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Journal of Health Care Law: "[T]rue consent to what happens to (CHADD), the national parent support group for ADHD. one's self is the informed exercise of choice, and that entails an Perhaps most troubling is the concern expressed by a University opportunity to evaluate knowledgeably the options available and of Michigan neuroscientist and Professor Emeritus of Psychology: the risks attendant upon each." "Iam convinced that the pharmaceutical industry spends The issue of consent to health care of young people was the enormous amounts of money to increase its sales and profits by subject of a major 1996 report issued by the Queensland Law influencing physicians and the public in ways that sometimes Reform Commission.* It has also been identified by representa- bend the truth and that are often not in the best interests of science tives of various organisations as a major issue throughout or the public." Australia: 2) The Physicians. The primary reason that physicians are "The Commissioner for Children and Young People advised the seduced by the idea of ADHD as a biomedical entity is that they committee that issues of confidentiality and consent to health care desire to be helpful to their patients. Their entire training and per- of young people were major concerns raised by representatives of spective is steeped in the "medical model": a patient comes to see more than thirty youth and health-related organisations at a them with a symptom and they diagnose and treat it. If ADHD National Youth Health Summit organised by the Australian does not exist, and the behaviours are either part of the range of Medical Association held in Canberra in July 2001."°° normal childhood experience or reflective of some dysfunctional Consent without information is no consent at all, and parents environment, the medical practitioner is helpless. Plus, as we'll who are told their child has "ADHD" are virtually never told of see in a moment, the stimulant drugs they can prescribe do pro- the lack of scientific reliability or validity to the diagnosis. duce the desired effect for parents and teachers, so physicians are Typically they are not told that there is no organic or positively reinforced by their patients (or at least their patients’ physiological finding associated with the diagnosis, nor are they parents) for being helpful. told that no one has been able even to demonstrate that "ADHD" At the same time, it would be naive to overlook the profit exists. Parents are also often not told about the dangers of motive in this part of the equation. American psychiatrist Peter psychostimulants. Australian Breggin noted: "Biological interest common law, international law (particularly the United Nations Convention on the Rights of the Child, to which Australia is a The rise in the number of signatory) anda basic sense of human decency demand that any | Children diagnosed in Australia groups have been pressing for decades to capture the child market for drugs and for their professional services."** Tunku Varadarajan of the Wall Street Journal wrote: "For psychia- individual masa right to coment to an with ADHD over the past trists to receive payments from health invasion of their personal/physica! A insurance companies, they must fin integrity. 25 years has been nothing a way to label a patient with a recog- Children are almost never given an short of astronomical nised condition—which is why they opportunity to give consent to treat- ment with psychostimulants, nor are they privy to the debate that rages in the professional community about conditions added to the existing this diagnosis. This egregious violation list."° of a basic human right would not be tolerated were it done direct- 3) The Parents. The strongest force in popularising the ly, but in the guise of "helpful medical care" it becomes more elu- ADHD diagnosis (and the use of stimulant drugs) has been sive and difficult to combat. parents. Without a "market", the ADHD phenomenon would have recognise more, and more, and more conditions. Wait for the next DSM, and there will be at least another 50 children diagnosed in Australia with ADHD over the past 25 years has been nothing short of astronomical. 3) The Parents. The strongest force in popularising the ADHD diagnosis (and the use of stimulant drugs) has been parents. Without a "market", the ADHD phenomenon would have died in its tracks. Parent support groups, such as CHADD, vehemently deny any implication that ADHD is anything but a "real" disorder, and many parents cite the diagnosis and the prescription for stimulants as having been a miracle for their child and for their family. The seductiveness of the diagnosis for parents is readily seen by anyone who has worked clinically with families experiencing behaviour problems with a child. In Western society there is an implication that if your child is misbehaving, then you are an inadequate parent. If your child is constantly misbehaving around other people or "getting into trouble" at school, there is an unspoken assumption that you are unable or unwilling to discipline properly. The idea of a disease afflicting these children and causing their misbehaviour is emotionally perfect for some parents, as they can go instantly from being under suspicion of inadequate parenting to being martyrs, struggling to cope with a sick child. Instead of going to family therapy and learning how they might understand why their child is really misbehaving or what they could do about it, they can go to support groups and receive positive strokes and sympathy for having been dealt such a cruel biological hand. Why Is ADHD Diagnosis So Popular? The rise in the number of children diagnosed in Australia with ADHD over the past 25 years has been nothing short of astronomical. Given the acknowledged lack of a known aetiology or organic/biological marker for ADHD, the question remains as to why this diagnosis is so popular. There are four primary "constituencies" for whom the ADHD diagnosis has been an economic, practical and emotional godsend. 1) The Drug Companies. The market for stimulant medica- tion specifically to treat ADHD exceeds US$600 million annually in the United States alone! With this sort of profit motive, it is not surprising that major pharmaceutical companies have been outspoken proponents of psychiatric diagnoses in general and ADHD in particular. Novartis Pharmaceuticals—which held the original patent on methylphenidate (Ritalin), the most popular US drug for ADHD—has advertised extensively in both professional journals and popular media, with ads in the latter aimed specifically at convincing parents that their child might benefit from using stimulants. Novartis has also been a generous financial supporter of Children and Adults with Attention Deficit Disorder 16 = NEXUS The rise in the number of ; Continued on page 74 www.nexusmagazi ne.com FEBRUARY — MARCH 2005