Welcome to my Attention Deficit “Disorder” Activist Blog. To keep confusion to a minimum, I am using this site primarily for “activist” and advocacy posts related to the world of ADD. I only use the term ADD because it is widely used. I only use the term “Disorder” because it is also widely used. To use different terms would be more scientific, but confusing. For instance, Distractibility Disorder would be a more precise name, but even more precise than that would be Suboptimal Dopamine Brain (“SODB”). Although the SOD Brain has some significant suboptimal processes, it also has a huge upside. Since the Optimal Dopamine Brain (“ODB” or “OD” Brain) has a significant downside, why isn’t it also a disorder? Those are a few of the questions I have pondered and answered over the years. I hope to rattle your brains a bit, whether SODB or ODB, to mix in to your current consciousness and knowledge base some new and tasty ingredients. My name is Ron Sterling, M.D., and you can read more about me at www.ronsterling.com.
The New York Times Endorses “Fearmongering” (updated 9/10/2014)
So, fearmongering, Dr. Ron, is a pretty pejorative term to be applying to such a revered newspaper, don’t you think? I don’t. I say, “if it swims, walks, and quacks like a duck, it probably is a duck.”
I think the New York Times (NYT) would agree with me, if they would just take enough time to understand why Adderall, in particular, is one of the most problematic ADD medications, but they won’t. How do I know that? I sent three copies of the fourth edition of my Adult ADD Factbook to Alan Schwarz on June 11, 2012, just two days after the NYT published Mr. Schwarz’s extended article entitled Risky Rise of the Good Grade Pill, with a snotty note that read “Dear Mr. Schwarz: This will help you understand ADHD and all the misinformation contained in your recent NYTimes article, that is, if you care.”
I was hoping it would get his attention. It did. I received a return voice message from Mr. Schwarz on June 13, 2012, that has to be one of the most arrogant and angry voice messages I have ever received. Someday, maybe I’ll reveal the contents of that message since, after all, it was an unsolicited, free-of-duress, voice message and could be about as permanently available as an undeletable embarrassing and inane comment posted on the Internet. I am thinking an experienced NYT journalist would understand the permanent quality of such an audio recording. I called him back and we had a somewhat contentious conversation in which he was completely unwilling to look at what I considered to be at least two fatal flaws in his article which, in the scientific community, would likely discredit the major conclusion(s) of his article. Did he care? He didn’t.
What became clear was that Mr. Schwarz was on a mission to not only save people from the dangerous downside of the non-medical use of Adderall, but also to instill fear about all restricted ADD medications by either intent or ignorance, by not letting his readers know why Adderall, more than any of the other restricted ADD medications, is the most problematic.
The logical fatal flaw, even if you argue that the article was not meant to be rigorously scientific was Mr. Schwarz’s complete reliance on the subjects of his article to self-diagnose as “not fitting the criteria for ADD” and thus give the impression that for anyone, ADDer or not, Adderall will give you a leg up. I am not sure how a journalist arrives at such a decision to trust the self-diagnosis of high schoolers for the purpose of establishing data that ends up being the main support for a conclusion that Adderall can give anyone an advantage in test taking or studying.
Just because a student or a student’s parents claim the student does not fit the criteria for ADD does not mean it is true. Mr. Schwarz did not claim to screen for ADD so that there could be at least some indication of whether the cognitive improvement that was being claimed by the students was or wasn’t a form of unprescribed, illegal, but still likely appropriate self-medication. In my world, I would especially doubt the credibility of testimony from a student who claims to have “faked ADD” to obtain medications. Attempting to, or being successful at, “faking ADD” implies that the faker does not actually fit the criteria for ADD. Anyone claiming to have been successful at faking ADD for the purpose of obtaining “neuroenhancing” drugs for themselves or for gifting or selling to others would be, on that basis alone, demonstrating enough sociopathy, impulse dyscontrol, and short-term thinking (what consequences?) to be a prime candidate for ruling in or ruling out the diagnosis of ADD.
Additionally — just wondering — why do folks like Mr. Schwarz think that teenagers in upscale neighborhoods and schools would want to cop to the diagnosis of ADD? Really? One method for avoiding the whole currently messy and over-stigmatized process of being diagnosed and treated is to get your medications some other way, or if not, to deny that you actually fit the criteria for ADD and were just “faking it.”
That was the beginning of a period of time at the NYT where it published several articles that contained increasingly dire warnings regarding the alleged over-diagnosis of ADD in the U.S. population and the subsequent alleged “loose” prescribing of controlled substances which Schwarz and others proposed as the primary cause for the easy illegal access to controlled medications without prescriptions.
On April 9, 2013, apparently succumbing to the constant drumbeat of the dramatic writings and dire warnings of several NYT journalists, the NYT Editorial Board issued their own opinion entitled Worry Over Attention Deficit Cases. The Board concluded their editorial — “With the growing concern that many young people may be sharing or abusing these drugs, it is crucial that parents and doctors are vigilant about overmedication.” No one is going to argue with that sentiment.
However, I find it particularly irrational and dangerous that an Editorial Board of a major newspaper would buy into the lazy science found in the articles that led up to their endorsement of them. Those articles do not disclose crucial information that would allow readers to figure out the difference between one ADD medication and another, or take a closer look at why the rates of ADD diagnosis and the use of traditional ADD medications are, using the NYT’s language, “skyrocketing.”
“Skyrocketing” is definitely a term that sticks in your head.
Using terms like that clearly influences cognitive processes and generally produces a response that is emotional rather than mindful or logical.
The definition of propaganda is “The withholding of information or the misrepresentation of data to bring about a desired outcome.” The definition of “fearmongering” is propaganda to induce fear, as opposed to your regular marketing propaganda to produce sales.
Instead of passing some of those articles by some scientific or logic consultants, the NYT chose to beat the drum the way they wanted to beat it come logic, science, different data or high water. It is particularly insulting to the scientific mind (not found much anymore, by the way) for the NYT to appear to claim that the “skyrocketing” diagnosis of ADD and its controlled medication treatment have been caused by aggressive marketing, colleague pressure, or parental or patient pressures and to look no further or deeper than that.
However, the blame for the NYT type of superficial discussion that mostly creates a pernicious amorphous fear can certainly be spread around. One other usual suspect worth mentioning here is the scientific community which, in its mostly passive acceptance of political influences, has contributed significantly to the brainwashing mantra of “ADD medications are interchangeable, they all have side effects, they will always interfere with good sleep, and their efficacy can be compared head-to-head in ADD populations.”
I just want to scream!
If the NYT wanted to be truly informative and not just facilitate powerful amorphous fear, it would let its readers know what the primary literature and my book have been saying for more than three years about Adderall and how to choose the correct medication for any particular ADDer. The NYT could have a huge influence on helping professionals and patients understand the truth about traditional ADD medications. Couldn’t they?
Asymptomatic and Symptomatic ADD
Now, what about the truth of NYT’s allegation of the “skyrocketing” increase in the diagnosis of ADD in the United States and its causes?
Asymptomatic ADHD is a phrase that you cannot find in the title of any research currently indexed at pubmed.com. It is a phrase that can only rarely be found buried in the text of published research. In my opinion, you cannot have a truly scientific (or even logical) discussion of the “the skyrocketing frequency of the diagnosis of ADD in the United States” without understanding what “asymptomatic ADD” means. Since that phrase does not appear to exist, let’s start with a disorder in which the phrase “asymptomatic” is often used and has very important meaning.
First, let me say that I can understand how it might be hard to grasp that a disorder could even be a disorder if there were no symptoms. That is what asymptomatic means — “no symptoms.” In medicine, the definition goes like this: “a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms.” Still wondering, aren’t you? How do you know someone is a carrier if they don’t have any symptoms? And, doesn’t “carrier” mean that there would likely never be any symptoms in the carrier, but possibly in their offspring?
The definition should be more like “a disorder is asymptomatic if it is in remission and there are no observable typical symptoms present during the remission, and, a disorder is considered asymptomatic if it has been identified previously in its symptomatic state and the genetics of it are known, and it only becomes problematic when certain circumstances arise that bring it out of hiding.”
Here’s a classic and quite familiar disorder — lactose intolerance. Overwhelmingly, genetically controlled lactase deficiency is the most frequent cause of lactose intolerance. However, just because you have the genetic markers for lactase deficiency does not mean that you will get sick. You have to eat lactose to challenge your lactase deficiency enough to end up sick with symptoms.
You probably know what the symptoms look like if a person who has lactase deficiency chooses to eat a lot of lactose (dairy products, etc.), but just in case you don’t, here they are: abdominal bloating and cramps, flatulence, diarrhea, nausea, borborygmi (rumbling stomach), and frequently, vomiting. Some pretty awful symptoms, but easily avoided once you know what you’ve got. Generally, once you know you can avoid those bothersome symptoms (be asymptomatic) by simply avoiding lactose containing food, you will do your best to do that, well, unless you enjoy those kinds of symptoms.
There are a couple of moderately successful work arounds for avoiding the downside of lactase deficiency: one is called “lactase supplementation” consisting of pills that you take to optimize your deficient lactase system, and the other is using products that have a particular yeast already mixed in to the product (like in milk) to optimize your deficient lactase system.
So, I am hoping you are already getting this. But, I will say it anyway.
We clearly know at this point in time in history many of the major genetic contributions to sub-optimal dopamine function in humans. There is likely much more to learn, but we have enough data to know this: If you don’t challenge your low working memory due to your genetically-determined sub-optimal dopamine functions, you will not likely experience much of the downside of that sub-optimal dopamine function.
Depending upon how compromised your dopamine system is, you may have to more-or-less live in a cave to reduce your data loads to the point that they no longer make you sick (symptomatic). As I have noted in my book, many people figure this out and stubbornly stick to what is often called a simple life: structured job, live alone, minimize exposure to noise and people, don’t carry a smart phone and, often, don’t drive. By doing so, they will reduce their data loads to the point that they won’t experience a lot of forgetfulness (less to remember in the first place), anxiety or irritability (feeling constantly overwhelmed or on the verge of overwhelmed), or have their limited patience challenged very often.
If you take the term lactase deficiency in my preceding sentences and change it to dopamine deficiencies, you will see how you might be able to remain dopamine-deficient symptom-free by just not “eating” too much data, or by supplementing your sub-optimal dopamine in some effective way.
The largest contributor to making what was formerly asymptomatic ADD into what appears to be a “skyrocketing” symptomatic population of ADDers is clearly exponential increases in hourly, daily, monthly and yearly data loads that Americans have either been actively or passively opting into for the last 50 years.
Why us more than them? You know, why us more than, let’s say, the French or Germans or Swedish? First, because there is less asymptomatic ADD in European old blood still in Europe, so they can generally handle higher data loads without becoming symptomatic (they can drink more data before becoming symptomatic). Second, because they have less asymptomatic (genetic) contributors to sub-optimal dopamine function, they don’t easily buy into the kinds of values or styles that, in America, substantially contribute to huge, constant individual data loads: impulsive, impatient, distractible, easily manipulated, poor innate analytical and reading abilities, vulnerable to tobacco, alcohol, and many illicit drugs, and an economic system that exploits all of the above for profit.
How can I say that the prevalence of asymptomatic ADD in Europe, generally, is much less than in the Western Hemisphere? You will need to read my book to fully understand that conclusion.