Intended for healthcare professionals

Rapid response to:

Clinical Review

Neurogenetic determinism and the new euphenics

BMJ 1998; 317 doi: (Published 19 December 1998) Cite this as: BMJ 1998;317:1707

Rapid Response:

Using methylphenidate within a developmental perspective

Stephen Rose claims that the recent rise in the prescribing of
methylphenidate is the product of a society at the mercy of large
pharmaceutical companies (1,2). Seemingly, by his reckoning their economic
interest drives the labelling of children’s behaviour in such a way that
it can be treated to their profitable gain.

There are a number of problems with this argument. Firstly, contrary
to his assertion, the condition is not new and has been recognised for
many years. Secondly, the medical treatment is cheap and the manufacturers
do not even bother to promote it. I would suggest that the increase in the
diagnosis of hyperactivity disorders is because of increased recognition
resulting from the rise of Child and Adolescent Psychiatry as a
discipline. This has occurred because society is placing more value on the
mental well-being of its young people. This itself is partly because of a
more developmental perspective taken with regard to mental health and
partly because of more equitable and less age-discriminating values in

As such, I would expect Prof. Rose to welcome the prescription of
methylphenidate. He would be welcome to come and visit our department.
Here he would met some of the social workers, family and behavioural
therapsts who work alongside the psychiatrists, treating ADHD in a
multidimensional way from a developmental and non-reductionist
perspective. He might meet some of the children with ADHD and their
families and he would see the misery caused by the condition. He would see
children rejected by their peers, parents and teachers because of their
impulsive nature. He could see the dramatic effects of methylphenidate
upon their lives and then he would realise that most child and adolescent
psychiatrists don’t give a hoot as to whether genes are involved or not.
They use methylphenidate because it makes kids better.

1. SPR Rose (1998). Neurogenetic determinism and the new euphenics.
British Medical Journal 317, 1707-1708
2. S. Rose (1997). Lifelines - biology, freedom, determinism. Penguin,

Justin HG Williams
SpR Child and Adolescent Psychiatry
Centre for Child Health
19 Dudhope Terrace, Dundee DD3 6HH

Competing interests: No competing interests

30 December 1998
Justin H G Williams
SpR Child and Adolescent Psychiatry
Centre for Child Health, Dundee