US doctor warns of misuse of prescribed stimulants
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7380.67 (Published 11 January 2003) Cite this as: BMJ 2003;326:67All rapid responses
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Editor-In the December 2000 Issue of the Western Journal of Medicine
I published a short electronic addendum to Lawrence Diller's article "The
Ritalin War continues".I now read in this week's BMJ that the Ritalin War
will now also be fought on our shores.
That stimulant drugs of the amphetamine type have often a beneficial effet
on children and adolescents suffering from the "Attention seeking
Hyperactivity syndrome" is the reason, why this class of drug is
prescribed, and more than 1.500000 American children are now supposed to
be subjected to this treatment.
I believe that the grossly increased exposure of the developing brain of
our young people due to visual, auditory and emotional stimulation is
responsible for a developing underreaction of the prefrontal cerebral
cortex and its underlying cerebral connections.This diminished function
due to reduced neuronal secretions leads to loss of critical faculty,
increased suggestibility and loss of inhibition, hyperactivity, lack of
attention,increased delinquency of all kinds by juveniles, and also to
mounting evidence of psychiatric disorders.
I have tried to bring this view into the public domain by writing to the
the Secretaries of State for Health,for Education, to the Home Secretary,
to the Editors of the BMJ,The Lancet and all the National Newspapers. I
received polite acknowledgements but no other response.
In view of the impending danger of Ritalin reaching our shores I felt
obliged to send this rapid responce message.That an underreaction of the
prefrontal cerebral cortex is found after excessive stimulation has been
recognised, but the connection between this phenomenon and environmenta
overstimulation , particularly of an emotional kind,has not been
adequately researched.I think the future of a civilised society might be
at stake.
Eric Frankel
20 Hermon Hill, Wanstead, London, E11 2AP
efrankel@doctors.org.uk
Competing interests:
None declared
Competing interests: No competing interests
I was appalled by the news piece on stimulants.
ADHD is still vastly underdiagnosed and undertreated in Europe. No wonder
increases of medication are in hundreds of percent: starting from zero,
that's not difficult.
Talking about Italy and France in this context is absolutely unfair,
because readers of this journal are probably not aware of the fact that
psy-people in those countries still imagine ADHD can be treated by
psychotherapy. Reading Alexandre Minkowski's "Ce que je crois" (Ed. Grasset,
1997), is very interesting in that regard. The famous neonatologist
explains (p.44) there how a psychotherapist asked him permission to
psychoanalyse premature babies.
Competing interests:
Consultant to a parents of ADHD children self-help group
Competing interests: No competing interests
The BMJ has done a grave disservice to Paediatricians and children
with ADHD in it's highly biased "news" item on methylphenidate. The
article presents misleading statements as facts, implying, for instance,
that methylphenidate is addictive when this has never been demonstrated
when it is used to treat ADHD. Dr Diller condems the use of stimulants to
treat unruly children with poor school performance but these are symptoms
typical of ADHD. Are parents wrong to want their children to be able to
conform to society and succeed? Finally the article is accompanied by an
unfocused picture of a child with ADHD, what message was that ment to
send?
The use of stimulants is controversial and every parent who decides
to try that therapy agonizes over the decision. We do not need unbalanced
inflamatory articles that are designed specifically to encourage GP's not
to prescribe.
Atomoxetine, a new non-stimulant is now licensed in the US and is
anticipated in the UK in 18 months. This may make treatment of ADHD less
controvertial, or will we have another group protesting the wide spread
use of antidepressents in children? Unfortunately a few voicerferous
Psychologists and Psychiatrists persist in the belief that medication
should not be use to treat a condition that the believe is caused by
environment and poor parenting.
The evidece is growing that ADHD symptoms are related to biological
differences that are genetic in origen. This needs to be kept in mind when
understanding why medications have a role in treatment.
Competing interests:
None declared
Competing interests: No competing interests
In 2000 wjm (the Western Journal of Medicine) published an editorial
by Lawrence Diller, called "The Ritalin wars continue," which is at
http://www.ewjm.com/cgi/content/full/173/6/366.
Although wjm folded last year, the content is still freely available
online at http://www.ewjm.com.
Competing interests:
None declared
Competing interests: No competing interests
Re: Brain washed youth in contemporary society
Sir,
"I believe that the grossly increased exposure of the developing
brain of our young people due to visual, auditory and emotional
stimulation is responsible for...loss of critical faculty, increased
suggestibility and loss of inhibition, hyperactivity, lack of attention,
increased delinquency of all kinds by juveniles, and also to mounting
evidence of psychiatric disorders...I think the future of a civilised
society might be at stake." [1]
Without doubt, Dr Frankel highlights a very troubling issue of modern
times, especially for parents.
Interesting though it is, this largely physiological hypothesis for
youth mis-behaviour seems isolated from other valuable perspectives on the
issue. Rather than a bottom-up [mostly molecular] view, one could take a
top-down politico-economic view. As Dr Frankel says, there probably are
biochemical and hormonal triggers that elicit such bad youth behaviour as
drug-taking, violence and excessive vandalism, egged-on no doubt by
television.
Another equally valid source of such mis-behaviour lies in the
frustration many young people feel through peer pressure, fierce
competitiveness and a desire for upward-mobility in an increasingly
fashion-obsessed, wealth-oriented and acquisitive society. People these
days won't even talk to you unless you drive a Mercedes, wear gold
jewellery, a Calvin Klein sweater, an Armani watch and stink of Gucci
perfume; it is becoming ridiculous!
Go back to the quieter days of the 1950s and 1960s and such behaviour
was nowhere near so prevalent. Things were by no means perfect then, of
course, it was not a Utopia, but the pace was a lot slacker and generally
speaking folks had more time and respect for each other. Greed, egotism
and speed of change have come to dominate modern life to a repugnant
degree and these factors seem to have pushed humane values and caring much
lower down on the agenda, especially for the rebellious young.
Is it any wonder, then, that the 'have-nots' fight ever more fiercely
to obtain those material things others seem to obtain and flaunt so
effortlessly - nice clothes, mobile phones, ready cash, attractive sexual
partners and nice cars? Quantity seems to have entirely eclipsed quality
at every level of society.
And advertising on every front seems only to fan the flames of such
incipient desires in the young today. What they have difficulty obtaining
by legitimate and orthodox means, they seem impelled to acquire illegally
and through shady deals. Much of what Durkheim called the 'natural crime'
and violence in any society [2] chiefly springs from frustrated ambition,
unfulfilled desires [wealth, career, relationships] and other such social
frictions. The more that desire for these becomes cranked-up in an
affluentising society like ours, the more anger, violence and human
disrespect spills out onto the streets. And as society becomes
increasingly polarised between the haves and the have-nots, frustrations
of every type become accentuated for those at the bottom of the heap.
Drugs cannot solve that.
Therefore, I would simply say, because the causes of such complex
problems are not solely chemical, nor can be their cure. Such cures cannot
flow from the pharmacopoeia, but are mostly socio-economic and political.
Source
[1] Eric Frankel, Brain washed youth in contemporary society, BMJ
letter, 16 Jan
http://bmj.com/cgi/eletters/326/7380/67#2881
[2] Durkheim on Deviance and Criminality,
http://www.gossamer-wings.com/soc/Notes/dev/tsld012.htm
cited in: P Morrell, For Social Exclusion read Deviance and Marginality,
BMJ letter, 6 November 2001,
http://bmj.com/cgi/eletters/323/7306/0#17325
Competing interests:
None declared
Competing interests: No competing interests