Once again the NY Times has taken the pharma industry to task with a front page story on the ADHD market. In fact the subtitle of the story “The Number of Diagnoses Soared Amid a 20-Year Drug Marketing Campaign”[pretty much sums up the article’s thesis. While it’s true that the drug industry has made some mistakes in marketing ADHD products let’s not forget that parents want an “easy fix” to get their kids better grades and patients still have to go through their physician to get an Rx.
The Centers for Disease Control and Prevention shows that the diagnosis of ADHD had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990.
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. 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.”
The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years 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 A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Too many people with scant symptoms receiving the diagnosis and medication. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.
Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular 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 A.D.H.D. drug for false and misleading advertising since 2000, some multiple times. Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often that discredit growing concerns about overdiagnosis.
Shire — the longtime market leader, with several A.D.H.D. medications including Adderall — recently subsidized 50,000 copies of a comic book that tries to demystify the disorder and uses superheroes to tell children, “Medicines may make it easier to pay attention and control your behavior!” 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.
Tom Casola, the Shire vice president who oversees the A.D.H.D. division, said in an interview that the company aims to provide effective treatment for those with the disorder, and that ultimately doctors were responsible for proper evaluations and prescriptions. Janssen Pharmaceuticals, which makes Concerta, said in an email: “Over the years, we worked with clinicians, parents and advocacy groups to help educate health care practitioners and caregivers about diagnosis and treatment of A.D.H.D., including safe and effective use of medication.”
One physician said that concern about abuse and side effects is “incredibly overblown,” and that his longtime work for drug companies does not influence his opinions. He said he received about $2,000 for the 2002 talk for Shire. He earned $45,500 in speaking fees from pharmaceutical companies in 2010 to 2011, according to ProPublica, which tracks such payments.
First let me say again that illegal marketing activities, under any condition, are a stain against an industry that is trying so hard to earn the trust of skeptical consumers. With that being said we now need to ask the question “is this just good use of marketing or is the pharma industry promising too much via a quick fix in a bottle?”
First we need to look at parents and their behavior when it comes to their children. When I didn’t do well in school my mother made an effort to ensure that I spent more time studying to improve my grades. Today dual working spouses don’t have the time to necessarily sit with the kids to help them focus on their school work. It’s much easier to suggest that poor grades might be the result of ADHD than disciplined study. There is also a very fine line between suggesting that someone might have ADHD and recommending an Rx to “get better grades”. In this case the pharma industry seems to have promised too much to parents who want their children to succeed.
Then there are the final gatekeepers: doctors. According to the article pharma has “sold” ADHD meds into docs so they prescribe them like a placebo. I would argue that this is another symptom of physicians who like to diagnose and treat a condition rather than the patient. Are we to believe that in the era of physicians online that they are just going to write ADHD meds because of drug company details ?
In short there are many complex reasons why ADHD medications are prescribed too much and the “blame” should be spread around not laid solely at the feet of pharma. Marketing that suggests ADHD medication can improve grades has to be based on science not marketing that is looking for a way to sell more product. I believe good science can coexist with marketing and that is the challenge for all of us.