One in seven children in the US and a growing number of children in the UK are being given stimulants with a long list of side effects to treat a condition that may be due to a simple deficiency of certain vital nutrients.
Attention-deficit hyperactivity disorder (ADHD) in children is fast becoming one of the most overdiagnosed and many would argue overprescribed paediatric 'diseases' both in the US and now in Britain. It is certainly one of the most fiercely debated childhood disorders.
In the US, its incidence is estimated to be 3-5 per cent and as high as 10 per cent if less stringent criteria are used. In the UK, 2 per cent of children aged 6-16 years are diagnosed as hyperactive, with some 69,000 considered to be suffering from 'severe ADHD' (Crit Pub Health, 2000; 10: pp?).
While many argue over what exactly constitutes ADHD (see box, p 2), the medical profession especially in the US tends to speak with one voice as to the solution. Since the 1960s, the psychostimulant Ritalin, generically known as methylphenidate hydrochloride (MPH) an amphetamine like addictive drug that mimics the biochemical properties of cocaine has been administered to thousands of children. It is now estimated that up to one in seven American children is being given the substance daily.
A similar staggering increase in use has been recorded in the UK, where MPH is designated a class B controlled drug (class A if in solution). Professor Steve Baldwin of the University of Teeside states that the rate had risen 15 fold, from 6000 prescriptions a year in the UK in 1994 to 92,000 in 1997 (2000, op cit). By 1999, this had reached 131,000 (covering some 21,000 children), but this is likely to be a gross underestimation because official statistics (based on pharmacy returns) do not include prescriptions given out in private practices, young offender centres or social services residentials.
In France, MPH use is rare and, in the rest of Europe, its prescription for minors is either uncommon or unheard of. However, Baldwin and colleague Rebecca Anderson estimate that if MPH prescriptions were allowed to double year by year, by 2007, the UK would match the US in having one in seven schoolchildren taking the drug daily (Crit Pub Health, 2000; 10: 81-6).
All the indications suggest that drug companies have just this kind of scenario in mind. Since the end of 1999, the leading manufacturer of MPH Novartis (formerly Ciba Geigy and Sandoz)has lost its sole product license for the compound (as Ritalin), allowing other companies to launch their own brands (such as Equasym, by Medeva) while three others Mallinckrodt, Schein Pharmaceuticals and MD Pharmaare in the process of preparing products (2000, op cit).
The selling of Ritalin
In the US, where Ritalin was first used in 1955, Novartis and other drug companies producing similar drugs for use in children, such as dextroamphetamine and metamphetamine, have been very successful in persuading psychiatrists and health authorities of the alleged benefits of these drugs, despite the potential risks and contraindications.
MPH is not licensed for use in children under the age of six (although, in practice, it is given
to children as young as three) nor is it for those who suffer marked anxiety, agitation or tension, or those who have symptoms or a family history of tics or Tourette's syndrome, hyperthyroidism, severe angina or cardiac arrhythmias, glaucoma or thyrotoxicosis (a condition caused by an excessive amount of thyroid hormones). Caution is required in the prescribing of MPH for children and young people with epilepsy or psychotic disorders, or a history of drug or alcohol dependence.