There have been quite a lot of stories recently about Adult ADHD and the way the condition is being ‘marketed’, both here and in the US. Once the condition itself has been successfully marketed to a suitably enlarged target audience then the medicinal ‘cure’ can be sold to all the many hundreds of thousands of newly diagnosed ‘sufferers’.
Now we get the Royal College of Psychiatrists singing from the same hymn sheet:
A significant number of adults with unresolved depression, anxiety or addiction may actually have Attention Deficit Hyperactivity Disorder (ADHD), a condition that has been widely considered to resolve in late adolescence.
Armed with the correct diagnosis, adult ADHD sufferers could soon be prescribed Ritalin-style stimulant medications for a range of mental health problems that are not usually associated with the disorder, the Royal College of Psychiatrists’ annual meeting was told on Friday 4 July.
Stimulant medication is currently only licensed for children with ADHD. However, the National Institute for Health and Clinical Excellence (NICE) is expected to recommend that this class of drug can be prescribed adults with ADHD in September 2008 – following the recognition that the condition persists into adulthood in about 20 per cent of cases diagnosed in childhood.
But while ADHD symptoms in children include inattentiveness, hyperactivity and impulsiveness, the condition in adults is associated with a much wider range of co-existing mental health problems.
Professor Phillip Asherson, professor of molecular psychiatry at the Institute of Psychiatry, told the meeting: “Most frequently, adults with ADHD are diagnosed with chronic and persistent depression and anxiety, difficult-to-treat alcohol and drug addiction and personality disorders.
“We don’t yet know whether these co-existing disorders are separate problems or whether these people are actually suffering from a form of ADHD that is presenting in a different way from the normal symptoms. It could be that many people are being diagnosed as having a separate disorder when in fact they have got ADHD.”
Currently, clinicians are wary of using stimulant medication in adults, as the only group of drugs that are licensed only for use in children. However, Professor Asherson said: “This is likely to change once the new NICE guidelines are launched in September.”
Meanwhile, Professor Asherson is about to embark on a major study to identify adults with ADHD who present in GP surgeries and addiction centres. “We have no idea as yet whether these problems will respond to stimulant medication. If they do, then this type of drug could provide effective treatment for a significant number of adults who currently have unresolved mental health problems,” he said.
The Annual Meeting of the Royal College of Psychiatrists, Imperial College, London, 1 – 4 July 2008
Now I wrote about the start of the Adult ADHD marketing campaign a while ago… a year ago in fact:
The excerpt below is from David Healy’s Marketing Drugs and Changing Lives in the US… you can read more here.
Consensus conferences aimed at producing guidelines for clinical practice came into existence in the late 1980s (Sheldon and Smith 1993). A range of bodies took up this apparently academic development. Within psychiatry, groups such as the British Association of Psychopharmacology and the European College of Neuropsychopharmacology, for example, produced guidelines on the treatment of a range of conditions from depression through to schizophrenia. This may have happened in part in an effort to establish a political profile. In a number of the organizations that produced guidelines, the influence of key individuals with links to pharmaceutical companies is apparent.
At the same time pharmaceutical companies began to sponsor meetings aimed at producing expert consensus on issues such as the appropriate use of medication in schizophrenia. These company sponsored meetings have often resulted in products that may appear almost indistinguishable from non-company sponsored guidelines or algorithms. While this might be thought as an exercise designed to confound the recommendations of independent committees, in fact committees that should be independent have come up with recommendations that barely differ from explicitly company-sponsored exercises.
And my point is…?
A couple of posts ago I wrote about a news item that I saw last week – Adult ADHD Marketing Reaches the UK. I wondered where the story had come from – what the “strong evidence” and “research” is…
It is only in the last few years that strong evidence has emerged about the extent of ADHD in the adult population. It is thought up to 8% of children may be affected, and research suggests that half or more may have symptoms past adolescence into their twenties, thirties or even forties.
Yet the condition is barely recognised by the health service beyond 18 years of age.
Professor Anthony Hale, professor of psychiatry at the University of Kent, said patients are being failed by the system. “There are huge numbers of people across the country who are on waiting lists to see adult psychiatrists who don’t have the expertise to deal with them. The 4% of the adult population figure is very real.”
…Dr Marios Adamou, whose clinic is due to close in October due to lack of funding, said poor access to treatment is a real problem.
“For some people it may mean catastrophe, because some people without the medicine are prone to offending behaviour, and prone to aggression. So a few people may end up being arrested, being imprisoned. Others may fail in their courses, others may fail in their occupation.”
Dr Adamou says Britain is years behind most other European countries in dealing with this problem.
Most of the medication is licensed for use only in children, and many of the treatments are controlled drugs, so GPs – and many adult psychiatrists – are often reluctant to prescribe them.
The “strong evidence” and “research” mentioned, comes from a consensus meeting of 2006 (ADHD in transition from child to adult), organised by the British Association for Psychopharmacology (BAP) and funded by Cephalon, Janssen, Lilly, Shire UK and Shire US – all drug companies that manufacture ADHD drugs – Adderall, Modafinil, Concerta and Strattera. All of the drug companies also supplied ‘observers’ who attended the meeting to… ‘observe’, I suppose.
The Consensus Group was headed by Professor David J Nutt – would this be a good time to mention the Professor’s links, I wonder? – Professor Nutt has acted as a consultant to Pfizer, GSK, MSD, Novartis, Asahi, Organon, Cypress, Lilly, Janssen, Lundbeck, Wyeth. He has speaking honoraria (in addition to above) with Reckitt-Benkiser and Cephalon. Grants or clinical trial payments from MSD, GSK, Novartis, Servier, Janssen, Yamanouchi, Lundbeck, Pfizer, Wyeth, Organon. He has 300 shares with GSK (ex-Wellcome). Professor Nutt also promoted Seroxat at Glaxo’s launch of Seroxat for “social anxiety disorder”.
Also at the consensus meeting were Professor Anthony Hale and Dr Marios Adamou, who work together in Kent. In 2003 in a letter they co-wrote to the BMJ they signed off: Competing interests: M. Adamou is a co-investigator to pharmaceutical companies producing or developing neurotropics. A.S. Hale is an investigator and advisor to pharmaceutical companies producing or developing neurotropics.
I just can’t help thinking that maybe things might not be quite so clear cut as they seemed when this story was first published.
Adult ADHD – coming to a UK GP near you ASAP.