Study: Drugs and Doctors; Moral Obligations

Drugs given to help manage ADHD can be very effective when they are prescribed for kids who have been properly diagnosed. However, when these drugs are prescribed as study aids they can become addictive and can produce serious cardiac risks.  

Dr. William D. Graf, professor of pediatrics and neurology at Yale University School of Medicine New Haven, CT, and five colleagues became concerned when they noticed the increasing number of physicians prescribing ADHD drugs like Ritalin and Adderall- to perfectly healthy children.

The dramatic increase in the number of children taking stimulants and other "study drugs," as they are popularly known, seems to back up his anecdotal evidence.

The Yale doctors have publicly taken a position on this topic in a paper that offers guidance to physicians and discusses the ethics of prescribing stimulant drugs to children who do not have ADHD in order to help them do better in school.

The paper suggests that physicians have a moral obligation to prevent misuse of medication.

It concludes that the practice of "neuroenhancements" isn't justifiable. It adds that the prescription of these drugs is inadvisable because of "numerous social, developmental, and professional integrity issues."

"We are a highly competitive society, and we know some physicians are prescribing these at a parent's request," Graf said. "Other parents have told us they felt doctors pushed these drugs on their children."

Several studies have looked at the increase number of students who are taking study drugs. A 2004 study notes that in some U.S. schools "the proportion of boys taking methylphenidate (Ritalin) exceeds the highest estimates of the prevalence of attention deficit-hyperactivity disorder."

Another study suggests that about 16% of the population of some high schools and colleges use prescription drugs as study aids.

Other college professors have noticed the increase in college students who are either taking or asking for study drugs. Many students believe it is the only way they can have an advantage in competitive schools with rigorous curriculums.

Dr. Mark Wolraich, chairman of the American Academy of Pediatrics clinical practice guideline subcommittee on ADHD, says this newly published position paper represents "pretty much the position that all clinicians have." His only concern is that parents who hear about it may be too nervous to seek treatment for their children with ADHD, for whom the drugs would actually be beneficial.

"They can work really well with kids with ADHD," Wolraich said.

He also believes there may be a valid reason for the increase in students who are taking ADHD drugs. More is known about ADHD and more students are being correctly diagnosed with the condition. Until recently, many physicians believe that children would eventually outgrow ADHD symptoms. New research shows that ADHD symptoms can carry on into adulthood.

"We used to think it disappeared at puberty, but it's not the case. So there will be more cases of adolescents and people at older ages diagnosed with ADHD," Wolraich said.

Graf and his colleagues say they are more concerned about physicians prescribing ADHD drugs when there is not a medical need for it and believe that it is time to take a stand.

Parents and students should educate themselves about the dangers of taking these potent stimulants when they are not used to treat ADHD. It's far too easy to obtain them and justify that they are just temporary.

High school can be difficult and so can college. But previous generations managed to make it through both, with good grades, by doing what it takes to succeed without the use of stimulants. In our accomplishment driven society kids may have a more difficult time in school not because the pressure is greater, but because they are depressed, anxious or sleep deprived. These are situations that can be helped through counseling, understanding, motivation and better sleep habits. This solution doesn't offer a pill's temporary quick fix, but it may help students be better able to handle all of life's unexpected challenges in the long run.

If your child doesn't have ADHD and becomes dependent on prescription or illegally obtained pills to apply themselves or to be able to study, what are they going to do when school is finished and they have to continue to apply themselves and focus in the real world - take another pill?

Physicians can help guide parents and students. They can make sure that prescriptions are medically necessary. They can explain the side effects and offer other possible solutions. I think that's the important point the doctors at Yale University were trying to make.

The paper was published in the journal American Academy of Neurology.

Source: Jen Christensen,

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