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The history of ADHD policy and regulation nationally from 1992 to 2012, in WA from 1993 to 2011 and in NSW from 2007 to 2011 is that regulatory capture occurred in the majority of policy development and regulatory processes. These ‘captured’ processes have been associated with subsequent ADHD child pharmaceuticalization. Conversely the only ADHD-critic dominated process identified occurred in WA in 2002 and was associated with subsequent ADHD child de-pharmaceuticalization. The findings of this thesis are consistent with Abraham’s assertion that regulatory capture is a significant driver of pharmaceuticalization.

PDF of full thesis available at Martin Whitely PhD Thesis Copy – ADHD and Regulatory Capture in Australia PDF

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Sign the online petition to Boycott the DSM5 at http://dsm5response.com/

By Martin Whitely

DSM-5, the newest edition of the American Psychiatric Association’s ‘Bible of Psychiatry’ will be officially released in May 2013 and is already available for presale.  However, this edition of the DSM may not prove as profitable for the American Psychiatric Association (APA) as there is a growing international chorus of voices, many from within mainstream psychiatry, calling for a boycott of the DSM5.

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WA Stimulants Regulatory Scheme 2011 Annual Report contains both good and bad news. The good news is that the 2011 report confirms there has been a massive decline in per-capita prescribing rates for children since the Stimulant Regulatory Scheme was introduced in mid-2003. However, the bad news is that there was a spike in the number of new cases diagnosed in 2011.

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Stephen Colbert’s ‘Meducation’ plan for America’s third rate public schools – Don’t laugh too hard it is already happening!

A video and transcript of Colbert’s ‘Meducation’ rant is available at http://www.dailykos.com/story/2012/10/11/1143009/-Stephen-Colbert-on-medicating-children-to-improve-their-grades

On October 10 2012 American comedian Stephen Colbert coined the term “meducation” to describe the growing practice of drugging with ADHD amphetamines, American children with mediocre school grades, who do not have a diagnosis of ADHD.The catalyst for the mock right wing political commentator’s endorsement of ADHD drugs as smart pills was a front page article in the New York Times in which peadiatrician Dr Michael Anderson advocated their widespread use to compensate for America’s third rate public education system. Doctor Anderson said “we’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.” Unlike Colbert, Dr Anderson is not a comedian but unfortunately for some of the children of Ganton Georgia he is their doctor.

In his comedic monologue Colbert argues the child drugging program should be extended beyond amphetamines. “Folks, I believe this is a great fiscally responsible answer, but we can do more.  I mean, we might be cutting arts programs, but one tab of acid, and your kid will be seeing colours you can’t find in a Crayola box.” Colbert’s mock rant concludes with a serious warning; “Now, of course, eventually it may turn out that drugging poor students creates more problems than it solves.  In which case, we’ll have to stop trying to change our children, and think about changing ourselves.”

Despite Dr Anderson’s claims and Colbert’s mock endorsement, ADHD amphetamines are anything but ‘smart drugs’. Unique long term (8 year) Australian research shows that children diagnosed ADHD and ‘ever medicated’ with amphetamines were a staggering 950% more likely to be rated by their teacher as “performing below age-level” than children diagnosed with ADHD and ‘never medicated’. (see http://speedupsitstill.com/2010/02/17/excerpts-from-the-raine-study/ ) And as pointed out by Colbert the USA, the home of ADHD child drugging, lags most comparable developed nations (and a few second world nations) in terms of academic achievement.

The message is pretty clear – if you want to dumb down – speed up!

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“Personalities, rhetoric and charisma are driving the direction of mental health rather than science and evidence.” (Martin Whitely MLA, Parliament of Western Australia, 25 September 2012)

Related Media

Sue Dunlevy, News Limited Sunday papers, 7 October 2012, Doubts cast on youth mental health program. Available at  http://www.news.com.au/national/doubts-cast-on-youth-mental-health-program/story-fndo4eg9-1226489760605

Also see Patrick McGorry’s ‘Ultra High Risk of Psychosis’ training DVD fails the common sense test http://speedupsitstill.com/patrick-mcgorrys-ultra-high-risk-psychosis-theory-fails-common-sense-test

MARTIN WHITELY (Trancript of speech in the Legislative Assembly, Parliament of Western Australia, 25 September 2012): I want to use this opportunity to talk about some very serious concerns I have about the direction of the mental health policy in Australia. My basic contention is that personalities, rhetoric and charisma are driving the direction of mental health rather than science and evidence.

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By Martin Whitely MLA

The off colour Australian colloquialism ‘you can’t polish a turd but you can cover it in glitter’ is a fitting analogy for the danger of legitimising ADHD as a diagnosable mental illness by developing treatment guidelines. However, treatment guidelines are being developed and the more conservative the treatment guidelines, the fewer children risk damage with the long-term administration of amphetamines.

That is why I welcome the release by the National Health and Medical Research Council (NHMRC) of the Australian ADHD Clinical Practice Points (CPPs) as a small but significant step in the right direction. (The CPPs available at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/mh26_adhd_cpp_2012_120903.pdf )

Eventually ADHD will be regarded as an embarrassing footnote of history and society will collectively wonder how anyone ever thought it would be a good idea to give amphetamines to children. But in the meantime improvements like those in the ADHD CPPs, although modest, will hopefully see fewer children diagnosed and drugged.

That said, the CPPs are far from perfect. The statement that, “…stimulants might be considered for this age group (under 7 years)” leaves the door open for drugging very young children.[1] The manufacturers prescribing information for all stimulants state they should not be used in children under 6 years, since safety and efficacy in this age group have not been established.[2] Any clinician ignoring the manufacturers warning is inviting a future law suit for negligence.

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Part One – Is Nick Sick?   (11 minutes)

Part Two – Is Nick Sick?   (9 minutes)

Response to the ‘Is Nick Sick?’ video blog

by Professor Jon Jureidini

“Patrick McGorry’s Orygen Youth Health, CAARMS training video[1] on how to diagnose ‘Attenuated Psychosis’ demonstrates how not to carry out a psychiatric interview and interact with young people.”

As identified by Martin Whitely in his commentary about the CAARMS training DVD, describing Nick as being at ultra-high risk of psychosis (UHR) fails the common-sense test. Even more concerning is that Nick is labelled as having Attenuated Psychosis – in ordinary language, he is already mildly mad.

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How can this be? Don’t bother asking because privacy laws shield the drug company applications for PBS listing from public scrutiny.

by Dr Martin Whitely

ADHD drug Concerta is a slow release form of methylphenidate (the active ingredient in Ritalin) that can be taken once daily.  It was first licensed for use in Australia by the Therapeutic Goods Administration (TGA) in 2003 and subsidised via the Pharmaceutical Benefits Scheme (PBS) for use by children in 2007.

Recently Concerta’s manufacturer Janssen-Cilag (a subsidiary of Johnson and Johnson) applied to “extend the current Authority required listing” on the Pharmaceutical Benefits Scheme for Concerta “to include use in patients diagnosed with attention deficit hyperactivity disorder (ADHD) after the age of 18 years”. The Pharmaceutical Benefits Scheme Advisory Committee (PBAC) “rejected the application on the basis of uncertain efficacy and safety in the proposed PBS population and hence uncertain cost-effectiveness, and high and highly uncertain cost to the PBS.”[1] In response Janssen Cilag commented that “Concerta is already available on the PBS for use in adults who were diagnosed with ADHD ≤ 18 years. This submission requested the same access for all adult patients regardless of the age at which they were diagnosed. We will consult with the PBAC with regards to a future resubmission.”[2]

Janssen Cilag raise a valid point; How can Concerta be ok for children and yet have “uncertain efficacy and safety” for adults? Read the rest of this entry »

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by Martin Whitely

8 July 2012

An article in today’s Sunday Age, available at http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html, highlights the results of a prescribing audit of Patrick McGorry’s Orygen Youth Mental Health Service.  It found the service “prescribed medication to a majority of depressed 15 to 25-year-olds before they had received adequate counselling, despite international guidelines advising against the practice.”[1]

The audit of 150 patients treated in 2007 found “75 per cent of those diagnosed with depression were given the drugs too early. Clinical guidelines recommend that in most cases antidepressants should only be given to young people after they fail to respond to four to six sessions of psychotherapy, which usually takes about six weeks. However, the audit, carried out by Orygen’s own researchers, found on average patients received the drugs after just 27 days. It also showed that fewer than half were followed up to see whether their symptoms had improved or to check for side effects, which can include an increased risk of suicide.”[2]

It is commendable that Orygen[3] published the results of the audit, however the results make a mockery of Professor Patrick McGorry’s often repeated assertion that drugs are not the first-line treatment in any but the most serious cases.

In response Professor George Patton, director of adolescent research at the Centre for Adolescent Health at the Royal Children’s Hospital, told The Age, ”This paper illustrates how much we need to be looking at these new services [EPPIC and headspace] to determine the extent to which we’re following best clinical practice and to ask the questions, are we getting value for money out of these investments, and are we actually seeing better clinical outcomes?”[4]

At the very least there is an obvious need for an independent scientific review of the EPPIC and headspace programs identified for national rollout and for tight real time program wide auditing of medication practice.

 

Note: The issues raised in today’s Age article reinforce similar concerns I voiced last year about antidepressant prescribing at Professor McGorry’s other favourite project headspace.  I raised my concerns in the WA State Parliament and on my blog last year titled “Is Patrick McGorry’s and the Independent Mental Health Reform Group’s $3.5b blueprint for Australian mental health the way forward, or a prescription for more ‘psychiatric disorders’, ‘off label’ prescribing and youth suicide?” available at http://speedupsitstill.com/patrick-mcgorry%e2%80%99s-independent-mental-health-reform-group%e2%80%99s-3-5b-blueprint-australian-mental-health-forward-prescription-%e2%80%98psychiatric-disorders%e2%80%99-%e2%80%98off-label

[1] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012

http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html

[2] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012

http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html

[3] Orygen runs a range of youth mental health services, including EPPIC (Early Psychosis Prevention and Intervention Centre), PACE (Personal Assessment and Crisis Evaluation), YMC (Youth Mood Clinic) and HYPE (Helping Young People Early, for people with emerging borderline personality disorder).  In addition, Orygen is a partner in headspace.

[4] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012

http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html

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By Dr Martin Whitely

The central characteristics of ‘Disruptive Mood Disregulation Disorder’ proposed for inclusion in DSM5 are childhood “irritability” and “temper outbursts” occurring, ”on average, three or more times per week”.[1] Disruptive Mood Disregulation Disorder represents a disturbing evolution of the absurd and dangerous practice of diagnosing children, even very young children, with ‘Juvenile Bipolar Disorder’.  Although not an official psychiatric disorder Juvenile Bipolar Disorder was enthusiastically and successfully promoted by disgraced Harvard University Professor of Psychiatry, Joseph Biederman.

Biederman, who was also Director of the Johnson & Johnson Centre for Paediatric Psych-Pathology research at Massachusetts Hospital and according to the New York Times is the “the world’s most prominent advocate of diagnosing bipolar disorder in even the youngest children and of using antipsychotic medicines to treat the disease”.[2] He is largely responsible for the enormous growth in US antipsychotic prescribing rates to children including Johnson & Johnson’s very profitable antipsychotic Risperidone (brand name Risperidal).  In April Johnson & Johnson were fined US$1.2Billion by an Arkansas court for making misleading claims about the safety of Risperidal. This followed similar outcomes in other US states.[3]

In 2011, US congressional investigations led by Iowan Senator Charles E. Grassley exposed that Biederman received at least US$1.6m in undisclosed fees from drug-makers from 2000 to 2007 and only revealed a tiny fraction of this income to Harvard University.[4] The New York Times reports “court documents dating over several years that Dr. Biederman wants sealed showed that he told the drug-giant Johnson & Johnson that planned studies of its medicines in children would yield results benefiting the company”.[5]

Taking and not disclosing drug company money and planning beneficial research results is reprehensible behaviour. Harvard University’s decision to effectively give Biederman little more than a rap on the knuckles brings discredit to one of the world’s most prestigious universities.[6] Perhaps Harvard was motivated more by the funding that Biederman and his cronies attract to the university than by the damage they bring to the university’s reputation. Harvard’s failure to take strong ethical action against Biederman has meant that his influence, although waning, is still considerable.

Thankfully Juvenile Bipolar Disorder is not officially recognised as a diagnosable condition in the current DSM (DSMIV). Supporters lobbied to have it included in the DSMIV, however the DSMIV development committee “found scientific support unconvincing and refused to do so”.[7] Regardless, hundreds of thousands, possibly millions, of children have been diagnosed with the unofficial disorder and treated with anti-psychotics like Johnson & Johnson’s Risperidal.[8] These medications “can cause serious complications – major weight gain, obesity, diabetes, cardio vascular disease and possibly shortened life expectancy.  Sudden death has occurred in a few cases where excessive doses and/or multiple drugs were given to very young children.”[9]

The proposal to include Disruptive Mood Disregulation Disorder is in part a reaction to criticisms of the use of anti-psychotics for Juvenile Bipolar Disorder.  The authors of DSM5 are proposing Disruptive Mood Disregulation Disorder as an alternative to the diagnosis of Juvenile Bipolar Disorder, using the rationale that this will help curb anti-psychotic prescribing rates to children.  In effect, they are proposing a “juvenile bipolar light” disorder.

Given the unrestrained enthusiasm for prescribing psychotropics ‘off label’ to children exhibited by many clinicians, particularly paediatricians, the opposite is likely to occur.[10] The inevitable outcome is that more children will be diagnosed and experience tells us the more children diagnosed with a ‘psychiatric disorder’, the more children are subjected to the cheap and convenient practice of speculative ‘off label’ prescribing.

The only sensible course of action for the American Psychiatric Association is to reject out-of-hand the notion of Juvenile Bipolar Disorder or any lighter version thereof including Disruptive Mood Disregulation Disorder.  Failure to do so will drag the American Psychiatric Association into another epidemic of childhood drugging for which, unlike ADHD, they currently bear no responsibility.

 

[1] For a full description of the proposed diagnostic criteria see http://www.dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=397

[2] New York Times Topic Page for Professor Joseph Biederman available at http://topics.nytimes.com/topics/reference/timestopics/people/b/joseph_biederman/index.html]

[3] Companies belittled risks of Risperdal, slapped with huge fine, Los Angeles Times 11 April 2012. Michael Muskal available at http://articles.latimes.com/2012/apr/11/nation/la-na-nn-risperdal-arkansas-20120411

[4] New York Times Topic Page for Professor Joseph Biederman available at http://topics.nytimes.com/topics/reference/timestopics/people/b/joseph_biederman/index.html

[5] New York Times Topic Page for Professor Joseph Biederman available at http://topics.nytimes.com/topics/reference/timestopics/people/b/joseph_biederman/index.html

[6] For more detail see http://speedupsitstill.com/world-leading-adhd-%e2%80%98expert%e2%80%99-harvard-professor-joseph-biederman-sanctioned-hidden-drug-company-money-allegations

[7] Dr Allen Frances, Huffington Post, The false epidemic of Childhood Bipolar Disorder available at http://www.huffingtonpost.com/allen-frances/children-bipolar-disorder_b_1213028.html

[8] There are no reliable estimates of child prescribing patient numbers. In the U.S. outpatient office visits for children and adolescents with bipolar disorder increased 40-fold from 20,000 in 1994–95 to 800,000 in 2002–03. http://www.thedailybeast.com/newsweek/2011/06/19/mommy-am-i-really-bipolar.html

[9] Dr Allen Frances, Huffington Post, The false epidemic of Childhood Bipolar Disorder available at http://www.huffingtonpost.com/allen-frances/children-bipolar-disorder_b_1213028.html

[10] A recent study of psychiatrists in Christchurch New Zealand revealed that 96% of them prescribed antipsychotics off label. While it is unlikely that rate is replicated across the globe it is nonetheless an alarming statistic and indicates the practice is very common. M. Slezack, Psychiatry Update, 26 April 2012, 96% of psychiatrists prescribe off-label anti-psychotics  http://www.psychiatryupdate.com.au/latest-news/off-label-anti-psychotics-almost-universally-presc

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