FRED A. BAUGHMAN, JR. M.D.
NEUROLOGY AND CHILD NEUROLOGY (Board Certified)
FELLOW, AMERICAN ACADEMY OF NEUROLOGY fredbaughmanmd@cox.net
1303 HIDDEN MOUNTAIN DRIVE
EL CAJON, CA 92019
Tele:(619) 440-8236 Fax: (619) 442-1932
Re: NICE ADHD Guidelines
September 30, 2008
Ladies and Gentlemen,
Please publish the following:
ADHD is Neither a Disease or a Disorder
Comment on NICE ADHD Guidelines
By Fred A. Baughman Jr., MD
We should be clear from the start that having a disease or a disorder
means one has an objective physical abnormality. The first obligation of
all physicians is that of diagnosis. The first question posed by the duty
to diagnose is: Is there a physical abnormality—gross (a visible or
palpable lump), microscopic (cancer cells of biopsy or ‘Pap’ smear), or
chemical (as in diabetes, gout, phenylketonuria), yes or no? If “no,”
there is no disease and the patient is medically, physically normal. It
is this group, those with “no evidence of disease” (NED) from which all
psychiatric and psychological patients derive. The public worldwide has
been deceived and mislead for decades on this fundamental point that is
well known to physicians. No patient with ADHD or with any psychological
or psychiatric entity has an actual disease. Physicians telling them they
do knowingly deceive them abrogate their right to informed consent, and
drug normal individuals, that is, poison them. This is the standard of
care in psychiatry today.
NICE addresses the “disease” vs. “no disease,” physical vs. psychiatric
issue stating, “the disorder remains one that is defined at a behavioral
level, and its presence does not imply a neurological disease” (p. 17)
[1]. Using the term “disorder” which is synonymous with disease, meaning
“A disturbance of function, structure or both,” NICE sews the seeds of
confusion that for decades has lead patients and the public worldwide to
view ADHD and all psychiatric and psychological entities as diseases when
they absolutely are not [2].
Having called ADHD a “disorder” NICE stated: “The diagnosis of ADHD does
not imply a medical or neurological cause” (p. 29) [1]. Given that ADHD is
not a disease or a disorder, it is not appropriate to speak of it’s
possible medical or neurological causes. In medicine when no disease has
been found the diagnosis is “no organic disease” (NOD), or “no evidence of
disease” (NED), calling for no discussion of causation. To discuss cause
where no disease exists is to further mislead and confuse.
If one has relinquished all claims of a physical entity and has
accepted it is psychological or psychiatric, then and only then, would it
be appropriate to speak of contributing psycho-social causes such as home,
school, community, peer relations, etc., none physical. And yet NICE
concludes that medication should be used as a first line treatment in
‘severe’ ADHD as if “severe ADHD” was a proven, diagnosable disease, when
it too, along with all other classifications of ADHD, is not.
The American Academy of Pediatrics (AAP) ‘ diagnostic guideline’
referred to ADHD as the most common ‘neurobehavioral’ disorder of
childhood [3]. I responded
“‘Neurobehavioral,’ implies an abnormality of the brain, a disease [4].
And yet, no confirmatory, diagnostic, abnormality has been found…It is
apparent that virtually all professionals of the extended ADHD ‘industry’
convey to parents, and to the public-at-large, that ADHD is a ‘disease’
and that children said to have it are ‘diseased’-‘abnormal.’ This is a
perversion of the scientific record and a violation of the informed
consent rights of all patients and of the public-at-large. The wording of
the AAP Guideline should be changed, forthwith, to reflect the scientific
and medical facts of the matter.” Nor has there been proof of the
existence of ADHD as a disease from that date to the present.
In a letter to me of June 14, 2002, President of the Medical Board of
California, Bernard Alpert, MD, wrote: “Dear Dr. Baughman, Thank you for
your letter dated May 28, 2002 to Senator Liz Figueroa, relating to the
mental health profession’s representation of emotional and psychological
conditions as diseases of the brain…I share your concerns about the lay
public’s ability to correctly process and understand the prolific media
campaigns that target them for the sale of drugs and services. In my
opinion it is unfortunate that such advertising is allowed, and that it
often serves to mislead consumers rather than educate them…there is
tremendous professional support for categorizing emotional and
psychological conditions as diseases of the brain. In published
materials, some quoted in your letter, you will find that support from
chairs of psychiatric departments, the American Psychiatric Association
and professors of major medical schools. It is clear that the psychiatric
community has set their standard, and while one might disagree with it,
that standard becomes the legal standard upon which the Board must base
its actions. It is, therefore, the community that must change their
opinion and practice for it to become the legal standard. Sincerely,
Bernard Alpert, MD, Medical Board of California.”
One can see here that lies have become the legal standard of practice
of the psychiatric profession and of all physicians and other
professionals who practice mental health. Under the circumstances, to
state the truth and scientific facts of the matter would constitute
medical malpractice putting a critic, such as myself, in legal jeopardy.
All studies in the medical-scientific literature that have considered
ADHD to be a disease or disorder and that have conveyed this belief to
participating researchers, subjects and their families are invalid, should
be acknowledged as such, and should be withdrawn. Pam issued such a
challenge in 1990 when he wrote: “…any studies that do not meet standards
for proper research procedures or interpretation of data must not be
accepted for publication, or if already published must be discredited
within the professional literature” [5].
2. Stedman’s Medical Dictionary, 25th Edition, Williams and Wilkins,
Baltimore, MD, 1990.
3. American Academy of Pediatrics, Committee on Quality Improvement and
Subcommittee on Attention-Deficit/Hyperactivity Disorder Clinical
practice: diagnosis and evaluation of the child with attention-
deficit/hyperactivity disorder. Pediatrics. 2000; 105:1158-1170
[Abstract/Free Full Text]
4. Baughman, FA, Diagnosis and Evaluation of the Child With Attention
-Deficit/Hyperactivity Disorder (letter) PEDIATRICS Vol. 107 No. 5 May
2001, pp. 1239
5. Pam, A. A critique of the scientific status of biological psychiatry.
Acta Psychiatricia Scandinavica, 82 (Suppl. 362), 1-35.
Rapid Response:
ADHD is Neither a Disease or a Disorder
FRED A. BAUGHMAN, JR. M.D.
NEUROLOGY AND CHILD NEUROLOGY (Board Certified)
FELLOW, AMERICAN ACADEMY OF NEUROLOGY
fredbaughmanmd@cox.net
1303 HIDDEN MOUNTAIN DRIVE
EL CAJON, CA 92019
Tele:(619) 440-8236 Fax: (619) 442-1932
Re: NICE ADHD Guidelines
September 30, 2008
Ladies and Gentlemen,
Please publish the following:
ADHD is Neither a Disease or a Disorder
Comment on NICE ADHD Guidelines
By Fred A. Baughman Jr., MD
We should be clear from the start that having a disease or a disorder
means one has an objective physical abnormality. The first obligation of
all physicians is that of diagnosis. The first question posed by the duty
to diagnose is: Is there a physical abnormality—gross (a visible or
palpable lump), microscopic (cancer cells of biopsy or ‘Pap’ smear), or
chemical (as in diabetes, gout, phenylketonuria), yes or no? If “no,”
there is no disease and the patient is medically, physically normal. It
is this group, those with “no evidence of disease” (NED) from which all
psychiatric and psychological patients derive. The public worldwide has
been deceived and mislead for decades on this fundamental point that is
well known to physicians. No patient with ADHD or with any psychological
or psychiatric entity has an actual disease. Physicians telling them they
do knowingly deceive them abrogate their right to informed consent, and
drug normal individuals, that is, poison them. This is the standard of
care in psychiatry today.
NICE addresses the “disease” vs. “no disease,” physical vs. psychiatric
issue stating, “the disorder remains one that is defined at a behavioral
level, and its presence does not imply a neurological disease” (p. 17)
[1]. Using the term “disorder” which is synonymous with disease, meaning
“A disturbance of function, structure or both,” NICE sews the seeds of
confusion that for decades has lead patients and the public worldwide to
view ADHD and all psychiatric and psychological entities as diseases when
they absolutely are not [2].
Having called ADHD a “disorder” NICE stated: “The diagnosis of ADHD does
not imply a medical or neurological cause” (p. 29) [1]. Given that ADHD is
not a disease or a disorder, it is not appropriate to speak of it’s
possible medical or neurological causes. In medicine when no disease has
been found the diagnosis is “no organic disease” (NOD), or “no evidence of
disease” (NED), calling for no discussion of causation. To discuss cause
where no disease exists is to further mislead and confuse.
If one has relinquished all claims of a physical entity and has
accepted it is psychological or psychiatric, then and only then, would it
be appropriate to speak of contributing psycho-social causes such as home,
school, community, peer relations, etc., none physical. And yet NICE
concludes that medication should be used as a first line treatment in
‘severe’ ADHD as if “severe ADHD” was a proven, diagnosable disease, when
it too, along with all other classifications of ADHD, is not.
The American Academy of Pediatrics (AAP) ‘ diagnostic guideline’
referred to ADHD as the most common ‘neurobehavioral’ disorder of
childhood [3]. I responded
“‘Neurobehavioral,’ implies an abnormality of the brain, a disease [4].
And yet, no confirmatory, diagnostic, abnormality has been found…It is
apparent that virtually all professionals of the extended ADHD ‘industry’
convey to parents, and to the public-at-large, that ADHD is a ‘disease’
and that children said to have it are ‘diseased’-‘abnormal.’ This is a
perversion of the scientific record and a violation of the informed
consent rights of all patients and of the public-at-large. The wording of
the AAP Guideline should be changed, forthwith, to reflect the scientific
and medical facts of the matter.” Nor has there been proof of the
existence of ADHD as a disease from that date to the present.
In a letter to me of June 14, 2002, President of the Medical Board of
California, Bernard Alpert, MD, wrote: “Dear Dr. Baughman, Thank you for
your letter dated May 28, 2002 to Senator Liz Figueroa, relating to the
mental health profession’s representation of emotional and psychological
conditions as diseases of the brain…I share your concerns about the lay
public’s ability to correctly process and understand the prolific media
campaigns that target them for the sale of drugs and services. In my
opinion it is unfortunate that such advertising is allowed, and that it
often serves to mislead consumers rather than educate them…there is
tremendous professional support for categorizing emotional and
psychological conditions as diseases of the brain. In published
materials, some quoted in your letter, you will find that support from
chairs of psychiatric departments, the American Psychiatric Association
and professors of major medical schools. It is clear that the psychiatric
community has set their standard, and while one might disagree with it,
that standard becomes the legal standard upon which the Board must base
its actions. It is, therefore, the community that must change their
opinion and practice for it to become the legal standard. Sincerely,
Bernard Alpert, MD, Medical Board of California.”
One can see here that lies have become the legal standard of practice
of the psychiatric profession and of all physicians and other
professionals who practice mental health. Under the circumstances, to
state the truth and scientific facts of the matter would constitute
medical malpractice putting a critic, such as myself, in legal jeopardy.
All studies in the medical-scientific literature that have considered
ADHD to be a disease or disorder and that have conveyed this belief to
participating researchers, subjects and their families are invalid, should
be acknowledged as such, and should be withdrawn. Pam issued such a
challenge in 1990 when he wrote: “…any studies that do not meet standards
for proper research procedures or interpretation of data must not be
accepted for publication, or if already published must be discredited
within the professional literature” [5].
References.
1. NICE ADHD Guidelines:
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=12061
2. Stedman’s Medical Dictionary, 25th Edition, Williams and Wilkins,
Baltimore, MD, 1990.
3. American Academy of Pediatrics, Committee on Quality Improvement and
Subcommittee on Attention-Deficit/Hyperactivity Disorder Clinical
practice: diagnosis and evaluation of the child with attention-
deficit/hyperactivity disorder. Pediatrics. 2000; 105:1158-1170
[Abstract/Free Full Text]
4. Baughman, FA, Diagnosis and Evaluation of the Child With Attention
-Deficit/Hyperactivity Disorder (letter) PEDIATRICS Vol. 107 No. 5 May
2001, pp. 1239
5. Pam, A. A critique of the scientific status of biological psychiatry.
Acta Psychiatricia Scandinavica, 82 (Suppl. 362), 1-35.
Competing interests:
None declared
Competing interests: No competing interests