ADHD expert, Dr. Lawrence Diller, criticizes the role insurance and pharmaceutical companies play in over-diagnosis of ADHD.

Lawrence Diller, M.D.

What role do the insurance companies and pharmaceutical companies play in the world of ADHD?

. . . There's a suit going on right now in three states. It alleges that the major pharmaceutical company that makes Ritalin, the Novartis Company, along with the American Psychiatric Association, the main representatives of organized medicine in the ADHD movement, and the self-help group CHADD have conspired to dupe the American public into believing that there's such a thing as ADHD, and then thrust upon innocent children a potentially dangerous drug.

The suit alleges that there's a conspiracy. Now, there may be some legal definition that meets the conspiracy angle. But I don't believe that there's any conspiracy at all. We have what I call the "invisible hand" of Adam Smith at work. Adam Smith, as you know, wrote the fundamental textbook on capitalism. And we have market forces at major play here, getting people to think a certain way about medications, and then operating on the doctors and the patients to get them to take them first--often at the expense of other interventions that work.

As a doctor, how do you experience those forces?

. . . I experience them, first of all, by this unbelievable advertising barrage that has hit me first, and now is hitting the consumer directly. . . . I think Novartis has acted quite responsibly, relatively speaking, because I think Ritalin represents a drop in the bucket to them in terms of the kind of money they make. They're much more worried about their bio-engineered foods these days than they are about Ritalin.

On the other hand, the makers of Adderall have presented what I consider to be . . . the most disingenuous, elaborate campaign I've ever experienced. . . . Adderall has passed Ritalin in terms of trade medication written for ADHD. I've been offered $100 if I will sit and listen to someone talk about ADHD, funded by Adderall, for 15 minutes on the telephone, and then fill out a five-minute questionnaire. . . .

And now, with the loosening of controls on the pharmaceutical industry by the FDA, there is this direct marketing to families. You see this picture. . . . Well, it doesn't say that it's for Concerta. It says, "Learn more about ADHD." And it's this picture of this smiling boy who has a pencil in his hand, and on either side of him, his parents are beaming. . . . And underneath, it says something like, "They're happy, because now they know his ADHD is being treated." What's the problem with that? The problem is it pushes people to only one way of thinking about the problem--that this is a biological problem, and that it needs a drug. . . .

Is there an imbalance in how much money goes to studying the efficacy of drugs versus the efficacy of other things?

Yes. That's the other way that the market forces are operating here, in that virtually every ADHD researcher, now, because of previous cutbacks and because there is money out there, takes money from the pharmaceutical industry to do their research. And whether or not you're a doctor in the local hospital . . . or you are one of the editors of the New England Journal of Medicine, we all know that research gets influenced by the funding source.

And this is not impugning these men. It's just how it works. They don't publish negative findings. The studies are tilted more toward counting symptoms and pills, rather than looking at the bigger picture. And if you look at a very narrow picture, if you just ask very narrow questions, you will get answers that miss the big picture.

Dr. Peter Jensen, a respected authority in this field, says that, in the case of children's psychiatric medications, that it's not true; that the research money comes from the government, because the pharmaceutical companies are afraid of litigation, and they don't want to go there.

That was the case. It was difficult to fund pharmaceutical research in children, particularly psychiatric pharmaceutical research in children, because there was seen to be no market until the 1990s.  The government added this rider, where the pharmaceutical company will get an extra six months of patent protection if they study the drug in children. So what we're going to get, and what we're getting, is a flood of pharmaceutical research money directed toward children. And one could be very glad for that in some ways.  But again, if we only ask questions about how many symptoms does the kid have, and how many pills should he take, we are going to get a very, very narrow group of answers of what ails the kid, and what should be done about it.

So we are entrusting the research on our children's mental health and the solutions for their problems to pharmaceutical companies with vested interests?

You got it.   It's clear to all of us, even those of us who do receive medication pharmaceutical money, which I don't. And I would like to, because I have to pay for my own trips. But the moment I do, I'm potentially influenced by that money.