Tuesday, May 17, 2011

Ritalin: The jury remains out

In a study funded by Irish pharmaceutical Shire, a manufacturer of ADHD drugs, University of Pennsylvania researchers determined that kids who take medication for ADHD are “at no greater risk for heart problems than kids not taking ADHD medications.” The lead researcher says the findings of the study should "reassure parents that drugs such as Ritalin and Adderall aren’t associated with an increased risk of cardiovascular events." However, the researchers noted that "it was not possible to definitely rule out an association between ADHD drugs and increased rates of heart problems."

On the other hand, Dr. Steven Lipshultz, professor and chair of pediatrics at the University of Miami Miller School of Medicine is concerned these published results may be misinterpreted. HealthDay Reporter Steven Reinberg interviewed Lipshultz and presented his evaluation of the study this way:
"This study wasn't able to look carefully at where the major concerns are," he added.
The study did not specifically separate those children with heart disease from others, Lipshultz said, adding that the FDA's greatest concern was with the use of these medications in patients with underlying heart disease. In fact, the drugs may be contraindicated for such children, he said.
These drugs are a great benefit to children with ADHD, Lipshultz said. "On the other hand, there are still considerable safety concerns about the use of stimulant therapy in children, especially children with underlying health conditions," he said.

In 2007, the FDA ordered manufacturers of ADHD drugs to produce a "medication guide to alert doctors and parents" of heart-related risks associated with these medications. The results of FDA directed research on these risks are forth-coming. Manufacturer Shire supports the "careful medical evaluation of cardiovascular risk by physicians for patients diagnosed with ADHD as they seek appropriate treatment."

Fifteen years ago, Dr. Lawrence H. Diller, wrote a book “Running on Ritalin” describing what he viewed as an over-diagnosis of ADHD and over prescription of Ritalin and similar drugs to many children “who would respond well to family therapy and tailed programs and routines at home and at school.”
“Diller warned that as harried parents, teachers and physicians attached the ADHD label to more and more children who were dreamy, unmotivated, forgetful, restless, impulsive or distractible, the nation's tolerance for children's natural temperamental variance would narrow. Instead of helping children work around weaknesses and choose strategies and paths that played to their strengths, society's growing inclination to medicate them, Diller cautioned, could turn many into lifelong patients.”

Diller has just released a new book, “Remembering Ritalin”, in which he describes the lives of ten of his former patients now adults.

Watch one of those former patients from www.rememberingritalin.com website:

In a L.A. Times interview, Diller maintains his view on over diagnosis and over medication while noting value in medicines having prescribed them for 32 years:
Pills represent efficiency, and effective nondrug interventions like special education or behavior-modification value engagement with the child. The medical and educational systems value efficiency. Parents, when offered a choice initially between efficiency and engagement, almost always choose engagement. However, when offered the choice of only a pill or nothing, they'll take the pill. And that's often the only choice they're given.

So I remain a relatively lonely professional voice pointing out this moral dilemma. But it is greatly edifying that when people hear the full message, they invariably say, "You know, he's right."

For more information on Dr. Diller and ADHD, visit his website here.

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