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6Feb 2013

Sciam blogger on NY Times: "Yet another harrowing story of white collar addiction."

Sciam blogger on NY Times: "Yet another harrowing story of white collar addiction."

On Sunday, The New York Times ran a long story on page one by Alan Schwarz headlined, "Drowned in a Stream of Prescriptions." It is about a 24-year-old college graduate named Richard Fee who was "getting dangerously addicted" to the ADHD medication Adderall. (That characterization came from his mother, not a doctor.) The young man later committed suicide.

It's impossible to know whether taking Adderall contributed to the suicide, or whether Fee's suicide was caused by withdrawal from Adderall. But Schwarz seems to know:

...after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

That doesn't say withdrawal from Adderall caused Fee's suicide, but it certainly implies it.

The details in the story are gripping; Schwarz does an excellent job of reporting. But the overall approach of the story is what we've read so many times before: Over use of psychiatric medications is killing children and adults. Doctors too easily diagnosis ADHD, and they too easily dispense prescriptions.

The Times in particular has made this an act of faith, running story after story over the years showing the damage misuse of these drugs can cause. Schwarz himself wrote an earlier piece about the overuse of Adderall on page one of the Times on June 9, 2012 under the headline "Risky Rise of the Good-Grade Pill." Duff Wilson wrote a similar story on Sept. 2, 2010.

All of these stories are accurate: Overuse of the drugs can cause serious problems, and it is a national crisis. But what fails to excite the imagination of Times editors and reporters is the other side of that crisis: Most children and adults in need of treatment for mental illness are being woefully undertreated or not getting any treatment.

I found a smart rebuttal to the Schwarz story at Scientific American, where an Indiana University cognitive science graduate student writes under the nom-de-blog melody. Under the headline "Yet Another Harrowing Story of White Collar Addiction," she calls Schwarz's story "alarmist," and writes:

Schwarz is a Pulitzer-prize nominated journalist, renowned for exposing the danger of concussive head injuries in football. More recently, he has cast that same critical eye on how attention-deficit disorder is diagnosed. The question is – to what end?  Presumably – in the case of this story – to tighten the restrictions on how amphetamines are prescribed to adults, and to [warn] against the kind of negligence and lack of oversight that characterized Richard’s case. But there is a delicate balance to be struck here between serving the needs of the ADHD population, many of whom benefit tremendously from the regulated use of stimulants, and potential drug addicts, like Richard.  It is also far from clear, given the nature of psychiatric nosology, that there are any surefire ways of stopping con-artists and addicts from gaming the system.

She argues that Schwarz "plays the apologist" for his subject, writing that Fee, a pre-med student, had persuaded himself the drugs he was taking were O.K. Melody calls this "nonsense": It's more likely he "faked or exaggerated his symptoms" and "artfully scammed careless doctors and drugstores" to support his addiction, she writes. And more:

Schwarz whitewashes Richard’s narrative in part because he wants to fault the system.  But again, the question comes back to: What would tightening the reins on amphetamine actually do, in practice?  It might prevent a “worst-case scenario” like Richard Fee, but at the expense of many actual sufferers going unmedicated.

As melody points out, the same is true for other mental illnesses; there are no tests for these disorders, and misdiagnosis is common--as is failure to treat. "The science needs to improve," she writes, "before the medicine can."

The Times should, now and then, take a look at the other side of the story.

-Paul Raeburn




Drug manufacturers are facing crippling shortages of raw materials, causing drug shortages across the country. Adderall, a popular ADHD medication, is in alarmingly short supply. If you need help paying for your medical visit, personal loan can help.

Oh dear, pundits who poke holes in reportage should watch for their own biases and/or shallow knowledge base on the topic.

There is a lot more complexity to ADHD and its treatment strategies than either Alan Schwarz (and the rest of the New York Times' reporters) or Melody or anyone else is currently acknowledging.

How easily everyone wants to dismiss Richard Fee as a conniving drug addict, as if addiction has nothing to do with neurobiology or people with ADHD cannot be bright and articulate.

So many snap judgments and misconceptions.

I attempt to provide a little more complexity, briefly, in this blog post:

These stories also fail to address pharmacokinetic variables that a user with little psychopharmacological knowledge might not consider when taking a drug. Variation in dosages and release times and their potential effects on the addictive quality of the drug and the experience the drug delivers are not addressed by these stories. Further, variation in who is taking the drug (body type, vulnerability to addiction, susceptibility to placebo effect, etc.) is also not addressed. So, it's unclear whether a typical user is even taking an effective amount of medication. Non-prescription, non-psychiatric drugs that the average HS or college kid comes into contact with will have straight forward dosing. With the placebo problem, who is to say that a majority of kids are even taking an effective, let alone dangerous, dose of medication? If someone is taking 10 mg of Ritalin with a cup of coffee, the Ritalin probably isn't even be responsible for any effect the user feels.

It would be interesting if someone compared an outlet's coverage of the placebo problem in psychopharmacology with its coverage of the over medication problem. You would probably uncover more than a few contradictory messages about the effectiveness of today's psychiatric medications.

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