Ritalin Side-Effects Explained//Parents "Caught in the Middle"
Derek A. Wholeflaffer A.S.A.
If there's one image that has been used to illustrate the Ritalin
controversy, it's that of a line of elementary schoolchildren waiting at
the nurse's office at midday to receive their daily medication. The
image has been pervasive in the media for more than a decade but has
been popping up with increasing frequency in the past year or two,
particularly on television news, talk, and magazine shows.
The context into which these troubling questions and images fall
is not always reassuring. The use of psychotropic drugs as quick fixes
for complicated problems has been tried before--with results that
indicate mixed benefits and with problems that accrue over years and
require a long-term perspective to appreciate. How many American women
(and men), for instance, took the tranquilizer Valium, feeling the need
to blunt the edges of their jagged lives, only to discover later that
they were involved with a highly addictive drug? And a generation
later, similar questions are being raised about the antidepressant
Prozac--can a feel-good drug really make you feel good without exacting
a price?
The Ritalin debate, first spurred in the mid-1980's by attacks on
the drug from the church of Scientology, has often been rancorous. Even
as the scientific and medical establishment continues to build a
convincing case for the efficacy of Ritalin, with only minimal side
effects, media attention jangles a noisy counterpoint. The national
support organization Children and Adults with ADD (CHADD) is often
accused of being in financial cahoots with Ciba Pharmaceuticals, the
company that manufactures Ritalin, to promote the drug. Educators are
faulted for preferring chemical intervention over more difficult and
creative attempts to tailor teaching to a child's individual needs. And
if Ritalin works to adjust the world of disordered children, can it not
also boost the performance of "normal" children? Increasing evidence
and anecdotes say yes. While it was once thought that non-ADD children
did not respond top MPH, studies by NIMH's Judith Rapoport, M.D., and
others have determined that this is not the case. Non-ADD children
experience the benefits of a similar sharpening of focus when they take
Ritalin. In fact, more and more teens are using what they call "vitamin
R" or the "smart drug" recreationally and reporting energy bursts and
euphoria after crushing and snorting the pills they either steal from
their younger siblings or buy from children for whom they have been
prescribed.
Ritalin as a drug of abuse is a relatively recent phenomenon, and
one that is fueling the general debate over the medication. The Drug
Enforcement Administration (DEA) recently released preliminary findings
that bash a petition by CHADD and the American Academy of Neurology to
ease controls on prescribing MPH; the potential for abuse is the main
reason given. Even the United Nations has gotten into the act, in the
form of a recent report from its International Narcotics Control Board
that urges "all governments to exercise the utmost vigilance" to prevent
overdiagnsosis of ADD and "medically unjustifiable" treatment with MPH.
Caught in the middle are parents, who almost always struggle with
the decision to medicate their children, and the children themselves,
who, depending on their age, may or may not understand why the pills
they take seem to make life so much better.
About one fact there is no question. Statistics show a dramatic
increase in the use of Ritalin in recent years. More and more Ritalin
is being dispensed every year in this country, and the bulk of it is
prescribed to children.
The DEA classifies methylphenidate as a Schedule II drug, meaning
that it has a currently accepted medical use by a high potential for
abuse, which may lead to SEVERE psychological or physical dependence.
Schedule II regulations prohibit prescription refills and call-in
prescriptions and impose aggregate production quotas. From the
mid-1980's until 1990, the quotas rose slowly, with a couple of downward
blips. From 1990 until a slight leveling-off in 1996, production quotas
climbed relentlessly.
Methylphenidate is also used to treat narcolepsy in adults and
increasingly to treat adult ADD, but by far the most common use is for
children with ADD. According to the "Textbook of Pharmacotherapy for
Child and Adolescent Psychiatric Disorders (1994), nearly 2 percent of
school-age children--more than 600,000 children a year--receive
stimulant medication for ADD symptoms. Methylpyhenidate is not the only
drug used for ADD, but it is the most common. Dexedrine
(dextroamphetamine) and Cylert (pemoline) have been found to confer many
of the same benefits as Ritalin and are effective for some children who
do not respond to Ritalin, but they have their own problems.
Amphetamines have the reputation of being highly prone to abuse and may
be difficult to get in some area, and Cylert has been associated with
possible liver damage.
There is agreement among practitioners, among critics, and within
the DEA that there are two reasons for the steady rise in methyplenidate
quotas: the increasing number of ADD diagnoses and the widespread
acceptance by the medical community that methylphenidate is an effective
treatment. It is an acceptance based on EMPIRICAL scientific data:
Reviews of the thousands of studies that have been done on the efficacy
of methylphenidate in treating the symptoms of ADD final success rates
averaging about 75 percent, although there is NO evidence of continuing
relief of symptoms once the drug is discontinued.
Re: Parents Caught in the Middle Over Ritalin Side-Effects (Response)
From: tim...@minn.net (Tim McNamara)
> "Art Wholeflaffer <smq...@cyberhighway.net> wrote:
> There is agreement among practitioners, among critics, and within
> the DEA that there are two reasons for the steady rise in methyplenidate
> quotas: the increasing number of ADD diagnoses and the widespread
> acceptance by the medical community that methylphenidate is an effective
> treatment.
To my mind, the primary question isn't whether Ritalin is effective (the
evidence seems to be that it is, not only for ADD but also as an
alternative therapy for depression- especially post-CVA) but whether ADD
is being over-diagnosed. In other words, are kids being tagged as ADD
when in fact the real problem is the home environment, social environment,
school environment, nutritional, relationships, needing glasses, other
problems such as a central auditory processing disorder, etc.?
This is the part of the debate that is currently raging, I think, not the
medical efficacy of Ritalin. (At least, that's the focus of the Ritalin
controversy in my neck of the woods).
Steven B. Harris
<smcq...@cyberhighway.netXYZ> writes:
>To my mind, the primary question isn't whether Ritalin is effective
(the
>evidence seems to be that it is, not only for ADD but also as an
>alternative therapy for depression- especially post-CVA) but whether
ADD
>is being over-diagnosed. In other words, are kids being tagged as ADD
>when in fact the real problem is the home environment, social
environment,
>school environment, nutritional, relationships, needing glasses, other
>problems such as a central auditory processing disorder, etc.?
>
>This is the part of the debate that is currently raging, I think, not
the
>medical efficacy of Ritalin. (At least, that's the focus of the
Ritalin
>controversy in my neck of the woods).
Comment:
The real focus of the controversy should be the unfortunate fact
that ADD (at any age) is only a "disease" in the way that hypertension
and hypercholesterolemia are diseases. It's just one end of a spectrum
of degree of difficulty in focusing attention on one task for effective
periods, and the amount of it which one needs, in order to be labeled
as having a "disease" is largely arbitrary and socially constructed.
It's not as though there is a gene or any kind of marker for physical
damage which can be assessed, here. There are tests with scores, but
they only confer the illusion of objectivity, for the cutoff for the
score which makes the diagnosis is itself subjective.
Alas, a dose of methylphenidate, exactly like a dose of amphetamine,
aids allertness and performance in nearly all tired people-- something
long established in studies, and long used by the military (the Germans
at the Battle of the Bulge in late 1944 probably being first to exploit
our modern versions of these chemicals). And nearly all people working
at a difficult schedule or heavy school study load are tired. Thus,
these drugs are quite effective learning and attention focusing aids
for most people, which is the reason for their widespread use among
college students. You may call this "abuse" or "self-medication"
according to your philosophy. But your philosophy is the only thing
which differentiates the two, and this is a heavily judgemental issue
(something like the question of who is and isn't "sexually
promiscuous"-- answer: the person who has sex with significantly more
people than YOU do, is). Too often, "abuse" merely means "use the
doctor didn't sanction" but otherwise the same, and for the same
purposes. There's a heavy dose of hypocrisy, there.
The Apollo 13 astronauts-- frightened, isolated, cold, exhausted,
thirsty, and in one case infected, took amphetamines on doctor's orders
on their last leg of the journey before re-entry, a period in which
many complex and unrehearsed tasks had to be done, and during which
certain simple mistakes meant death. Instead of collapse into the arms
of the doctors after being plucked from the sea in their capsule and
put on deck, these half frozen and tortured men emerged from their ship
smiling and waving and standing on their own feet. Perhaps looking
around for a floor to vacuum, or some income taxes to catch up on.
That's amphetamines. In my mind's eye I have a picture of these
sterling heros promptly being denouced by Nixon as a bad example to the
nation's youth, who are expected to get high on life, and not rely on
an artifical chemical to help them achieve. Unless someone tells them
they can. That is, if given permission by *authority*, why then it's
all right. It's not alright if they decide for themselves. How dare
you decide for yourself about something like that for your own body,
and your life? Why, the very idea.
THAT is the real message we're sending with trimethylphenidate, aka
speed. And the disease we're looking at is a lot worse than ADD. It's
a worship of authority, and the idea that you'll be told what to do by
the proper authorities, and you'll be evil if you decide for yourself
what to do, instead. The Germans had this diease bad in 1944. So did
the Japanese. Let's hope that in this era of big government, it's not
too catching in America. From all the signs, though, I'm not too
hopeful.
Steven B. Harris, M.D.
Derek A. Wholeflaffer A.S.A.
sbha...@ix.netcom.com(Steven B. Harris) wrote:
>In <7ilep1$jbo$1...@news.cyberhighway.net> "Derek A. Wholeflaffer A.S.A."
><smcq...@cyberhighway.netXYZ> writes:
>
>>To my mind, the primary question isn't whether Ritalin is effective
>(the evidence seems to be that it is, not only for ADD but also as an
>>alternative therapy for depression- especially post-CVA) but whether
>ADD is being over-diagnosed. In other words, are kids being tagged as ADD
>>when in fact the real problem is the home environment, social
>environment, school environment, nutritional, relationships, needing glasses, other
>>problems such as a central auditory processing disorder, etc.?
>>>This is the part of the debate that is currently raging, I think, not
>the medical efficacy of Ritalin. (At least, that's the focus of the
>Ritalin controversy in my neck of the woods).
>
>
Derek A. Wholeflaffer A.S.A.
Art A.S.A. and D.P.R.
D. C. & M. V. Sessions
> In <7ilep1$jbo$1...@news.cyberhighway.net> Jerry Kolnick
> <smcq...@cyberhighway.netXYZ> writes:
>
> >To my mind, the primary question isn't whether Ritalin is effective (the
> >evidence seems to be that it is, not only for ADD but also as an
> >alternative therapy for depression- especially post-CVA) but whether ADD
> >is being over-diagnosed. In other words, are kids being tagged as ADD
> >when in fact the real problem is the home environment, social environment,
> >school environment, nutritional, relationships, needing glasses, other
> >problems such as a central auditory processing disorder, etc.?
It's an interesting question, but for some reason most of the people
posing it in public fora seem to be confident that the answer is "yes"
without having to actually investigate the matter.
> >This is the part of the debate that is currently raging, I think, not the
> >medical efficacy of Ritalin. (At least, that's the focus of the Ritalin
> >controversy in my neck of the woods).
Jerry, the controversy in your neck is entirely confined to the bony
enclosure attached thereto. (For the curious, have a look at the
posting
history of smcq...@cyberhighway.net, aka Art Wholeflaffer, aka Dr.
Richard Frager, aka H. G. von Frugelblitz and several variant spellings.
Always unctuous, Jerry hasn't presented a single fact in his time on
Usenet but manages to blather endlessly.)
> The real focus of the controversy should be the unfortunate fact
> that ADD (at any age) is only a "disease" in the way that hypertension
> and hypercholesterolemia are diseases. It's just one end of a spectrum
> of degree of difficulty in focusing attention on one task for effective
> periods, and the amount of it which one needs, in order to be labeled
> as having a "disease" is largely arbitrary and socially constructed.
> It's not as though there is a gene or any kind of marker for physical
> damage which can be assessed, here.
Actually, there are at least two implicated in ADHD but it doesn't
seem to be a single-gene condition like haemophilia or Tay-Sachs.
> There are tests with scores, but
> they only confer the illusion of objectivity, for the cutoff for the
> score which makes the diagnosis is itself subjective.
Dr. Harris, would you please clarify for us the diagnostic protocols
for appendicitis, tendonitis, and small kidney stones? We trust that
there isn't any 'controversy' about the reality of these conditions
or objections that the diagnostic protocols suffer from lack of
objectivity?
--
| Microsoft: "A reputation for releasing inferior software will make |
| it more difficult for a software vendor to induce customers to pay |
| for new products or new versions of existing products." |
+---------- D. C. & M. V. Sessions <sess...@primenet.com> ----------+
Derek A. Wholeflaffer A.S.A.
"D. C. & M. V. Sessions" <sess...@primenet.com> wrote:
>"Steven B. Harris" wrote:
>> In <7ilep1$jbo$1...@news.cyberhighway.net>
>>
>> >To my mind, the primary question isn't whether Ritalin is effective (the
>> >evidence seems to be that it is, not only for ADD but also as an
>> >alternative therapy for depression- especially post-CVA) but whether ADD
>> >is being over-diagnosed. In other words, are kids being tagged as ADD
>> >when in fact the real problem is the home environment, social environment,
>> >school environment, nutritional, relationships, needing glasses, other
>> >problems such as a central auditory processing disorder, etc.?
>
>posing it in public fora seem to be confident that the answer is "yes"
>without having to actually investigate the matter.
Ignore VD Sessions, he is an agenda.
>> >This is the part of the debate that is currently raging, I think, not the
>> >medical efficacy of Ritalin. (At least, that's the focus of the Ritalin
>> >controversy in my neck of the woods).
>
>
>> The real focus of the controversy should be the unfortunate fact
>> that ADD (at any age) is only a "disease" in the way that hypertension
>> and hypercholesterolemia are diseases. It's just one end of a spectrum
>> of degree of difficulty in focusing attention on one task for effective
>> periods, and the amount of it which one needs, in order to be labeled
>> as having a "disease" is largely arbitrary and socially constructed.
>> It's not as though there is a gene or any kind of marker for physical
>> damage which can be assessed, here.
>
>Actually, there are at least two implicated in ADHD but it doesn't
>seem to be a single-gene condition like haemophilia or Tay-Sachs.
Wrong, but nice try, VD!
>> There are tests with scores, but
>> they only confer the illusion of objectivity, for the cutoff for the
>> score which makes the diagnosis is itself subjective.
>
>Dr. Harris, would you please clarify for us the diagnostic protocols
>for appendicitis, tendonitis, and small kidney stones? We trust that
>there isn't any 'controversy' about the reality of these conditions
>or objections that the diagnostic protocols suffer from lack of
>objectivity?
Please be advised that VD Sessions has an agenda to see that
as many young children as possible gets "hooked" on a
speed-like derivative known as ritalin.