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According to the Centers for Disease Control and Prevention (2011), attention-deficit/hyperactivity disorder affects 11% of people aged 4 to 17 years. In the year preceding the study, 6.4 million children were diagnosed with ADHD, and 4.2 million were prescribed psychostimulants. ADHD has increased at a rate of 4% per year since 2000. The percentage rise in these figures has been troubling, and stakeholders believe that the crisis might not be as severe as it seems. This paper explains the role that unnatural factors such as the influence of drug companies, demands of the parents, and pressure put on physicians play towards overdiagnosis
How Major Drug Push for The Consumption of ADHD Medications
According to Timimi (n.p), the main interest of many shareholders in the pharmaceutical industry is making profits. Profits as a motivation for healthcare stakeholders is more pronounced in privatised healthcare systems such as the American one. Therefore, the industry has aligned its market techniques to affect concepts of mental health towards more prescribing habits of doctors. Many western countries have experienced an increasing rate of diagnosis of psychiatric disorders in children. The number of children under psychotic medication has also increased dramatically over the recent years with children as young as two getting them.
Marketing strategies within the pharmaceutical industry have strongly influenced the change in prescribing habits of physicians. Entities within this industry have joined efforts to convince teachers, parents, doctors and individuals with responsibilities towards the children that behavioural and emotional issues faced by children are a result of behavioural and emotional problems are caused by certain chemical imbalances within the central nervous system. Timimi (n.p.) refers to the current medical era as that of ‘pill for every ill,’ where pharmaceutical companies promote discourses that create new diagnoses that are labelled as undiagnosed and untreated.
Pharmaceutical companies have been considered a key stakeholder in healthcare. According to Schwarz (n.p) the support that the industry gained from other stakeholders, especially the government, saw it experience unprecedented growth in the 1990s. Before this time, most of the child and adolescent psychiatrists concentrated on the use of therapy. The use of medication for childhood mental health problems and non-serious conditions among adults was infrequent. Timimi (n.p) narrates his experience where pharmaceutical companies facilitate meetings where professions fill questionnaires about their practice and drug trials for patient’s. Positive responses that propagate the companies’ interests are publicized while the psychiatrists enjoy financial inducements.
Marketing is a business concept that has grown tremendously with changes in technology. Psychotherapists are brought on board by the manufacturers and distributors of ADHD medications. These individuals help in propagating what Timimi (n.p) refers to as ‘pill for every ill’ narrative. According to Thomas et al. (3), about 78% of advisers of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are related to drug-manufacturing or distribution entities. This situation is likely to create financial conflict of interest. Therefore, there are high chances that the DSM-5 may be biased in order to favor the drug companies.
Direct consumer advertising by pharmaceutical companies has also been credited as a key driver for demand. The internet has created a new avenue where many websites are put up claiming to have credible information on mental health. These websites provide visitors with an opportunity to discuss mental healthcare. Commercial influence has been spread to educational institutions and curricula, non-governmental organizations and consumer websites. The companies have also been using celebrities to promote self-diagnosis. Thomas et al. (3) notes that the six questions commonly used lead to misdiagnosis but help the companies achieve their mandate by increasing demand for ADHD medications.
The Relationship Between ADHD Medication Prescription and Money That Doctors Receive from The Manufacturers
Keith Conners, a ADHD specialist, notes that a look at the number of people who are diagnosed with the condition every year may reveal that it is an epidemic. However, this is not the case because it is merely used as a justification of the issuance of medication at unjustifiable and unprecedented levels. The children’s market has been a key target for pharmaceutical companies. Doctors who deal with this condition among the young people are desperate to portray medications as benign. Scwarz (2013) notes that medical advice from professionals has been biased in order to convince the population that the ADHD medications have only mild effects on the patients and need to be regulated in similar classed as aspirin. However, the truth is that users of these drugs are exposed to addiction and should be classified in similar categories as morphine and oxycodone.
Ornstein et al. (n.p) note that doctors who receive money from the pharmaceutical industry prescribe drugs in a different manner from the rest of their colleagues. The beneficiaries of the funds are usually loyal to the brand names from which they receive money. This observation was arrived at after matching records on payments from pharmaceutical firms and manufacturers of medical equipment and devices with data on the medication choices of the corresponding doctors. This pushes pharmaceutical producers into making more payments to as many doctors as possible. This results
ADHD medications have several side effects, especially on children. These effects escalate when attempts are made to help in weaning the patients. According to Gajria et al. (1543), the main factor leading to reduced effectiveness in the current pharmacological treatments is low treatment adherence and discontinuation. Many patients and their caregivers realize that the drugs are exposing them to danger and end up discontinuing their consumption. In some instances, it is the doctors who realize that the ADHD was made out of misdiagnosis. Whichever the case, it is clear that discontinuation of the medication may pose even a greater risk. Therefore, many doctors are unlikely to discontinue when they discover that the patient is harmed.
When fatalities occur after discontinuation of ADHD medications, the attention of the authorities is usually drawn to the underlying reasons that led to the prescription and discontinuation. As described above, many doctors prescribe ADHD medications due to external pressures rather than necessity created by the condition. Discontinuing these medications will lead to investigations which may expose that the decision to prescribe them was biased. This will put the reputation of the doctor and the facility at risk. In order to avoid such situations, many prescribing physicians keep the patients on medication (Foreman 193).
ADHD prescriptions that are not based on the patient’s condition are associated with more adverse effects than in situations where they are justified. In these cases, the prescribing medics have to ensure that they deal with the effects. The creation of new treatment goals through misdiagnosis and over prescription stimulates a new demand for ADHD prescriptions. Therefore, the number of prescriptions keep increasing with time. Gajria et al. (1544) notes that 60% of individuals diagnosed with ADHD continue demonstrating notable symptoms for the rest of their lives. Once these people start using the drugs, it becomes almost impossible to lead a normal life. Attempts by doctors to wean them off the drugs can easily expose biasness in the process of diagnosis and prescription leading to legal suits by the patients and their caregivers.
The Role of Parents in ADHD Over-Diagnosis
According to Mariani and Levin (2), many healthcare systems have become too dependent on medications, even in situations where there are alternative interventions. In addition, pharmaceutical companies have stepped up their campaigns that are aimed at portraying medications as more effective than alternative interventions. Most of the campaigns target parents because they are the primary caregivers and financiers of the children’s healthcare. One of the most frustrating behaviours displayed by children with ADHD is being combative. Patents are usually desperate to help the child recover and minimize combative behaviour.
Some parents believe that ADHD medications stop combative behaviour, even in instances when the child is not suffering from ADHD (Gajria et al. (1546). As a result, they will insist that the child be put on ADHD medications despite the condition of the child. In these cases, the child’s behaviour is unlikely to stop if they are not suffering from ADHD. When the doctors give in to the parents’ pressure, they have to indicate that they prescribed the medication on the basis of their diagnosis. Therefore, they will indicate that the child is suffering from ADHD. This leads to an increase in the number of ADHD diagnoses, against the reality. The child will thus suffer from the side effects of the medications. The prescriptions are also likely to increase with time in order to deal with the initial side effects.
ADHD prescriptions have been used by medics and caregivers to substitute the rigorous diagnosis and treatment processes of children who exhibit symptoms of mental problems. It is important that parents, guardians, other caregivers and medics appreciate the role that they have towards the wellbeing of the children. However, the spread of information on the availability and accessibility of ADHD medications makes these stakeholders resort to them as a shortcut. Many facilities and medics no longer carry out the traditional rigorous diagnosis process to understand the root cause of the child’s mental problems (Mariani and Levin 47).
Diagnosing mental problems among children is more challenging compared to adults. The main barrier in this case is communication. Children do not have the ability and experience that can enable them communicate their inner mental feelings and experiences as good as the adults. As a result, their caregivers cannot fully understand the changes that the child has undergone. These individuals look for a less expensive and less time consuming procedure that can assist the child back to normalcy. According to Shute (n.p), some parents have been liaising with doctors to have their children on ADHD medications to deal with simple problems such as lack of concentration on studies.
The pharmaceutical industry, physicians and caregivers have been blamed as the key stakeholders whose actions have led to over-diagnosis of ADHD. Drug companies have invested billions towards advertisements and lobbying aimed at increasing the consumption of ADHD medications among the public. Doctors have been beneficiaries of the funds released by these companies. As a result, they are indebted to ensuring that they prescribe as many ADHD medications as possible to help their financiers gain profits. Parents have also been pushing that their children be put on ADHD medications, even in circumstances where they are undergoing mere stress. Parents, guardians, other caregivers and medics have been resorting to ADHD medications to save time and resources that would have been spent on proper diagnosis. In these cases, the root cause of the child’s mental problem is not handled.
Centers for Disease Control and Prevention. Attention-deficit/hyperactivity disorder (ADHD): data & statistics. New data: medication and behavior treatment. CDC, 2011. http://www.cdc.gov/ncbddd/adhd/data.html. Accessed July 28, 2015.
Foreman DM. Attention deficit hyperactivity disorder: legal and ethical aspects. Archives of Disease in Childhood. 2006;91(2):192-194. doi:10.1136/adc.2004.064576.
Gajria, Kavita, Mei Lu, Vanja Sikirica, Peter Greven, Yichen Zhong, Paige Qin, and Jipan Xie. "Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder–a systematic literature review." Neuropsychiatric disease and treatment 10 (2014): 1543.
Mariani, John J., and Frances R. Levin. "Treatment strategies for co‐occurring ADHD and substance use disorders." The American journal on addictions 16.s1 (2007): 45-56.
Ornstein, Charles., Grochowski, Ryann., Tigas, Mike. Drug-Company Payments Mirror Doctors' Brand-Name Prescribing. National Public Radio, March 17, 2016. https://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing. Accessed July 28, 2015.
Schwarz, Alan, and Sarah Cohen. "ADHD seen in 11% of US children as diagnoses rise." The New York Times 31 (2013).
Shute, Nancy. Neurologists Warn Against ADHD Drugs To Help Kids Study. National Public Radio, March 14, 2013. https://www.npr.org/sections/health-shots/2013/03/13/174193454/neurologists-warn-against-adhd-drugs-to-help-kids-study. Accessed November 18, 2017.
Thomas, Rae, Geoffrey Mitchell, and Laura Batstra. "Attention-deficit/hyperactivity disorder: are we helping or harming?." BMJ (2013).
Timimi, Sami, and Eric Taylor. "ADHD is best understood as a cultural construct." The British Journal of Psychiatry 184.1 (2004): 8-9.
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