Apparently the ADHD Profit Curve Has Flattened

[DSpencer]

Re: Apparently the ADHD Profit Curve Has Flattened

This explains it! I'm not "slow", I just have sluggish cognitive tempo!

attention deficit disorder is a real phenomenon, although i think it's really a "final common pathway" for a diverse set of underlying conditions which are not well understood. i had a patient in his early 20's come to me after dropping out of his 3rd college, saying he thought something must be wrong with him, since he didn't seem able to succeed doing work that appeared to be within his understanding. i gave him a stimulant and he went back to school and got a degree in computer science. he said that before he was given meds, he only knew the nature of his own consciousness, and thought everyone must experience the world the way he did. he then said that, in retrospect, being OFF meds was like having two drinks, in terms of the difference in his ability to focus on a task.

These scenarios raise interesting questions. Does the fact that the drug has a positive effect mean that he had a "disorder"? It seems similar to steroid use. A healthy man can take anabolic steroids and experience the desired effects of building more lean muscle mass. That doesn't mean he previously had some kind of testosterone deficiency. There seems to be a growing trend of seemingly healthy men going to their doctor for "low T" so they can get legal, prescription testosterone.

I knew people in college who never claimed to have ADD/ADHD but would buy black market Adderall when they wanted to study hard for exams.

Similarly, I also knew people who stocked groceries for a living and used/abused other more illicit forms of amphetamines and talked about how much more work they could do while high on speed.

The point being that just because drugs "work" doesn't necessarily mean they are curing or treating any specific "disorder". It seems to me that we have avoided the overall question of whether healthy people should be able to take performance enhancing drugs because they feel like it. Instead we just pretend that everyone who gets their drugs from a doctor "needs" them and everyone else is just a criminal looking for the easy way out.

[jk]

Re: Apparently the ADHD Profit Curve Has Flattened

This explains it! I'm not "slow", I just have sluggish cognitive tempo!



These scenarios raise interesting questions. Does the fact that the drug has a positive effect mean that he had a "disorder"? It seems similar to steroid use. A healthy man can take anabolic steroids and experience the desired effects of building more lean muscle mass. That doesn't mean he previously had some kind of testosterone deficiency. There seems to be a growing trend of seemingly healthy men going to their doctor for "low T" so they can get legal, prescription testosterone.

I knew people in college who never claimed to have ADD/ADHD but would buy black market Adderall when they wanted to study hard for exams.

Similarly, I also knew people who stocked groceries for a living and used/abused other more illicit forms of amphetamines and talked about how much more work they could do while high on speed.

The point being that just because drugs "work" doesn't necessarily mean they are curing or treating any specific "disorder". It seems to me that we have avoided the overall question of whether healthy people should be able to take performance enhancing drugs because they feel like it. Instead we just pretend that everyone who gets their drugs from a doctor "needs" them and everyone else is just a criminal looking for the easy way out.

you are absolutely right: getting a cognitive benefit from a stimulant, especially when tired, is a non-specific effect, and not diagnostic of an attentional disorder.

[GRG55]

Re: Apparently the ADHD Profit Curve Has Flattened

this financialization may also explain why big pharma no longer does its own basic [early] research/drug development. instead big pharma just buys small companies which have developed something new.

The analogue for Big Oil (and Big Mining) is they don't do all their own exploration any more. Some fund of the juniors in specific plays, and some just buy them out when a project of sufficient size has been adequately defined.

[Polish_Silver]

overdiagnosis on Brain science podcast

there is a diagnosis, attention deficit disorder, inattentive type, which does not require hyperactivity. it sounds like this group of kids might meet criteria for that, called ADD instead of ADHD for a reason.

there are several problems raised here:

as i tell medical students when i teach them, psychiatry has a 19th century diagnostic system [along with 20th century treatments, and some 21st century basic science]. !

Very informative post. There's a highly relevant brain science podcast, by a guy who worked on the DSM. Over diagnosis out the Wazoo.

[Polish_Silver]

ADHD: who has it?

there is a diagnosis, attention deficit disorder, inattentive type, which does not require hyperactivity. it sounds like this group of kids might meet criteria for that, called ADD instead of ADHD for a reason.



attention deficit disorder is a real phenomenon, although i think it's really a "final common pathway" for a diverse set of underlying conditions which are not well understood. i had a patient in his early 20's come to me after dropping out of his 3rd college, saying he thought something must be wrong with him, since he didn't seem able to succeed doing work that appeared to be within his understanding. i gave him a stimulant and he went back to school and got a degree in computer science. he said that before he was given meds, he only knew the nature of his own consciousness, and thought everyone must experience the world the way he did. he then said that, in retrospect, being OFF meds was like having two drinks, in terms of the difference in his ability to focus on a task.
!

In europe they do not flood classrooms with Ritalin. I have a hard time thinking that making lots of children take this for 5 years is a good idea. And how do we know it has no long term side effects?

The case you describe is quite different---a grown man who diagnosed himself with performance problems, went to a professional for help, and got results.

[Polish_Silver]

Why no R&D at Big Co.

this financialization may also explain why big pharma no longer does its own basic [early] research/drug development. instead big pharma just buys small companies which have developed something new.

I don't think it's that. I think they realized they cannot do it cost effectively. It is cheaper to find small companies with good ideas and buy them. Big companies are lousy at innovation. Too much bureaucracy.

Interestingly, though, they justify exhorbitant prices based on the cost of developing "new molecular entities", which, in fact, they are not doing.

[jk]

Re: Why no R&D at Big Co.

I don't think it's that. I think they realized they cannot do it cost effectively. It is cheaper to find small companies with good ideas and buy them. Big companies are lousy at innovation. Too much bureaucracy.

Interestingly, though, they justify exhorbitant prices based on the cost of developing "new molecular entities", which, in fact, they are not doing.

iirc about 85% of their "research" dollars are spent on brand extensions- e.g. proving that THEIR ssri can treat some condition which we know every other ssri can treat, so as to allow them to get a new official indication from the fda so that they can market more widely.

[Polish_Silver]

Re: Why no R&D at Big Co.

iirc about 85% of their "research" dollars are spent on brand extensions- e.g. proving that THEIR ssri can treat some condition which we know every other ssri can treat, so as to allow them to get a new official indication from the fda so that they can market more widely.

India clamped down on that. I wish the US could do that.

[flintlock]

Re: Apparently the ADHD Profit Curve Has Flattened

I'm appalled at how many highly addictive drugs are handed out like candy. Drugs with horrible withdrawal symptoms, often for minor medical reasons. Yet people freak out over pot.

[jk]

Re: Apparently the ADHD Profit Curve Has Flattened

I'm appalled at how many highly addictive drugs are handed out like candy. Drugs with horrible withdrawal symptoms, often for minor medical reasons. Yet people freak out over pot.

i'm in favor of legalization, or at least decriminalization of mj, but the answer to your implicit question is that the drugs that may be addictive are [supposed to be] being prescribed and monitored by someone other than the consumer of those drugs, someone licensed by the state, with what society considers appropriate qualifications to make such judgements.

those prescriptions are monitored in various ways. for example, i think [i'm not positive] that whenever a patient fills a stimulant prescription the information is recorded in computers in both in the state capitol and in washington, d.c. i know of physicians who have been investigated by the dea because of their prescribing habits. pain management doctors are especially paranoid and rigid in their prescribing habits and documentation.

[shiny!]

Re: ADHD: who has it?

In europe they do not flood classrooms with Ritalin. I have a hard time thinking that making lots of children take this for 5 years is a good idea. And how do we know it has no long term side effects?

The case you describe is quite different---a grown man who diagnosed himself with performance problems, went to a professional for help, and got results.

My late husband worked with a lot of special ed students who were on Ritalin. He saw huge benefits for the children who really needed it but thought it was being massively overprescribed. Children with true ADD or ADHD can't focus their minds or control their behavior. Ritalin normalizes their brain chemistry somehow: their minds become focused, they can learn, they can control their emotions and physical movements. These kids really do benefit from the drug and most of them feel better on medication.

Where it's being overprescribed is for normal, high energy, rambunctious kids who naturally chafe in a child-unfriendly environment that forces them to sit still and be quiet all day.

Children are like kittens and puppies: they need to move, run, play, explore. It's not wasting time, it's how they learn. Kinesthetic learners are especially underserved by an educational process that overdepends on verbal lectures and visual transmission of information. Bored out of their minds, many of them act out, disrupt class, eventually drop out. So they get drugged.

These kids thrive in kinesthetic, hands-on vocational shop classes but those classes have been eliminated through funding cuts. Now the current (highly lucrative) fashion is "every child should go to college."

[Polish_Silver]

How to go backwards!

. . .

Children are like kittens and puppies: they need to move, run, play, explore. It's not wasting time, it's how they learn. Kinesthetic learners are especially underserved by an educational process that overdepends on verbal lectures and visual transmission of information. Bored out of their minds, many of them act out, disrupt class, eventually drop out. So they get drugged.

These kids thrive in kinesthetic, hands-on vocational shop classes but those classes have been eliminated through funding cuts. Now the current (highly lucrative) fashion is "every child should go to college."

I heard similar from a junior high english teacher. Completely unrealistic and it will dumb down the colleges, as well.

Frighteningly, some people think the junior colleges are poorly serving their students. Many never get the AA degree.

[charliebrown]

Re: ADHD: who has it?

Children are like kittens and puppies: they need to move, run, play, explore. It's not wasting time, it's how they learn. Kinesthetic learners are especially underserved by an educational process that overdepends on verbal lectures and visual transmission of information. Bored out of their minds, many of them act out, disrupt class, eventually drop out. So they get drugged.

+1 on that one.

tabgo principio, audio non principio

[photon555]

Re: ADHD: who has it?

Currently, there appears to be a growing epidemic of Super Hyperactive Acquisitiveness Trending Syndrome, especially on the part of overgrown corp/gov entities. I am in favor of an expedited effort to develop a mandatory treatment for this condition since it appears to be highly contagious.