October 18, 2001

Selling the Need for Speed

(first appeared in Salon.com)
The pharmaceutical industry is poised to take a megastep in its influence over how we view ourselves. Alza Corportion has announced a campaign beginning this summer that will use television commercials to promote their drug, Concerta, used in the treatment of attention deficit/hyperactivity disorder or ADHD. Alza, having pioneered the use of direct to consumer print ads for ADHD last year, breaks new ground as being the first drug company to promote the use of a medication for a childrenís psychiatric disorder on television.

Actually, the ' ads will never mention Concerta directly which is illegal. Concerta like most of the medications used to treat ADHD in children is a stimulant drug and potentially abusable. Its production, like its better known competitor, Ritalin, is tightly controlled by the Drug Enforcement Administration (DEA). Specifically with regards to promotion, the U.S. is a signatory to the Psychotropic Convention Treaty of 1971, monitored by the UN Narcotics Control Division, which prohibits the advertisement of controlled substances to the consumer. Meanwhile Celltech, another stimulant manufacturer, directly mentions its product, Metadate CD, in its ads which has triggered DEA to issue a cease and desist order. Court actions and even international sanctions could follow.

', along with some other half dozen companies marketing stimulants directly to parents (in magazines like Redbook and Good Housekeeping) is taking the safer route. It neatly sidesteps the limits on specific product advertising by promoting awareness of the condition, ADHD, not the drug treatment itself. Note an ' print ad from last year. A smiling school age boy holds a pencil surrounded by his beaming parents and sister with a caption that reads, ìThanks to new ways for effectively managing ADHD, homework may be a more relaxing time at the Wilkin house.î Readers are advised to call a toll free number for the ìlatest treatment information.î Parents are then sent a video, a copy of a government study on ADHD treatment and material on Concerta.

So what's wrong with this picture? The several companies now involved in advertising stimulants through promoting "awareness" over ADHD, would say they are performing a public service. However, in the affluent suburban middle class community where I work you'd have to be living in a cave without children for the last ten years to be unaware of ADHD. Indeed, I regularly hear parents and teachers describe children's problems of behavior and performance in what sounds like a learned catechism of ADHD symptoms. "He's distractible in the class. He can't focus. He'll only concentrates on the things he likes."

It's almost like they've read a script. And that's the point. Increasingly the pharmaceutical industry has come under fire for influencing the way we think about ourselves and now our children. David Healy, a prominent British psychiatrist, was fired from his high profile University of Toronto mental health post for speaking out on his provocative revisionist history of American psychiatry. He claims that our entire psychiatric diagnosis and treatment model of the last fifty years has been determined by drugs like Thorazine and Prozac and by the pharmaceutical industry's influence in research, publications, professional organizations and promotion. In fact, a consortium of legal firms have filed class action suits in five states against Novartis, the maker of Ritalin and the American Psychiatric Association claiming a conspiracy to defraud the public over ADHD and the need for stimulant medication.

However, one needn't invoke an active conspiracy when the "invisible hands" of Adam Smith's market forces -- are at work. Our free speech rules allow the financial power of the pharmaceutical industry to promote a particular point of view on children's problems, ADHD, a purported brain-based disorder calling for a medication. A child's brain is important but common sense says that homework completion is a complex social/developmental undertaking that involves many more factors. Unfortunately there is no equal countervailing influence to the drug companies' promotion of ADHD as the cause. There are no stock dividends or equity for special education teachers, no TV commercials for family therapists.

Drug advertising works. In 1999, after four years of relentless advertising directed to physicians, Adderall, another stimulant, surpassed Ritalin as the most common brand name drug prescribed for ADHD. With nearly a dozen stimulants now available without too much to distinguish them clinically, manufacturers will have to advertise heavily to maintain or create their niche in the $750 million dollar a year legal stimulant market. Stimulants do work too -- in low doses to improve concentration and work completion for everyone (child or adult, ADHD or not). But stimulants are not a moral equivalent to or substitute for better parenting and schools for kids. Yet I'm afraid in our current environment that this opinion is likely to be dwarfed by the next thirty second spot.


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