The New York Times recently ran a lengthy investigative report called “The Selling of Attention Deficit Disorder,” a compelling account of how drug companies have pursued aggressive and deceptive strategies to boost diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) and promote sales of medications to an increasing pool of potential users.
Marketing appeals to clinicians and worried parents have frequently included false or misleading claims—that the drugs are “safer than aspirin” and are not subject to abuse, for example—and many doctors unqualified to make an ADHD diagnosis have prescribed the medications based on such assurances.
The article noted that a startling rise in prescriptions for ADHD medications paralleled the two-decade promotional effort, which often played into societal concerns about misbehaving and underachieving children, usually boys. In 1990, 600,000 children in the U.S were taking ADHD medication; currently, the number is 3.5 million.
Earlier this year the same reporter, Alan Schwartz, wrote a hair-raising and heartbreaking account of a young man’s descent into addiction to ADHD medications, and his eventual suicide. Several years ago, Schwartz’ superb coverage of concussions among football players helped bring national attention to the issue.
Schwartz’ deconstruction of how pharmaceutical companies boosted sales of their products represents a classic case of what scholars and journalists have called “disease-mongering.” According to Australian researcher Roy Moynihan, who has written extensively on the issue for the BMJ and other publications, disease-mongering is “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments…Observers have described different forms of disease mongering: aspects of ordinary life, such as menopause, being medicalized; mild problems portrayed as serious illnesses, as has occurred in the drug-company-sponsored promotion of irritable bowel syndrome; and risk factors, such as high cholesterol and osteoporosis, being framed as diseases.”
There’s little doubt that some children—perhaps five percent, according to some cautious estimates—suffer from ADHD, and many are greatly helped by medications, which curb impulsivity and increase the ability to focus.
But the Times investigation suggests that under-diagnosis of the condition is not the problem. The piece also reminds us that disease categories are not written in stone and change over time, for any number of reasons.
How an illness or condition is described and defined plays a significant role in how it is researched, who is determined to have it, and what treatments they might receive, so it is understandable that drug companies would want to influence the outcome. Hopefully, Schwartz’ work will encourage parents to question doctors or educators who appear too eager to diagnose their child with ADHD.