Book Review: ADHD Nation

A.D.H.D. Nation:Children, Doctors, Big Pharma, and the Making of an American Epidemicby Alan SchwarzScribner, 2016Longtime New York Times reporter Alan Schwarz opens his alarming and thought-provoking new book A.D.H.D. Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic by writing flatly: “Attention deficit hyperactivity disorder is real. Don't let anyone tell you otherwise.” But this isn't true. There's no uniform standard of diagnosis for this “disorder,” no way to detect it physically in the body, no proven method of treatment, no clear clinical history, and no research elaboration that isn't tied lock-step to the pharmaceutical industry that profits from that elaboration. The entire concept is far, far too plastic to be considered “real” in any useful sense of the word. I could try for months with every practicing physician in Boston, but I would never succeed in getting even one of them to diagnose me with lung cancer if I didn't have it; I could have not only a diagnosis for A.D.H.D with less than an hour's effort, but I could walk out of that diagnosis loaded with script for powerful medication I in no way need. And if I were the enterprising sort and had an extra hour, I could almost certainly tie the prescribing physician financially to the manufacturer of the prescribed “medication.”I suspect Scwharz opens his book with such a claim because he's driven by compassion; A.D.H.D. Nation is an unfailingly compassionate book, presenting a gallery of vivid portraits of people on both sides of the equation, the doctors and researchers doing the developing and prescribing the drugs, and the individuals and families who consume those drugs in numbers that increase enormously every year, especially in America, as Schwarz reports:

As for ADHD drugs in and of themselves, no country has anywhere near the enthusiasm of the United States, which until recently had prescribed more than 90 percent of the world's amphetamine and methylphenidate. But the rest of the world is catching up. From 2000 through 2010, its consumption of ADHD drugs almost doubled.

Five million adult Americans are taking some kind of A.D. H. D. drug like Adderall, according to Schwarz (this is more optimism; there are plenty of indications that the actual number is astronomically larger). The target diagnostic demographic has steadily widened, from children to adults and now with more and more seniors included. Virtually all of these diagnoses are to one extent or another the product of purely economic aggression on the part of multi-billion-dollar global pharmaceutical companies like Pfizer and GlaxoSmithKline – with all the predictable results you'd expect when some kind of problem is being described by the same people who are selling its solution. Pfizer and GlaxoSmithKline funded the bogus research that gave these “disorders” a clinical paper trail; Pfizer and GlaxoSmithKline bought the American Psychiatric Association wholesale and strong-armed it into including a host of such “disorders” in successive editions of the Diagnostic and Statistical Manual; Pfizer and GlaxoSmithKline flooded their “medications” onto the market through the people Schwarz rightly calls the “gatekeepers” – physicians with their prescription pads (whose offices are full of free samples and whose travel itineraries feature Big Pharma-funded trips to “conferences” in scenic locales); Pfizer and GlaxoSmithKline ruthlessly suppressed public awareness of the many and terrifying short- and long-term negative side effects of their snake oil (to the limited extent that the long-term effects can even be guessed – check back with the “millennials” in 2035 and ask about their incidence of cancer or psychiatric problems, and while you're at it, ask about their kids, all of whom will have been “medicated” since kindergarten); Pfizer and GlaxoSmithKline poured so many hundreds of millions of dollars into shaping public and professional perception of both the “disorders” their fraudulent research identified and the fraudulent “medications” they then sell to treat those disorders that even so clear-eyed a reporter as Schwarz includes pieties like “It's unassailable that the vast majority of ADHD medications are used properly by people with legitimate medical needs” with absolutely no evidence that such claims are true – in fact, as a close reading of his book makes clear, with ample evidence that such claims are false. A sixth grade boy disliking homework is not experiencing “legitimate medical need.” A teenager feeling self-conscious because of acne or small breasts or a stutter is not experiencing a “legitimate medical need.” A twenty-something occasionally feeling adrift in life is not experiencing a “legitimate medical need.” And yet, vast uncounted thousands of people in America alone have access to unscrupulous doctors nonchalantly renewing script for powerful psychotropic drugs for just such “legitimate medical needs.” The result is a quiet nightmare: tens of thousands of children and adults who have absolutely nothing medically wrong with them casually talking and texting and tweeting about their “meds” and casually ingesting mystery chemicals while Big Pharma rakes in more pure profit in a year than the US Treasury.One of the many merits of Scwharz's book is its willingness to keep up at least a faint refrain of skepticism, far, far in the background. He regularly – well, semi-regularly – reminds his readers that nothing in science ever happens without at least some dissent:

As diagnoses rose, so did skepticism of just what doctors were truly identifying. If the syndrome were minimal, why use such serious medications to treat it? If it involved the brain, why didn't anything show up on any cerebral scans? And what constituted dysfunction, anyway? What was wrong with these kids medically? The critics did have a point.

In fact, it's the whistleblowing aspects of ADHD Nation that stand out as its best subordinate strand. Schwarz's narrative is empathetic toward all the people on the receiving end of this enormous industry, especially those who come to seem like that industry's most abject victims: the tiny percentage of people who actually do have the kind of crippling chemical imbalances that legitimately researched and targeted medications could help alleviate. That percentage is likely somewhere around one in one million, perhaps one in two million; Big Pharma would have you believe it's one in one hundred, perhaps one in ten (or, thanks to the invention of the concept of a “spectrum,” it could be that sweetest of all Big Pharma dreams: every single person on Earth). And since every regulatory agency or institutional check has long since been fatally compromised with political pressure, lobbying finesse, and canvas sacks stuffed with cash, the only way to help that tiny percentage – the only way even to know anything about how to help – is to tear down the entire system and begin again from scratch.But that would result in over 80 million people in America alone beginning withdrawal symptoms that are in many cases as severe as those experienced by detoxing cocaine addicts. It's almost like Big Pharma thought of everything.