Brain Atrophy - Amphetamine based Drugs

Education and Health Wednesday, 02 June 2004 Page 1

Before we commence, I am required to advise you that a committee hearing is a proceeding of the

Parliament and warrants the same respect that proceedings in the House itself demand. Even

though you are not required to give evidence on oath, any deliberate misleading of the committee

may be regarded as a contempt of Parliament. I remind those in the public gallery that at no time

during the hearing can they interject or interfere with these proceedings. Have you completed the

“Details of Witness” form and do you understand the notes attached to it?

evidence before parliamentary committees?

before us today. As you are aware, the committee is conducting an inquiry into attention deficit

disorder and attention deficit hyperactivity disorder. Before we ask any questions, are there any

particular issues that you would like to bring to the committee’s attention?

to give his evidence.

The Citizens Committee on Human Rights is the local chapter of an international organisation

called the Citizen’s Commission on Human Rights. CCHR was founded by professor of psychiatry

Dr Thomas Szasz and the Church of Scientology. CCHR is an independent organisation set up to

investigate and expose violations of human rights within the psychiatric industry. I am the

chairman of CCHR here in Perth. We consider the false labelling and consequential drugging of

children a violation of their human rights. Also, the lack of factual information given to parents

about the dubious nature of the ADHD label stigmatising children and the dangerous nature of the

drugs is a violation of their right to fully-informed consent. Since 1991, CCHR has said that

antidepressants are dangerous and could cause suicidal thoughts. Earlier this year, the British

Medicines and Health Care Products Regulatory Agency banned SSRI antidepressants bar one from

being prescribed to children because of the risk of suicide. It has taken 13 years for the Australian

Therapeutic Goods Association, along with the US Food and Drug Administration, to finally agree

with this and choose to review the use of antidepressants. CCHR has also been saying this about

the drugs to treat so-called ADHD. How many more years and how many more children are we to

lose to these drugs before we do something? Are we to find out later, at a terrible cost to future

generations of children, that it was a bad mistake?

The Monthly Indexed Medical Subscriptions, or MIMS, is the manual doctors use to prescribe

drugs. The 2003 MIMS states under the drug dexamphetamine that some of the adverse reactions

Education and Health Wednesday, 02 June 2004 Page 2

are psychotic episodes at recommended doses, aggressiveness, anxiety, confusion, delirium,

hallucinations, panic attacks and suicidal or homicidal tendencies. It further states that there is no

specific evidence which clearly establishes the mechanism whereby amphetamines produce mental

and behavioural effects in children.

Remarkably, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental

Disorders No 4 - Text Revision - states that there are no specific physical features associated with

ADHD. It states also that there are no laboratory tests, neurological assessments or attention

assessments that have been established as diagnostic in the clinical assessment of ADHD.

Additionally, it states that signs of this disorder may be minimal or absent when a person is

receiving frequent rewards for appropriate behaviour, is under close supervision, is in their normal

setting, is engaged in especially interesting activities or is in a one-to-one situation, e.g. the

clinician’s office. So, a psychiatrist diagnosing a child cannot see it and cannot test for it, and it

will probably not be there when the psychiatrist sees the child in his office. From the earlier

evidence that the committee has been given, WA appears to be going the way of the trends in the

United States. It is patently obvious that legislation is required to protect the rights of children and

their parents. Schools, school administrators and personnel, and teachers specifically, should be

excluded from the promotion and unqualified pseudo-diagnosis of ADHD. CCHR is aware that in

Western Australia we are remote from the rest of the world and that it is not possible for this

committee to visit the United States to become informed of the latest information. As such, we

have brought paediatric neurologist Dr Fred Baughman to the committee so that he can update the

members on the latest and historical data on ADHD.

I have brought with me copies of the most recent Bills and resolutions passed and proposed

throughout the United States, which are also available on the CCHR web site, fightforkids.com. Dr

Fred Baughman has given me other information that I will provide to the committee later. If

members want any further information, please ask.

mentioned?

has also prepared videos on a national conference on ADHD in America - I believe one is 55-

minutes long and the other is 3.5-minutes long - which address the specific issues he would like to

raise.

this issue. I am a retired physician, neurologist and child neurologist. I have a research

background. I have discovered and described real diseases. Throughout the late 1970s and early

1980s, I began to see in my practice a growing number of children labelled hyperactive child

syndrome, minimal brain dysfunction and ADD. I would take a careful history and do a

comprehensive examination, as with all patients, and I grew increasingly alarmed about this

epidemic in light of the fact that I was not able to adduce evidence of physical abnormalities in

these children. In other words, I was unable to determine that they were other than normal.

Increasingly, when sending these children back to their schools and teachers, I was told by such

personnel that if I could not find the ADHD, they would, or they knew someone who would, and

that if I would not write the Ritalin prescription, they knew someone who would.

I took to writing and speaking about my concerns throughout the last decade of my practice and

then, as of retirement in 1993, I was able to devote full-time to this issue and to writing and

speaking about it and to participating in medical legal cases bearing on this issue. I have testified in

state legislatures in about nine states as we, in recent years, have passed legislation that would in

effect ban teachers from participating in what are medical decisions to keep them from mentioning

such diagnoses, such treatments and forcing parents to get their children to physicians. I testified

Education and Health Wednesday, 02 June 2004 Page 3

before the US Congress in September 2000 and before the European Union in November 2001. I

am in touch with persons here and all over Australia and have been sent items of concern on this

refers to Dr Kosteric of the General Practice Committee, whom I have had the pleasure of meeting,

who said that he had great concerns about a 21-fold increase in the prescription of ADHD

medication since 1990. He said that the diagnosis of ADD is entirely subjective. From the journal

disease. He said that the symptoms of its three-dimensions - activity, attention and impulsivity - are

normally distributed in the population with an arbitrary level of symptoms being designated as

February of 1999 reported that the use of mind-altering drugs to treat hyperactive children has

recently risen by more than 100 per cent in 50 countries. Australia is one of several countries in

that one in four Tasmanian children in primary school is on drugs for behaviour problems according

to a leading parent-support group. I am told that the rate of ADHD diagnosis and drug use here in

Western Australia is four times the national rate and that the rate of prescribing is said to surpass

that in the US, where I can tell you that currently the epidemic stands at six million to seven

million, or roughly 11 to 12 per cent of our public school population.

I will read some of the criteria from the Diagnostic and Statistical Manual No 4 of the American

Psychiatric Association. It is these criteria authored by the APA that provide the diagnostic tool -

the parent and teacher behaviour check lists. It calls for checking any six of nine items pertaining to

inattention, which are as follows -

(a) has to do with making careless mistakes

(b) difficulty sustaining attention

(c) does not listen appropriately

(d) does not follow through

(e) is not organised

(f) cannot sustain mental effort

(g) often loses things.

Finally, there are criteria such as: is distracted, is forgetful, fidgets, leaves seat, runs and climbs

excessively, is not quiet, is often on the go and talks excessively. If six of nine of these items are

checked in the inattention or hyperactive categories, a diagnosis is made of a brain disease, and the

parents of such a child are asked to believe that a brain abnormality, due to a chemical imbalance of

the brain, has been diagnosed. I submit that if we do not abandon our commonsense and we read

and re-read the criteria that psychiatry puts forth, and that increasingly other specialties have

coopted into their practices, this does not meet the commonsense test and one should be

immediately doubtful.

I testified in hearings in the State of Tennessee in 1997, during which a young father testified about

meeting his son’s psychiatrist for the first time. He had just gained custody of his boy, a 10-yearold,

I believe. He asked his psychiatrist why his son was on Ritalin. The psychiatrist said that it

was for his chemical imbalance. The father said, “I would like to see the laboratory results that

designate that he has this chemical imbalance.” The psychiatrist said that he did not have the

records at hand. The father persisted, and the psychiatrist said the records were in storage. The

father persisted, and the psychiatrist became flustered and banished the father and son from his

office - because there was no chemical imbalance; there were no tests. There never are.

All physicians, even psychiatrists, go to medical school. We all study normal anatomy, biology,

physiology and chemistry and then we study abnormalities or diseases. Abnormalities or diseases

Education and Health Wednesday, 02 June 2004 Page 4

are those that are grossly evident, such as a mass or a growth from the shoulder or felt in the belly.

They might be microscopic, as with the cells taken in a pap smear from a woman at her annual

physical, or they might be biochemical, as with the testing that must be done to diagnose diabetes.

Very simply, until any physician has demonstrated an objective physical abnormality, gross

microscopic or chemical, they have not demonstrated the presence of disease and should not say

that there is a disease present. In ADHD, there is no tangible gross microscopic or biochemical

abnormality; yet this diagnosis virtually always leaves the diagnosing physicians to tell the parents

and all concerned in the life of the child that there is a brain disease present and that it, indeed,

needs treatment almost always with methylphenidate or an amphetamine, all of which are schedule

2 drugs, which means they are highly controlled substances under the International Narcotics

Control Board, or, in the United States, under the Drug Enforcement Administration. Attempts

have been made by CHADD in the United States and my own organisation, the American Academy

of Neurology, to lessen the addictive classification of this group of drugs, but those attempts have

all been turned back by the INCB and the DEA, attesting to the high degree of addictiveness of

these drugs, not to mention their other dangers.

All physicians have this duty of diagnosis of determining whether there is a disease or not. They

then have a duty of informed consent, which is to tell parents and patients all the facts about their

condition and about the drugs that might be used in their treatment. I submit that, in saying ADHD

is a disease, they totally abrogate informed consent with that one statement alone. If they go on to

categorise these drugs as non-addictive or hardly addictive, they defeat informed consent on yet

another score. There is a line of research that organised psychiatry in the United States offers as its

proof that ADHD is a disease. This research has mainly been done at our National Institute of

Mental Health. This involves brain scans of a kind that we all have in our major hospitals at least -

so-called magnetic resonance imaging scans. People who have had an automobile accident and a

head trauma or who have mounting headaches, possible brain tumour, subdural haematoma and

things of that sort, commonly get what is called a structural MRI brain scan. Back in 1986, a study

was done - this one was not with an MRI; it was with the MRI predecessor, a CT scan - by the

group at Ohio State University and it did CT scans on 24 young adult males, all of whom had had

hyperactivity, all of whom had been drugged - that is, had been treated. They scanned 27 matchedcontrol

subjects. They found that 58 per cent of the ADHD subjects had shrunken brains - brain

atrophy - that was evident to the naked eye of the radiologist, whereas in the control group - the

normal controls, never treated or diagnosed as ADHD - only one of 27 had such brain atrophy.

These authors, Nasrallah et al, suggested that it might be that the drugs were causing the brain

atrophy, not the never-proved entity ADHD.

Beginning in 1990 up to the present time there have been a total of roughly 14 studies that similarly,

though using MRI technology, have looked at populations of ADHD subjects and compared them

with matched normals. In all instances, as reported in 1998 by Swanson and Costellanos at the

consensus conference, which is the substance of the tape I have submitted, the ADHD groups had

brain atrophy or shrinking. James Swanson was the presenter of the review of that brain imaging

literature. He presented it, and concluded that it was clear that ADHD was causing this on average

10 per cent brain shrinkage and that this was the proof that ADHD was a brain disease. I was an

invited presenter at that consensus conference. I took a floor microphone and asked Dr Swanson

why he had not told the audience that all of the ADHD cohorts in this research had been drugged -

every last group, which is true to this present day - and that the only physical variable was the

drugging. That these drugs cause brain atrophy or shrinkage has been proved time after time - as I

said, a total of approximately 14 studies, which are all summarised and reviewed in a review article

by Johnathon Leo and David Cohen that I will leave with the committee. However, here they were

prepared to represent this as the “always needed proof” that ADHD was a real disease. From 1990

to 2004, they have continued to do the studies, knowingly always on treated populations of ADHD

subjects, always down-playing the drug exposure, and always concluding that this was due to

ADHD - the proof that ADHD was a disease. However, the fact of the matter, as shown by the

Education and Health Wednesday, 02 June 2004 Page 5

Leo-Cohen Review, and others, is that there has never been any proof and there is no proof that

ADHD is an actual brain disease. There is irrefutable proof that these drugs are causing, among

other things, brain shrinkage, which is a gross abnormality of the brain.

The committee will have the videos and they will see my encounter with Dr Swanson. You will

hear the consensus conference panel conclude that we have no evidence that ADHD is a brain

disorder or brain dysfunction. We have no test to diagnose it. I conclude by urging that, if it is

contended that this is a brain disease and that so many of the children here in Western Australia

have it, the committee write to the Australian and/or the Western Australian neurological

association and ask it for proof that this is a disease and what tests are available to diagnose it

objectively. I also ask that the committee write to the Australian and Western Australian

pathological association and ask it whether there is any proof in the form of biochemical tests or if

there is any histologic confirmation at post mortem or in any way during life by which to diagnose

this entity. With that, I will close and entertain any questions members wish to ask.

an article.

left 30 documents that I have submitted. Many of those are letters from officials or from scientists

at the NIMH. One is from the director of the NIMH, Stephen Hyman, of about September 2000

confessing that as of that time there was no proof and so on.

present to our committee. This committee has been established to try to resolve what is now a

difficult and complex issue and to give some direction to state policy in Western Australia, because

there are mixed opinions that we are hearing, and there are also a lot of parents who seek to do the

right thing by their children but are confused about what is the correct thing to do and what is not.

You are obviously fairly definite in your views, which is fine. However, you base your views on

the fact that there is no evidence for the existence of ADHD. To me that is fairly clear, because if

there was evidence, we would not necessarily be having this inquiry, nor would there be as much

confusion in the community. It seems to me that there is not a lot of evidence for a range of

“mental illnesses”, and for people who seek psychiatric attention or who seek support from

psychiatrists or psychologists or other people involved in mental health there is very rarely

evidence. There might be physical evidence as a result of an outcome, but in terms of the existence

of their particular mental illness it is often difficult to diagnose. Therefore, for the majority of the

community we rely heavily on the advice of psychiatrists and I guess history of events and similar

activity and so forth. You base your evidence on the fact that there is no proof for ADHD. We

could apply that to many other so-called mental illnesses as well. Why single out ADHD for a

situation for which there is no proof when there are many other areas of mental illness - if it is a

mental illness - in which we would find it very difficult to apply a given test and get some evidence

that it exists?

not only become a psychiatric entity but also in the States the American Academy of Paediatrics has

reprinted the DSM 4 criteria for use in diagnosis by the academy. That so-called guideline for

diagnosis of ADHD was co-authored by the Academy of Paediatrics, the Child Neurology Society

and the American Academy of Family Practice, so it is not just a matter of psychiatric practice and

psychiatric criteria. The other reason for concern is that this entity is uniformly represented to be a

brain disease due to a chemical imbalance of the brain. This almost uniformly is what parents in the

US are told. They are not told that these are just troublesome behaviours, which is what I feel they

are. In fact, at the ADHD consensus conference in 1998, eminent paediatrician William Carey

reviewed these vague subjective criteria and said that these do not constitute anything abnormal and

Education and Health Wednesday, 02 June 2004 Page 6

that one would look at these criteria and have to conclude that the children are normal, even if

troublesome, but they are normal. So a treating physician would tell a naive trusting parent or

patient that the child has six out of nine of these behaviours; therefore, this is a brain disease and the

child is not normal any more but is abnormal. That is what they are being told. They are being told

that this is a disease that is urgent to treat. In the States, increasingly parents are being told that it is

essential that they treat, and if they do not they are negligent parents and they will lose custody of

their child. It concerns me when the basic requirements of informed consent drafted at the

Nuremberg trials following World War II are flagrantly violated and when parents have the nature

of the behaviours so misrepresented to them, for whatever motivation. I cannot say why given

physicians do this. Is it to make patients out of normals, which is what happens? Normal children

become patients, and then when they are drugged that really affirms that they are patients. They do

not get off these drugs. They are on them in the long-term until either they rebel as teens and take

themselves off; or, if they succumb, they stay on these drugs, and others, in addition, as other

diagnoses are done. I would have no problem at all if these were represented to be troublesome

behaviours, which we would say are our parental responsibility, or our teachers’ responsibility, to

deal with in commonsense, talk, therapy and counselling ways. However, instead, what are nonspecific

subjective behaviours are undoubtedly generally being framed as a disease - as a physical

abnormality that must be treated medically.

that there are levels of extreme hyperactivity among some people, particularly some children, and

when some drugs - Ritalin or dexamphetamine - from the evidence we have been given have a clear

effect in being able to provide what appears to be a better outcome for those children in terms of

their studies, social behaviour and so forth, would you feel that would be a reasonable result? In

other words, if it is not a disease any longer - let us say we have assumed that - but it is an extreme

case of hyperactivity, which is caused by whatever, but it becomes so antisocial and so difficult for

the individual and his family that their life suffers, in your opinion would that be a case in which

people would be entitled to seek some medical attention that included drugs?

on the one hand, and treatment, surgery or a drug on the other hand, which always have to be

balanced. In ADHD there is no discernible disease on the one hand, and there are drugs with

multiple and very tangible risks on the other hand. As a matter of fact, even ADHD advocates at

the National Institute of Mental Health point out that a diagnostic trial is never valid and that

normals are always changed by these drugs, so practitioners say we are going to try a child on this

drug, and if they are better and more quiet, more subdued and more attentive, that makes the

diagnosis. There was a paper in 1978 authored by Judith Rapaport of the NIMH that debunked that

notion, so it is not appropriate practice to conduct a trial of a drug and to think that that is a

diagnostic trial. Secondly, about long-term outcomes, the ADHD literature is full of trials and of

studies that average a few weeks in duration. Among the longest of such studies was that of

Gillborg a couple of years ago, which was an 18-month study. I have forgotten exactly what it was.

There are almost no long-term studies, so there is almost no research or empirical literature to guide

us as to what happens with these kids when they are on these drugs for years. We just do not know.

I have my own suspicions, but that is anecdotal as well. The empirical research literature does not

guide us.

associated with hyperactivity and so forth, for you the downside of the prescription drugs that are

given to deal with those issues is far worse than the perceived benefit?

addictiveness and of dangerous side effects, in the decade 1990 to 2000 the voluntary reporting

system - the FDA medical watch program- reported that there were 186 deaths due to Ritalin alone,

without any of the amphetamines. That is a voluntary reporting system thought to account for more

Education and Health Wednesday, 02 June 2004 Page 7

than 10 per cent of the actual incidents. I am talking about children who are on the go, who are

hyperactive and have these troublesome behaviours. There was an era not too long ago when I was

in school, and much more recently than that, when there were no such diagnoses and no such drugs,

and we did not see predictable grim outcomes for children said to have these behaviours, so when

dealt with in commonsense, sympathetic and understanding ways by the adults in their lives - their

parents and their teachers - they turned out to enter normal adult life.

behaviours that are classified now as pertaining to ADHD are not neurologically caused, what are

the causes of hyperactivity and impulsive behaviour?

to read aloud and reads only at first grade level, you will see that child sweat, become fidgety, and

perhaps tremulous. You may have children in your grade schools who come to school underfed.

You may have children coming from homes in which they are dealt with too harshly, perhaps

physically or corporally punished. There are infinite unhappy situations in childhood, all of which

can lead to these non-specific behaviours. It is the duty of the adults in their lives - their parents

and teachers - to understand these possibilities and to try to know whether such things are at work

or are not at work. However, there is nothing more specific than that going on in this list of

behaviours that the American Psychiatric Association seeks to medicalise but that Dr William

Carey says should not be medicalised. He made a heartfelt plea to just call them normal.

Australia - I do not know about the United States - if you take out the little piece of paper that is

usually attached to the medication it will give a long list of possible side effects, yet for the majority

of people who are taking the particular medication it is quite safe. In other words, I am saying that

in 99 per cent of cases a particular medication might be perfectly safe but it might affect one per

cent. With the medication that is used to treat ADHD, could it be that in 99.9 per cent of cases the

medication is safe?

referred to me who have had the ADHD diagnosis and are on drugs. When you are talking about

nervous system active drugs such as anticonvulsants, virtually all of them have some side effects.

The patients do not feel right. They become tremulous, they have a rapid pulse and they have a rise

in blood pressure. I think almost all patients going onto nervous system active medication have side

effects, and this is part of the process of adjusting the dose as they go on these medications. There

are many kids for whom the side effects continue, and they are kept on medications regardless

because the adults in their lives want them on these medications. There are lots of kids who

articulate when they are out of earshot of parents, doctors, teachers and so on that, “I don’t like this

stuff. It makes me feel weird. It makes me feel odd”. I can tell you that the frequency of

aggressive behaviour and anger that comes from going onto amphetamine and methylphenidate is

very high. I would say such things are probably witnessed in greater than 50 per cent of kids.

which I believe is the US brand name for dexamphetamine. They are mainly short-term side

effects. To your knowledge have any long studies been done as to the effect of the use of

amphetamines on a developing brain?

cadre presents to the public as proof that ADHD exists, is in fact irrefutable proof that the grossly

evident - radiographically evident - brain atrophy is due to these drugs. As I mentioned before,

there is almost no real long-term empirical research literature. Some practitioners have a very

glowing view of what these drugs do and never see side effects. I as a neurologist get these kids

referred to me when they have side effects. I would see them developing so-called Tourette

syndrome or tics. It is Tourette syndrome if the tics develop out of the blue with no drug in the

Education and Health Wednesday, 02 June 2004 Page 8

picture. If they never had tics before they went onto Ritalin or onto amphetamine, then it is Ritalininduced

or amphetamine-induced tics. If the exposure to the drug is kept up long enough, the tics

can become a permanent fixture. Tics will be things like shoulder hiking and neck turning. There

are patients who have first seizures on these medications. For patients who have a seizure disorder

and are on anticonvulsant medication, their seizure threshold is lowered; so in my opinion no

patient with a seizure disorder should be put on these drugs, because it makes the likelihood of

seizures increase. Some patients on therapeutic doses become frankly psychotic, confused and

delirious. Cardiac side effects are notable, because they are the cause of most of the deaths. I have

been consulted on 11 deaths, most of which were cardiac deaths. Matthew Smith from Detroit had

been on Ritalin for five years. He did not like being on it, and his parents did not want him on it,

but the school coerced the continued use of drug. He fell over and died at age 13. He had a grossly

enlarged heart - what we call cardiac hypertrophy, or hypertrophic cardiomyopathy. The coronary

arteries were markedly narrowed. The medical examiner said this was the heart that you would

usually see in chronic amphetamine addicts and that Ritalin had unquestionably been the cause of

death. Most cardiac deaths are due to cardiac arrhythmia and cardiac arrest, as in the case of

Stephanie Hall of Canton, Ohio. Her Ritalin was increased, because her grades had fallen and she

was unhappy about that. The first night of the increase, she bid her parents good night and went to

bed, and she died in bed. She had an autopsy, and that was a cardiac arrest, I have no doubt, due to

Ritalin. Several of the other of the 11 cases were cardiac arrests as well. If you look at the

physicians desk reference and at the side effects, there are side effects for virtually every organ

system. You must always remember that on the disease side, there is no proven disease. The risk

benefit ratio under the circumstances in my view is not justifiable.

manufacturer of dexamphetamine. It lists a whole range of side effects, and at the end it says -

Individual patient response to amphetamines varies widely. While toxic symptoms occur as

an idiosyncrasy at doses as low as 2 mg, they are rare with doses of less than 15 mg; 30 mg

can produce severe reactions, yet doses of 400 to 500 mg are not necessarily fatal.

That would tend to indicate that the response is highly individual; that is, it varies across

individuals. Is that your experience?

episode on a relatively low dose of methylphenidate or one of the amphetamines, and the majority

going onto these drugs would not, so I do agree with that. Speaking of manufacturers, I would

point out that Novartis, the manufacturers of Ritalin, has come out and been quite forthright in

saying that ADHD is a neural-biological disorder - a disease. A statement like that coming from the

manufacturer I think is fraud, because as will you see in the review of the literature, there is no

proof that it is a disease.

I have a personal interest, because I am the member for the Kimberley. The Kimberley has the

highest suicide rate in Australia. The second highest, of course, is in Mandurah. They are both

regional centres in Western Australia. We do not actually have a high level of medication in

relation to ADHD. However, to assume that there is suicide if people medicate is a bit of a problem

for me. Can you explain that a bit more?

specifically states that withdrawal from the drug can produce suicidal tendencies. The other

statements that I read came directly from the manual that doctors use to diagnose all forms of drugs.

Education and Health Wednesday, 02 June 2004 Page 9

What I read was directly from the drug dexamphetamine. There is nothing in those books that

correlates specifically that ADHD will produce a higher suicide rate in a given area if prescribed as

a drug. What it states is that suicide and homicidal tendencies, aggressive behaviour, are adverse

reactions to these drugs. What the causes may be in your area may be some other issue.

and the literature with regard to that, then all we are doing is stating what has been established to be

fact. This is established within organisations such as the International Narcotics Board, the Drug

Enforcement Agency, the Food and Drug Administration overseas and here in Australia - the

various government organisations which acknowledge that.

are not being upheld within the whole process from diagnosis to medication. The issue I have then

is that if the parents are not provided with all the information, then there is no process of informed

consent, yet suicide is something that becomes a problem at the other end when you are trying to

get the kids off the medication. The issue for me is that if there is no informed consent, and, as you

assert, the rights of the child are not paramount, then at the other end parents are not aware of the

threats and the real issues of children suiciding.

known information throughout the medical profession, and specifically psychiatry, is made

available to parents when they are given this diagnosis, and obviously also information of the drug

and treatment. Parents have complained to us about being coerced, although certainly not to the

degree that is happening in America. When I or any members of our organisation discuss the

possible side effects of these drugs, they indicate that they were never made aware of some of them.

They are often made aware of mild symptoms, but they are certainly not made aware of the

possibility of what Fred mentioned; namely, tics, otherwise known as dyskinesia. A mother asked

me about what was going on and in discussion she mentioned that her son had developed tics. I

mentioned that perhaps she should go back to her physician and address this issue, because that was

possibly a result of the drugs. She then talked to me some months later and said she had taken the

child off the drugs and the tics had disappeared. What was of concern was that she was not aware

that they could develop, and she was not aware that they could become permanent.

methylphenidate can be put in that category, the Drug Enforcement Administration background

paper of 1995 discussed methylphenidate and the amphetamines as one, saying they all shared

essentially the same addictive potential and essentially the same side effects. It has long been

known that deep, unremitting depression is a side effect of chronic amphetamine abuse and of

trying to withdraw from amphetamine, so suicide is very much a risk of chronic use and abuse of

this group of medications.

One other thing I would like to mention is that when a normal child is said to be brain diseased and

have a chemical imbalance of the brain, this is invariably stigmatising. In the United States I can

tell you that once this label is applied there is almost always an automatic application of one of

these drugs and that further affirms in the self-image of the child that they have something abnormal

about them that requires a pill for them to be able to control themselves and behave normally.

There is invariably a stigmatising effect. A normal child has his self-image changed, and it also

changes the parents’ image of the child, their peers’ image and the community’s image. In the

United States once you have a diagnosis of a health condition like this your insurability is

diminished. The cost of health care insurance increases for you. You are suddenly no longer able

to consider a career in the armed forces nor in many jurisdictions in the United States in police and

Education and Health Wednesday, 02 June 2004 Page 10

fire work. The diagnosis has very grave implications. If you do not have objective evidence of an

abnormality of disease, it is truly unfortunate to label or brand a person a abnormal or diseased.

of the inquiries that you have done throughout the world. However, so that we can get it on our

record, obviously many people in the medical fraternity have a different opinion. Many

paediatricians prescribe these prescription drugs. Your opinion is that the drug has a down effect

which is worse than the benefit, yet we have heard evidence, and in fact I have visited a number of

heroin-type clinics at which those doctors say that, according to them, the majority of their patients,

who are in the main ADHD affected, are undiagnosed, and had they been diagnosed earlier it might

not have led to their illicit drug use. They are very firm in that opinion. Their opinion is that the

dangers of not being prescribed are far worse than the outcomes for some. I am sure there are down

sides for some, as there would be for many other drugs. I imagine there is likely to be an effect.

How do you answer that sort of thing? It is hard to believe there are that many ill-informed

paediatricians and others who are doling out prescription drugs solely because it is an easy out or

solely because they will get repeat attendances and they will make money or they are tied up with a

drug company that will make money out of the issue. I do not believe that to be the case. What

makes these people ill-informed or go down that path? Is there any legitimacy in these people who

say unprescribed diagnoses of ADHD are an even worse effect?

way - as a neurologist and diagnostician, whose first obligation to my every new

patient was to determine whether there was an abnormality or not. If there is not, there is no need in

that patient to ask which disease. The patient goes out the door to a mental health provider or

psychologist or something like that. If there is some abnormality, it becomes my duty to define that

abnormality, what we in medicine call differential diagnosis. What I have told you here today is

that ADHD has not yet met the criteria for a tangible, objective abnormality or disease. That being

the case, here on the risk side, there is no proven disease, but on the treatment side, there are real

risks such as addictiveness, cardiac problems, central nervous system side effects and so on. I

would not be justified in starting chemotherapy in a patient before having biopsy confirmation of a

malignancy. I would not be justified in starting insulin before knowing full well what the blood

sugar range was. I would not be justified in starting radiotherapy for an intracranial tumour without

a good idea of what the histology or microscopy is. This is the point of concern that I hope I have

been able to share with you today. Why other practitioners do what they do, I cannot say. I can

only tell you that the fact that we in the United States have six million to seven million children, all

of whom were said to be normal when they were born, and who walked and talked on time, and

who were normal when they walked down the school house path, and all of whom have been

labelled and drugged thusly with these dangerous drugs, has me mightily alarmed. I sense a degree

of alarm in this community. The motivation of health care professionals in doing this when they

have access to no proof other than what I have articulated to you, you will have to sort out.

diagnosed patients have a tendency to become drug abusers. I am unaware of any valid scientific

proof that that is correct. There is one study - a Californian study, which we put in our submission -

that indicates that adults who had been diagnosed and treated as children were three times more

likely to become cocaine abusers. That does not indicate necessarily that ADHD is a cause but

quite potentially that the drug they were on leads them on to further drug abuse. The drug itself is

chemically similar to cocaine insomuch that when they do drug trials on cocaine they often replace

the cocaine with methamphetamine. It is still a valid cocaine trial but they use methamphetamine

instead because humans and animals cannot tell the difference between cocaine and

methamphetamine.

Education and Health Wednesday, 02 June 2004 Page 11

of ADD medication. Is that correct?

Nadine Lambert of the University of California, Berkeley, presented her ongoing prospective

controlled follow-up study of more than 400 children with ADD-ADHD diagnoses drugged, and

with a control group - matched controls - of normals not drugged. This is by far the biggest, most

valid such study addressing the issue of addictiveness of these drugs. She concluded at the analysis

of the data as of 1998 that there was no doubt that there was an increased rate of the use of addictive

substances generally and of cocaine in particular in children who were ADHD treated and that there

was an increased incidence of smoking on the short-term end of lifetime smoking up to that point.

Since 1998 and near the end of 1998, several small studies have been rushed into print that have, I

think, attempted to counter the conclusions of Dr Lambert. The first of those was by Dr Joseph

Bederman and associates from Harvard University. I think they presented 29 subjects and

concluded that ADHD children not treated with these substances of addiction are much more likely

to become addicts. So they maintain not only that ADHD is a disease but also that it is a disease a

feature of which is an addictive propensity. They concluded in rationale that is truly amazing that

the sooner and more comprehensively these ADHD children are treated with substances of

addiction, the less subsequent addiction they manifest in later life. I personally think that and other

small studies like it, often cited by Novartis, even in ads, are merely attempts to counter the study of

Lambert.

and use of ADHD medications. In Western Australia, the rate of legal prescription for

amphetamine for ADHD is four times the national average and the rate of abuse of illicit

amphetamines is actually twice the national average. That tends to fly in the face of the argument

that unmedicated ADD leads to drug abuse. It in fact indicates that there may be some sort of nexus

- some sort of black market trade - in amphetamines. I have certainly heard lots of anecdotal

evidence to that effect. Is that something of which you are aware from your experience?

now in college in Florida and she tells me that seven out of 10 fellow students are using Ritalin or

adderall or something of the sort to help them prepare for tests. It is no longer unusual to hear of

kids in grade school - under 12 years of age - pedalling these drugs in the schoolyard or

immediately outside the schoolyard or of teachers pilfering the nurse’s supply in the schools, or of

school coaches passing out the drugs or urging kids to take them. Their availability has become

truly alarming. Further, with regard to drugs of addiction, I think your observations thus far tend to

support the research of Dr Nadine Lambert, for which I will happily provide references as soon as I

return home. Among the other systems of tracking drugs of addiction are what we call the DAWN

system - the drug abuse warning network system - which is run by a government mental health

agency. The DAWN system tracks emergency room visits for complications of drug use or abuse.

The number of emergency room visits across the United States for Ritalin and amphetamine use has

just skyrocketed, almost surpassing that for cocaine. I think as of 1996 it was on a level with

cocaine.

you define for me what normals means?

mean a normal child; and, if that is the case, what is a normal child?

physician. All physicians have a reality. All physicians, when they go to medical school, study

pathology, which means disease, which means abnormality, and then we are all taught to

Education and Health Wednesday, 02 June 2004 Page 12

distinguish diseased patients from normals. We are all taught that, even those who subsequently go

into psychiatry.

definition was made. That is why I have asked the question.

another definition entirely - but the medical definition requires a gross microscopic or biochemical

abnormality. It has to be an objective abnormality. That is what medicine requires. If you were to

come to my office as a physician, I should not call you diseased or abnormal medically unless I

could find an object of abnormality defined in one of those ways.

different sorts of behaviour.

in with your child and say he does not sit still, he blurts out, he jumps up out of his seat -

Association’s Diagnostic and Statistical Manual?

hyperactivity. I have had 17 children come through my house over the past 15 years, and every one

of them has done these things, so I am wondering: are these kids normal, or what?

abnormality.

child has got a neurological or biological abnormality of the brain”, and you look at this list, if you

are a parent, your antennae should go up.

worse!

using that page, and they are saying that if you are the parents, or you are the teacher, and you have

checked six out of nine of those, that is a brain disease.

but by paediatricians, general practitioners and neurologists - who should know better - and so on.

Parents have to have their wits and commonsense about them.

remote Aboriginal communities. Every single kid in those communities is hyper - I mean, really

hyper. You have to run to really keep up with them. There must be other reasons. I understand

your point that children have the rights of other human beings, even though they do not necessarily

have the representation. You are asserting that there needs to be informed consent, and at the

moment there is no evidence, so I take that on board too. However, the one little thing that I am a

bit concerned about is that there is something that obviously exists that causes these children to

behave in that way. I understand that in the cultural context that I come from, that is normal

behaviour for children in a remote community. I understand in my own home, from a cultural

context, that their behaviour is as normal as breathing, because that is the context that they are

brought up in. However, from what we are talking about here, we have these poles, and, in the

middle, judgments seem to be made. My concern is that I do not think any of us has the right to do

Education and Health Wednesday, 02 June 2004 Page 13

that, based on the tools that we have right now. What we want to do is get the information. I really

appreciate what you have said, because you have been quite candid, but I still do not have an

answer. I am hoping that we will get somewhere. I will leave it at that.

who have said that they were never diagnosed with ADHD at school, but they have realised that

they have had a difficult social situation, a lack of attention - a range of activities that you have

described, but probably in an exaggerated sense - and they have gone through life dealing with this.

They have then been diagnosed by someone as having ADHD later in life, and they have taken

some prescription drugs, and they have indicated to the committee that life has then become very

clear. They indicated to the committee that it was like having blurred vision and it suddenly

becoming very clear, and for them their life changed significantly. They gave clear evidence that

they felt as though something had been wrong with them all this time that had been undiagnosed,

and that they now feel that they are coping better, their social situation is under control, they can

deal with pressure situations, they can deal better with their jobs, and so forth. A lot of evidence

was given along those lines. For us as a committee, obviously these people have some difficulty,

whether it be a brain disorder, a mental disorder or something else, but they felt they had this

abnormality, and it is now under control. What would you say to that?

people who are angry with me for the stand that I take because they believe that they have got this

entity - this disease - and that the amphetamine that they are living on is a medical treatment

without which they would not be able to function. However, those are in the realm of individual

reports and anecdotes. There is no long-term evidence to buttress the regular lifetime prescription

of these entities, and, more fundamentally, there is no proof and no test that determines that they

have got an actual disease that needs such drugging as treatment. I have met many a drug abuser

who swears that he or she has been very happy to have the ADHD label appended and has been

very happy to have his or her situation get a medical stamp of approval, but there is no empirical

long-term literature to support the people who give you those glowing reports and who are really

very difficult, if not impossible, to deny. They make a very compelling case, but that is not in the

realm of proof in the medical literature.

was going to give a specific example of an 18-year-old girl who had struggled through primary

school and was then diagnosed as having ADHD and was medicated, and she said her life had

changed after she was medicated. Given the answer that you have just given, is a possible

explanation that she has just matured or some other factor has changed rather than the medication?

university entrance there are dispensations for people with learning disabilities. Is ADHD one of

those?

or psychiatric assessment to validate a diagnosis - a specific reading disability, dyslexia, or ADHD -

then yes, the person may be allowed to take an untimed test. This happens even for the LSAT - the

law school admissions test - and the MSAT - the medical school admissions test. These entitlement

have been legislated for. Our Congress I feel has been listening to and believing testimony from US

psychiatrists since 1970 that ADHD is a disease.

you may have already covered this, but I have been looking at recent reports from both the United

States and Australia about the growing levels of obesity in young children. A lot of that is brought

Education and Health Wednesday, 02 June 2004 Page 14

about by dietary changes that you and I might not have been subjected to in our youth. There is

now more use of artificial colourings and all that sort of thing. How much research are you aware

of in the United States that has been done on the effects of the changing dietary habits of children

and how that might be correlate to their behaviour and hyperactivity?

factor in so-called hyperactivity or brain dysfunction, and there was a series of pretty well-authored

controlled studies. I have forgotten the name of it, but there was an elimination diet, and a man’s

name was attached to it, that serially removed various food groups and colourings. However, that

did not hold up under research scrutiny. Similarly, there was a careful controlled study of children

whose parents viewed them as rendered hyper by sugar content. Mark Wolraich at Vanderbilt

University authorised a very careful large controlled study of children whose parents thought they

responded in that way to sugars, and he found under objective observation that they could not

validate that. I do not know if there have been any more recent studies. There have been a lot of

blind alleys in research so far as ADHD and learning disabilities are concerned. Most of the blind

alleys have to do with the fact that there is limited proof of a specific physical abnormality or

marker by which to objectively identify the entity at hand.

transcript of the oral evidence that you have presented today, along with a letter that explains the

process for making any corrections. Any alterations must be confined to the correction of errors. It

is not an opportunity to add bits and pieces, or whatever. If there are any parts of the evidence that

you would like to expand on, you can make a supplementary submission. You will be given 10

working days in which to return the corrected transcript to the committee office. If the transcript is

not returned within that time, it will be deemed to be correct. I take this opportunity, on behalf of

the committee, to thank you for addressing the committee. We really appreciate all of the

information that you have provided to us.

chosen to have five days in Fiji to relax. That may make it a little tight to meet that 10-day time

frame. Is there some way in which we can address that?

Education and Health Wednesday, 02 June 2004 Page 15