John B. Edwards III appeared to have a promising future ahead of him.
Graduating from Wellesley High School, just outside of Boston, Mass., in 2006, Edwards was both class president and valedictorian.
Boasting a 4.0 high school GPA, Edwards would enroll at Harvard University, where he dreamed of becoming a doctor. In his first year there, Edwards continued to receive all A’s, and as a sophomore, was accepted into a special science program that allowed him to conduct stem cell research at Harvard Medical School.
Despite his impressive pedigree and high marks, Edwards grew concerned that he was struggling to keep pace with the other students. Frustrated by his inability to devote the same degree of concentration to his studies as many of his friends, Edwards visited Harvard’s University Health Services to seek treatment in June 2007.
After a single examination lasting only an hour, nurse practitioner Marianne Cannon diagnosed Edwards with attention deficit hyperactivity disorder (ADHD) and prescribed him Adderall and the antidepressants, Prozac and Wellbrutin.
Edwards was taking Accutane at the time, a powerful anti-acne medication that has been linked to severe depression and a heightened suicide risk. When combined with the medications prescribed by the nurse practitioner, two of which are also associated with heightened risk of suicide, the drug cocktail bordered on dangerous.
Six months after receiving his diagnosis and beginning treatment, Edwards was working in the Harvard Medical School’s New Research Building on the night of Nov. 29, 2007, just 11 days before his 20th birthday.
Around 11 pm that evening, the Boston Police Department received a call informing them that a body had been found in the New Research Building’s fourth-floor bathroom. The body belonged to Edwards, his death ruled a suicide by investigators.
In 2009, Edwards’s father, John, filed a lawsuit against Harvard’s University Health Services, alleging that his son was misdiagnosed with ADHD and that Harvard’s original diagnostic procedure and prescriptions for Adderall failed to meet medical standards.
During pretrial testimony, Cannon recalled Edwards telling her that “I can’t study like I would like to, as much as my friends.”
While recounting her initial examination, Cannon said that aside from noting Edwards’s difficulty with focusing, he had received two minor traffic citations. This, according to Cannon, showed that Edwards was impulsive and suffered from a poor attention span.
Further defending her diagnosis, Cannon said that Edwards regularly consumed the energy drink Red Bull, suggesting that he might require stimulants to aid his concentration.
She did not, however, speak with Edwards’s friends or family about his symptom history to determine if his troubles with concentration manifested before the age of 7, as was required at the time to make a diagnosis of ADHD according to the American Psychiatric Association’s guidelines.
In 2013, the age was raised to 12, allowing doctors an additional five-year window to draw from when diagnosing the disorder.
A Manufactured Epidemic
Edwards’ tragic tale is an anecdote that underscores a burgeoning crisis in America.
Over the past decade, the rate of ADHD diagnoses in the United has exploded, especially among high school age boys. These soaring rates have stirred controversy in the psychology and medical communities, prompting some experts to question whether the ADHD diagnostic requirements have grown too broad.
Today, nearly one in five high school boys in the United States and 11 percent of all grade school children have been medically diagnosed with ADHD, according to data from the Center for Disease Control and Prevention.
This amounts to an estimated 6.4 million children between the ages of 4 and 17 having received the diagnosis, marking a 16 percent rise in ADHD diagnoses among adolescents since 2007 and a 41 percent rise over the last decade. By high school, nearly 20 percent of all boys receive the diagnosis, a 37 percent increase since 2003.
In 1990, only 600,000 children were prescribed ADHD medication. Now, that number has soared to more than 3.5 million.
While some doctors and ADHD advocates believe that the rising diagnosis rates are a good thing, insisting that the medical community is simply getting better at recognizing and accommodating patients suffering from the disorder, others argue that the surge in ADHD cases are the direct result of a push from the pharmaceutical industry to bolster profits.
Among those troubled by the uptick in ADHD cases is Dr. Keith Conners, who a half-century ago, led the fight to have ADHD classified by the psychiatric community as a mental health disorder.
Last December, while addressing a group of ADHD specialists in Washington, DC, Conners expressed concern over the spiking rates of diagnosis, describing the trend as “a national disaster of dangerous proportions.”
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Conners, now a psychologist and professor emeritus at Duke University, told The New York Times in an interview following his address in Washington. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
The unjustifiable levels described by Conners appear to closely correlate with a 20-year campaign by the pharmaceutical industry to educate the public on ADHD and to encourage doctors to prescribe powerful stimulants like Ritalin, Adderall, Vyvanse and Concerta to treat the disorder.
Historically, ADHD has been estimated to affect between 3 and 7 percent of children. Because there is no definitive test to determine whether or not an individual has ADHD, its diagnosis is entirely subjective.
Under intense pressure from drug manufacturers, insurance companies and parents desiring to improve their children’s social behavior or school performance, physicians are often forced to quickly diagnose the disorder and prescribe drugs, often without completing a thorough examination.
“There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood,” said Dr. Jerome Groopman, a professor of medicine at Harvard Medical School.
The American Psychological Association broadly defines ADHD symptoms as “trouble getting organized, staying focused, making realistic plans and thinking before acting.” It describes individuals with the disorder as possibly being “fidgety, noisy and unable to adapt to changing situations,” and children with ADHD as “defiant, socially inept or aggressive.”
“There’s no way that one in five high-school boys has A.D.H.D.,” said James Swanson, a professor of psychiatry at Florida International University and a foremost ADHD researcher to The New York Times. “If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable — some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 percent.”
As segments of the medical community grow increasingly concerned about the over-diagnosis of ADHD, there is little incentive for the pharmaceutical companies to slow down their push.
Since 2002, sales of prescription stimulants have skyrocketed, with sales approaching $9 billion in 2012, up from $1.7 billion a decade ago, according to IMS health.
The incredible rise in sales can be directly attributed to efforts from ADHD drug companies aggressively marketing their medications, even to children.
Last year, Shire, the maker of several ADHD medications including Adderall, subsidized 50,000 copies of a children’s comic book that helps explain the disorder to kids. The featured superheroes, proclaiming: “Medicines may make it easier to pay attention and control your behavior!”
Representatives from Shire insist that the company’s marketing strategies are perfectly ethical.
“Shire, and I think the vast majority of pharmaceutical companies, intend to market in a way that’s responsible and in a way that is compliant with the regulations,” said Tom Casola, Shire vice president who heads up the companies ADHD division in an interview with The New York Times. “Again, I like to think we come at it from a higher order. We are dealing with patients’ health.”
But even Roger Griggs, who introduced Adderall in 1994 while an executive at Shire, believes that marketing stimulants to the general public is a dangerous proposition, calling the drugs “nuclear bombs” that should only be prescribed in extreme circumstances after a thorough examination by a physician.
Still, that hasn’t stopped Shire from peddling its medication to children, parents and, its latest target, adults.
“The fastest-growing segment of the market now is the new adults who were never diagnosed,” said Angus Russell in an interview with Bloomberg TV in 2011, when he was CEO of Shire.
According to IMS Health, approximately 16 million prescriptions for ADHD drugs were provided to individuals between the ages of 20 and 39 in 2012, nearly tripling the number of ADHD prescriptions written for the age group five years prior.
Featuring celebrities like Maroon 5’s Adam Levine and television personality Ty Pennington, ADHD advocacy groups and pharmaceutical companies have attempted to establish a new consumer base of people suffering from adult ADHD.
They are targeting people like Richard Fee, who like Edwards, received an ADHD diagnosis as an adult.
"You keep giving Adderall to my son, you're going to kill him," Rick Fee recalls telling one of his son’s doctors.
Richard was prescribed Adderall as a 24-year-old after graduating from college near Virginia Beach, Va., where he was class president and an aspiring medical student. Soon after beginning his treatment, Richard became addicted to the drug and began to spiral out of control.
In 2011, following a week-long stint in a psychiatric hospital after becoming violent and suffering from delusions, Richard visited his doctor and received an Adderall prescription that would last 90 days. Two weeks after Richard ran out of pills, he hanged himself in his bedroom closet.
Sluggish Cognitive Disorder: The Next Frontier
Stories like Edwards’ and Fee’s have done little to curb the rise in ADHD diagnoses.
In fact, drugmakers Eli Lily and Shire, among others, have led a campaign to have the medical community officially recognize a new ADHD-related disorder called sluggish cognitive tempo (SCT), which is characterized by lethargy, daydreaming and slow mental processing, according to FiercePharma.
Some, who presumably advocate for SCT to earn a place in the Diagnostic and Statistical Manual of Mental Disorders, believe that as many as 2 million children nationwide suffer from the disorder.
Eli Lily has already conducted clinical trials to determine whether its ADHD medication Strattera could be effective in treating SCT. But they are only the first company to conduct such a trial. Still many more are likely to follow suit.
If SCT comes into vogue, an untold number of new individuals could become eligible for ADHD prescriptions. Were that scenario to unfold, the pharmaceutical industry’s profits would likely climb higher still as more and more Americans begin each day swallowing a pill.
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