Drug firms spend big to sell public on ADHD

After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder, Keith Conners could be celebrating.

Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurobehavioral problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic ADHD, helping youngsters succeed in school and beyond.

But Conners did not feel triumphant this fall as he addressed a group of fellow ADHD specialists in Washington.

He noted that data from the Centers for Disease Control and Prevention show that the diagnosis has been made in 15 percent of high school-age children, and that the number of children on medication for the disorder has soared to 3.5 million from 600,000 in 1990. He called the rising rates of diagnosis "a national disaster of dangerous proportions."

"The numbers make it look like an epidemic. Well, it's not. It's preposterous," Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. "This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels."

Profits for the ADHD drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health.

The rise of ADHD diagnoses and prescriptions for stimulants over the years has coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents.

Few dispute that classic ADHD, historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, at work and in personal lives. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person's underlying drive and intelligence to emerge. But even some of the field's longtime advocates say the zeal to find and treat every ADHD child has led to too many people with scant symptoms receiving the diagnosis and medication.

Advertising on television and in magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in "schoolwork that matches his intelligence" and ease family tension.

The Food and Drug Administration has cited every major ADHD drug -- stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera -- for false and misleading advertising since 2000, some multiple times.

Roger Griggs, the pharmaceutical executive who introduced Adderall in 1994, said he strongly opposes marketing stimulants to the general public because of their dangers. He calls them "nuclear bombs," warranted only under extreme circumstances and when carefully overseen by a physician.

Psychiatric breakdown and suicidal thoughts are the most rare and extreme results of stimulant addiction, but those horror stories are far outnumbered by people who, seeking to study or work longer hours, cannot sleep for days, lose their appetite or hallucinate. More can simply become habituated to the pills and feel they cannot cope without them.

Like most psychiatric conditions, ADHD has no definitive test, and most experts in the field agree that its symptoms are open to interpretation by patients, parents and doctors. The American Psychiatric Association, which receives significant financing from drug companies, has gradually loosened the official criteria for the disorder to include common childhood behavior like "makes careless mistakes" or "often has difficulty waiting his or her turn."

The idea that a pill might ease troubles and tension has proved seductive to worried parents, rushed doctors and others.

"Pharma pushed as far as they could, but you can't just blame the virus," said Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek. "You have to have a susceptible host for the epidemic to take hold. There's something they know about us that they utilize and exploit."

Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often. Many doctors have portrayed the medications as benign -- "safer than aspirin," some say -- even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction.

Patient advocacy groups tried to get the government to loosen regulation of stimulants while having sizable portions of their operating budgets covered by pharmaceutical interests.