Field of Science

Parents: ADHD drugs don’t work

If you want to start an argument, try telling a parent – any parent – how to raise their kids. So I'm going to preface this by saying that I'm just trying to make parents aware of something that might concern them. One of the most controversial issues among parents of school-age children today is the shockingly large number of children who are being treated with drugs to control their behavior, especially those children who have been diagnosed with attention-deficit hyperactivity disorder (ADHD). Now it appears that these drugs simply don’t work, except in the short term. The results of a scientific study reported this past week showed that long-term use of drugs to children with ADHD doesn’t provide any benefit over behavioral therapy. Not only that, but children who took medication ended up, on average, one inch shorter than children who didn’t. That’s right: ADHD drugs stunt children’s growth.

This seems to be rather shockingly bad news for the ADHD drug manufacturers. The news was reported on the front page of the Washington Post and in many other media outlets. The study, an 8-year followup of the Multimodal Treatment Study of Children With ADHD (MTA), was reported in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The study divided children into 4 groups: medication (M), behavior therapy (B), both treatments (M+B), or no treatment. The authors of the study had reported in 1999 – with great fanfare – that children who received drugs (M and M+B) did better than children who only had therapy (B) after 14 months and at 2 years followup. In other words, over the short term, the drugs seemed to work. As the Washington Post reported: “Because children given drugs alone appeared to do about as well as those treated with both drugs and talk therapy, the study skewed treatment in the direction of medication.”

However, over longer time periods, the drugs (including Adderall and Concerta, two of the most commonly prescribed drugs for ADHD) didn’t help at all – and they stunted growth. Children who took ADHD drugs for 3 years or longer were an average of one inch shorter than children who didn’t take drugs. The study looked at “grades earned in school, arrests, psychiatric hospitalizations, [and] other clinically relevant outcomes,” and found no differences in children given drugs compared to children given only behavioral therapy.

What should be even more disturbing is that this isn’t really news at all – it was reported two years ago, in 2007. The same authors reported then, in a 3-year followup study, that “treatment groups did not differ significantly on any measure at 36 months.” In other words, the benefits of drugs disappeared by 3 years after treatment started. Some of the scientists involved have downplayed these results, but one, William Pelham, was quoted in the Post saying his colleagues are “embarrassed to say they were wrong and we led the whole field astray.”

Another scientists leading the study, Peter Jensen, shot back that Pelham was biased against drugs. However, Jensen has been pushing drug therapy quite publicly for years. In the press release from the National Institute of Mental Health after the 2007 report, he said that “medication can make a long-term difference for some children if it's continued with optimal intensity.” This despite the fact that the 2007 results indicated that medication was not providing any benefit over behavior therapy, results that appear even stronger now. In contrast, William Pelham was already saying in 2007 that ADHD drugs were “all risk and no reward.”

It’s worth noting also that NIMH heavily promoted the initial results of this study back in 2000, and its website still states that “combination treatments as well as medication-management alone are both significantly superior to intensive behavioral treatments and routine community treatments in reducing ADHD symptoms.”

Reporter and blogger Maggie Mahar tried to draw attention to the story in 2007, but the U.S. media simply didn’t pick up on the story. Mahar also pointed out that “drug manufacturers have a serious interest in keeping the U.S. discussion on ADHD married to the medical-disease model.”

All of this made me wonder if Peter Jensen, who seems determined to continue to support the use of drugs to treat ADHD, might have ties to pharmaceutical companies. It took me only a few minutes to discover that he has received funding or grants from: UCB-Pharma, Cephalon, Novartis, McNeil Consumer & Specialty Pharmaceuticals, and Janssen Pharmaceutica. I found confirmation of these ties here. Novartis and UCB-Pharma are manufacturers of ADHD drugs (Ritalin or methylphenidate), and Cephalon makes Provigil, which they attempted to promote as an ADHD drug for years until the FDA rejected it.

Far too many of our children – primarily boys, who are diagnosed with ADHD 3-4 times more often than girls – are being medicated for ADHD. There is ongoing controversy, which I won’t get into here, over whether ADHD is grossly overdiagnosed. Whether ADHD is correctly diagnosed or not, though, it now seems clear that putting children on drug therapy might cause them long-term harm (stunting their growth) while only providing temporary, short-term changes in behavior.

Washington Post shines light on waste at NCCAM

Science reporter David Brown at The Washington Post wrote an excellent article today entitled "Critics Object to 'Pseudoscience' Center," which focused on my efforts - and the efforts of others, notably bloggers at Science-Based Medicine - to eliminate the funding for NIH's National Center for Complementary and Alternative Medicine (NCCAM). You can read the article here (requires login, but it's free).

I'm quoted in the beginning of the article, which also makes reference to my proposal to de-fund NCCAM, posted on Change.gov in January. Brown also reports that NCCAM is getting a boost of $31 million in its budget this year, thanks to the recently-passed stimulus bill in Congress. That's on top of an overall NIH portfolio of $300 million dedicated to "alternative medicine", which includes $122M for NCCAM and $122M for OCCAM.

NCCAM was created initially by Senator Tom Harkin, who continues to push it. In a hearing just a couple of weeks ago, he stated
"One of the purposes when we drafted that legislation in 1992 . . . was to investigate and validate alternative approaches. Quite frankly, I must say it's fallen short. I think quite frankly that in this center, and previously in the office before it, most of its focus has been on disproving things, rather than seeking out and proving things."
Brown quoted this in his article and also paraphrased my response that this shows how badly Harkin understands science. Science doesn't set out to "investigate and validate" - it just investigates, and sometimes the results are negative. That's precisely what has happened with every well-done study of many of the pseudoscientific claims that NCCAM supports, including energy healing (see my previous blog post), acupuncture, homeopathy, magnet therapy, Ayurveda, qi, and others.

In an effort to achieve balance, Brown also interviewed a leading naturopath, Carlo Calabrese, who was formerly on NCCAM's advisory board. Calabrese seems to concede - oddly - that his practices might be no better than placebo treatment, but he argues "What can be done to generate a better placebo? Why isn't that an interesting and valid area of investigation?" How telling: he thinks that even if the methods are just placebos, they still deserve funding. He doesn't seem to see the problems inherent in lying to patients - which is exactly what you're doing if you give them a treatment that you know is a fake.

Kudos to David Brown, and to the Washington Post, for shining some light on the use of NIH funds to support pseudoscience.

Healing Touch for cancer (thanks, NCCAM!)

I was looking at recent grants made by NCCAM, and found a project that just started last year: R15AT003591, “Use of Energy Biofield Therapy for the Treatment of Cancer and GVHD”, from the Univ. of Nevada-Reno, led by Alice Running in their nursing school, and co-directed by Lisbeth Welniak of UC Davis. It’s a 3-year award, and the first year was for $210,688, so I’m estimating the total cost at roughly $630,000. That's a nice chunk of change. But what the heck is "energy biofield therapy"?

Well, NCCAM supports a variety of pseudoscientific practices in the “energy therapy” category, including this study. Running and Welniak plan to look specifically at two methods, Reiki and “Healing Touch”, to see if they can (1) cure cancer and (2) reduce the likelihood of immune rejection (graft versus host disease, or GVHD) of transplated tissues or cells. Really? Remarkable.

First, a very quick look at the two “therapies” proposed by Running and Welniak. Healing Touch is another name for “Therapeutic Touch,” a technique that is little more than magical thinking, but that is very popular (unfortunately) among many nurses and nurse-training programs (including, obviously, the PI of this study, Alice Running). Basically, the claim is that a Healing Touch practitioner (let’s call this person a “healer”) can wave her hands over the patient, manipulate the patient’s “energy field” (an invisible field, undetectable by any known technology), and heal all sorts of illnesses, relieve pain, etc. During a session, the healer doesn’t even touch the patient.

This is all complete nonsense, of course. Therapeutic Touch (and Healing Touch) were most famously debunked in a 1998 article in the Journal of the American Medical Association (Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 279:1005-1010, 1998), using an experiment designed by Emily Rosa, a 4th-grade student at the time. The results have been summarized in many places:
“Emily was able to recruit 21 experienced TT practitioners for her experiment. The TTP's were allowed to "feel" Emily's hands prior to the test, and choose which one they felt the strongest energy radiating from. With the TTP seated behind the screen, Emily then placed her hand over one of the TTP's hands. After 20 trials, these experienced TTP's, some of whom had even published articles on TT, could only sense Emily's hand correctly 44% of the time. By chance alone, they should have guessed correctly 50% of the time. Clearly, except in their own mind, they were not sensing an energy field.”
If TT was debunked 10+ years ago, why is this obvious pseudoscience still being funded by NCCAM? The leaders of this new study claim (with no evidence) that “The mental ability of a being, whether conscious or not, to influence physical parameters especially those linked to stress and inflammatory pathways has become more evident in recent years.” Ah, I see. It's "evident" to someone - presumably Running and Welniak.

Unfortunately, there is big money behind Healing Touch. Programs such as this one - http://www.healingtouchprogram.com - have sold certification classes to over 100,000 nurses (so they claim), making this a multi-million dollar industry with many “experts” who aren’t likely to admit that they are frauds (or that they’ve been made to look like fools). This is despite the fact that websites promoting Healing Touch proudly admit that "many of the techniques used in energy therapies come from practices in shamanistic and Asian traditions with thousands of years of use." That's right, these techniques were used by shamans. Sounds trustworthy to me.

Reiki, by the way, is pretty much the same thing, only with different mumbo-jumbo surrounding it. The Reiki “therapist is supposed to direct their energy into the client to promote the body's self healing” and some Reiki instructors even claim that Reiki can heal genetic disorders.

Oh, and I should mention: this NCCAM study will look at mice. That’s right, they will use Healing Touch to try to cure cancer in mice. As they describe it: “we will determine the limits of Healing Touch to reduce tumor growth and symptoms of graft vs. Host disease in murine models.”

What seems to be going on is that Running believes in this nonsense, and she has recruited Welniak – a scientist at another institution who has published legitimate work on GVHD in mice, and doesn’t seem to have published anything relating to pseudoscience before – to provide cancerous mice for her study. The two of them submitted a proposal to NCCAM, and now they have NIH funding. But by participating, Welniak is lending her scientific reputation to this nonsense, and seriously tarnishing it in the process.

I can’t imagine a better use for $630,000 of taxpayer-provided NIH funds, can you?