MEMORANDUM

TO: Republican Members of the Early Childhood, Youth, and Families Subcommittee

FROM: Krisann Pearce, Professional Staff

Shane Wright, Staff Assistant

DATE: May 15, 2000

RE: Ritalin Hearing on May 16, 2000 at 2 pm in Room 2175:

"Ritalin Use Among Youth: Examining the Issues and Concerns."

HEARING DATE AND TIME

On Tuesday, May 16, 2000 at 2 pm in 2175 Rayburn House Office Building, the Subcommittee on Early Childhood, Youth, and Families will hold a hearing to explore the issues surrounding the increased use of Ritalin and related drugs by youth.

The hearing is intended to raise public awareness of the concerns surrounding the drug Ritalin and similar drugs, the reasons for taking such drugs, and alternative methods for helping students who have attention disorders. The Ritalin debate continues to gather public attention. This hearing seeks to add reliable information to the debate.

BACKGROUND

Ritalin is used to treat Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). ADD/ADHD can generally be described as a disorder in both children and adults that manifests specific symptoms of inattention and hyperactivity/impulsivity

[how specific? It was invented in 1980 for DSM-III. Why was it changed in 1987 for DSM-III-R when the 1980 construct had not been validated as a disease with a confirmatory, objective abnormality by which to diagnose it? Why was it changed again in 1994, for DSM IV, making of it a third, distinct condition when neither the 1980 or 1987 constructs had been validated as a disease? Researcher Monique Ernst of the NIMH lamented that this state of affairs confounded researchers creating 3 distinct and incomparable entities; those of the 1980 variety were not comparable to the 87 or 94 nor were the 87 and 94 versions comparable one with the other—hardly the way of science.]

The terms ADD and ADHD are used in tandem and interchangeably, although some may consider ADD to be different from ADHD in that ADHD incorporates the hyperactivity element. It is estimated that ADD/ADHD affects between 3 and 5 percent of children in the United States and boys more often than girls.

[a conservative estimate today is 6 million with this psychiatric diagnosis alone and on Ritalin and other stimulants, most of them amphetamines, like Ritalin, methylphenidate, an addictive, Schedule II drug. Those of the psych/pharm industry are embarrassed to admit the extent of the drugging and mumble 3-5 %. 6 million is about 11%, K-12. Adding to this all other in-school psych diagnoses and drugs and we probably have 9 million or 15 going on 20 %. 20-50% in some classes and whole schools are not unusual.]

Please note that some doctors and advocates argue that ADD/ADHD does not exist; it is just a symptom of another underlying problem. They argue that the underlying problems could include a learning disability, poor parenting, or poor teaching

[Addressing the November 16-18, 1998 National Institutes of Health, Consensus Conference on Is ADHD a Valid Disorder? William Carey, M.D., concluded: "…What is now most often described as ADHD in the United States appears to be a set of normal behavioral variations… This discrepancy leaves the validity of the construct (ADHD) in doubt…"

With no proof to counter Carey’s assertions, the final statement of Consensus Conference Panel read: "…we do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction."

Countering psychiatry’s claims of ‘overdiagnosis’ and ‘misdiagnosis,’ I testified, without rebuttal, that "ADHD is a total, 100% fraud."

National Public Radio correspondent, Joe Palca, summarized: "What you're telling us is that ADHD is like the Supreme Court's definition of pornography, 'You know it when you see it.'"

The latest word comes from F.X. Castellanos, M.D., of the National Institute of Mental Health. "Incontrovertible evidence is still lacking!" he says, interviewed in the January, 2000, Readers Digest. Twenty years and 6 million children after it’s ‘invention,’ and "incontrovertible evidence is still lacking!"]

Last week the American Academy of Pediatrics (AAP) released new guidelines for diagnosis and evaluation of children with ADHD. The guidelines offer six issues for consideration by a doctor when diagnosing whether a child has the disorder, including requiring the doctor to obtain detailed evidence directly from parents and caregivers or teachers, as appropriate, and requiring an assessment for co-existing conditions (such as a reading deficit). Within the year, AAP expects to issue treatment guidelines.[the incredible size of the unnatural epidemic of this unnatural disease has begotten this call for some semblance of restraint from the AAP. James M. Perrin, MD, of the AAP was at the Consensus Conference and knows as well as I do of it’s outcome (see above) as well as the fact that between that time and the present, there has been no validation of ADHD as a disease, that is, no proof whatsoever that the children thus labeled and drugged are abnormal—other than normal. So it is that we are drugging—with addictive, dangerous, at times deadly drugs, 6,000,000 entirely normal, US school children.]

Children with significant attention disorders face extreme difficulties in academic and social settings. These children can be treated with drug and non-drug intervention, such as behavior modifications (i.e.: learning appropriate behaviors and organizational skills) and individually appropriate teaching strategies (i.e.: hands-on learning and curriculum modifications). Ritalin and similar drugs often can help these children focus on the activity at hand and find success where they previously had only found failure. That is the good side.

[ There are virtually no studies of these drugs of more than 12-18 months duration, thus there is no proof of long term safety or efficacy. There is absolutely no long-term evidence that the academic outcome is improved for use of such drugs]

The improvements in social and academic skills also explain why some parents report that school personnel push them to seek Ritalin for a difficult-to-teach child.

The bad side is that the media increasingly reports quite alarming drawbacks with the use of Ritalin and similar drugs. Depending on the medical expert being quoted, Ritalin could be blamed for violent behaviors in youth.

[definitely causes psychosis, seizures, violent behavior as do all amphetamines, and this is not rare].

Additionally, some studies report that Ritalin is becoming ever more popular as a recreational drug and that those who are prescribed the drug sell it to others while at school.

[it is now as common a cause of emergency room visits for adverse effects as is cocaine. See Drug Awareness Network--DAWN data].

Ritalin is a Schedule II drug under the Controlled Substances Act, and it has been approved for treatment use in children over 6 years old. Its scientific name is methylphenidate. It is a stimulant similar to cocaine and has a high propensity for abuse, similar to amphetamines, methamphetamines, and cocaine. The literature also describes it as a psychotropic drug, meaning it is a mind-altering drug [there is indisputable evidence that long-term use of stimulants causes on-average 10% brain atrophy (shrinkage) when compared to normal controls (see Readers Digest, January, 2000, interview with FX Castellanos of the NIMH].

Much of the recent media attention upon Ritalin stems from the publication of a study of the use of psychotropic drugs among preschool age children. The February 23, 2000 issue of the Journal of the American Medical Association reported on a study of psychotropic drug prescriptions written for children ages 2 to 4 in the years 1991-1995. The study found a 50 percent increase during those years in the number of children ages

2 to 4 who were prescribed psychiatric, behavior altering drugs such as Ritalin or Prozac. Even the researchers commented that these findings were "remarkable in light of the limited knowledge base [lack of research on the drug’s effect on children this age] that underlies psychotropic medication use in very young children." [the risk/benefit equation herein looks like this: no discernible organic disease on the risk side of the equation, only the known risks of these drugs. Knowing what we do of their dangerous potential in adults and those K-12, I cannot conclude but that this use in preschoolers is criminal. It is in no way a legitimate medical endeavor and is not medically, ethically or morally justifiable (as if that of minors K-12, based on the deception that ADHD is a ‘disease’, the children diseased, abnormal, were, to any extent, justifiable) There is no justification for its use in children K-12. Parents are invariably deceived, told ADHD is a brain disease due to a chemical imbalance of the brain, and that not treating it is parental negligence, reason to terminate their custody of their own child. This is rampant. Violation of informed consent from school personnel as well as physicians is universal: "it’s a disease!" Coercion, force to accept label and drugging is near universal to a greater or lesser extent]

Not only are we seeing increasing numbers of young children being identified as ADD/ADHD and in need of Ritalin, but over-identification of school age children as having ADD/ADHD and the accompanying over-prescribing of Ritalin may also be occurring. Over the past decade (1990 – 2000), the production of methylphenidate (Ritalin) has increased from under 2000 kg annually to over 14,000 kg annually. In 1991, over 3 million prescriptions for methylphenidate were written and by 1998 over 11 billion such prescriptions were written. While most agree that medication is necessary for certain behaviors and children, the concern is that too often there is a rush to medication without a consideration of non-medical treatments. Additionally, some critics of Ritalin usage argue that the drug is being used to control typical childhood behaviors [in the absence of evidence it is a bona fide disease, this is the scientific fact of the matter as stated by William Carey (see above)].

Researchers have looked at the issue of whether treating a child with drugs only, non-drug interventions, or a combination of both produces the best results for the child. The December, 1999, issue of the Archives of General Psychiatry (published by the American Medical Association), reported on a highly regarded study that found that the carefully structured use of drugs (including Ritalin) in combination with non-drug interventions (termed behavior therapy in the study) produces the best results for children. Improvements in teacher-rated social skills, parent-child relationships, and reading achievement are among the results that were found. The study looked at four groups of children. The children in the carefully structured use of drugs group received systematic monitoring of drug use so that the optimal level of dosage was found for each child. This may explain why that group found such success with the use of drugs while the group receiving "community treatment" (their pediatrician prescribing a dosage of Ritalin and leaving it at that) did not show the same level of success.

[This the MTA study, AKA the multi-site, multi-modality study, leaves ADHD wholly unconfirmed as a disease, the children as other than normal. What it concludes is that normal children function best not just with the best possible schooling, parenting and behavior therapy, but, that they need amphetamines to really succeed.]

Schools are increasingly becoming aware of drug-trafficking in Ritalin by students. Most students using Ritalin need to take a dose sometime during the school day. Therefore they are bringing the drug to school. While most school districts likely have a policy that any prescription drugs must be given to the school nurse or other school official for safe-keeping upon the student entering the building, states do not consistently have a state law requiring this. Also, some students or parents may not want to have the school aware that the student is on medication. Either way, schools are not always aware of the drugs that are in the school. This is one of the major concerns for the Drug Enforcement Administration.

[Surgeon General, David Satcher in his mental health statement to the nation urged, contrary to all medical science, that ADHD and all emotional and behavioral disorders are diseases just like diabetes, cancer, stroke, etc., diseases by virtue of ‘chemical imbalances of the brain’—chemical imbalances that neither he nor medical science has yet discovered in even a single instance. Nor, although regularly claimed has a genetic basis for a one of them been validated. This stark difference between science and the claims of the extended psychiatric/pharmaceutical/mental health industry represents the totality of the deception—the fraud. Further, Dr. Satcher has told the country that the ADHD epidemic continues to explode at 21% per year. CHADD, it should be noted has taken the Surgeon Generals say so on the validity of ADHD as proof, having no proof within medical science or it’s literature.]

WITNESSES

The hearing will consist of two panels of witnesses.

Panel I

The Honorable Deborah Pryce (R)

Representative of the 15th District of Ohio

U.S. House of Representatives

Washington, DC

The Honorable Dennis Kucinich (D)

Representative of the 10th District of Ohio

U.S. House of Representatives

Washington, DC

Panel II

Mr. Terrance Woodworth

Deputy Director, Office of Diversion Control

Drug Enforcement Administration

U.S. Department of Justice

Washington, DC

[I urge that the Congressman’s staff get the 10/95 DEA background paper on methylphenidate (Ritalin). It tells, 15 years after the invention of ADHD of the role of CHADD in disseminating skewed information to the nation, specifically that Ritalin is safe and non-addictive, so much so that the DEA concluded that "…parents of children and adult patient are not being provided with the opportunity for informed consent or a true risk/benefit consideration in deciding whether methylphenidate therapy is appropriate." (page 4, paragraph 4). And this was the determination based solely on misinformation regarding the drugs in question, that is the ‘benefit’ or treatment side of the risk/benefit equation. Nothing was said at the time of the fact that ADD/ADHD by whatever name was regularly represented, throughout the industry as well as by both the NIMH and CHADD as a disease, a brain disease, something ‘neurobiological,’ meaning something wrong neurological and with the biology. Writing to experts in the field I received the following replies. On 12/25/94, Leber of the FDA, responded: "…no distinctive pathophysiology for the disorder has been delineated." On 10/25/95, Gene Haislip, formerly of the DEA, wrote: "We are…unaware that ADHD has been validated. Swanson, of the University of California, Irvine, never replied. However, speaking to the American Society of Adolescent Psychiatry, March 7, 1998, he concluded: "I would like to have an objective diagnosis for ADHD… psychiatric diagnosis is completely subjective…" On May, 13, 1998 Castellanos of the NIMH, also a member, today, of CHADD’s Professional Advisory Board, confessed: "… we have not yet met the burden of demonstrating the specific pathophysiology…we are motivated by the belief that it will be possible in the near future to do so." Carey [16], of the University of Pennsylvania, replied: "There are no such articles. There are many articles raising doubts, but none that establish the proof you or I seek." Addressing the subject: Is ADHD a Valid Disorder? at the November 16-18, 1998, NIH, Consensus Conference on ADHD, Carey concluded: "…common assumptions about ADHD include that it is clearly distinguishable from normal behavior, constitutes a neurodevelopmental disability, is relatively uninfluenced by the environment… All of these assumptions…must be challenged because of the weakness of empirical (research) support and the strength of contrary evidence…What is now most often described as ADHD in the United States appears to be a set of normal behavioral variations… This discrepancy leaves the validity of the construct in doubt…"

And so we see that nothing about the information given the public in the psychopharm propaganda, or given patients individually was truthful or other than a abrogation of the right to informed consent, a right I prefer to call our right to informed decision making, because patients in a democracy should have the right to reject treatment offered, as well, a right that is being trampled in millions of cases day in and day out in our purported democracy. One will also read herein (pages 3-4) of CHADD’s creation and funding ($748,000 ‘91-‘94) by Ciba-Geigy (now Novartis), manufacturer of Ritalin, of CHADD’s being "…essentially a conduit (of Ciba-Geigy’s) for providing information to the patient population, and of their (CHADD’s) promoting sales of an internationally controlled substance in contradiction of the provisions of the 1971 Convention on Psychotropic Substances (an accusation by the United Nations-International Narcotics Control Board)

Mr. Woodworth has served in his current capacity since 1995, and has worked with the Drug Enforcement Administration and its predecessor agency the Bureau of Narcotics and Dangerous Drugs since 1972. His testimony will focus upon the findings and perspectives of the Drug Enforcement Administration (DEA) regarding the use of Ritalin by youth. He is also expected to discuss any trends the DEA has found in the use and production of Ritalin and similar drugs, as well as any trends they have found in the unauthorized use, including misuse and abuse, of such drugs.

[I also advise that Committee personnel obtain the DEA Conference Report of 12/10/96 on Stimulant Use in the Treatment of ADHD. While it fails to address the issue of the lack of legitimacy of ADHD it tells us (page 32) "Since 1990, the Drug Abuse Warning Network data show a five-fold increase in the total number of estimated ER mentions for methylphenidate and a ten-fold increase among children age 10-14…the 1994 and 1995 data show that 10-14 year old youngsters are just as likely to report methylphenidate as cocaine.]

2 Dr. Lawrence Diller

Pediatrician

Piedmont, CA

Dr. Diller is a behavioral pediatrician with extensive experience treating children with Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). His testimony will focus on the characteristics of a child diagnosed with ADD or ADHD and what treatment options are available for such children. Additionally, he is expected to share his view regarding the considerations to be made in diagnosing a child suspected of having ADD/ADHD and determining treatment recommendations, ethical concerns in prescribing Ritalin or other similar drugs, and the way in which doctors, parents, and teachers should work together in designing the appropriate treatment of a child.

[Lawrence Diller author of the book, Running on Ritalin , puts his finger on the one-and-only cause of the US-as-nowhere-else-in-the-world, psychiatric/educational, labeling/drugging frenzy. He states, "Both the professionals and public have come to believe most serious childhood emotional problems have a biological basis and therefore should be addressed with a medication." But the US hasn’t just ‘come’ to believe this, they have been ‘lead’ to believe in a new reality in which there is no longer any such thing as ‘normal childhood’, or a ‘normal child.’ This is the lie of ‘biological’ psychiatry; the lynch-pin of the psychopharmaceutical propaganda campaign. They call every psychiatric ‘disorder’ a ‘disease,’ without a shred of evidence of a physical or chemical abnormality within the brain or body of the individual—the definition of the word ‘disease.’

Diller a conferee at the DEA Conference on Stimulant Use in the Treatment of ADHD, December, 10-12, 1996, wrote to Mrs. Sue Parry of Mercer Island, Washington: "The reason why you have been unable to obtain any articles or studies presenting clear and confirming evidence of a physical or chemical abnormality associated with ADHD is that there are none. Not that medical science, especially in recent years, hasn’t tried. However the search for a biological marker is doomed from the outset because of the contradictions and ambiguities of the diagnostic construct of ADHD as defined by the DSM. I liken efforts to discover a marker to the search for the Holy Grail." It appears that Diller understands that the children are normal. How does he justify the risk/benefit computation as it truly exists: no disease on the risk side (where there should be a disease) and addictive, dangerous, even death-dealing medications on the ‘benefit’ side (also on the risk side)?

When is it OK to put normal children on dangerous addictive drugs the long term consequences are not known, safety not established. How does Diller portray the condition—ADHD to parent in eliciting informed consent. He must portray a distinctly positive risk/benefit ratio for in his book is the confession: "Before 1990 I needed perhaps one pad of a hundred forms (prescription) every nine months; by 1997 I realized it was one every three months (a rate of 400 per year). Diller and all testifying pro-ADHD and pro-drugging should be asked, "where (if at all) in the scientific literature, is the article that proves a confirmatory physical or chemical abnormality in ADHD, by which it can be recognized and diagnosed?"]

Mrs. Francisca Jorgensen

Special Education Resource Teacher

Taylor Elementary School

Arlington County Public Schools

Arlington, VA

Mrs. Jorgensen has over a decade of experience educating students with disabilities both in public and private school settings. Her testimony will focus upon the characteristics of students with ADD/ADHD in the classroom, as well as the teaching styles, including behavior modification, used to educate all children, especially those with ADD or ADHD. Additionally, it is expected that she will comment on the ways in which she approaches and works with parents of such students.

[In that Mrs. Jorgensen’s testimony is to focus "upon the characteristics of students with ADD/ADHD in the classroom," one wonders, as is clearly the case across the country, if she and other educational personnel undertake psychological assessment of children prior to eliciting informed consent to do so from their parents. Where they do they abrogate the informed consent rights of the parent and, if they do the undertake medical diagnosis—diagnosis that is ‘medical’ by virtue of the fact that virtually all such children are ‘referred’ for medical consultation, consultation that almost always results in the diagnosis of ADHD a ‘brain disease’ and ‘treatment’ with a dangerous, addictive, sometimes deadly drug, all of which constitutes the practice of medicine without a license. I have yet to review a case for medical-legal purposes that has not entailed abrogation of informed consent by school personnel and physicians alike and the practice of medicine without a license by school personnel.]

Ms. Mary Robertson, R.N.

Parent, and

Immediate Past President

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

Lexington, KY

Ms. Robertson is a parent of two, a Registered Nurse, and the Immediate Past President of CHADD. Additionally, she is the past Director of the ADD Clinic at Columbia Counseling Center in Lexington, Kentucky, and co-founder of the first CHADD Chapter in Kentucky. Her testimony will specifically focus upon her experiences as a parent of a child with ADD/ADHD. Her child tried many non-medical interventions before taking Ritalin, which he currently takes. Additionally she is likely to comment on her experiences relating to her work with CHADD.

[Ms. Robertson and many from CHADD participated in the 11/98 NIH Consensus Conference on ADHD and could not have missed the lack of evidence of a confirmatory physical abnormality in ADHD, leaving it without confirmation as a disease or a chemical imbalance, without evidence that children said to have ADHD are anything but normal. And yet to this day CHADD persists in disseminating the lie to the US public that ADHD is a ‘neurobiological disorder" implying, without mistake, and without scientific evidence, that their is something wrong with the biology of the brains of normal children. This, in and of itself, absent the drugging that almost always follows, is incredibly stigmatizing and hurtful and leads in time to the child’s coming to believe it and to all of the adults in their life coming to believe that they are impaired, disabled, and that their best chance for near normalcy comes from the ‘chemical balancer’ the pill that always comes. Robertson must be asked "where (if at all) in the scientific literature, is the article that proves a confirmatory physical or chemical abnormality in ADHD, by which it can be recognized and diagnosed?" Given her position with CHADD she has a duty to answer this question and she has a Professional Advisory Committee to provide here with such answers. Remarkably, members of CHADD’s PAB include top NIMH researchers, Castellanos, Jensen, Swanson, Biederman, Barkley and Wilens] Ms. Robertson should be asked, why, without scientific evidence, CHADD’s current president, Matthew Cohen represented to the Colorado State Board of Education, in November, 1999, that ADHD is a ‘neurobiological’ disorder with no evidence of an abnormality that is ‘neurological’ or ‘biological’ or, for that matter, anywhere to be found in children or adults said to have ADHD. She should also be asked why the same Mr. Cohen made the same misrepresentation, via, a representative, to the Arkansas State Legislature, 5/3/00, again without benefit of scientific evidence. How, one wonders, could their PAB members, knowing their is no disease, that the children are normal, be a party to this on-going mis-representation; deception; fraud. ]

On April 15, 1998, I wrote to Attorney General, Janet Reno, "Dear Madam Attorney General, The single, biggest heath care fraud in US history—the representation of attention deficit hyperactivity disorder (ADHD) to be an actual disease, and the drugging of millions of entirely normal American children, as "treatment," is spreading like a plague—still. That ADHD is wholly devoid of validity as a disease, a medical syndrome or, anything biologic or organic, is the pivotal element of the fraud."

Respectfully submitted, Fred A. Baughman Jr., MD., 5/15/00