct 04 20:21
___ Blue Wave/386 v2.30 [NR]