Feb9

ADHD and Pharmaceutical Fearmongering.

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ADHD and Pharmaceutical Fearmongering.

It’s never difficult to find articles about how ADHD is some trumped-up condition made up to excuse poor behavior and/or line the pockets of the medical industry. Whether the writer assumes one or both of these, it’s necessarily bound together with denial, ignorance, and hyperbolic claims. Sometimes all you can do is get angry, but other times the writer gives you a chance to deconstruct his points. The Price of ADHD Business is that second kind.

He opens with this blockbuster:

Over 12 million children and young adults consume ADHD stimulant and psychiatric medications in the United States. Pharmaceutical corporations generated near 9 billion dollars in 2012 for ADHD stimulant drug sales, representing 5x the 1.7 billion in sales ten years ago.

Shocking, isn’t it? Except that in the US, the Pharmaceutical Industry makes about $345 billion a year. That means that psychiatric medications make up a whopping 2.6% of the bottom line. Hardly one of their biggest players, compared to drugs for cholesterol, pain management, and cancer treatment, which are much better performers when it comes to percentage of business. Also, notice the subtle slide from “ADHD stimulant and psychiatric medications” to “ADHD stimulant drug sales,” because this will be important.

More alarming, this rate of consumption represents 3x the world’s children combined, according to data collected by Scientific American. The business model of behaviorally assessing and prematurely medicating young school age children with powerful stimulant and psychoactive drug therapy for over 40 years is now under fire. The Government Accountability Office (GAO) Child Foster Care Drug Audit Report uncovered dangerous and unethical prescribing practices. Widespread abuses of overmedicating young foster care children with ADHD stimulant as well as psychiatric medications prior to ruling out nutritional, physiological, and environmental risk factors were uncovered by the largest child foster care prescription drug audit in American history.

Of course, being a first-world country, it’s more likely that we have 3x the children being treated for, say, cancer or juvenile diabetes, or any number of other childhood diseases, so there’s something of a leap from claiming that 3x the children being treated means that something is being treated too much – or “prematurely.” I notice also that the source of the alarmist rhetoric comes from a study of children in foster care. Well, this is a problem with foster care, not with all children. Foster care children are more likely to have disabilities, both physical and mental, meaning they’re more likely to actually need treatment. They’re also covered by state medical programs that make it pretty easy to get treatment that a self-payer parent might not be able to obtain. There’s more, but if a mere scratch on the surface can reveal that we’re comparing apples to oranges, there’s not much need to go even deeper.

In today’s America parents, educators, and prominent healthcare professionals challenge the 40-year ADHD business model, as the ADHD diagnosis rate surpasses epidemic status in 2014. The symptoms of ADHD are real and in many cases can be debilitating to children as well as adults. Especially in the young child population, the ADHD business model of assessment and treatment requires immediate reform. Children have a right to receive comprehensive bio-assessments as well as behavioral assessments to determine cause of their symptoms prior to powerful stimulant and psychoactive drug therapy.

Yes, we have a serious epidemic of about 5-8% of the population. That’s massive. Not. Notice how he snuck in the disclaimer (like, some of my best friends have ADHD!!!) but still calls the diagnosis and treatment of ADHD a “Business Model.” I sense a broken irony meter. Also, have you ever taken any of these medications? The stimulants are among the least powerful ones out there, with the most immediate effect (no two-month waiting period) and little to no withdrawal problems. Lumping them in with all psychoactive medications is disingenuous, especially for someone banking on his rep as a Pharmacist.

The Diagnostic and Statistical Manual for Mental disorders (DSM) lists ADHD as a mental disorder. The DSM diagnosing criteria, created by psychiatrists, involves a subjective behavioral assessment process which forces children primarily into premature drug therapy. Although seven out of ten children may exhibit an initial positive behavioral response to stimulant drug therapy for focus and attention, the long term side effects are now known.

Yes, they are, and they’re not terribly scary. Children who start using methylphenidate or dextroamphetamine medications may grow up to be as much as one centimeter shorter than their peers. Of course, they’ll also grow up happier and more successful and less likely to abuse drugs than their non-medicated ADHD peers, but that runs counter to the narrative here.

The Johns Hopkins Child Center Study results of 2013 prove that stimulant drug therapy should not be the primary intervention in young children. This study followed four year old preschool children who were diagnosed by their physicians for ADHD and medicated with stimulant drug therapy for a six year period. When the ADHD assessments were reviewed at age ten, over ninety percent of the children were worse off in their condition. Long term side effects of ADHD stimulants may include anxiety, minor depression, as well as aggressive behavior. Additionally, the Hopkins study determined that ADHD causes an economic burden to the US exceeding 45 billion dollars, annually.

To the first sentence I say, “Well, duh.” The primary intervention should be behavioral, with medications added to supplement as needed. This is not news, and it does not run counter to what any Medical Association is recommending, even the American Psychiatric Association, which says “Behavioral therapy and medication can improve the symptoms ofADHD. Studies have found that a combination of behavioral therapy and medication works best for most patients.” Add to this yet another lie, because what the Johns Hopkins study revealed was (prepare to be shocked) that ADHD doesn’t go away, and medications don’t cure it, just relieve the symptoms while they are in effect. And the economic burden he’s talking about? That relates to the consequences of untreated ADHD – people in jail, people who are substance abusers, people who are unable to work, people who have other health issues that are related to ADHD.

Many parents are not aware that a diagnosis of ADHD for their child is a diagnosis for mental disease in accordance to the DSM. Once a young child is placed on ADHD stimulants including Adderall or Ritalin prior to ruling out causative risk factors, there is an increased health risk. Additional medications for the treatment of long term side effects may be required due to the development of other behavioral symptoms.

Actually, parents know this, because lots of the evaluations are related to getting assessments for school. And it’s not the stimulants that increase the risk of further diagnoses and additional medications as much as the fact that ADHD is usually not alone, and the co-morbid conditions are discovered because the children are being observed and treated by doctors. The medications don’t produce these problems.

For example, the GAO drug audit uncovered a 2,200 percent increase in drug expenditures for atypical antipsychotic medication reimbursement to the state of Michigan during an eight year period from 2000 to 2008. Children in foster care, as the report states, were abusively prescribed powerful antipsychotic medications including Abilify, Zyprexa, Seroquel, Geodon and Risperdal. The Michigan Medicaid system was billed an increase of 40 million dollars during an eight year period just for this one class of medications in foster care children. US Senator Thomas Carper, requestor of the GAO drug audit and chairman of the Homeland Security & Government Affairs Committee, stated “I was almost despondent to believe that the kids under the age of one, babies under age one, were receiving this kind of medication”.

Remember what I said about the creep from the “all psychiatric medications” to “ADHD stimulant medications”? Here we go with another false equivalency. Antipsychotic medications are the last resort, used for treating not just ADHD, but ADHD with serious comorbids that would make the children a danger to themselves or others. Also, remember that this is the foster children, not all children with ADHD as a whole. AND keep in mind that several of these antipsychotics are essential for the treatment of schizophrenia and seizure disorders, which are probably too legitimate to mention in the context of this article. So the figures on antipsychotics for foster children in one state is cherry-picked data that in no way reflects that there is an epidemic of children with ADHD receiving inappropriate medications.

Should ADHD be labeled a mental disease especially in young children who have not been given the right to find the cause of their symptoms prior to stimulant drug therapy? Or, should ADHD be classified as a symptom of condition with underlying causative nutritional, physiological, and environmental risk factors?

Um, yeah, it should. Get inside our heads, mister – it’s definitely a mental disease. It’s certainly not something we can choose or turn off at will. And the cause of their symptoms is mental – the other “causative” factors have been thoroughly debunked as “causes” in study after study. So this is a giant flaming strawman.

The German magazine, Der Spiegel, quoted a prominent American ADHD psychiatrist in their February 2, 2012 issue. Dr. Leon Eisenberg, who coined the term ADHD over forty years ago, stated “ADHD is a prime example of a fictitious disease.” At age 87, this was Dr. Eisenberg’s last interview prior to his death. During the last forty years, he was involved in pharmaceutical trials, research, teaching, as well as the development of social policy pertaining to child psychiatry. He was a recipient of the Ruane Prize for Child and Adolescent Psychiatry Research. Currently, over fifty percent of psychiatrists on the DSM panel responsible for ADHD diagnosing and treatment protocols have direct business ties to drug manufacturing corporations.

All that education, and Mr. Granett doesn’t know how to check snopes. How sad. As to that second claim, well, a link would be nice, but I’m not surprised it’s absent, since the actual ties would be openly disclosed and not as incriminating as the author would like them to be.

Dr. Thomas Insel, Director of National Institute of Mental Health, stated on April 29, 2013 “patients with behavioral conditions deserve better… the current assessment process lacks validity.” He supports research that better treats and may even prevent the development of behavioral symptoms in children.”

Again with a diversionary link. Psych Central has some validity, but “The Verge”? Really? Why not link to the NIH’s Research Domain Criteria which explains that what this means is that the NIH wants to have research focused on multidimensional approaches to research, and research that is targeted towards evaluation of symptoms and behaviors rather than whole conditions, because we now know that there’s a lot of crossover and and a narrower approach will produce more successful and useful research. Oh, but that would not support the POV of the author. That’s OK, now you can see what Insel was really talking about. You’re welcome.

ADHD symptoms can be reversed through a process of differential diagnosing. The elimination of nutritional, physiological and environmental risk factors prior to premature drug therapy is the new ADHD Business Model for helping children and adults reclaim their behavioral and mental health. The Action Plan for Childhood Behavioral Conditions discussed in the book Over Medicating Our Youth as well as the upcoming 2nd edition T he American Epidemic: Solutions for Over Medicating Our Youth provides critical bio-assessment information to find the cause of ADHD symptoms. This action plan provides an informational template to unite parents, teachers as well as all healthcare professionals for the purpose of helping children win the battle against behavioral challenges.

Many assessments help determine the cause of ADHD symptoms. Learn how bio-assessments for reactive hypoglycemia, diabetes, the brain-gut connection, cervical spinal alignment, exercise, whole food nutrition, brainwave optimization, and nutritional enzyme supplementation may reverse ADHD symptoms.

And now, ladies and gentlemen, we begin our final descent into woo. ADHD symptoms cannot be reversed by any of these things, and. . .OMG, this whole thing is an advertisement for. . .wait for it. . .a book co-authored by Frank J. Granett! It’s so good that he had to cite himself! And real medical terms weren’t sufficient, so we have to make up some that sound really sciency, like “differential diagnosing,” and “reclaim their behavioral and mental health,” and “bio-assesment” so we can sell ineffective treatments to gullible patients. Blood sugar problems can be diagnosed and treated without ADHD medications. The “brain-gut connection” has no supportive research except in patients with full-blown Celiac Disease. Cervical Spinal Alignment is Chiropractic’s uglier younger brother, even less useful than regular Chiropractic for treating anything, much less neurological conditions. “Brainwave Optimization,” don’t even get me started. As for the rest, we already touched on how none of these things are causative, so they are not going to be curative.

But this is what it usually comes down to, isn’t it? The voices that protest the loudest that ADHD is a fake disease created to make money by the pharmaceutical industries tend to end up thinking that it’s real enough to be treated by whatever they themselves are selling. If only there were an all-natural cure for hypocrisy. . .

Feb3

Boost Your Immune System in One Easy Step!

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Boost Your Immune System in One Easy Step!

Get sick.

No, seriously. That’s it. Get sick. It will get your immune system working like nothing else can, guaranteed.

People have this idea that the immune system is like a neighborhood watch, cruising around your body looking for suspicious characters and picking them off before they can do any damage. That’s. . .not even wrong.

Skeptical Raptor has an excellent article called Boosting the immune system–sorting science from myth, and you should go read it, but I’m going to take the part that explains how it works and share it here. First, the Innate Immune System. . .

This is the immune system’s ability to prevent or detect foreign material, then eliminate it without a specific physiological response of the body. It is the body’s quick and initial response to disease causing organisms (pathogens) which invade our body. The innate response either directly prevents an infection or slows it sufficiently for the slower but more effective and selective adaptive Immune system to activate. But it isn’t a simple system, the innate immune system is extremely complex, consisting of:

Anatomical barriers–These consist of physical barriers. The skin itself is impermeable to pathogens providing defenses like a solid wall. Our nasal passage is lined with mucous that is constantly moved into the stomach catching pathogens and killing them. Our eyes are covered in caustic tears and our mouths in saliva which contains a variety of enzymes. all these ensure that the vast majority of pathogens are killed before they can even enter an area where they can cause harm.

Inflammation–This response include the symptoms we associate with inflammation, fever, swelling, increased blood flow, and other activities, is due to the localized response of the body to the presence of a foreign body or pathogen. It’s main purpose is to provide a physical barrier to control the spread of infection and to heal damaged tissue in the region. Damaged cells release an array of chemical factors which cause pain and blood vessels to become more permeable. This response then attracts phagocytes, cells which recognize and consume foreign or dead tissue. Inflammation is normally a healthy response to injury or pathogen invasion, but in some autoimmune diseases, such as rheumatoid arthritis, it can be painful and debilitating.

Complement System–This system is group of biochemicals, produced by the liver, that helps or “complements” the ability of antibodies and phagocytic cells to clear pathogens from an organism. It is part of the immune system that is not adaptable and does not change over the course of an individual’s lifetime. However, it can be recruited and brought into action by the adaptive immune system.

Cells–Mostly white blood cells (WBC) are involved in the innate immune system:
Mast Cells – A group of cells that mediate the inflammatory response. Although they are often associated with allergies, they are a critical part of the immune response.
Phagocytes – Large cells that move like amoeba. They “eat” other cells by surrounding them with their plasma membranes producing “bubbles” in which they can release enzymes safely without damaging other cells. They also have a “clean-up” role to remove the body’s dead and dying cells.
Macrophages – Large phagocytic cells that efficiently consume multiple pathogens. Heavily motile and actively cross from the blood stream into tissue to hunt down pathogens. They kill by manufacturing and releasing free-radical oxygen in a local area.
Neutrophils/Eosinophils/Basophils – A group of similar cells that are the “first responders” to migrate to an inflammation site. They appear at the site of a wound within a few minutes of trauma.
Natural Killer Cells – These cells recognize the body’s own cells that are infected by viruses or are cancerous. They then induce controlled cell death to halt the spread of the infected or cancerous cells. Recent research shows that Natural Killer Cells also play a role in the adaptive immune response.
Dendritic Cells and Gamma/Delta T Cells – These are the bridge between the innate and adaptive systems and their main role is antigen presentation. They harvest antigenic proteins from damaged pathogens and present them to T-Cells, which allows them to find and attack the pathogens.

Then there’s the Adaptive Immune System.

The dendritic cells, from the innate immune system, activate the body’s adaptive (or acquired) immune system. The adaptive immune system is composed of highly specialized, systemic cells and processes that eliminate or prevent pathogen growth. In acquired immunity, pathogen-specific receptors are “acquired” during the lifetime of the organism (whereas in innate immunity pathogen-specific receptors are already encoded in the germline). The acquired response is said to be “adaptive” because it prepares the body’s immune system for future pathogenic challenges. In some cases, the acquired immune response can be maladaptive when it results in autoimmunity. Antibodies, produced by B-lymphocyte cells, are the main weapon of the body’s immune system to battle pathogens. It is a larger response than innate immunity and once sensitized to an antigen, the adaptive immune system often fights of diseases even before we can exhibit symptoms of disease. Immunizations introduce the pathogen’s antigen to the adaptive immune system so that it can form those pathogen-specific receptors and, thereby, are able to quickly and efficiently respond to an attack by a pathogen.

Cells involved –There are three types of cells involved with the adaptive immune response:

T – Lymphocytes (also known as T-cell) – The main role of the cell is to recognise cells infected by viruses and trigger the apoptotic pathway that destroys the cell and its viral contamination. Since viruses only replicate inside cells by hijacking the cell’s manufacturing process, this apoptosis kills the virus (and the host cell) and phagocytes swoop in to consume the destroyed cell debris and digest the contents. The antigen of the viral cell is recognised by surface antibodies on the T-Lymphocyte, which activate it. There are also helper T-Cells whose role is control and organisation of the apoptosis response to the infected cells.

B – Lymphocytes – The main role of these cells is to produce humoral (free floating) antibodies that recognise pathogens and mark them for destruction by other cells. This process occurs by activating the complement system and by causing the pathogen to become “sticky” but only with other pathogens. This causes them to clump together and make them easier to kill by T-cells.

Memory Cells – After an infection has passed (and most of the T-cells and B-cells have died), a few do remain in circulation to remember the antigens of the pathogens who attacked. In future infections these are rapidly activated to produce a humoral response which quickly destroys any new infections even before they produce any symptoms. There are two types of these cells: Memory B cells, which, produce the antibodies that recognize the pathogens, and Memory T cells, which remember the viral antigens that infect cells.

The article continues with more specific information about how the system works, but essentially, most of the immune system’s action consists of responding to a pathogen. Ergo, if you want to “boost” it, then you need to introduce a pathogen into your system to make it work. So get sick.

If you want to boost it a little, you can cut yourself and get it infected. Some food poisoning or a common communicable disease can boost it some more. A chronic condition is the gift that keeps on giving – your immune system will constantly be boosted.

But if you really want to boost your immune system to the max, then you need to go for an autoimmune disorder. This will boost your immune system so much that it won’t attack just harmful invaders, but your own cells. Even though they’re cells you’d kind of like to keep. I’d suggest Diabetes, that’s one that’s a little easier to self-induce. But there’s always Lupus, or Multiple Sclerosis, maybe Rheumatoid Arthritis. Get yourself one of those, and you will have one of the most boosted immune systems it’s possible to have.

Unfortunately, no amount of boosting your immune system is going to make you healthier. And that’s why, even if those ads for stuff that “boosts your immune system” sold stuff that worked, you really wouldn’t want it.

Jan28

My Brain Diary, Part 11

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My Brain Diary, Part 11

Right now is not so good. I’m going to be pretty frank, but I don’t want people to worry. I’ve been through some bad brain stuff even before Roscoe took over my life, and even when I’m close to the bottom of the deep well of suckitude, I can still remember to look up to the light at the top and know there’s a way up as well as a way down.

My medications aren’t working the same way as they did before, which is no surprise. If you look at the early MRIs, there was a lot of compression. Blood supply was rerouted or restricted. Neurons were obviously going to be moving around trying to get past blockages. And the limbic system, where most of our emotions are seated, was pretty wonky from getting pushed out of shape. So this is just like starting all over again from scratch. Cymbalta is too stimulating an antidepressant because it’s a norepinephrine reuptake inhibitor, meaning that my whole “fight or flight” reaction is on higher alert than it should be. I also had to discontinue Adderall for the same reason, and add in Klonopin because my life had become all panic, all the time.

When you’re transitioning from one antidepressant to another, there’s this horrible period during which you’re getting too little of both of them. That’s where I’m at right now. I’m titrating down on Cymbalta – 15mg per day. This is enough to reduce the panic and keep the brain zaps to a minimum, but not enough to affect my depression. At the same time, I’m beginning sertraline (Zoloft) but only a measly dose of 25mg. Not only not enough to even tickle the edges of depression, but also only starting the 4-6 week journey before it shows any effect whatsoever. In a few days I’ll be off the Cymbalta (protip – it’s a capsule full of beads, so if you feel a brain zap, and ONLY if you feel a brain zap, take one or two BEADS. Makes it less awful.) and up to 50mg of sertraline. Still a baby dose, and still at least two weeks away from making even a tiny bit of difference.

So, yeah, I’m in a pretty bad way right now. Fortunately, even when a smidgen of suicidal ideation pops up, it’s easily quashed by reminding myself of the light at the top of the well of suckitude and by making a plan so elaborate (typical ADHD) that I’d decide it was too much effort before I even came close to doing anything about it. No matter what I might say in the throes of depressive misery, you’re not going to get rid of me that easily. Heh.

The whipped cream and cherry on top is the visit to the neurosurgeon. My brain, right now, is about as good as it’s going to get. I’m going to see a neuropsychologist for an evaluation, and probably end up with some kind of therapy to help me adapt to my new neurological paradigm, but I was kind of hoping for normal. Having that hope dashed is not helping with my mood. Yes, I’m way, way better than I was two years ago, but there are things that are a struggle still.

My spatial relations are vastly improved – I have a much better concept of where I am in the space that surrounds me, I have my sense of direction back, and I’m aware of objects around me, both moving and stationary. However, “mirror images,” both literally (myself in the mirror) and figuratively (looking at pictures or looking at other people) are bizarre and confusing. I have trouble telling right from left, and forwards from backwards. Up and down are intact, thank goodness. Blow drying my hair has been an adventure, and I still haven’t quite mastered the art of flossing my teeth without hurting myself. If I look at my MRIs, I have to pretend that they are someone else’s, because their orientation is like a mirror, and they start from the far side and come forward. If I think of them as mine, I can’t get past the idea that my left side is on the right of the image, and the coronal slices as they move from the back of my head to the front are coming towards me instead of moving away from me.

I don’t lose my balance all that much anymore, either. . .but it still happens.

Since the tumor smooshed my left occipital lobe and left temporal lobe, I also have some problems that are related to vision and vision-related language performance. I don’t have any consistent object or color blindness, but sometimes I will look at things, see them, but not really “recognize” them, or know what they are. Quick example – we were at a food kiosk, and I wanted to leave a tip. There was a bright blue tip cup by each cash register. On the one that was right in front of my face, I couldn’t see the word “tips” written on it. I saw only the “s” and thought for some reason that it meant that was a cup for straws. So I reached over and put the tip in the cup on the other side of the kiosk, because I could perceive the whole word on that one. Other times, I won’t see things outside of what I’m looking at because I simply don’t understand why the thing I’m looking at isn’t the thing I want. Really. I look at it, and I think “this isn’t what I want? Why isn’t it what I’m looking for?” and the thing I want is right there above it or below it or next to it.

The most frustrating thing, though, is the anomia. This is where the temporal lobe gets involved. Most of your language processing occurs in your left temporal lobe, and the normal loop between seeing something and saying it involves the visual image that’s processed somewhere in your right hemisphere (depending on what it is) being “translated” by your left occipital lobe and sent into the language loop in your temporal lobe. That’s not happening for me. But only in one direction. If I see an object or a person (or picture an object or person in my head) there’s a good chance that I will not be able to name that object or person. I could tell you everything about that object or person that I knew, except for what that object or person is called. And the name I remember this morning may well be completely inaccessible in a few hours. No amount of prompting, besides actually telling me the word, is going to bring that name into my conscious thoughts.

In the other direction, no problem. If I hear or read a noun or a name, I have no trouble whatsoever picturing that object or person in my mind. But it is kind of a problem – because when I’m circumlocuting to try to use the words I have to describe the word I don’t, people try to be helpful and finish my sentences for me. And once they say the word that isn’t the one I’m looking for, it creates a new mental image that supersedes the one I’m trying to describe, and all is lost. I know they’re trying to be helpful, and I know it’s awfully difficult to listen to me when I’m struggling through this, but really, the only thing it accomplishes effectively is to make me feel like crap and maybe even start crying. Just a heads up. I won’t hold it against you, I promise, but I will probably start to cry.

So. . .I see the psychiatrist in another couple of weeks and we’ll ramp up the sertraline if it’s working OK. I may even be able to go back on Adderall once my dose is stabilized. We’re looking at mid-March here. If you’re worried about my mood, look at your calendar. If it isn’t halfway through March, stop worrying. I’m just transitioning between medications.

February 11th, I go for a consult with the neuropsychologist, and get another dose of reality about how much improvement, if any, I can expect with therapy. Until then, I have regressed to the mean, and everything I just described above is SOP. And that’s just the way it is.