The Politics of ADHD

The Politics of ADHD

There are votes to be lost telling parents that the ‘magic bullet’ they are giving their ‘improved’ child is in fact sometimes a crutch propping up their inadequate parenting or simply masking a host of other more complex problems.

ADHD is a ‘disorder’ manufactured to match our times. It is a quick catch all diagnosis with a magic bullet treatment. The contrived ADHD epidemic started in the United States and has been adopted around the globe with varying degrees of enthusiasm. ADHD drugging works well for cynical, populist, governments. At a relatively low cost it gives the appearance of addressing children’s mental health needs. Even governments, which believe there is something not quite right with giving amphetamines to inattentive children, become fearful that if they go too hard they will alienate parents who have come to depend on subsidised drugs as their chief means of behaviour control. This is entirely understandable. There are votes to be lost telling parents that the ‘magic bullet’ they are giving their ‘improved’ child is in fact sometimes a crutch propping up their inadequate parenting or simply masks a host of other more complex problems.

This is part of the reason we have independent regulators like the Food and Drug Administration (FDA) in the US and the Therapeutic Goods Administration (TGA) in Australia whose task it is, without fear or favour, to protect the public from unsafe treatments. However, over the last 20 years, Australian Government agencies charged with protecting patients, including the TGA and the National Health and Medical Research Council (NHMRC), have allowed drug companies to hype the benefits and distort the risks of ADHD drugs. Eli Lilly (Strattera), Novartis (Ritalin), Janssen-Cilag (Concerta) and Glaxo Smith Kline (dexamphetamine) benefit enormously from having their drugs sponsored by Australian taxpayers through the Pharmaceutical Benefits Scheme. The TGA has accepted drug-company funded research to determine drug safety approvals and has relied on the same companies to collect and evaluate adverse side effect incidents, virtually without scrutiny.

Instead of forcing drug companies to prove their products are safe, regulators pay lip service to public safety and effectively force the public to prove, beyond a doubt, the drugs are unsafe. This is well after any damage has been done and profits have been distributed to directors and shareholders. In addition the medical practice standard setters, the NHMRC, have a history of producing influential ADHD industry friendly reports.

ADHD is a clear example of market failure, in that the private interests of maximising drug companies and public well being are divergent. There is a clear need for government intervention, in order to borrow an old Australian political slogan; ‘keep the bastards honest’.

Too Hard Basket

Most governments leave the issue in the too hard basket. Typical of this timid approach was former West Australian Health Minister Kevin Prince’s response in 1997 to a parliamentary question regarding the State Government’s attitude to ADHD. Despite Western Australia then having 4 times the national rate of ADHD prescriptions Minister Prince said, ‘(ADHD) is a matter that should be addressed on a nationwide basis and it should not be taken up by one State to the exclusion of all others, because it clearly affects the totality of Australian people.’[1] Minister Prince’s almost comical desire to pass the buck to another level of government reflects in ‘Yes Minister’ terms how ‘courageous’ it is to express a view on this issue. When responsible governments rise to this challenge they, naturally, have one eye on the public good and the other on the ballot box. Good governments express concern about misdiagnosis and over-prescription. None are ever brave enough to say ADHD is a fraud.

Even Martin Whitely’s advocacy on ADHD has until recently been tempered by the reality that parents with children on ADHD medication vote, and if he tells the whole brutal truth, they may not vote for him. In truth, Martin considers parents at best desperate, vulnerable and gullible, and at worst reckless, in regard to the long term wellbeing of their child. When lobbying both his own government and other governments it has been Martin’s tactic to try and position the government as concerned about prescription rates and supporting other strategies so that medications are not the first and only line of treatment. This pragmatic approach shifts government policy to a less pro-drugging position, however, it leaves the door open for drugging children with amphetamines and implicitly recognises the validity of ADHD, even if as a diagnosis of last resort.

Perhaps the strongest statement ever to be backed up with action by a significant Australian political leader was made in September 2007 by the then Western Australian Premier Alan Carpenter. Premier Carpenter, while announcing the funding for the new multidisciplinary clinics for children exhibiting ADHD type behaviours, told state parliament that, ‘Although medication may still be required for severe cases of ADHD, this new approach will ensure that stimulant medication is not the first line of treatment….The aim is to reduce the prescription rates for young people suffering ADHD. If our recent history is any guide, reducing ADHD prescription rates will reduce amphetamine abuse rates, and we all know that the abuse and misuse of amphetamines is a major issue in our society broadly.’[2] The Western Australian Government has been as interventionist to protect the rights of children as any government. Whilst some U.S. states have taken action to protect children, they have only done so to protect parents and their children from state enforced drugging. None have acted to protect children from parental enforced drugging. In 1999, Colorado legislated to prevent school personnel from recommending psychotropic drugs to students. Other states followed, however, the legislation does not stop teachers and other school employees recommending to parents that their child should be assessed by a doctor.[3]

In the next 5 to 10 years ADHD child drugging will be seen for what it is; a tragic abuse of child rights and society will collectively wonder how it all happened. However, democratically elected governments rarely get ahead of public opinion and for the moment getting governments to support strategies aimed at making ADHD medications a last order treatment is a good result. Unfortunately no government will ban the use of amphetamines or Strattera in children until it is no longer brave to do so.

[1] Western Australia Hansard, Hon Kevin Prince, Minister for Health – Attention Deficit Disorder, 22 October 1997

[2] Hansard, Hon Alan Carpenter, Thursday 27 September 2007 p5946c-5948a

[3] R.B. Schmitt (2001) quoted in Linda J. Graham, “Drugs, labels and (p)ill-fitting boxes: ADHD children who are heard to teach”. Discourse: Studies in Cultural Politics of Education, Vol1 (March 2008): p95