
ADHD Pill Faces High Hurdle in Europe as Stigma Persists - JumpCrisscross
http://www.bloomberg.com/news/2013-10-01/adhd-pill-faces-high-hurdle-in-europe-as-stigma-persists.html
======
linuxhansl
Good.

Medicine in the form of antibiotics and inoculations against various dangerous
diseases has brought us far, but it seems to be time to rethink some of the
recent developments.

Maybe we can stop growing a monoculture of humans where the slightest
deviation from the norm must be treated with some kind of drug.

I am from Europe (but live in the US) and I salute the folks there resisting
this nonsense. (And for the record I am not saying there do not exist cases
where treatment with such drugs would be indicated, just that the extend to
which this is done in the US is not healthy).

~~~
anigbrowl
thanks to uninformed attitudes like yours, I was unable to get any treatment
for my ADHD for years while living in Europe. Instead I was told that I was
stressed because I was depressed, and depressed because I was stressed, and
made to feel like it was my fault for not being easily treatable.

 _Maybe we can stop growing a monoculture of humans where the slightest
deviation from the norm must be treated with some kind of drug._

Yes, yes, and vaccines are a pharmaceutical industry plot, and all the rest. I
am really tired of this amateur-hour analysis from people who can't even be
bothered to muster up a citation for their hand-waving argument.

~~~
uniclaude
What you should think about is that for one person like yours that stays
untreated with your ADHD, in the US there might be a lot of kids forced to
undergo treatments for what is no real ADHD. I grew up in Europe, and I
seriously think that I would have spent my life under a very high amount of
drugs if I had been raised in the US.

I'm very glad I didn't have to go through this, because in Europe it is much
more difficult to be recognized as someone having ADHD.

So I'm sorry for you to have suffered, but I can't say I'm not happy I didn't.

All of this said, I no I have no data to back this up, it's just a gut
feeling.

~~~
Bluestrike2
Of the two attitudes, only one ensures that those who _do_ suffer from ADHD
aren't able to receive treatment. Misdiagnosis, when it occurs, is able to be
handled on a case-by-case basis; the "no such thing" stigmatization and other
similar lines of reasoning, on the other hand, are a priori positions that
reinforce biases that actively work against those who are seeking treatment
and those who should but aren't, and as a result, directly contributes to
underdiagnosis.

No one looks at increases in cancer rates and decries them as an rising tide
of overdiagnoses. Only when talking about mental health can people get away
with this sort of shoddy reasoning. A few points:

First, the argument itself is faulty. By their very nature, diagnosis rates
aren't able to support conclusions in _either_ direction on the matter. An
increase in diagnoses is not the same as an increase in misdiagnoses. There
are multiple significant factors that can contribute to an increase in
diagnoses over time (i.e. heightened awareness, decreased in stigma that would
otherwise have prevented the patient from seeking treatment, better diagnostic
tools, properly recognizing edge cases where ADHD was previously misdiagnosed,
etc.). We've seen similar things with other illnesses as well.

Simply put, the question that you're trying to raise (but aren't) is more
nuanced: what percentage of those diagnosed do not meet the diagnostic
criteria? The two questions are quite distinct.

Second, we're not exactly working from a comparable baseline when we look
towards previous years. Consider factors such as a broader recognition of ADHD
symptoms, openness to not simply writing those same symptoms off as "that's
the way the world works" or "kids will will be kids", and relative decreases
in stigmatization of ADHD itself (e.g. "ok, this is different from those
really _bad_ disorders like... schizophrenia [gasp]"). Net result, increased
visibility which damn well ought to lead to increases in overall numbers just
as it would for any diagnosis, psychological or otherwise.

Third, there isn't much scientific evidence to support the idea that ADHD is
overdiagnosed. Even in cases where patients don't meet the diagnostic
criteria, there's a growing body of evidence that they nevertheless exhibit
more symptoms than average. So even in those cases, they're quite different
than your idealized vision of regular kids being fed a daily diet of all the
psychopharmaceuticals they can swallow. If you're interested, here are a few
articles you can start off from:

\-
[http://www.cdc.gov/ncbddd/adhd/play2.html](http://www.cdc.gov/ncbddd/adhd/play2.html)

\- [http://www.psychiatrictimes.com/adhd/problems-
overdiagnosis-...](http://www.psychiatrictimes.com/adhd/problems-
overdiagnosis-and-overprescribing-adhd)

\-
[http://jad.sagepub.com/content/11/2/106.abstract](http://jad.sagepub.com/content/11/2/106.abstract)

\-
[http://www.ncbi.nlm.nih.gov/pubmed/22956714](http://www.ncbi.nlm.nih.gov/pubmed/22956714)

Anyhow, mental illness--regrettably--has a nasty assortment of baggage. For
centuries the mentally ill were criminalized, marginalized, and locked away.
Crazy or not crazy. And though we've moved away from a great deal of the worst
of these excesses, many of them are still with us. Maybe one day we'll get our
heads out of our collective asses.

~~~
bayesianhorse
In the US, the mentally ill are still often criminalized, and care for mental
patients has shifted disturbingly from hospitals to prisons...

Mental illnesses predispose for bad health care coverage...

------
chimeracoder
I posted this in a HN thread about therapeutic uses of nicotine a week ago,
but it's even more relevant here:

> A friend of mine is a psychiatrist who specializes in treating ADHD. She
> told me about a conference she went to recently, where someone presented an
> interesting paper.

> Apparently, there was an amazing study done relatively recently (last five
> years), in which they demonstrated that, in mice, exposure to nicotine
> during pregnancy results in higher rates of ADHD in the grandchildren
> (passed down through the female offspring exposed to nicotine in utero, not
> the males).

As with any study conducted on animals and not humans, there's an asterisk
next to it, but these findings would be monumentally significant for
understanding ADHD.

Separately, I've never understood why Adderall isn't approved for use in
Europe (or, futhermore, why Vyvanse should be approved, if Adderall isn't -
Vyvanse is just a more concentrated version of the d-enantiomer, making it
more effective[0] and reducing the side-effects).

On an unrelated note, it looks like the copy editing on the article was a bit
off. Concerta is a long-acting drug, just like Vyvanse (the article makes it
seem like it isn't). Also, I'm not sure what to make of the sentence "The U.S.
still dwarfs Europe in sales of ADHD drugs, but the rest of the world has been
catching up."

[0] It's actually _less_ effective by weight than Adderall XR, but that's
because the mechanism it uses for the extended release is very different.

 __EDIT __: It 's interesting watching all six of the comments on here (not
counting losethos's) get upvoted and downvoted in roughly equal proportions.
Clearly this is a controversial topic on here; I only wish the those
upvoting/downvoting would join in the discussion.

~~~
jasonlotito
Of note: Adderall is by far not the only drug available for ADHD, and
considering its addictive nature, should not be the first on you try.

~~~
code_duck
What could be wrong with dosing children with amphetamines every day for
years?

~~~
bayesianhorse
If you are not treating a child with severe or even moderate ADHD with
Amphetamines, the risks are severe and not so rare at all.

Almost by guarantee the child will not achieve remotely as well as it could.
Both in school and within social groups. Both of these failures will almost by
guarantee lead to further problems down the road.

It has been shown that untreated ADHD multiplies the risk for other very real
disorders, like bipolar disorder for example.

~~~
code_duck
I disagree, and I'm confident sane history will eventually look back in horror
at the idiots giving their kids amphetamines willy-nilly.

Perhaps some children need this. The vast majority receiving these drugs would
benefit a lot more from realistic parenting and school situations than from a
toxic, addictive stimulant pill.

~~~
bayesianhorse
Those enlightened future beings will have to discover some theoretical side
effects which justify the obvious disadvantages of denying treatment and just
haven't been seen yet despite of decades of experience with these drugs.

These side effects need to be severe, given the massive amount of consequences
of untreated ADHD.

~~~
code_duck
I don't even really believe that ADHD exists. I'm quite confident that I'm
amphetamine addiction exists, however.

~~~
bayesianhorse
There is a very good MOOC on ADHD from coursera, the videos should still be
up. I don't think anyone who has a low to medium understanding of the topic
can claim that ADHD does not exist. The evidence for the existence is
compelling and overwhelming.

A short non-exhaustive summary: visible symptoms, effects on specific
cognitive tests, reversal of symptoms under treatment, significant changes in
neuroanatomy and brain activity in MRI, differences in EEG spectra and severe
consequences like lower Income, higher propensity for violence and addictive
behavior plus a markedly worse social life.

~~~
code_duck
The thing is that I'm more likely to believe its a combination of
environmental toxins, food poisons such as artificial coloring and
preservatives and incomplete parenting than something that could be treated
effectively with more chemicals.

------
DanBC
> “There’s been a great deal of resistance to even believing there is a
> disease,” said Mary Baker, president of the European Brain Council, a
> Brussels-based non-profit representing doctors, patients and companies
> including Shire that work on neurology and psychiatry issues.

Here's a PDF of funding for the European Brain Council.
([http://www.europeanbraincouncil.org/pdfs/Publications_/EBC%2...](http://www.europeanbraincouncil.org/pdfs/Publications_/EBC%20Funding%20Statement.pdf))

~~~
MichaelGG
Novartis and Jannsen are on that list, and they make Ritalin and Concerta,
respectively.

------
DanBC
The big thing this article misses is the god awful state of Child and
Adolescent Mental Health Services in the UK.

MH services in England for adults are overworked and under funded, and that's
much worse for CAMHS.

This is a left over effect of the weird split by age for services (children;
working age adults; older adults; learning disability) which we used to have.
Those lines are blurring. If you have a dementia like illness you go to a
dementia specialist, and it doesn't matter if you're 40 or 70. If you have a
first episode of psychosis you go to a psychosis specialist and it doesn't
matter if you're 15 or 28. (Although there does have to be splits for in
patients, because it's problematic to have under 18s in adult hospitals.)

ADHD is real. (Weird that I need to say that, but there are the usual suspects
in this thread with their hateful denial of mental illness.)

But bad parenting is also real. Disturbed behaviour as a result of abuse is
real. The meds are troubling. It's important, to protect vulnerable children,
that people with ADHD are correctly diagnosed (and medicated if needed) but
that people without ADHD are not misdiagnosed. Diagnosis is probably not going
to be done by GPs, but by CAMHS specialists, which means that children are
going to have to wait considerable lengths of time to get the help they need.

Here's the UK advice for ADHD. Healthcare trusts do not need to conform to the
NICE recommendations, but they need good reason if they deviate from these
recommendations.

([http://www.nice.org.uk/Search.do?x=-1070&y=-75&searchText=ad...](http://www.nice.org.uk/Search.do?x=-1070&y=-75&searchText=adhd&newsearch=true#/search/?reload))

Here's the UK patient information about ADHD

([http://www.nhs.uk/Conditions/Attention-deficit-
hyperactivity...](http://www.nhs.uk/Conditions/Attention-deficit-
hyperactivity-disorder/Pages/Introduction.aspx))

------
DannyBee
Given there are non-stimulant alternatives available at this point, one would
hope they would be tried first with children.

Among other things, Ritalin and friends used to completely suppress my
appetite, which while it may sound cool, is really "not great".

~~~
saosebastiao
I only know of one non-stimulant alternative (strattera), and it didn't work
for me (it handled the ADHD to some degree, but the side-effects were
terrible). They definitely could use a little more progress in that area, as I
would love to stop using Amphetamine derivatives.

~~~
DannyBee
For children, there is Intuniv and Kapvay.

For adults, only straterra.

You do sometimes see wellbutrin as an off-label use.

I'm also curious which side-effect you experience from strattera. In my
mid-20's, I moved off amphetamines onto it, and have had no side-effects at
all.

There is essentially no progress in this area because nobody cares. They keep
finding new amphetamine derivatives to make, and they are quite cheap to
produce, and still patentable.

~~~
saosebastiao
For me, it was major cottonmouth, to the point where I constantly felt like I
was choking on something.

------
bradleyjg
Vyvanse is a prodrug of dextroamphetamine, which means that it turns into that
in the body. The advantage allegedly is that it's less prone to abuse but the
real reason it exists is that dextroamphetamine entered the market in 1937 and
so its patent has long since run out. Dextroamphetamine in turn is just
amphetamine with the left-handed isomer removed. This left-handed isomer is
less potent than the right, but both promote higher concentrations in the
brain of the same chemicals norepinephrine and dopamine.

Amphetamine you may know better under its colloquial name -- speed. That's
right, Shire Pharmaceticals is upset that European doctors and parents aren't
rushing to give children fancy, expensive, speed.

~~~
saosebastiao
And heroin (with a few chemical bit twiddles) is used to treat pain after
major surgeries and accidents. And methamphetamine (with a few chemical bit
twiddles) is used to treat stuffy noses. Face it, almost all drugs can be
misused...but that is not a reason for them to be banned.

After 8 years and 3 dropouts into my 4 year undergrad degree, I was finally
diagnosed with ADHD. My pre-diagnosis GPA was 1.9, my post-diagnosis GPA was
3.9. I graduated less than two years later, and within 3 years I was earning a
6-figure income and providing for a wife and newborn child. I would likely be
a divorced, homeless, deadbeat dad without Vyvanse (or its similarly
Amphetamine-derived Adderall).

Don't take my life away from me, and don't take it away from anyone else, just
because you have a fucking delusional conspiracy theory that a drug company is
trying to addict kids to speed.

------
jotm
How about making it available for adults first?

------
UK-AL
ADHD is defiantly a real thing, but I don't think we should drug it out of
them. We should make sure they go into suitable jobs/schools, where adhd would
have advantages as opposed to disadvantages.

~~~
saosebastiao
Why not "drug it out of them"? If the disease is caused by a chemical
imbalance, why not try to fix the chemical imbalance? Some people (myself
included) are not functional without medication.

~~~
wpietri
Personally, I'm pretty skeptical that most of the people diagnosed with it
have a disease. I think it's a perfectly normal human variation that just
doesn't match well with our Industrial Age approach to education.

The way I think of it is like height. There's a normal range of tall and
short. There are also diseases that make people unusually tall or short. But
mere shortness doesn't prove disease. And just because short people have
trouble reaching cabinets built for average people doesn't mean we must give
short kids extra hormones to make them be average in height.

I think it's reasonable to say, "Hey, in the world we want to create, it's
better if many or all people take drugs to shape behaviors so that they match
the system they should fit into." Why I don't like is the medicalization of
variation.

~~~
com2kid
People with ADHD have reduced brain growth in areas associated with executive
control.

ADHD is very real. So is the 50%+ of untreated people with ADHD having
substance abuse problems. So is the higher suicide rate. So is the reduced
rate of high school and college graduation. So are the dramatically increased
rates of depression. Then there is the incredibly high rate of co-morbidity of
ADHD with other psychological disorders, most prominently Bipolar Disorder.

~~~
wpietri
Those are interesting facts, but I don't think they prove anything about
existence of ADHD as an actual disease. Lower-than-average height is also
correlated with many diseases but it isn't a disease on its own.

~~~
com2kid
The portion of the brain associated with self control is smaller in people
with a mental disorder that is characterized by a lack of self control.

Now obviously proving the entire causation thing here is pretty hard, but, if
someone is missing their eyes, and that person is blind, there might just be a
causative relationship happening.

To put it in perspective
([http://www.medscape.org/viewarticle/549973](http://www.medscape.org/viewarticle/549973)),
32% of people with ADHD suffer from depression. 21% bipolar. That isn't some
statistical oddity.

(The % is higher in the untreated population, no citation on hand right now
sorry)

Over 50% of people with ADHD have substance abuse problems.

Imagine taking a population and saying "oh yeah half those people are
alcoholics, but there is no strange underlying cause, nope, we should just let
them be."[1]

ADHD isn't the popularized image of "little Johnny can't do his boring old
homework that the mean teacher assigned", but rather "Jenny can't make herself
go to sleep even though if she is late one more day for work she will be fired
and have no money for food or rent."

ADHD is like having your entire sense of self control ripped away from you, no
matter how much you want to do something, you cannot force yourself to do it.
Pleading and begging doesn't work. Breaking down in tears over one's complete
lack of ability to accomplish the simplest of tasks doesn't help any. The
neurochemical responsible for self control quite literally _isn 't there_.

[1] Well ignoring that America has basically done that for multiple cultures
already...

~~~
wpietri
I'm not our society is structured such that in many common circumstances,
greater linearity is beneficial. I'm also not denying that there could be
relationships between size of brain regions and various physical
characteristics. And I'm certainly not denying your experiences.

What I'm questioning is constructing this as a mental disorder.

That's distinct from, say, psychosis. 100k years ago, being totally delusional
would have been harmful. But there's no reason to think that most people
classified as ADHD would have been at any disadvantage.

Again, come back to the height analogy (which you haven't addressed so far).
There are obvious advantages in our society to being taller, including greater
career success. Many short people hate being short. Does that mean there's
something wrong with short people, or that they should all be treated with
drugs as soon as we can diagnose Tallness Deficit Disorder?

~~~
com2kid
Actually below a minimum height, treatment options are given to parents to
help their children grow taller. There is a well estab

I also feel that you are tending towards the naturalist fallacy here. Just
because something is natural doesn't mean that it is good (or neutral). Mother
nature doesn't care.

As for ADHD existing 100k years ago, a large percentage of ADHD cases are in
children born to mother's who used drugs during pregnancy. (Obviously not all,
but there is a very large %). One cannot discount at least some modern factors
being responsible for some percentage of ADHD cases.

------
coopaq
Some of the signs for ADHD from wikipedia:

"Become bored with a task after only a few minutes, unless doing something
enjoyable"

"Have trouble completing or turning in homework assignments"

"Struggle to follow instructions"

"Be very impatient"

"Be constantly in motion"

"Thinks constantly being told what to do by others for 18 years kinda sucks"

[http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity...](http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder)

~~~
Mqlpidrien
If I read the description of the wikipedia article, I could easily think that
I suffer from ADHD. To me it feels a little bit like asperger syndrome where
you can pick and choose related syndrome and believe you might suffer from it
when you are just a little bit asocial. To exaggerate, it is like reading an
horoscope and thinking that, woah, it is exactly how you are or how this
person is.

Obviously there are trained doctors and psychiatrist and whoever who can judge
whether or not a kid suffer from adhd but it seems that it will be way more
than 7% of kid that could get bored by tasks they are being test for and that
is why adhd seen from outside the usa feels too often diagnosed.

Others have said how the drug would have helped themselves or is helping
themselves but has it been shown that the drug would not help everyone who
takes it to focus and perform better at test and studying or working. Since I
live in the USA, I have asked the questions to college student and it seems a
fairly common thing to take a pill before exam to get that extra edge for
focus (granted you don't start cleaning your apartment and become very
thorough while doing it).

Even if the drug could help some people, it is not unreasonable to consider
whether introducing the drug to society has an overall benefit and not just a
benefit to the company selling it. France has already a problem with to many
prescriptions of anti depressor drugs so maybe it is not a good idea to jump
on adhd pills.

