<DOC>
[107th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:83516.wais]
ATTENTION DEFICIT/HYPERACTIVITY DISORDER--ARE WE OVERMEDICATING OUR
CHILDREN?
=======================================================================
HEARING
before the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 26, 2002
__________
Serial No. 107-141
__________
Printed for the use of the Committee on Government Reform
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COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
ILEANA ROS-LEHTINEN, Florida EDOLPHUS TOWNS, New York
JOHN M. McHUGH, New York PAUL E. KANJORSKI, Pennsylvania
STEPHEN HORN, California PATSY T. MINK, Hawaii
JOHN L. MICA, Florida CAROLYN B. MALONEY, New York
THOMAS M. DAVIS, Virginia ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
BOB BARR, Georgia DENNIS J. KUCINICH, Ohio
DAN MILLER, Florida ROD R. BLAGOJEVICH, Illinois
DOUG OSE, California DANNY K. DAVIS, Illinois
RON LEWIS, Kentucky JOHN F. TIERNEY, Massachusetts
JO ANN DAVIS, Virginia JIM TURNER, Texas
TODD RUSSELL PLATTS, Pennsylvania THOMAS H. ALLEN, Maine
DAVE WELDON, Florida JANICE D. SCHAKOWSKY, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
ADAM H. PUTNAM, Florida DIANE E. WATSON, California
C.L. ``BUTCH'' OTTER, Idaho STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia ------
JOHN J. DUNCAN, Jr., Tennessee BERNARD SANDERS, Vermont
JOHN SULLIVAN, Oklahoma (Independent)
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
James C. Wilson, Chief Counsel
Robert A. Briggs, Chief Clerk
Phil Schiliro, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on September 26, 2002............................... 1
Statement of:
Nakamura, Richard K., Acting Director, National Institute of
Mental Health.............................................. 63
Ross, E. Clarke, chief executive officer of CHADD--Children
and Adults with Attention Deficit/Hyperactivity Disorder,
Landover, MD; and David Fassler, M.D., representative,
American Psychiatric Association, and American Academy of
Child and Adolescent Psychiatry, Washington, DC............ 92
Weathers, Patricia, president, Parents for Label and Drug
Free Education; Mary Ann Block, D.O., author and medical
director, the Block Center; Lisa Marie Presley, national
spokesperson, Citizens' Commission on Human Rights; and
Bruce Wiseman, U.S. president, Citizen's Commission on
Human Rights............................................... 24
Letters, statements, etc., submitted for the record by:
Block, Mary Ann, D.O., author and medical director, the Block
Center, prepared statement of.............................. 31
Burton, Hon. Dan, a Representative in Congress from the State
of Indiana, prepared statement of.......................... 5
Fassler, David, M.D., representative, American Psychiatric
Association, and American Academy of Child and Adolescent
Psychiatry, Washington, DC, prepared statement of.......... 115
Kucinich, Hon. Dennis J., a Representative in Congress from
the State of Ohio, prepared statement of................... 136
Morella, Hon. Constance A., a Representative in Congress from
the State of Maryland, prepared statement of............... 135
Nakamura, Richard K., Acting Director, National Institute of
Mental Health, prepared statement of....................... 67
Presley, Lisa Marie, national spokesperson, Citizens'
Commission on Human Rights, prepared statement of.......... 36
Ross, E. Clarke, chief executive officer of CHADD--Children
and Adults with Attention Deficit/Hyperactivity Disorder,
Landover, MD, prepared statement of........................ 96
Roukema, Hon. Marge, a Representative in Congress from the
State of New Jersey, prepared statement of................. 140
Watson, Hon. Diane E. Watson, a Representative in Congress
from the State of California, prepared statement of........ 17
Weathers, Patricia, president, Parents for Label and Drug
Free Education, prepared statement of...................... 26
Wiseman, Bruce, U.S. president, Citizen's Commission on Human
Rights, prepared statement of.............................. 42
ATTENTION DEFICIT/HYPERACTIVITY DISORDER--ARE WE OVERMEDICATING OUR
CHILDREN?
----------
THURSDAY, SEPTEMBER 26, 2002
House of Representatives,
Committee on Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 10:28 a.m., in
room 2154, Rayburn House Office Building, Hon. Dan Burton
(chairman of the committee) presiding.
Present: Representatives Burton, Gilman, Morella, Horn,
Souder, LaTourette, JoAnn Davis of Virginia, Weldon, Putnam,
Duncan, Cummings, and Watson.
Staff present: Kevin Binger, staff director; Chad Bungard,
John Callendar, Jason Foster, Randall Kaplan, and Matt Rupp,
counsels; S. Elizabeth Clay and Gil Macklin, professional staff
members; Blain Rethmeier, communications director; Allyson
Blandford, assistant to chief counsel; Robert A. Briggs, chief
clerk; Robin Butler, office manager; Joshua E. Gillespie,
deputy chief clerk; Michael Layman and Susie Schulte,
legislative assistants; Nicholis Mutton, deputy communications
director; Leneal Scott, computer systems manager; Mindi Walker,
staff assistant; Sarah Despres, minority counsel; Ellen Rayner,
minority chief clerk; and Jean Gosa and Earley Green, minority
assistant clerks.
Mr. Burton. Good morning. A quorum being present, the
Committee on Government Reform will come to order.
I ask unanimous consent that all Members' and witnesses'
written and opening statements be included in the record.
Without objection, so ordered.
I ask unanimous consent that all articles, exhibits, and
extraneous or tabular material referred to be included in the
record. Without objection, so ordered.
Today we're going to be discussing a very important issue
that affects many, many children in the United States. As all
of us know, our children are our future. I doubt there's a
single Member of Congress that doesn't feel strongly that we
need to do our dead level best to protect and improve the
health and well-being of the children of this Nation.
Today we're going to talk about a group of symptoms known
as ``attention disorders.'' In the last two decades, we've
heard more and more attention about deficit disorders, ADD, and
attention deficit hyperactive disorder, ADHD.
The most common treatment for this disorder is a drug
called Ritalin. This drug is being given to more and more
children in this country. It has become very controversial.
There have been a 500 percent increase in the use of Ritalin in
the United States since 1990, a 500 percent increase. It is
estimated that 4 to 6 million children in the United States
take Ritalin every single day.
On one side of this issue we're going to hear from the
associations of psychiatrists and a parents' organization known
as ``Children and Adults with Attention Deficit/Hyperactivity
Disorder, or CHADD. They believe that 13 percent of the U.S.
population, adults and children, suffer from an attention
disorder, and that it should be treated with medication.
At the other end of the discussion is the Citizen's
Commission for Human Rights. They challenge the legitimacy of
calling ADHD a neurobiological disorder. They raise serious
questions about giving strong medications to young children.
Also in the discussion are concerned parents.
Imagine being a parent of a young child and receiving a
note from your school instructing you to take your child to
their pediatrician for evaluation. In this note from the school
there's a checklist for you to take to the doctor. The school
officials have diagnosed your child as possibly having ADHD.
These are the teachers and the school officials. They make this
diagnosis because your child makes careless mistakes on
homework, does not follow through on instructions, fails to
finish school work, has difficulty organizing tasks, loses
things, and is forgetful in daily activities. That sounds like
me when I was in grade school. I did not take Ritalin and I
became a Congressman. [Laughter and applause.]
When you take your child to your doctor, instead of blood
tests and a thorough medical evaluation, you have a
conversation with the doctor about the school's checklist, and
you leave a few minutes later with a prescription for your
young child for a psychotropic drug.
Did the doctor test your child for a thyroid disorder? Did
your doctor test your child for a heavy metal toxicity? Did
your doctor talk to you about your child's allergies? Did your
doctor even mention nutrition or possible food sensitivities?
Did your doctor ask if your child's IQ had been tested and if
he was gifted? Probably not.
We all know that prescription drugs continue to command a
greater percentage of the overall health care dollar. According
to the Department of Health and Human Services, prescription
drugs accounted for 9 percent of all U.S. health care
expenditures in fiscal year 2001. This is a 14.7 percent
increase in 1 year.
Ritalin, as you know, is classified as a Schedule II
stimulant under the Federal Controlled Substances Act. In order
for a drug to be classified as a Schedule II, it must meet
three criteria:
One, it has to have a high potential for abuse; two, it has
to have a currently accepted medical use in treatment in the
United States; and, three, it has to show that abuse may lead
to severe psychological or physical dependence.
This is a Schedule II drug, and this is the definition.
Some of the things we've heard about Ritalin cause me to
have some concerns, and I'd like to hear from all of our
witnesses today about those issues. The ``experts'' tell us
that Ritalin is a ``mild stimulant.'' However, research
published in 2001 in the ``Journal of the American Medical
Association'' showed that Ritalin was a more potent transport
inhibitor than cocaine. This isn't me saying this. This was in
the ``Journal of the American Medical Association.'' It said
that Ritalin was a more potent transport inhibitor than
cocaine. The big difference appears to be the time it takes for
the drug to reach the brain. Inhaled or injected cocaine hits
the brain in seconds, while pills of Ritalin normally consumed
take about an hour to reach the brain. Like cocaine, chronic
use of Ritalin produces psychomotor stimulant toxicity,
including aggression, agitation, disruption of food intake,
weight loss, stereotypic movements, and death.
There have been only two large epidemiological studies on
the long-term dopamine effects of taking Ritalin for years. One
study found more drug addiction in children with ADHD who took
Ritalin compared with children with ADHD who took no drug,
while the other study shows the opposite result, so they are
inconclusive at this moment.
The question that remains to be answered, according to the
authors of this study, is whether the chronic use of Ritalin
will make someone more vulnerable to decreased dopamine brain
activity, as cocaine does, thus putting them at risk for drug
addiction.
Even more disturbing than the prescribing of Ritalin to
school-age children is a trend to prescribe this medication to
preschoolers. A study published in the ``Journal of the
American Medical Association'' in 2000 offered some key
insights into this dangerous new trend. Of 233 Michigan
Medicaid enrollees younger than 4 years of age with a diagnosis
of ADHD, 57 percent received at least one psychotropic
medication to treat the condition during a 15-month period in
1995 to 1996. Ritalin and Clonidine were prescribed most often.
Additionally, the authors found that in the midwestern
States' Medicaid population there was a threefold increase in
total prescribing of stimulants between 1991 and 1995--a 300
percent increase. There was a threefold increase in prescribing
Ritalin, a 28-fold increase in prescribing Clonidine, and a
2.2fold increase in prescribing of antidepressants. This is
children between the ages of 2 and 4 years old.
These are trends that I think we ought to be concerned
about. Is it safe to give these drugs to very young children?
What will the long-term effects be? Are children being
diagnosed correctly? I hope we can shed some light on all of
these issues today.
In concluding, let me just say over the last 4 years this
committee has looked at numerous health issues. We've looked at
the role of dietary supplements, nutrition, and physical
activity in improving health. We've looked at the role of
complementary and alternative medicine in our health care
system. We've looked at pharmaceutical influence on Advisory
Committees at the Department of Health and Human Services. And
we've looked at the possible relationship between childhood
vaccines and the autism epidemic.
It is obvious to me that we can no longer ignore that our
health care system is in need of a major overhaul and attitude
change. We have a generation of doctors who have not been
trained in nutrition. We have statistics that show that 85
percent of the illnesses Americans face are related to
lifestyle. We have camps of conventional doctors who are
trained to suppress symptoms through drugs, and camps of
complementary and alternative medical professionals, including
doctors, who are trained to look at the whole person and their
environment. It's time that we put the labels of conventional
and alternative aside and think about an integral approach, a
complete approach to care. We owe it to all of us, but
especially our children.
I'm pleased that we have such a stellar list of witnesses
today. Mr. Neil Bush, the brother of the President, was going
to be here with us, but unfortunately he could not be, so what
we have done is we have a tape of an interview that was
conducted with Mr. Bush that we will show at the outset of our
hearing before we hear from our witnesses. As everybody knows,
he is not only the brother of the President, but he is the CEO
of Ignite Learning and the son and brother of two Presidents
and was supposed to be here, but unfortunately he couldn't. He
did have a family experience with a misdiagnosis of ADHD.
Ms. Lisa Marie Presley--I'm sure everybody knows who Ms.
Presley is. She's not only a very talented young lady and a
very attractive young lady, she's the daughter of Elvis Presley
and his lovely wife, and she's here today to testify, and we're
looking forward to her testimony. She's a concerned mother and
the international spokesperson for the Citizen's Commission on
Human Rights.
Mrs. Patti Weathers, who is here with us--we're glad to
have you--she will share her family's story about a school
trying to force medication as a condition of school
participation.
Dr. Mary Ann Block, the author of ``No More ADHD'' is here.
We appreciate your being here, as well.
And, of course, we have Mr. Wiseman, who has been active in
this issue for a long time.
We appreciate your attendance, as well, Mr. Wiseman.
Mr. Wiseman. Thank you.
Mr. Burton. I want to thank all of our witnesses for being
here to day. I look forward to your testimony. The hearing
record will remain open until October 10th.
Mr. Waxman is not here at the present time, so I will now
yield to the distinguished gentleman from New York, my
colleague, Mr. Gilman.
[The prepared statement of Hon. Dan Burton follows:]
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Mr. Gilman. Thank you, Mr. Chairman. I want to thank
Chairman Burton for holding this important hearing to examine
the issue of medicating school children and the treatment of
attention deficit hyperactive disorder.
As a congressional Member who has long been interested in
the ongoing war on illicit drugs, I'm surprised by the
extensiveness of the use of controlled substances such as
Ritalin, with a high potential for abuse and the propensity for
its dependence, to treat psychiatric disorders of children.
This issue is surrounded by a substantial controversy, a debate
that we fully expect to be highlighted by today's witnesses.
While we recognize the merits of the positions argued by
each side, my concerns lie in another area. I don't doubt that
there are many children with genuine illnesses and disorders
that could benefit from a treatment regime involving Ritalin
and similar drugs. I am concerned, however, with a number of
other issues. The first of these is the trend toward treating
younger and younger children with these dependent drugs.
Ritalin is generally not recommended for children under age 6;
yet, there was a threefold increase in its prescription for
children aged 2 to 4 between 1991 and 1995.
Also of concern is that parents are being pressured into
having their children take these drugs when a diagnosis is made
by a teacher or other school official and not by any medical
professional. As a result, the potential for abuse is enormous.
Educators want conformity in the classroom, but the desire for
order needs to be balanced against the health of the children.
The heavy advertising and the extensive lobbying on school
districts by drug companies for these products is very
distressing. The decisions involving treatment need to be made
by medical personnel who know the individual patient and not by
someone with some financial stake in the system.
Moreover, we've not seen any evidence that suggests the
medical profession has any significant knowledge about the
long-term effects of these drugs. Given that this is a
relatively recent phenomenon, it is possible that long-term
studies have not been undertaken. If that's the case, we could
be setting ourselves up for a potential disaster down the road.
Once again, Mr. Chairman, thank you for holding this
important hearing this morning. I look forward to the testimony
of our witnesses.
Mr. Burton. Thank you, Mr. Gilman.
Ms. Watson, do you have an opening statement?
Ms. Watson. Yes, sir.
Mr. Burton. Ms. Watson, you are recognized.
Ms. Watson. I want to thank you, Mr. Chairman, and I have a
few observations I'd like to share based on an experience while
I was teaching and as a school psychologist.
Although fidgeting and not paying attention are normal and
common childhood behaviors, a diagnosis of ADHD may be required
for children in whom frequent behavior produces persistent
dysfunctions. The challenge is to evaluate, inform the parents,
and consider the alternatives before choosing an invasive and
artificial drug treatment.
An adequate diagnostic evaluation requires histories to be
taken from multiple sources--from the parents, from children,
from teachers, and from others that are associated with the
child; a medical evaluation of general and neurological health;
a full cognitive assessment, including school history, use of
parent and teacher rating scales, and all necessary adjunct
evaluation, such as an assessment of speech and language
patterns, etc. These evaluations take time and require multiple
clinical skills. Regrettably, there's a lack of appropriate
trained professionals and monetary resources in the current
school systems.
As a school psychologist in Los Angeles, for every 10
students that I worked with, there were approximately 4 or
maybe even 5 on Ritalin. It was very frustrating to see many of
the medicated children completely numb to stimuli. In many
cases they were almost like robots.
Drugs should not be overly prescribed or seen as the only
solution to these problems. The American Academy of Pediatrics
published a policy statement in 1996 on the use of medication
for children with attentional disorders, concluding that the
use of medication should not be considered the complete
treatment program for a child with ADHD and should be
prescribed only after a careful evaluation.
Because stimulants are also drugs of abuse, and because
children with ADHD are at an increased risk of substance abuse
disorder, I have concerns about the potential for the abuse of
stimulants by children taking the medication or diversions of
drugs to others. Just yesterday I read in the ``Washington
Post'' sports Section that the Hall of Fame Pittsburgh Steeler,
Mike Webster, pleaded no contest in September 1999, to forging
prescriptions to obtain Ritalin.
I finally say that this point has to be made, and it goes
to the fact that this great athlete is probably someone who
early on showed hyperactivity and probably because he was bored
in class, or whatever the circumstances might have been, but he
now has an addiction that I think in some ways could be equated
with the use of cocaine, which is so prevalent in my District
and in the school district that I represent.
So I am very, very concerned that we are bringing our
children up in a drug culture, and you can't turn on the
television or the radio or read a newspaper that we're not
pushing something to wake you up, put you to sleep, 1-2-3 take
this, and so children are surrounded by this culture. We need
not have this particular effect in our schools.
So, Mr. Chairman, thank you very much for holding this
hearing. I look forward to hearing the presenters.
Mr. Burton. Thank you very much, Doctor. We appreciate
that.
[The prepared statement of Hon. Diane E. Watson follows:]
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Mr. Burton. Mr. Horn.
Mr. Horn. Mr. Chairman, I thank you for this further series
of where there has been misuse of pharmaceuticals. I agree
completely with my colleague, Mr. Gilman. We have been all over
Europe and everywhere else to see that drugs, and when it's
used for small children and they have no say about it and when
it's wrong, we should make sure that doctors are properly put
together, have what type of either adolescents or the others.
So I would commend you and would hope that we could get
soon to the witnesses, since they are outstanding.
Mr. Burton. Thank you, Mr. Horn.
Mr. Burton. Mr. Cummings.
Mr. Cummings. Thank you very much, Mr. Chairman. I want to
thank you for holding this hearing. I bring a very interesting
perspective to this hearing in that, as a young African
American boy in South Baltimore, I know that what happened to a
lot of us, because we were actually pushed into special
education, we were given all kinds of drugs, and they said that
we were hyperactive, and told that, you know, our hyperactivity
could not be controlled. But what they failed to understand in
this poor neighborhood in South Baltimore was that we didn't
have the playgrounds. We didn't have them. We played on glass,
G-L-A-S-S. We didn't have the leagues, the baseball leagues.
That's stuff that little boys would normally do to get that
energy out of them.
And so what happened, as is happening today in my District,
are little children are being drugged to keep them stable, so
they say, so that they can learn.
I agree with Congresswoman Watkins that we've got a
situation where we have to bring this whole situation under
control.
Mr. Chairman, I applaud you for bringing attention to it,
because it is a very serious thing.
Just today I was listening to one of our national stations
and they were talking about how there are over 1 million
African American men in prison, 1 million. There are more
African American men in prison than there are in college. You
have to wonder how many of them may have started off with folks
saying that, you know, ``There's something wrong with you.''
We have to understand, when you tell a child that there's
something wrong with them, it goes with them until they die,
and it's not--I've often said it's not the deed, it's the
memory that haunts folks.
And so I think that perhaps--I don't know what our
witnesses will touch on this. I think that perhaps we
categorize children at an early age and we misdiagnose them and
then we put them on a train on a track that leads to nowhere,
and so that's why, Mr. Chairman, I'm glad we're exploring this.
I think that it took a lot of foresight on your part to even
open up this door so that we could peek in, because I can tell
you that I know of a lot of children right now who are sitting
in classrooms and they have been drugged and they don't know--
they're not sure what's going on with them. All they know is
that they have been labeled.
And, last but not least, Mr. Chairman, let me say this. In
our society today too often what we do is we look at a child's
behavior and say to ourselves that that behavior is a deficit
as opposed to an asset. I can recall as a young boy, one of the
reasons why they put me in special education and put me to the
side is because they said I talked too much. They said, ``You
talk too much.'' I'm so glad that there were some people that
saw it as an asset, did not drug me to quiet me, and said to
use this asset that God has given you so that you can help to
bring benefit to the rest of society.
And so for those reasons I take it very personal, what
we're doing here today, because there are so many people that
don't get off of that train leading to nowhere.
With that, Mr. Chairman, I yield back.
Mr. Burton. Thank you, Mr. Cummings.
I'd just like to say that your testimony parallels some of
the things I heard about me when I was in school. I guess I
still talk too much sometimes.
Let's see. Mrs. Davis.
Mrs. JoAnn Davis of Virginia. Thank you, Mr. Chairman. I
appreciate your holding this hearing.
I want to bring an entirely different perspective to what
has been said. I'm the Mom of an ADHD son who is now 21. I
would have given anything back when he was 6 or 7 if someone
from the school would have sent a note home and said, ``Have
your son tested or checked out.'' Instead, we went for several
years thinking we were bad parents, something is wrong. We
could not control our child. We didn't know what was wrong with
him. And it was at the end of his second grade when his teacher
said, ``He's below grade level,'' and she passed him because
she just didn't want to deal with him any more. It was a
struggle at home. It was a strain on our marriage. This is our
younger son. We just couldn't handle him. We couldn't control
him.
During that summer, I happened to be talking to a lady who
asked me had I ever had my son tested for attention deficit
hyperactivity disorder, which I'd never heard of. I took him to
my pediatrician, who sent me to a psychologist. We wrestled
with putting our son on Ritalin. I did not want to medicate my
child. My husband didn't want to medicate him. We wrestled with
that a great deal.
The first day of school in third grade he was sent to the
principal's office for acting up. That went on for a week. It
wasn't acting up like bad behavior, it was he just couldn't
control himself. And, to make a long story short, the second
week we put him on Ritalin. We did not tell the school. Back
then the teachers in our area were not trained on attention
deficit hyperactivity disorder. They didn't know much about it.
At the end of the first 9 weeks when the report card came
out--keep in mind, this is the young man they wanted to hold
back in second grade, or said he was below grade level--we
received a call to come to the school. I went to the school,
met the principal, the reading specialist, and the third grade
teacher, who said our son was a brilliant, gifted child and
wanted to put him in the gifted learning class. He made
straight A's.
We then told them we did not want him in the gifted class.
We explained the Ritalin.
I will tell you that Ritalin was the savior to us for our
son. We tried everything. We tried the diet. We tried the
behavior changes. We tried everything before we succumbed to
the Ritalin.
We didn't keep him on it during the holidays. We didn't
keep him on it during the summer. He did great. The
psychologist said it was all right not to have him on it during
the summer and during the holidays. He did great.
When he was in high school he opted to go off the Ritalin.
We've had no trouble with our son. He's not had a problem with
drugs. In fact, just the opposite. We explained to him that
with the Ritalin if he were to ever try drugs that it could
totally harm him.
I believe that in this country we have a tendency to swing
from one end to the other. I do believe we've swung to the
other. We've gone from when people didn't know about Ritalin
and attention deficit disorder to now any time you have a child
who is active at all we put them on Ritalin.
I would not want to see the children going on Ritalin at
age 2, 3, 4, 5. It was a hard decision for us at 8 to put our
son on Ritalin. I do believe that in some cases Ritalin is what
helps.
One thing we explained--and I don't mean to take up too
much time, but one thing we explained to our son is that the
Ritalin didn't make him smart. It didn't make him get the A's.
It just helped him to concentrate to be able to use the
abilities that he already had.
I do think there are children and parents who will need to
put their children on Ritalin, but I don't think it is anywhere
near the number of kids that I see on Ritalin today.
I appreciate your holding this hearing, and I hope and pray
that before parents put their children on Ritalin they will
have them tested in every respect, they will talk it out with
everyone before they do it, and that they know it would just be
the last resort. For us it was a lifesaver. He's 21. He's doing
great. He's not on Ritalin, hasn't ben on it since 10th grade,
but it was a lifesaver, Mr. Chairman. So I would hope we
wouldn't outlaw it altogether, but that we would take a serious
check on our conscience before we put our kids on the Ritalin.
I thank you, Mr. Chairman.
Mr. Burton. Thank you very much, Mrs. Davis.
Dr. Weldon.
Dr. Weldon. Mr. Chairman, I want to commend you for holding
this hearing and just mention that you are taking us into a
very complicated but very, very important arena. I'm very, very
appreciative of the lady from Virginia's testimony.
My perception is that Ritalin is, to a certain degree, a
victim of its own success. It has helped a lot of children, but
there are many children who are being placed on it
unnecessarily.
I think there's a broader issue that I would like to see
the committee address, though I expect we will not be able to
in the confines of the amount of time remaining on the
calendar, and that is: is there some other underlying process
going on to account for the larger and larger number of kids
that are being labeled with this behavioral and learning
disorders? I'm specifically talking about something in the
environment, something in the food that could be playing a
role. Vaccines is another thing worth considering.
Again, thank you very much for convening this hearing. I'm
looking forward to hearing the testimony of our witnesses, so I
yield back.
Mr. Burton. If we don't get to those other issues you
referred to, Dr. Weldon, we'll try to hopefully do that in the
coming year.
Judge Duncan.
Mr. Duncan. Mr. Chairman, first of all I want to thank you
and the staff for calling this hearing. I don't believe there's
any committee in the Congress that has held hearings on a wider
variety of really important topics than this committee has
under your chairmanship.
I listened very closely and intently, as all of us did, to
Mrs. Davis' statement. I can tell you that I remember having
lunch 1 day in the House dining room with a family that told me
almost the exact same story. And I have no doubt that there are
some children in this country, many children, perhaps, in this
country that have benefited from Ritalin, but I also have
spoken on the floor of the House twice about this subject
because I believe that this drug--I have to believe that this
drug is way over-prescribed in this country, and I believe it
is all really about money.
I mentioned in one of my floor statements that I'd read an
article in 1998 by the former second-ranking official of the
Drug Enforcement Administration who had retired to Knoxville,
and he wrote an article in the ``Knoxville News Sentinel'' and
said that Ritalin was being prescribed in the United States six
times more than in any other industrialized nation in the
world. And he said in this article that Ritalin had the same
properties basically as some of the most addictive drugs there
are.
I read in 1999 in ``Time Magazine'' that production of
Ritalin had increased seven-fold, seven times, in the past 8
years, and that 90 percent of it was being consumed in the
United States. And ``Time Magazine'' said in that article,
``The growing availability of the drug raises the fear of the
abuse. More teenagers try Ritalin by grinding it up and
snorting it for $5 a pill than get it by prescription.''
Then I read in ``Insight Magazine,'' which has had several
articles about this, that almost every one of the teenage
shooters that we've read about in recent years have been boys
who were at the time or had recently been taking Ritalin or
other similar mind-altering drugs.
Late last year the same magazine, ``Insight Magazine,'' had
an article which said, ``Thirty years ago the World Health
Organization concluded that Ritalin was pharmacologically
similar to cocaine in the pattern of abuse it fostered, and
cited as a Schedule II drug, the most addictive in medical
use.'' The Department of Justice also cited Ritalin as a
controlled substance, as a Schedule II drug under the
Controlled Substances Act. And the Drug Enforcement
Administration warned that ``Ritalin substitutes for cocaine
and deamphetamine in a number of behavioral paradigms.''
I also read one study that said that almost all Ritalin was
being prescribed to young boys who were the children of very
successful parents, both of whom were working full time outside
of the house. Now, I say again I know that there are people for
whom Ritalin has been a lifesaving drug, but I also know that I
think--and I have a family that has many teachers in it, but I
know sometimes that there are some poor teachers who I think
have recommended Ritalin just because they personally couldn't
properly handle a young boy that was being what we used to say
``he's all boy. He's very, very active.''
I have known personally two or three of these young boys
that have been put on Ritalin, and they've appeared to me to be
in zombie-like states.
So I think we need to look very closely at this. I don't
believe we need to outlaw Ritalin, but I believe it needs to be
greatly, greatly reduced in its usage.
I'll say again I believe it is being over-prescribed in
this country just because of the profit factor, the money
that's out there that the drug companies want to make.
Thank you very much.
Mr. Burton. What I'd like to do is take the committee to
the 5-minute mark. We have almost 12 minutes left on the clock.
Then we will have to recess for three votes. I would urge all
Members to come back so we can hear our witnesses if it is at
all possible.
With that, I'd like to have our witnesses stand and be
sworn in. Would you please rise and raise your right hands.
Do you swear to tell the truth, the whole truth, and
nothing but the truth, so help you God?
[Witnesses sworn.]
Mr. Burton. Be seated.
I'd like to start off by showing a tape of Neil Bush, who
could not be with us today, because he had some things he
wanted to say and we'd like to show real quickly. So would we
put our attention on the monitors.
[Videotape played.]
Mr. Burton. I want to thank ABC for providing that tape to
us. We are now at a point where we have to recess. Please
forgive me, you on the panel and everybody in the audience.
We'll get back here just as quickly as possible.
We have three votes. The first one will be through in about
10 minutes, and then we have two 5-minute votes, so we'll be
back here in about 25 minutes. So get a cup of coffee or a
glass of water and forgive us for having to recess. We'll be
right back.
We stand in recess to the call of the gavel.
[Recess.]
Mr. Burton. The meeting will once again come to order.
There will be other Members coming back besides me and Mrs.
Davis, but we just had votes on the floor and we rushed back,
so they will be wandering in. Those things happen.
Before we start with the panel--who are on our way out, as
I understand it--I want to thank Sam Brunelli for helping me
arrange this. For those of you who don't know who Sam Brunelli
is, he was an All-Pro football player for some team out west
called the Denver Broncos. Is that what it was, Sam? Yes. Well,
Sam did a great job for them. He was All-Pro, but I think this
year they're going to be whipped by the Indianapolis Colts in
that division. And Sam's thinking over there, ``Not in your
lifetime.'' [Laughter.]
In any event, you've all been sworn and I want to thank you
for being patient with us while we were gone.
I think what we'll do is we'll start right down the list
there.
Ms. Weathers, why don't you start with your testimony? And
if you can, keep your testimony to 5 minutes, but we won't kill
you if you go just a few seconds over.
STATEMENTS OF PATRICIA WEATHERS, PRESIDENT, PARENTS FOR LABEL
AND DRUG FREE EDUCATION; MARY ANN BLOCK, D.O., AUTHOR AND
MEDICAL DIRECTOR, THE BLOCK CENTER; LISA MARIE PRESLEY,
NATIONAL SPOKESPERSON, CITIZENS' COMMISSION ON HUMAN RIGHTS;
AND BRUCE WISEMAN, U.S. PRESIDENT, CITIZEN'S COMMISSION ON
HUMAN RIGHTS
Ms. Weathers. My name is Patricia Weathers. I am a mother
from New York State. I have considerable concern regarding the
outcome of this hearing because my son, Michael, was one of the
children profiled for ADHD by our school district. When Michael
was in kindergarten, I began getting reports that he was having
behavioral problems. What was meant by this is that Michael was
talking out of turn, clowning around in class, and apparently
not sitting still.
The following year, while Michael was in first grade, his
teacher told me that his learning development was not normal
and that he would not be able to learn unless he was put on
medication.
Near the end of first grade, the school principal took me
into her office and said that, unless I agreed to put Michael
on medication, she would find a way to transfer him to a
special education center. I felt intimidated, scared, and
unsure of what to do as a result of the school's coercive
tactics. At no time was I offered any alternatives to my son's
needs, such as tutoring or standard medical testing. The
school's one and only solution was to have my child drugged.
At this point, his teacher filled out an actor's profile
for boys, which is an ADHD checklist, and sent it to his
pediatrician. This checklist, along with a 15-minute evaluation
by the pediatrician, led to my son being diagnosed with ADHD
and put on Ritalin. After a while, my son started to exhibit
serious side effects from the drug. He was not socializing,
became withdrawn, and began chewing on various objects. His
eating and his sleeping were sporadic and of great concern to
me.
Instead of recognizing the side effects of the drugs, the
school psychologist claimed Michael now had either bipolar
disorder or social anxiety disorder and needed to see a
psychiatrist. She produced a name and a number of the
psychiatrist I was to call. The psychiatrist talked to my son
and I for a short period and, again, with the aid of school
reports, diagnosed him with social anxiety disorder. She handed
me a prescription for an antidepressant, telling me it was a
``wonder drug for kids.'' Those we her exact words. There was
no information about the serious side effects associated with
this drug.
The drug cocktail that was to follow caused even more
horrendous side effects, making his behavior more and more out
of character. I could no longer recognize my own son.
Fearing what these drugs had done to him, I stopped them.
Through this whole ordeal, the school psychologist's
favorite saying was that it was trial and error. If one drug
didn't work, try another.
Realizing that I was no longer willing to fall in line and
give my child drugs, the school threw him out. For a final
blow, they proceeded to call child protective services on my
husband and I, charging us with medical neglect for refusing to
drug our child. This charge was later ruled unfounded.
On August 7th of this year the ``New York Post'' featured
my son's story and the fact that I had decided to file a
lawsuit against the school system on behalf of my son Michael's
ordeal. On Friday, September 20th, this lawsuit was officially
filed in Federal court. Within just a few days of the ``New
York Post'' article being published, over 65 parents came
forward to describe their own personal stories of coercion and
intimidation used by school districts used to strong-arm them
into drugging their children. Since then, many more have come
forward.
Through my family's experience, I feel the issue of
informed consent is crucial. As a parent, I was simply not
provided with accurate and critical information regarding the
issue of ADHD. I was never made aware of the controversy
surrounding this disorder whereby many medical professionals do
not validate it as a true medical condition. I was never
provided with the information that there is no independent,
valid test for ADHD. I was never given any warnings about the
documented side effects that could occur with the drugs used to
treat it. I was never informed that there are studies showing
the correlations between stimulant use and later drug use. As a
final point, I was at no time made aware that this drug use
could bar my child from future military service. As a mother, I
should have been given all of this information to make an
informed decision on behalf of my child. After all, it is we
who are ultimately responsible for the nurture, care, and
protection of our children. We are unable to fulfill this
obligation and make sound educated decisions without getting
all the facts.
Accountability is what I am seeking. I would never have
subjected my son to being labeled with a mental disorder if I
had known that it was a subjective diagnosis. I would not have
allowed my son to be administered drugs if I had been given
full information about the documented side effects and the
risks.
It is for this reason that I am asking this committee to
fully investigate these matters as they relate to the issue of
informed consent and to enact legal safeguards so that parents
can fulfill their obligations to shield their children from any
potential harm.
Thank you.
Mr. Burton. Thank you very much, Ms. Weathers. I think that
was a very, very important statement and we really appreciate
your coming here to day.
[The prepared statement of Ms. Weathers follows:]
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Mr. Burton. Dr. Block.
Dr. Block. Thank you for inviting me to this hearing. I am
Dr. Mary Ann Block, an osteopathic physician from Texas. For
those of you who are unfamiliar with the osteopathic
profession, let me tell you a little bit about us. We are fully
licensed physicians with the ability to write prescriptions,
perform surgery, and be residency trained in all the same
specialties as M.D.s. The difference between M.D.s and D.O.s is
two-fold: one, as a D.O. I had 150 more hours in medical school
than M.D.s. Osteopathic physicians tend to be more holistic in
their approach because of a philosophy that teaches us that the
body and mind should be viewed as a unit.
Because of my medical training, my goal as a physician is
to look for and treat the underlying cause of a patient's
problem, rather than just covering the symptoms with drugs. I
have seen and treated thousands of children from all over the
United States who had previously been labeled ADHD and treated
with amphetamine drugs. By taking a thorough history and giving
these children a complete physical exam, as well as doing lab
tests and allergy testing, I have consistently found that these
children do not have ADHD but, instead, have allergies, dietary
problems, nutritional deficiencies, thyroid problems, and
learning difficulties that are causing their symptoms.
All of these medical and educational problems can be
treated, allowing the child to be successful in school and in
life without being drugged.
The American Osteopathic Association has published my
program as the osteopathic approach to treating the symptoms
called ADHD. This approach is supported in the medical
literature, as well. The ``Annals of Allergy'' reported in 1993
that children with allergies perform less successfully in
school across the board than children who do not have
allergies, yet doctors prescribe amphetamines without ever
checking the child for allergies.
A study in the ``Journal of Pediatrics'' in 1995 reported
that children who ate sugar had an increase in adrenalin levels
that caused difficulty concentrating, irritability, and
anxiety.
A double blind cross-over study published in ``Biological
Psychiatry'' found that Vitamin B-6 was actually more effective
than Ritalin in a group of hyperactive children.
Another study found that children with magnesium
deficiencies were characterized by excess fidgeting and
learning difficulties.
There are many more studies in the medical literature that
indicate an association between nutritional deficiencies and
attention and behavioral problems, yet doctors prescribe
amphetamines without checking a child's diet.
There is no valid test for ADHD. The diagnosis called ADHD
is completely subjective. While some like to compare ADHD to
diabetes, there really is no comparison. Diabetes is an insulin
deficiency that can be objectively measured. Insulin is a
hormone manufactured by the body and needed for life. ADHD
cannot be objectively measured and amphetamines are not made by
the body, nor are they needed for life.
The prescription drugs that are used to treat symptoms of
attention and behavior come with a host of potential side
effects. According to the manufacturers of the drugs, the
following side effects can and do occur: insomnia, anorexia,
nervousness, seizures, headaches, heart palpitations, cardiac
arrhythmias, psychosis, angina, abdominal pain, hepatic coma,
anemia, depressed mood, hair loss, weight loss, tachycardia,
increased blood pressure, cardiomyopathy, dizziness, and
tremor, to just name a few.
These drugs are classified as Schedule II controlled
substances with high abuse potential. According to reports in
the ``Journal of the American Medical Association,'' the drug
Ritalin has been found to be very similar to and more potent
than cocaine. Ritalin and cocaine are so similar that they are
used interchangeably in scientific research.
There are no long-term studies on the safety and
effectiveness of these amphetamine drugs, though millions of
children are treated with them for years at a time.
When I was in school and when my children were in school,
there was no need to drug millions of children. While there are
children who have attention and behavioral problems, and these
problems may have increased due to poor diets, an increase of
sodas and candy in our schools, an increase in allergies due to
changes in our environment, and an increase in learning
problems, it does not mean these children have a psychiatric
disorder called ADHD. It means they have medical and
educational problems that can be fixed.
Most of the children I have seen who have been prescribed
these drugs have never had a physical exam. No doctor listened
to their heart, even though many of the side effects of the
drugs are heart related. Since there is no valid test for ADHD,
most doctors get the information for the diagnosis from the
child's teacher in the form of a checklist. If the teacher
wants the child to be taking these drugs, all she or he has to
do is fill out the checklist indicating that the child has many
problems in the classroom.
One child was diagnosed as ADHD and prescribed Ritalin, but
I got to treat him, instead. Once his allergies and learning
problems were corrected, he went on to become a National Merit
finalist and accepted to an Ivy League university. Every child
deserves that opportunity.
Many of the parents of these children have told me that the
teachers and principals have pressured them to put their
children on these drugs, threatening to report them to child
protective services if they do not comply.
CPS actually removed a child from his home after the school
reported the mother for not giving the child his drug. The
ironic thing was she had been giving him the drug. The drug
made him worse, not better.
I cannot imagine any reason to give a child an amphetamine
to cover up symptoms when the problem can be fixed and no drug
is required. Let's give our children the medical and
educational evaluations they need to diagnose the real
problems. Let's treat these real problems and give our children
the future they deserve without drugs.
I will show a brief video which shows a child disruptive
behavior caused from allergies. I'm also submitting as part of
my written evidence my latest book, ``No more ADHD: Ten Steps
to Help your
Child's Attention and Behavior Without Drugs.''
Thank you.
[Videotape presentation.]
Mr. Burton. Thank you very much.
[The prepared statement of Dr. Block follows:]
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Mr. Burton. Ms. Presley.
Ms. Presley. Thank you very much, Congressman Burton and
committee members, for the opportunity to address this hearing.
I'm here as a mother mostly, because I have to put my
children in school, and I've also had direct contact with these
children who are medicated, and I can tell by their behavior
that they are. They're usually manic, very destructive, very
interested in destruction. You know, we have already said it a
hundred times, but between 6 and 8 million American children
are being given Schedule II narcotics and/or mind-altering
antidepressants. It's not just ADHD.
Some of the other drugs case tics, cause this, which goes
into a spiral of OCD, Turrette's, this, that, and the other
thing, and all these, normal behaviors for children are now--
everything is a disorder. I mean, I basically would have
everything under the sun at this point. I'll stand up and
testify to that, too.
But, anyway, I'm just saying I have personally seen the
side effects of these drugs. Ritalin, for example, can cause
nervousness, loss of appetite, weight loss, and manic behavior.
Even the manufacturer warns that it can cause psychotic
episodes. Suicide is a risk during withdrawal.
Some of these drugs are advertised as non-addictive, but I
have known numerous people who have been to rehab centers to
get off of them. Teenagers on powerful psychiatric drugs
committed more than half of the recent teenage shooting
sprees--that's very alarming--resulting in 19 deaths and 51
wounded. I don't think there has been a correlation made in the
media with that, but it seems awfully coincidental--not
coincidental.
Parents need to be informed of drug-free alternatives to
the problems of attention behavior and learning. A child could
be fidgeting in class or simply bored with what they are
learning and then are diagnosed with a learning disorder and
put on drugs. Some of these disorders, from what I understand,
are also--you know, psychiatrists raise their hand and decide
something is a disorder that's not factually, scientifically
proven to be such. There is no blood test. There have been no
autopsies to confirm brain chemical imbalance. A child could
have allergies, lead poisoning, eyesight or hearing problems,
be simply in need of tutoring, or something even more basic
than that, which could be phonics.
I have not seen one happy and well-adjusted child as a
result of these drugs. That's just my personal experience. What
is basically happening is that we are relying on a chemical to
change the mood of a child. At least one of these more drugs is
more potent than cocaine, and we are turning children into drug
addicts at a very young age.
My hope is that the committee will recommend legislation
that prevents school personnel from coercing parents into
placing their children onto mind-altering drugs. They become
dependent on them and that leads to further drug addiction,
which then leads to crime, which leads to all the other
terrible things we always have to deal with in life, and
ultimately that we don't allow these drugs into the schools,
period. Our schools should only be there to educate our
children and not to diagnose any--have the ability or the right
to diagnose children with mental health problems. It is way
over-prescribed, way over done, and I think that at least--even
with the people, from what I've seen here today, that want to
go on the other side of the fence--still see that it is a
situation and it is a problem.
That's all I have to say. It is a concern.
[The prepared statement of Ms. Presley follows:]
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Mr. Burton. And you have been the head of this organization
or one of the leading spokesmen for some time now?
Ms. Presley. Actually, no, I'm just becoming one. I mean, I
have done a lot of things with them before on this front, but
I'm now taking on the title as the spokesperson for this
committee.
Mr. Burton. Very good.
Ms. Presley. Yes.
Mr. Burton. Mr. Wiseman.
Mr. Wiseman. Thank you, Chairman Burton and members of the
committee, for the opportunity to speak today. For over 30
years, CCHR's observations and conclusions have been drawn from
speaking to hundreds of thousands of parents, doctors,
teachers, and others.
For example, at 7, Matthew Smith was diagnosed through his
school as having ADHD. His parents were told he needed a
stimulant to help him focus and that noncompliance could bring
criminal charges for neglecting their son's educational and
emotional needs.
On March 21, 2000, while skateboarding, Matthew tragically
died from a heart attack. The coroner determined that he had
died from the long-term use of the prescribed stimulant.
We all know that there are children who are troubled who do
need care, but what that care is or should be is the point of
contention.
In 1999, in the wake of the Columbine school shooting, CCHR
worked with Colorado State Board of Education member Mrs. Patty
Johnson, who had a precedent-setting resolution passed that
recommended academic rather than drug solutions for behavioral
and learning problems in the classroom. Mrs. Johnson stated,
``The diagnosing of children with mental disorders is not the
role of school personnel, nor is recommending the use of
psychiatric drugs.''
The resolution told educators that their role was to teach
and pursue academic and disciplinary solutions for problems of
attention and learning.
In 2000, Jennifer L. Wood, chief legal counsel for the
Rhode Island Department of Education, issued a letter to all
schools that under the Individuals with Disabilities in
Education Act, ``it is not lawful for school personnel to
require that a child continue or initiate a course of taking
medication as a condition of attending school.'' School
personnel cannot require, suggest, or imply that a student take
medication as a condition of attending school, yet this is
violated across the Nation.
Millions of children are being drugged with powerful
stimulants and antidepressants, placing our Nation's children
at risk. In 2001, the ``Journal of the AMA'' reported that
Ritalin can act much like and is chemically similar to cocaine.
It admits that, while psychiatrists have used this drug to
treat ADHD for 40 years, they have never known how or why it
worked.
As a result of over-medicating our children and the fact
that so many parents were being forced to place their child on
such drugs, currently more than half of our States have
introduced and/or passed some type of legislation or regulation
to restrict the use of psychiatric drugs for children. I'm
submitting a selection of these for the committee's review. One
of which cites the 1998 NIH Conference on ADHD, which said, in
part, ``We don't have an independent, valid test for ADHD.
There are not data to indicate that ADHD is due to a brain
malfunction. And finally, after years of clinical research and
experience with ADHD, our knowledge about the cause or causes
of ADHD remain speculative.'' This is perhaps the crux of the
problem. We're relying on a diagnosis that is subjective and
open to abuse.
Evidence reviewed by the National Academy of Sciences this
year indicates that toxic chemicals contribute to learning or
behavioral problems, including lead, mercury, industrial
chemicals, and certain pesticides. Furthermore, thousands of
children put on psychiatric drugs are simply smart. The late
Dr. Sydney Walker, psychiatrist and author, said, ``These
students are bored to tears, and people who are bored fidget,
wiggle, scratch, stretch, and start looking for ways to get
into trouble.''
All of this information should be made available to parents
when making an informed choice about the medical or educational
needs of their child. This is in keeping with U.S. Public Law
96-88, which states, ``Parents have the primary responsibility
for the education of their children and States, locality, and
private institutions have the primary responsibility for
supporting that parental role.''
As senior Government officials, you represent the lives of
all citizens. Families are grieving for the loss of children
because they are not provided with all the facts about mental
health treatments, especially psychotropic drugs, and were
denied access to alternative and workable solutions.
We respectfully request that the Government Reform
Committee recommend Federal legislation that: A, makes it
illegal for parents or guardians to be coerced into placing
their child on psychotropic drugs as a requisite for his or her
remaining in school; B, protects parents or guardians against
their child being removed from their custody if they refuse to
administer a psychotropic drug to their child; C, provides
parents the right of informed consent, which includes all
information about alternatives to behavioral programs and
psychotropic drugs, including tutoring, vision testing,
phonics, nutritional guidance, medical examinations, allergy
testing, standard disciplinary procedures, and other remedies
known to be effective and harmless; and, finally, that such
informed consent procedure must include informing parents about
the diverse medical opinion about the scientific validity of
ADHD and other learning disorders.
Thank you.
Mr. Burton. Thank you very much.
[The prepared statement of Mr. Wiseman follows:]
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Mr. Burton. Let me just start with you, Mr. Wiseman. You
indicated that--are there some States that don't allow the
dismissal of a child because of the parents' refusal to use
these mind-altering substances?
Mr. Wiseman. That don't allow the dismissal of a child?
Mr. Burton. No. Are there some States that have some kind
of a last right of refusal for parents to keep the child in
school if they refuse to take these mind-altering substances?
Mr. Wiseman. Well, there are States, if I am understanding
the question correctly, States have started in 1999 to actually
pass legislation and regulations prohibiting schools from doing
that, but it has been a problem--so much of a problem that
there are now 27 States that have passed or have legislation or
resolutions in progress that address this issue. So it was
enough of a problem that, as I say, more than half the States
in the country have actually had to address the problem with
legislation because it was being abused. Parents were being
coerced.
Mr. Burton. Well, the reason I ask that question is many
school districts and many States around the country, they
require children to get inoculations for as many as 26
different childhood diseases. My grandson received 9 shots in 1
day, and I think in total number of shots that he will receive
prior to going to first grade would be around 26.
Mr. Wiseman. My word.
Mr. Burton. He received 47 times the amount of mercury that
is tolerable in an adult in 1 day, and 2 days later he became
autistic. While we're hoping he is going to recover, he may be
permanently damaged.
I guess the point I'm trying to make is these requirements
are at the school board level or at the county level or at the
State level, they're not requirements that the Federal
Government imposes. And so I'm wondering, you're asking for
legislation at the Federal level that would give parents the
right to refuse these mind-altering substances, and one of the
problems that we will have with some of our colleagues is that
that will be looked upon as an infringement of the local school
boards' or States' rights. I just wondered if you had given
that any thought.
It's not that I'm opposed, you understand, to trying to do
what we can here at the Federal level to deal with the problem
after we hear all the testimony, but each individual State has,
up to this point, been dealing with childhood problems like
this.
Mr. Wiseman. Yes. Unfortunately--and not to be repetitious,
but, unfortunately, we hear in our organization mothers calling
in that are being coerced, and the abuse is tragic. Parents are
being threatened with either criminal charges, as I mentioned
in my testimony, or in some cases the loss of their children
because they're not put on mind-altering drugs. I mean, we're
at the dawn here of the 21st century, and there are some
children who aren't permitted to go into school unless they're
on a mind-altering drug.
The Federal legislation that bears on this is the
Individuals with Disabilities in Education Act. The problem is
that the definitions in that law and the definitions that
filter down to the school districts under that law are so
subjective that the disorder is in the eye of the beholder.
There are no objective tests for this, as has been testified
here this morning and from folks on the panel. There is no
scientifically based studies that enable somebody to make such
a diagnosis. So, because they are so subjective, it is open to
abuse.
Mr. Burton. What I'd like to have from you, Mr. Wiseman, is
some proposed language that we can take a look at that might be
appropriate at the Federal level. We approach stepping into
States' rights with great trepidation, at least on this side of
the aisle, so this is something we'd have to take a hard look
at. But I will look at it and see if we can fashion something
that will maybe encourage the States to be more concerned about
parental rights and how the children are handled and whether or
not they're completely, properly tested before they start
putting these drugs into them.
Mr. Wiseman. As a former teacher of American history, I
share, one, your love of the Constitution, and your concern for
States' rights very, very much. But with somewhere on the order
of 6 million children in this country being placed on the
Schedule II narcotics, I do think it is something the Federal
Government should look for, and we'll be happy to provide you
with some suggested wording.
Mr. Burton. Very good.
I'll get to you, Mrs. Davis, in just a minute, as soon as
we finish these first questions. We'll be with you in just a
second.
Ms. Weathers, you stated that your son's school pressured
you to medicate your son, and that at the time you trusted them
because they were ``the experts.'' At any time did the school
or your son's doctor talk to you about the potential side
effects of those drugs?
Ms. Weathers. Absolutely not. The most the pediatrician had
told me was that there was possible appetite suppression and
possible insomnia. She never at any time advised me that there
are deaths related to this, there's cardiac problems, heart
problems related to these drugs, that his growth would be
seriously impaired.
When I took Michael off these drugs, within 3 weeks he grew
three sizes, so nobody can tell me that those drugs didn't have
a great, a tremendous, a horrendous effect on him.
Mr. Burton. Did your doctor also recommend any behavioral
modification training or counseling for your son?
Ms. Weathers. Absolutely not. She did not. Basically, I had
to go in, I believe every 3 to 4 months, for a prescription
refill.
Mr. Burton. So they just didn't check any of that out? They
just said, ``These are the things that you have to do,'' and
prescribed the drugs?
Ms. Weathers. They basically--all she did was ask me how he
was doing.
Mr. Burton. Did the doctor ever do any blood tests or
objective medical evaluation to look at any possible biological
basis for his behavior?
Ms. Weathers. I don't believe there was. I think early on
there was a blood test taken, but, once again, you don't have a
blood test to determine ADHD. You can only have a blood test to
rule out underlying causes. I believe the only thing they did
rule out was lead toxicity.
Mr. Burton. Dr. Block, what have you found that the schools
do specifically to encourage the use of medications for
attention behavior?
Dr. Block. The parents that come to me report consistently
that the teachers and the principals and even the school nurses
pressure them to go to a physician and get their child labeled
and drugged. In addition, even though the State of Texas Board
of Education has passed one of these State resolutions being
concerned about the drugging of children, it appears to me that
the teachers are not yet aware of it, because nothing seems to
have changed since that resolution has passed.
Some schools are giving lectures to parents, inviting
parents to come hear talks about diagnosing and drugging their
children for ADHD.
Another thing that has recently occurred, it's not unusual
for me to make recommendations for certain nutrients or other
things that the child may need to naturally help their body and
mind work better, and I will write a prescription for that
child to receive that nutrient at school. What is happening
now, though, is that the schools are denying my medical
prescription and saying that they will not give a child
anything at school except a drug. That, to me, is practicing
medicine without a license.
And, unfortunately, physicians, themselves, according to
the FDA, less than 1 percent of doctors actually know the side
effects of the drugs that they are prescribing. Pharmaceutical
reps that come to my office have told me more than once that
I'm the only doctor they've called on that asked what the side
effects of the drug was that they were repping to me.
Mr. Burton. Let me--I see I'm running out of time here and
I want to get to Mrs. Davis, but do you have any idea how
physicians are influenced by the pharmaceutical companies to
prescribe these medications for kids?
Dr. Block. Yes. As a physician I see this influence all the
time. For one thing, I don't think any of us can turn on the
television, radio, open up a newspaper or magazine without
seeing multiple advertisements for prescription drugs. They go
so far as to say, ``Ask your doctor if this drug is right for
you,'' encouraging the public to go to the doctor to get a
drug.
But, in addition, I don't believe the public is aware of
the strong influence the pharmaceutical industry has on
physicians. From the time we start medical school until the day
we stop our practice, we are strongly influenced or attempted
to be strongly influenced by the pharmaceutical industry. Our
medical journals, which are purported to be unbiased, usually
have about 60 percent of their pages as full-page ads from the
pharmaceutical industry.
If I go to a continuing medical education meeting, which is
required by law that I attend so many hours each year, the
doctors who are talking to us are being paid by the
pharmaceutical industry to give those lectures. Many doctors
are being paid in their offices to do research for the
pharmaceutical industries, as well. They also give money to
different groups who go out and promote the use of these drugs
for our children.
So the pharmaceutical companies have a tremendous influence
on our society, and especially on physicians. It is concerning
when doctors don't even know the side effects. There's no way
that they can tell a patient if they don't know them
themselves.
Mr. Burton. I will yield to Mrs. Davis, but let me just say
my son-in-law is a doctor and I've gone to a number of these
lectures that are put on by pharmaceutical companies, and I can
tell you, as one who goes--and they're very nice dinners they
put on, and very expensive in many cases, have great wines and
all those sorts of things--they do have doctors that come in
and talk about the attributes and the positives about these
drugs so that they are very effective in selling their products
to the doctors and the doctors writing those prescriptions.
Incidentally, we will have a second round of questions,
because I have some more questions for the panel.
Mrs. Davis.
Mrs. JoAnn Davis of Virginia. Thank you, Mr. Chairman. I
don't have too many.
I tried to say at the beginning that we just have this
tendency in our country to go from one end to the other and we
never seem to find the right balance, and I think that's where
we are right now with the ADHD and the Ritalin. Like I said,
when my son was put on it the teachers didn't even know about
ADHD, and I understand now they're even training the teachers
in school or something. In fact, my son's pediatrician wasn't
even that familiar with it. He sent me to a psychologist, and
we did a lot of testing.
It was explained to me--and, Dr. Block, this is for you--it
was explained to me that, with the ADHD, the child has the
blood in the frontal lobe of his brain, I guess, just goes so
slow that that's why he can't concentrate--he's seeing, like,
three different pictures, or what have you, and that's why they
can sit in front of a TV for hours, because so much is going
on--and that the Ritalin would speed up the blood flow and then
cause them to be able to concentrate. Have you ever heard that?
Dr. Block. I certainly have heard that and it is an
interesting theory, but it has never been proven. In fact,
drugs like Ritalin and other amphetamine-type substances, one
of the basic things they do is make you focus. They can make
you over-focus, but they--it has been found that anyone who
takes this type of drug will have a similar effect, because
that's what it is. It doesn't prove that someone needs the drug
because they have that effect.
But there is many theories going around, and there's many
people who are looking at all kinds of brain scans and
everything else, but when you look at the child in my video who
was reacting to an allergy, I assure you if you did a brain
scan of him at the time when he's reacting you would see
reactions.
And so my focus is really on information, informed consent,
that parents be told what all their options are, that they be
told all the possible side effects to any treatment.
You know, I think parents always care so much for their
children, they're going to do what is right for their child if
they are given all the information.
Mrs. JoAnn Davis of Virginia. I agree with you, and we were
told the side effects of Ritalin when we gave it to our son.
That's why it took us so long to give it to him, because you
just--we didn't want to do it. We did not. And it was actually
a last resort for us to do that. It did work for him.
Ms. Weathers, I had a question for you, and if you will
give me a second it will come back to me.
You said that the teachers all said your son had a problem.
Did you ever find out what the problem is or was? Or is this
just recent?
Ms. Weathers. No, this isn't recent. You know, in my
opinion Michael is extremely bright. He was not reading at
grade level. There was a lot of factors that were playing a
role in his behavior that were not even addressed by the
teachers. When he was going into fifth grade he was reading at
a second grade 8 month level. OK? That isn't normal. They were
putting him in a special ed room and not teaching him phonics.
I think that's horrendous. I really do.
Mrs. JoAnn Davis of Virginia. Did you have problems with
him at home?
Ms. Weathers. No. I would never, ever--and I want to make
this perfectly clear for everybody in this room--I would never
have contemplated drugging my child ever. He never had behavior
problems at home. The minute he entered school, that's when the
trouble started. That is when I was coerced. I felt under
pressure. I felt like everyone was telling me that this was the
best thing. I was a single mom. I was scared. I was unsure. You
know, I felt, ``These are the experts. They know children.''
And I know, I get hundreds of phone calls throughout the
country, hundreds from other parents having the same experience
that I have endured and my family and my son has endured, as
far as Hawaii. I have a woman in the State of Hawaii who had to
leave the State of Washington because she was so pressured. She
wanted to pick the State with the lowest consumption of Ritalin
abuse, and she flew her entire family to Hawaii. Her name is
Susan Perry, and I am in contact with her now, and we are
fighters, and I'm going to fight this issue until the very end,
because parents are not informed nowadays. We're not told the
side effects. We are just not. And it is just tragic because
our children are suffering and our children are what counts.
Mrs. JoAnn Davis of Virginia. Thank you, Ms. Weathers. I
totally agree with you. As a Mom, there's nothing more
important to me than our kids, and I know how you feel.
Thank you, Mr. Chairman.
Mr. Burton. We'll have a second round of questions.
Let me just tell you something that is of interest that you
might find interesting, Ms. Weathers. Mercury is in a lot of
our vaccines. Mercury is a toxic substance. I've talked to a
number of doctors, including doctors here on the Hill that
treat Congressmen, and I told them, I said, ``Do you know that
in our flu shots that we get there's mercury?'' And some of the
doctors said, ``No, no. There's no mercury in there.'' And I
took the insert out and I showed it to them, and it says,
``thimerosal.'' And they said, ``See, there's no mercury in
there.`` And I say, ``Thimerosal contains mercury.'' It has
never been properly tested since 1929. It was tested on 27
people who all were dying from meningitis. All of them died,
and so they said that the mercury didn't cause it. But they've
never tested it ever since, and it has been given to our
children. My grandson got nine shots, many containing mercury,
in 1 day, and 2 days later he was autistic and may be maimed
for life. He's not responding as we would like.
And so you are absolutely correct. Parents need to be
informed about the substances in the vaccines and in the pills
and all the other treatments they're getting, and if they don't
get that then shame on us. And doctors need to be given the
proper information from the Food and Drug Administration, and
the Food and Drug Administration has been derelict in their
responsibilities in doing that.
I'm very sorry we don't have the FDA here today, because
the FDA's responsibility is not only to test these things, to
do double blind studies and everything else before we start
administering these things to the population and our children,
but they're also supposed to inform people, and they haven't
been doing that, as well, and that's one of the reasons why
we've had so many problems with them over the years. But we
will be contacting the FDA about that.
Let me ask you, Dr. Block, one more question. And I will
have other questions I'd like to submit to you for the record
that you can answer later.
As you know, we've learned that a Government-funded study
found a correlation between the use of thimerosal, mercury-
containing vaccines, and a diagnosis of ADD. Do you think that
every child that is referred to a doctor for ADD evaluation
should be tested for heavy metals?
Dr. Block. Yes, I do think every child should be. In
addition to seeing a lot of children with attention and
behavioral problems in my practice, I see a lot of children who
have been diagnosed as autistic, and through testing these
children for heavy metals and often finding mercury and lead
and other heavy metals, begin testing the children who have
attention and behavior problems, and often find the same thing
with them, as well.
I think that these problems are on a continuum where one
child has severe symptoms and gets the autistic label, while
another child gets an ADHD label, but I'm finding the same
underlying problems in all of these children.
Mr. Burton. Heavy metals being one of them?
Dr. Block. Heavy metals being a major one, yes.
Mr. Burton. And so it would be your opinion that these
preservatives they're putting in that contain aluminum and
mercury, in particular, should be taken off the market? They
should take those things out of there?
Dr. Block. They should be taken off the market. They were
supposed to be taken off the market was my understanding, but
they have not been taken off the market. Many pediatricians
actually believe they have been taken off the market, so
they've not looked to see if the thimerosal is in the vaccine.
But they are still in the vaccines. Children are still getting
as many as eight or nine different diseases immunized against
in a single visit to the doctor's office, and many of those
vaccines do contain the mercury and aluminum, which work
together to make the problem even worse.
Mr. Burton. Let me just say that we suspect--in fact, I'm
pretty sure--that, while they're starting to get mercury out of
children's vaccines here in the United States, we send vaccines
all over the world to Third World countries, and we send them
with multiple vaccines in one vial, and they are still using
the mercury, the thimerosal in those almost entirely around the
world. And so, while we're starting to get them out of our
vaccines, we're continuing to inject mercury into children all
over the world in Third World countries, which I think is
almost criminal.
Let me ask Ms. Presley a question here.
Ms. Presley. Yes, sir?
Mr. Burton. Why did you choose to get involved in this
discussion of ADHD? Have you had a family that was
misdiagnosed?
Ms. Presley. Yes, I have. I have also had experience with
mercury. I had nine fillings at one point, and I went 2 years
almost going crazy getting asthma, hypoglycemia, candida, all
these troubles. I've baffled every doctor from one coast to the
next. And then, when I finally got the diagnosis you're
supposed to have between zero and three normal in a human body
and I had 1,000-plus. The doctor called me and said the term
``Mad as a Hatter'' is from people who used to work in felt
factories where they would be exposed to mercury and they would
go crazy.
I had experience with that, and the moment I started taking
things either naturally or a chelation agent to get it out, all
the symptoms stopped. So I have had personal experience with
that and I do know that mercury is not only in vaccines, they
are in fillings of children. They still use it in the mouth.
Mr. Burton. Amalgams.
Ms. Presley. Yes, amalgams.
Mr. Burton. Most people don't know that 50 percent of the
silver fillings in your mouth, 50 percent of those are mercury.
Ms. Presley. Yes, sir.
Mr. Burton. A lot of people don't know that.
Ms. Presley. Other than that--I'm sorry--the reason I got
involved was because I've had personal experience around
children who are medicated and I see their behavior and I see
that it is usually something very obvious, they do have
allergies. I've seen them. I've seen them manic, crazy, and
then they come off of it and there's a whole other story. They
actually find the reason. You know, there's always a simple
explanation for it. I just don't want to see our future
generation being drugged, and I also don't like to see it being
promoted as something non-addictive when it absolutely is.
Mr. Burton. One last question of Mr. Wiseman, and I may ask
a few more after we get through with my colleagues here.
Are teachers qualified to diagnose medical conditions?
Mr. Wiseman. Absolutely not, Congressman. We have talked to
people in the Department of Education who say that that's a DOE
policy, and virtually every State has that as a policy, yet it
is happening across the country.
Mr. Burton. We actually have teachers in schools using a
checklist that go to a doctor and they are making a direct or
indirect recommendation to the doctor that this child be put on
Ritalin.
Mr. Wiseman. Yes. They have checklists that come out of the
``Diagnostic and Statistical Manual'' for ADHD. I've seen them.
Mr. Burton. And the doctors many times have followed the
recommendations of the teachers?
Mr. Wiseman. Of course.
Mr. Burton. Yes.
Mrs. Morella, do you have questions?
Mrs. Morella. Yes, sir.
Mr. Burton. Mrs. Morella.
Mrs. Morella. Thank you. Thank you, Mr. Chairman, and thank
you for calling this hearing. I want to thank the witnesses
also for coming together to offer their comments on it.
You know, what I particularly like is that you brought in
witnesses that have various perspectives from all sides of the
debate, and I think it is important that we listen to arguments
from those who believe attention deficit disorder is not a
brain disorder and those who believe it is and warrants
medication along the lines of Ritalin.
Considering there has been a 500 percent increase in the
use of Ritalin in the United States since 1990, and roughly 4
to 6 million children may be using it daily, I think it is
important that we ascertain the root causes of ADHD and how to
best alleviate its effects.
I wanted to ask a couple of questions, if I may. One, I
might ask it of Ms. Presley. It is a pleasure to see you in
person.
Ms. Presley. Thank you.
Mrs. Morella. Thank you for being here, and also to Mr.
Wiseman, because I have before me a statement that has been
made by the International Citizens Commission on Human Rights
president, Jan Eastgate. This is a quote. ``Society has been
under a concerted attack for decades. Designed and implemented
by psychiatrists, this attack claims countless lives each day.
Like some malignant disease running rampant, it threatens the
future of society and ultimately mankind.''
Now, what I'm wondering is: do you believe in this
expression that I have just read to you? If both of you would
comment on that, I'd appreciate it.
Mr. Wiseman. I can comment, Congressman. We are a
psychiatric watchdog group. We investigate and expose
psychiatric abuse. And what we see going on in psychiatric
hospitals, not only in the United States but around the world,
would make you weep. I have personally investigated the abuses
that go on in these hospitals, the physical abuse, the sexual
abuse, the drugging people into stupors, the electroshock
treatments, what psychiatry has done to our educational system,
psychiatric testimony in the courtroom where murderers and
rapists are let go because they're not guilty because they had
an irresistible impulse based on psychiatric testimony. So I
would certainly agree with Ms. Eastgate's comments.
Ms. Presley. I personally have not seen psychiatry do any
good for anyone I've ever known, personally. That's just my own
experience, whether it be drugging, electric shock therapy,
which does still exist, which is very barbaric. I don't think
it goes--I mean, I have my own personal issue with the subject,
but that's not why I'm here right this moment. This is more
related to the drugs, again, upon which psychiatry is based, of
course.
Mrs. Morella. So you put them all into that one category?
Ms. Presley. I think they're all correlated.
Mrs. Morella. All right. If I could ask one other question,
several medical organizations like the AMA, the Centers for
Disease Control and Prevention, and the National Institutes of
Health believe that attention deficit hyperactivity disorder is
a brain disorder that may require psychiatry or psychiatric
drugs for treatment. I wonder how could you explain the
considerably different viewpoint that they hold as opposed to
the viewpoint of CCHR?
Mr. Wiseman. Well, I don't know if you are asking me or Ms.
Presley, but I'll address it and she can, as well.
Mrs. Morella. If she would like to add something.
Ms. Presley. I'll address it, as well.
Mrs. Morella. Thank you.
Mr. Wiseman. I think the operative word in your question,
Congresswoman, is the word ``believe.'' It is a matter of
belief. Our concern is that there is no biologic, organic,
scientific basis for ADHD. These are subjective symptoms. These
are behavioral symptoms. The child fidgets, he looks out the
window, he butts into line. The psychiatrist wraps these
attributes up and throws a label on it, and the children are
subsequently drugged.
That various medical organizations believe that it is a
brain disease is just that. It is a belief without true
scientific validity.
Our point here really is parents should have an opportunity
to get the other side. They need to have informed consent. They
need to know, at the very least, that the diagnosis is
controversial.
Mrs. Morella. Ms. Presley, did you want to comment on that?
Ms. Presley. Yes. I haven't seen any evidence. I'm not a
scientist. I can't back it up scientifically, but I just have
not seen, whether it be a blood test to diagnose or any other
thing to diagnose, it is not confirmed, there is no way to do
it. And there are too many people, if you spend--I would like
to do a documentary on it, actually, 1 day, just to show how
long it takes, if you take a child to a psychiatrist, before
they whip the thing out and start writing a prescription. It's
usually 10 minutes, 15 maybe, and it is usually just basically,
you know, based on--sorry.
Mrs. Morella. Well, I could go on, and I'm not a scientist,
but I have always had a great belief in CDC and NIH and AMA,
and you just said forget it.
Ms. Presley. I would like to just also point out that there
is an inter-mingling of those three, of course. You know, the
drug companies, pharmaceutical companies go along very much
with the APA. They all make money. It's a big industry, you
know, to push drugs--diagnose disorders and give drugs for it.
It is an industry. They're making money, a lot of money, a lot
of money.
Mrs. Morella. Dr. Block, did you want to comment?
Dr. Block. Yes. The National Institutes of Health has
stated that there is no valid test for it and that it is not a
brain disorder. And also, the medical profession is based on
coding, and it is coding based on getting paid by the insurance
company, so a diagnosis that can be objectively defined such as
diabetes, hypertension, things like that, there are codes for
those things. The psychiatric community has made codes for
their psychiatric disorders. But just because there is a code
for it and doctors can diagnose it and get paid for it doesn't
mean that there is an objective brain disorder going on.
Mrs. Morella. Mr. Chairman, I would yield back, but I would
guess, Dr. Block, you probably would gain a little bit, too, if
we--if people were scared away from psychiatric drugs, right?
Dr. Block. Do I gain?
Mrs. Morella. You probably would gain financially.
Dr. Block. I have a medical practice working with these
children, but for me if I get them well and out of my office
they don't have to keep coming back, whereas if they're being
drugged they do keep coming back.
Mrs. Morella. Fine. Thank you very much, Mr. Chairman.
Mr. Burton. Mrs. Davis.
Mrs. JoAnn Davis of Virginia. I have one more question for
Ms. Weathers. When you took your son back to the pediatrician
to get the prescription refilled, did you say he did not do a
physical--he or she?
Ms. Weathers. No, she didn't. She did not do a physical
exam to refill the prescription for Ritalin. He would have
once-a-year physical before he started school. That was the
only physical he had during the course of the year.
Mrs. JoAnn Davis of Virginia. Thank you, Mr. Chairman.
Mr. Burton. Judge Duncan.
Mr. Duncan. Mr. Chairman, I apologize. I have another
meeting I had to go to, so I'm not going to ask any questions
at this time. I'll ask them of the next witnesses.
Mr. Burton. OK.
Let me just ask a few more questions. In particular, since
Mrs. Morella is still here, I'd like for her to hear just a
couple things that were said in her absence.
According to the AMA, the properties of Ritalin very
closely parallel cocaine; is that correct?
Mr. Wiseman. Yes.
Dr. Block. Yes.
Mr. Burton. And, according to the AMA--or not the AMA in
this particular case, according to some testimony that was
given today, if you grind up Ritalin and make it into a powder,
the effect of the Ritalin is very, very similar to the effect
of cocaine, and it is habit forming?
Dr. Block. Not just the same, it is. I mean, it is the
same, not just similar.
Mr. Burton. So cocaine and Ritalin, when put into powder
form, are the same?
Dr. Block. They go to the same receptor site in the brain
and they provide the same high when taken in the same manner
and are used interchangeably in scientific research.
Mr. Burton. They're used interchangeably in scientific
research?
Dr. Block. Correct.
Mr. Burton. OK. So when you put a child on Ritalin for a
long period of time, there is a fairly good chance that that
child will be addicted, just like a person who uses cocaine?
Mr. Wiseman. Congressman, I know you asked that of Dr.
Block, but if I might point out, there's a study by a Dr.
Nadine Lambert at the University of California Berkeley that
followed 492 children for 26 years and found that those who
were labeled with ADHD and given stimulants were 200 to 300
times more likely to abuse tobacco and cocaine in adulthood.
Mr. Burton. They were 300 times more----
Mr. Wiseman. Two to three times more.
Mr. Burton. Two to three times more likely to use----
Mr. Wiseman. Tobacco and cocaine.
Mr. Burton. OK.
Mr. Wiseman. In adulthood.
Mr. Burton. Now let me ask you a question that I think we
will ask of the doctors that are going to come up here, so
they'll have a preview of some of the questions we're going to
ask. Has there been any autopsies on children who allegedly
have ADHD to see if there was any difference between their
brain and the brain of a child that had ADHD and were given
these substances like Ritalin?
Dr. Block. I don't know of any autopsies. I know that there
are studies that have shown changes in the brain of children,
but these children were taking drugs like Ritalin. And there
have been studies that showed children who took cocaine had
brain changes that looked like holes in their brain, just spots
on the X-rays. And so the Ritalin may be doing the damage that
shows up in these children's brains.
Mr. Burton. Is there any evidence through autopsies of
brains that would show that children who have ADHD have any
abnormality?
Dr. Block. I know of no such studies.
Mr. Wiseman. I know of no such, sir.
Mr. Burton. Any other questions?
Mr. Wiseman, let me just ask you a couple more questions.
We've seen reports that Ritalin and antidepressants are being
prescribed for 2-year-olds in the Medicaid population. Are you
aware of any clinical trials that have evaluated the safety of
these drugs in children age 2 years old?
Mr. Wiseman. No, sir.
Mr. Burton. OK.
Mr. Wiseman. In a word. And, if I can say, I think it is a
travesty that children in some cases still in diapers are
labeled with ADHD and put on, in some cases, several mind-
altering drugs. I think it is barbaric.
Mr. Burton. So there have been no clinical trials, to your
knowledge?
Mr. Wiseman. Not that I'm aware of, sir.
Mr. Burton. You are aware that the NIH conducted a
consensus conference on ADHD several years ago. Did they look
at the entire scope of treatment options, or did they just
focus on Ritalin?
Mr. Wiseman. No. They primarily focused on Ritalin. I
testified at those hearings in November 1998, and they had 3
days of slides and presentations and so forth, and I read the
final conclusion. We do not have a valid, independent test for
ADHD. There are no data to indicate that ADHD is due to a brain
malfunction. And finally, after years of clinical research and
experience with ADHD, our knowledge about the cause or causes
of ADHD remain speculative. That was after 3 days of
speculations.
Mr. Burton. But did they look at the entire scope of
treatment options----
Mr. Wiseman. No, sir.
Mr. Burton [continuing]. Besides Ritalin? It was just
Ritalin, only? OK.
And, finally, what biologic conditions can lead to an
inability to concentrate in class in a schoolroom?
Mr. Wiseman. Well, as I mentioned in my testimony, and as
Dr. Block has said, there's a number of underlying physical
problems such as mercury poisoning, lead toxicity, and those
kinds of things that actually can affect the nervous system and
can make children act hyperactively.
Mr. Burton. And just being kids.
Mr. Wiseman. Yes.
Mr. Burton. I will tell you, if they had had Ritalin when I
was a boy I have no question in my mind, as many times as I was
sent to the principal's office for being out of control, that I
would have been on Ritalin. I really believe that, because I
was a real pain in the foot. [Laughter.]
Did you have any questions?
Mrs. JoAnn Davis of Virginia. Yes, if you will indulge me
for a minute.
You're saying that there's no proof that it's not a
biological disorder, but there's no proof that it isn't--
there's no proof that it's not a biological disorder, as well,
right?
Mr. Wiseman. It's kind of trying to prove a negative, but
that's correct.
Mrs. JoAnn Davis of Virginia. What do you say to a parent
who has had their child tested, there's no physical disorder,
there's no mercury because there has been no fillings, there's
no allergies, there's no nothing, and you have more than, Mr.
Chairman--I believe the children who are ADHD, it is a lot more
than just out of control. There's many more symptoms other than
out of control. They're not just a hyper child. What do you say
to that parent who has had the child tested for everything and
there's no other explanation, and then they take the Ritalin
and it totally changes things?
Dr. Block. I think that every parent has the right to
choose what's best for their child. The problem is they're not
being made aware of the options and the possible side effects,
that they are being pressured to put the child on the drug,
even when they choose not to, and we are learning new things
all the time, because mercury doesn't just come from fillings.
Mercury comes from vaccines, and all children--almost all
children have had vaccines.
So there are many different reasons why children have these
problems, and learning problems are a big one that schools
often overlook. Nowadays, I'm finding out that even some of the
places that used to test children for learning disabilities are
now saying, ``Well, go see if they have attention deficit
first, and then we'll look at that.'' But it is the tail
wagging the dog--the learning problems causing attention and
behavior problems. We need to fix those first.
Mrs. JoAnn Davis of Virginia. I don't disagree with you.
And, just to set the record straight, Mr. Chairman, I fully
believe in my heart that children are being over-medicated and
everybody is being diagnosed if they are just being children.
Thank you.
Mr. Burton. Thank you, Mrs. Davis.
Mrs. Morella.
Mrs. Morella. Thank you, Mr. Chairman.
Mr. Burton. My great friend from Maryland.
Mrs. Morella. Thank you.
It's simply that I was looking over the credentials, and I
noted that the Citizens Commission on Human Rights was
established by the Church of Scientology; therefore, I wondered
how is the organization now related to Scientology, and what is
the church's stance on psychiatry and psychiatric drugs?
Mr. Wiseman. Well, Congresswoman, we're proud to have been
founded by the Church of Scientology some 32 years ago. We are,
however, an independent, IRS-recognized, public benefit
corporation, and our role is a social reform activity to clean
up the field of mental health, so we investigate and expose
psychiatric abuse and psychiatric violations of human rights.
Mrs. Morella. Does the church have a stance on it, or----
Ms. Presley. Can I just say ``no'' on that one? No. I'm
not--I mean, I personally am not here for that reason at all.
I'm here because I'm a mother and I care about children and
that's it. And I knew that that was going to come up as a
question in here and I knew that it was going to be speculated
that it is because you're a Scientologist, blah, blah, blah.
The bottom line is that I just think it is inhumane and it's
not right and it is abusive and an epidemic and it needs to be
looked into. It has nothing to do with religious beliefs and/or
anything else, as far as I am concerned.
Mrs. Morella. No. I believe that you are motivated,
obviously, because you care deeply about it, but I just
wondered does the church have a stand on it?
Ms. Weathers. Can I say something as a parent, and just as
a parent?
Mrs. Morella. OK.
Ms. Weathers. I feel that this issue transcends all social
and political and religious backgrounds. I think this is our
children, and we need to really address the issue that this is
our children, and this is our future generation here. This
doesn't have to deal with anything other than our children.
Mrs. Morella. I believe your motivation, I truly do. I'm a
mother, myself. But I am curious still about whether or not
Scientology----
Mr. Wiseman. Sure. I'm delighted to answer your question. I
have been a Scientologist for 32 years. Every Scientologist I
know is very concerned about human rights abuse, but that's not
really the issue from our point of view and why we're here. Our
concern is that parents aren't being given all the information
and the choices. They're not given informed consent on the
issue. That's really the concern, Congresswoman.
Mrs. Morella. Thank you.
Thank you, Mr. Chairman.
Mr. Burton. Before I yield to Mr. Gilman, let me just say--
because we're going to have some votes on the floor--we had 1
in 10,000 children, according to CDC, that were autistic a
decade or so ago. We now have 1 in 250 children or more that
are autistic today. We've had a 40-fold increase, 40 times
increase in the number of children that are autistic in
America. And there are a great many scientists and doctors who
believe that some of the contents, including mercury, in
vaccines are a major contributing factor. We have an epidemic.
The young lady, Ms. Weathers, talks about our kids and our
future and what it is going to do to our society. Put a pencil
to the amount of money it is going to take to take care of
children today who are going to be adults in 15 years who are
autistic, who can't get a job, who can't function properly in
society. You're talking about billions, maybe trillions, of
dollars, and we need to find the answers and get it
straightened out. And if mercury, as I suspect, is a major
cause, then we damn well better get it out of our vaccines.
Mr. Gilman.
Mr. Gilman. Thank you, Mr. Chairman.
I'm curious, Dr. Block--and I regret I had to go to another
meeting and couldn't be here for your testimony--has there been
any long-term study of the long-term effects of utilizing
Ritalin?
Dr. Block. No, there has not. The drug manufacturers,
themselves, say there are no long-term studies. The National
Institutes of Health, when they had their conference, stated
that most drug trials were very short, up to 3 months, yet
children are placed on these drugs for years and years without
the knowledge that we need to know if they are safe.
Mr. Gilman. Sounds like we have to undertake that study.
Background material provided to our committee cites
American Academy of Pediatrics data that estimates 4 to 12
percent of the children in the United States have some form of
ADHD. Is this estimate applicable to other countries like
Japan, or is this uniquely an American problem?
Dr. Block. This is uniquely an American problem. Of all
Ritalin in the world, 90 percent is sold in the United States.
I have seen families from all over the world at my medical
clinic, and those who have come from other countries always
have an American connection--they were in an American school
and told their child needed to be drugged. If they moved them
to a British school, they were told their child was fine. I've
seen this story occur over and over again.
Mr. Gilman. When educators observe potential ADMD [sic]
cases, how much weight is given to non-ADMD [sic] factors such
as level of physical activity, diet, environment, and other
possible disorders?
Dr. Block. Usually there's not anything given to that. What
is usually done is the teacher fills out a checklist describing
behaviors that the child has at school, and parents may be
asked to fill out this check list. The parents that bring their
children to my office have told me that their doctor, in most
cases, never did a physical exam, never listened to their
child's heart, even though many of the side effects of the
drugs can affect the heart. They're not looking for other
problems, not looking for allergies, learning problems, thyroid
problems, anything physical or educational that might be wrong
with the children before labeling and drugging them.
Mr. Gilman. In previous, unrelated hearings covering the
war on drugs, the Drug Enforcement Administration, DEA, has
testified that many adolescent takers of Ritalin often poured
more supply and sell it to customers through an illegal
secondary market. Is this a significant problem? I address that
to any of our panelists?
Dr. Block. This is a significant problem, and there have
been reports that indicate that Ritalin is the most abused drug
in high school and colleges. And there are other drugs like
Adderol. I don't want to just focus on Ritalin. There are many
other amphetamine or amphetamine-type drugs that are abused on
the street in the same way.
Mr. Gilman. And, in general, the percentage of the student
body taking Ritalin or similar drugs is smaller in parochial
schools than the same percentage in public schools. Why do you
think that's the case?
Dr. Block. Well, I can't speak to exactly why, but from
what I've heard there is a great deal of discipline in many
parochial schools, but I'm also seeing a change there where the
drugging of children is increasing in private and religious
schools to a great extent, as well.
Mr. Gilman. Do any of our panelists want to add any
comments to the questions I've just asked?
Mr. Wiseman. Only, Congressman, that last year, or perhaps
the year before, there was legislation proposed, and I believe
passed, by Congressman Henry Hyde's committee that dealt with
this issue of the abuse of Ritalin in schools. The DEA was very
concerned about it. I don't recall the number of that
legislation or its name, but I think that was in the year 2000.
Legislation was actually proposed and passed, I believe in this
Body, that dealt with that issue.
Mr. Gilman. Ms. Presley, did you want to comment?
Ms. Presley. I don't know the statistics and the
formalities of what exactly--this is more for you two, I think.
Mr. Gilman. And Ms. Weathers, did you want to comment?
Ms. Weathers. No, not at this time. I don't know the
statistics.
Mr. Gilman. All right. And, Dr. Block, do you have any
final statement you'd like to make?
Dr. Block. Well, as I think all of us have consistently
stated, we're very concerned about the abuse of these drugs in
our children and the fact that parents are not given informed
consent and not given all the options to look at all the
possible problems that their children might have to correct
those problems and not drug them. I think that's what we'd like
to see changed.
Mr. Gilman. I want to thank our panelists for being here
today and giving us your testimony.
Thank you, Mr. Chairman.
Mr. Burton. We have 8 minutes and 33 seconds on the clock.
I have a couple more questions for this panel, and then we'll
dismiss them, unless the other panelists have some questions.
We have one vote on the floor, and then if you could come back
we'd appreciate it.
Let me just say that I really appreciate your being here.
One thing I would like to clear up is, although there are
people here who are members of the Church of Scientology, there
are a lot of other people that you work with that are not
members that share the same views; am I correct on that?
Ms. Presley. Yes, sir.
Mr. Wiseman. We work with allied groups across the country.
Mr. Burton. Dr. Block, you're not a Scientologist are you?
Dr. Block. No, sir, I'm not.
Mr. Burton. Ms. Weathers, you're not a Scientologist, are
you?
Ms. Weathers. No. Absolutely not.
Mr. Burton. Well, I just hope that there's no stigma
attached to the people at this hearing because of their
religious beliefs. We're here today to find out if--find
evidence to find out if there is an abuse of Ritalin and other
drugs of that type and whether or not they are habit forming
and whether or not they are absolutely necessary and whether or
not parents are getting adequate information so they can make
an informed decision. Those are the major issues that we're
looking at here today, and I appreciate it very much.
I will have additional questions for this panel that I'd
like for you to submit in writing, and any legislative
proposals that you think need to be made, we'd like to have
that in writing. We can't guarantee that all of them are going
to be enacted. You know, the legislative process is like
watching sausage being made. You don't want to watch it. But we
will take a look at all of that.
Anything else from the committee before we recess?
[No response.]
Mr. Burton. OK. We stand in recess until the call of the
gavel, and we'll go to the next panel when we come back.
Ms. Presley. Thank you very much.
[Recess.]
Mr. Burton. The committee will reconvene.
We'll now hear testimony from the second witness panel, Dr.
Richard K. Nakamura. He is the acting director of the National
Institute of Mental Health, National Institutes of Health, U.S.
Department of Health and Human Services.
Unfortunately, the Department of Education's witness was
unable to be here today.
Would you please stand so you can be sworn, sir? Do you
swear to tell the whole truth and nothing but the truth so help
you God?
Dr. Nakamura. I do.
Mr. Burton. Thank you.
I presume, after hearing the testimony of the other
witnesses and the questions, you have an opening statement?
Would you proceed?
STATEMENT OF RICHARD K. NAKAMURA, ACTING DIRECTOR, NATIONAL
INSTITUTE OF MENTAL HEALTH
Dr. Nakamura. Thank you, Mr. Chairman and members of the
Committee on Government Reform, for the opportunity to discuss
an important medical condition here today. I am Richard
Nakamura, the acting director of the National Institute of
Mental Health. Professionally, I am a brain scientist, also
called a neuroscientist.
The National Institute of Mental Health is one of the
National Institutes of Health. We are the Federal health
institute responsible for research to reduce the burden of
mental illness and other behavioral disorders. We take that
responsibility seriously.
Ultimately, this hearing is about our children and helping
them live full, productive lives.
I come here before you both as a scientist and as a parent
of children, some of whom have received services themselves.
Permit me to provide some background information from the
neurosciences. We used to think that the brain simply unfolded
according to strict genetic instructions, and those
instructions, like body growth, ended in late adolescence and
the brain was done. From there it was thought that it was all
downhill and one could only lose neurons. But now we know that
the brain is actively constructed from birth, and even before
birth, by an interaction of genes with behavior and the
environment.
On the way, the brain goes through periods of massive
growth and significant pruning or cell loss. This is normal. We
know that that pruning occurs in neurons that do not get
incorporated into behavioral programs of the brain; thus, we
lose neurons that are not used.
Genes provide the scaffold for this growth, but the actual
survival of neurons and their connections are determined by our
environment and our behavior. This has important implications
for disorders such as ADHD. Parenthetically, we also know that
there are some new neurons that develop in the brain every day
of life through to at least the age of 72 to help us older dogs
learn new tricks.
What is ADHD, or attention deficit hyperactivity disorder?
There are two major components. First, there is an inattention
or distractibility component, and this is the primary feature
in ADD. Then there is a hyperactivity or impulsivity component.
For a diagnosis of ADHD, the condition must be of long
duration, it must be developmentally inappropriate, it must
cause significant impairment, and it must be present in two or
more settings of a child's life--for instance, at least school
and home.
When diagnosing ADHD, a clinician must be very careful to
distinguish between that disorder and several other conditions
that may look similar, such as sensory or learning disorders,
anxiety or bipolar disorders, and many others that have already
been mentioned here.
An adequate workup cannot be done in 15 minutes. In this
regard, I have the statement from the American Academy of
Pediatrics, which has a very good guideline for how to do an
adequate workup of ADHD, and I would like to submit this and
some other documents for the record.
Mr. Burton. Sure, without objection.
Dr. Nakamura. Of children, 3 to 5 percent are diagnosed
with ADHD, with boys being much more affected than girls. While
some have questioned the reality of ADHD because we do not have
a biological marker for the condition, the reality of
individuals that cannot focus on a task for developmentally
appropriate periods of time and show significant learning and
job performance deficits as a result have convinced most
physicians and scientists, just as most are convinced that
other behavioral disorders without clear biomarkers, such as
autism and schizophrenia and pain, are real.
In these cases, it is the clarity and consistency of the
behavioral syndrome or the effectiveness of interventions that
is convincing. Many large professional and scientific bodies
have looked into the topic of ADHD and have concluded that it
is real. Some of these groups, for the record, are: U.S.
Surgeon General, the American Medical Association, the American
Psychiatry Association, the American Academy of Child and
Adolescent Psychiatry, the American Psychological Association,
and the American Academy of Pediatrics. Also, in 2002 an
international consensus statement on ADHD was published by a
large group of scientists who indicated their belief that the
evidence for ADHD was very well justified and scientific.
What about the outcomes of untreated ADHD? There is an
initiation of a trajectory because children who cannot attend
or are hyperactive have great trouble learning. Since learning
is progressive and since our brain structures are determined by
our behavior and learning, we need an active intervention to
keep healthy outcomes on track. Untreated, ADHD leads to
increased medical utilization, school failure, poor social
relationships, antisocial activities, use of harmful
substances, brushes with the law, and serious accidents.
So how is ADHD treated? Because ADHD is a chronic problem
and treatments need to work for long periods, we recommend
early detection and beginning with behavioral approaches,
including parent and child training. Now, remember this is
after a diagnosis has been reached and all other possibilities
have been eliminated through the appropriate differential
diagnosis.
Obviously, if behavioral approaches work, they should be
employed with occasional booster training sessions; however, in
many cases this will not result in improvement, so then we
recommend a trial of stimulant medication. In our experience,
stimulant medications are highly safe and effective for
properly diagnosed children and adults.
No choice of a stimulant medication should be made without
careful consultation between parents, the children, and
clinicians. We do not believe that teachers--other than
potentially making a suggestion that the child has a problem
and it might be ADHD. Teachers should not be diagnosing nor
recommending treatment for the condition.
When stimulant medications are used, there should be a
long-term followup to ensure the continuing efficacy of
treatment, proper dosing, and proper adherence. What this means
for children is that a trajectory that can lead to school
failure--I'm sorry, there's one other important point to make.
We have estimated and our data suggests that behavioral
and/or medication treatment therapies will help 90 percent of
children with ADHD. What this means for children is that a
trajectory that can lead to school failure and social
difficulties can be interrupted and replaced by a trajectory
that can lead to more normal behavior and therefore more normal
brain and behavioral development.
Mr. Burton. Excuse me, Dr. Nakamura. Would it be possible
for you to summarize the rest of your statement so we can get
to the questions, because----
Dr. Nakamura. Sure.
Mr. Burton. I want to get all of the substance of
everything you have to say, and we will be--all the Members
will be reading your statement.
Dr. Nakamura. I have one more paragraph, if I can do that.
Mr. Burton. OK.
Dr. Nakamura. By intervening to keep a child's development
on track, many ADHD children can be helped to normal,
productive lives. That is the point of our efforts.
I would like to say a final word about science. Science is
a procedure that helps us learn the truth about interventions
and outcomes by systematically testing ideas about the world
and about human beings. This is the best way we know to learn
whose ideas are right and how to keep us from continuing
therapies that do not work or actually cause harm. Ultimately,
we need to move away from anecdotes to scientific tests of
ideas if we are to have the best and most helpful lives.
Thank you.
Mr. Burton. Thank you, Doctor.
[The prepared statement of Mr. Nakamura follows:]
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Mr. Burton. There are about 6 million children in America
that are using Ritalin or substances very similar to that. Do
you think they all need that?
Dr. Nakamura. We have heard different numbers. We don't
know exactly how many children are being prescribed, but we
have heard the number in the range of 3 million as opposed to
6; 6 might include all the adults.
Mr. Burton. Well, Pat----
Dr. Nakamura. But I won't dispute it.
Mr. Burton. Pat Weathers, who testified, she said that her
child was fine at home but at school didn't pay much attention
and was looking out the window and that sort of thing, like I
did when I was a child, because I wanted to play baseball or,
as I got older, chase the girl down the street. And she said
that the teacher had a checklist and went through the checklist
and called her in with the principal and said, ``Your child has
attention deficit problems, and we think that he ought to be
treated.''
They went to the doctor, and she said the doctor looked at
that, spent less than 15 minutes with them, and prescribed
Ritalin.
Now, according to your testimony, that's not the way it
should be done; is that correct?
Dr. Nakamura. Given the description, because I don't know
the particulars of this case, but, given the description, no,
that is not the way it should be done.
Mr. Burton. I mean, I listened to your testimony very
closely, and you said that you ought to look at school, you
ought to look at home, there ought to be consultation, there
ought to be a whole lot of things that take place before you
start using Ritalin. Isn't that what you said?
Dr. Nakamura. Yes.
Mr. Burton. Yes. We have heard a lot of stories about
teachers saying this child has an attention deficit problem,
and they do this checklist, and they send them to doctors, and
the Ritalin is just a fait accompli. They're going to give it
to them when they go there. You don't think that's right, do
you?
Dr. Nakamura. The guidelines of the American Academy of
Pediatrics and Institute's position are that you cannot make
the diagnosis and you should not be writing a prescription with
that little information.
Mr. Burton. Well, has our health agencies informed our
educational system around the country or State superintendents
of public instruction or local school boards that there are
certain things that should be followed to give them a diagram
on what they should do before they start giving children
Ritalin and sending them to the doctor?
Dr. Nakamura. The information is certainly available on Web
sites. We have not, as an institute, sent information directly
to all the schools in the country.
Mr. Burton. Well, let me just tell you a story. One of the
doctors, one of the most important doctors here on Capitol
Hill, I said, ``Did you know there's mercury in the vaccines
you're giving us for flu?'' And he said, ``No, there's not.''
And so I took the insert out and I gave it to him and he looked
at it and said, ``Well?'' And I said, ``Well, thimerosal has
mercury in it.'' Well, he didn't know that. The doctor didn't
know that.
Now, if we're spending all this money on our health
agencies and you have a criteria that's supposed to be used for
children before they go on these mind-altering drugs, then why
in the heck doesn't the schools know about it, because they
don't. Many of the doctors don't even know that.
I want to talk to you about neurons. And I would submit to
you that our health agencies for a very low cost could put it
on their e-mail site and they could send a notification out to
all State boards of education and local school boards and say,
``On our e-mail site we have the criteria that should be
followed before a child starts taking Ritalin or other drugs of
this type.'' I don't know why you don't do it. It makes sense
to me, and it would save the legislative branch a lot of time
and trouble.
Now I want to talk to you a little bit about the neurons
you were talking about. You talked about the neurons growing
and being replaced and replicated on a very regular basis. Do
you think mercury has an adverse effect on neurons?
Dr. Nakamura. I honestly don't know. I believe that mercury
is clearly a substance you don't want in the body.
Mr. Burton. Let me ask you this. Thimerosal--most of the
vaccines we're sending overseas to all these kids in Third
World country still has it in there, and they're getting it out
gradually here in the United States, but not as quickly as they
ought to because we've had this absolute epidemic of children
that are autistic, from 1 in 10,000 now to 1 to 250, and a lot
of people say, ``Well, that figure, 1 in 10,000 might be way
off,'' but everybody acknowledges we've got a big, big problem,
even if that figure is incorrect. I don't think it is.
But we had some scientists from Canada send us a video--
which I want you to give a copy to the doctor. Have you seen
that video?
Dr. Nakamura. I don't believe so.
Mr. Burton. It shows the neurons--there's a sleeve on the
neurons, is there not? Isn't there a sleeve?
Dr. Nakamura. Right.
Mr. Burton. It shows what happens----
Dr. Nakamura. Myelin.
Mr. Burton [continuing]. To the sleeve on the neurons when
a very minute amount of mercury is introduced into the close
proximity to it. It just destroys it. It just destroys it, and
ultimately it destroys or damages severely the neurons. Would
you say that would have an impact on the brain of that child?
Dr. Nakamura. Yes. It certainly depends on the form of the
mercury, but----
Mr. Burton. Wait. You say the form of the mercury.
Dr. Nakamura. There are some forms of mercury----
Mr. Burton. I know. There's two different kinds that we're
talking about.
Dr. Nakamura. Correct.
Mr. Burton. Has there been testing done to show that one
has an impact that the other one doesn't on neurons?
Dr. Nakamura. I could not tell you about that result. I do
know that one form is much more destructive than the other
form, and that thimerosal contains the less-destructive form;
however, I would agree that I would not like to see mercury----
Mr. Burton. Well, the hearings we've had--and I've had
scientists and doctors of your caliber from all over the world,
and the thimerosal and the mercury in these vaccines is very
damaging and they believe it contributes to neurological
problems in these kids. And you said yourself no mercury should
be introduced into the human body, and yet they're doing it
every day, and they did it to me, and they did it to every
Member of Congress that wanted to get a shot for flu.
Dr. Nakamura. Yes.
Mr. Burton. Why is that?
Dr. Nakamura. I can't offer you an explanation.
Mr. Burton. You're with the Department of Health here.
Dr. Nakamura. I am with the Department of Health and Human
Services, but the Centers for Disease Control and the FDA are
the controlling organizations.
Mr. Burton. Are they part of the Department of Health?
Dr. Nakamura. Yes.
Mr. Burton. Do you guys have any--do you ever talk?
Dr. Nakamura. They don't ask my advice on the issue of
vaccines.
Mr. Burton. So how do we get--I mean, how do we get the
message down to them besides going down there with a ball bat
and hitting them in the head?
Dr. Nakamura. I will be happy to pass this information on
through the Department, through the appropriate----
Mr. Burton. I think they already know this.
Dr. Nakamura. I believe they do, too, sir.
Mr. Burton. Yes, they've been to my committee before, and
they're going to be back here again, and they think they're
going to get rid of me when I----
Dr. Nakamura. You are very, very clear.
Mr. Burton [continuing]. When I'm not chairman any more,
but I'm going to be here and I'm going to probably be a
subcommittee chairman, and I can guarantee you, if I am, I'm
going to be on the Health Subcommittee, so I'm going to have
you guys back again and again.
Now let's talk about the cocaine. Is there any relationship
between--and I'm going to go to my colleagues as soon as this
question is over. I've run way over, so excuse me.
Is there any connection or is there any relationship
between cocaine and Ritalin? Do they have any of the same
properties?
Dr. Nakamura. Yes. The stimulant properties of both derive
from similar chemical properties, and----
Mr. Burton. If a person who has wanted to snort cocaine, if
they ground up Ritalin and made it into a powder form would it
have a similar effect on their brain?
Dr. Nakamura. It would probably not do as much for them;
however, yes, they would get a high from ground up
methylphenidate.
Mr. Burton. So they're similar?
Dr. Nakamura. They're similar in that sense, yes.
Mr. Burton. Could you become addicted to Ritalin ground up
and snorted like cocaine?
Dr. Nakamura. That would increase the addiction potential
of the methylphenidate, yes.
Mr. Burton. OK. So why is it that children taking Ritalin
might not become addicted and become a more likely prospect for
long-term addiction to more strong----
Dr. Nakamura. There are a couple of things going on. One is
that our experience has been that this is not happening; that
most children are using this appropriately; that pharmacies and
physicians are being fairly careful about their prescribing
practices, so they don't allow automatic renewals of
prescriptions; and that the number of pills are counted to make
sure of the number of pills being taken by the child----
Mr. Burton. I understand, but a lot of children get this in
early years and they spread it out, maybe all the way through
high school. Is there a possibility of addiction?
Dr. Nakamura. So far, when we have looked, there is either
no increase in addiction or slightly reduced level of addiction
for kids who are on medications compared to kids who are not on
medications.
Mr. Burton. You've done long-term studies on this?
Dr. Nakamura. We have done studies that have varied in the
amount of time from 14 months to 20-something years.
Mr. Burton. Is that right? And yet you say the properties
are very similar to cocaine?
Dr. Nakamura. Yes.
Mr. Burton. I don't understand that disparity there. Maybe
you can explain that in the second round.
Let me yield to my colleague, Mr. Gilman.
Mr. Gilman. Thank you, Mr. Chairman.
Dr. Nakamura, welcome to our panel.
Dr. Nakamura. Thank you.
Mr. Gilman. In your testimony you stated that, ``Good
treatment begins with accurate diagnosis, which can best be
achieved through implementation of state-of-the-art diagnostic
approaches in practice settings. We know through research that
a clinically valid diagnosis of ADHD can be reached through a
comprehensive and thorough evaluation done by specially trained
professionals using well-tested diagnostic interview methods.''
That's your testimony, is it not?
Dr. Nakamura. Yes.
Mr. Gilman. Basically, your testimony implies that doctors
don't need to do any evaluation of possible biological issues
such as thyroid or heavy metal toxicities, things for which
there are objective clinical tests, rather than the subjective
interview method. Doesn't it worry you that by not doing good
medicine--in other words, biomedical evaluation--children with
biological issues are simply having the symptoms suppressed
rather than resolved? Does that concern you at all?
Dr. Nakamura. By stating that a proper workup be done, we
meant that proper differential diagnoses also be done, and we
recommend the American Academy of Pediatrics clinical practice
guidelines, which make it very clear that you need to do an
adequate differential diagnosis, so you eliminate other
possibilities.
Now, there are, I think, reasonable questions about whether
or not some other factors may produce these kinds of symptoms,
so I believe between ourselves and the earlier panel there may
be disagreements about how much allergies can participate in
this, but we do recommend that those be checked before making a
recommendation and a diagnosis of ADHD.
Mr. Gilman. So there should be a good biomedical
evaluation? Is that what you're saying?
Dr. Nakamura. Yes.
Mr. Gilman. You state that ADHD is one of the most-
researched conditions in children's mental health. Just how
much is being spent on that kind of research at NIMH and NIH?
Dr. Nakamura. Well, while more than just NIMH is spending
money, I can tell you that last year NIMH spent $53 million
studying ADHD.
Mr. Gilman. Is any of this research evaluating biological
issues such as mercury or lead toxicity that our chairman has
indicated?
Dr. Nakamura. None of this at the moment is looking at lead
toxicity and mercury.
Mr. Gilman. Is there any reason why you're not looking at
it?
Dr. Nakamura. We have, as our process, a peer-reviewed
competition for grants. We would be quite interested in getting
an application which tried to look at the contributions of both
lead and mercury to ADHD.
Mr. Gilman. Do you need an application to undertake that
kind of a study?
Dr. Nakamura. Well, we've found that, in order to get
studies done well and assume excellence in science, getting
them in through a peer review process is very important. If you
have--if any of you have investigators who have indicated that
they are interested in pursuing this study----
Mr. Gilman. Well, we're interested in this committee. Do
you need an application to dig into that kind of an approach?
Dr. Nakamura. We need an application to make sure that the
research that is proposed will answer the question.
Mr. Gilman. Don't you initiate any studies on your own? Do
you have to wait for applications if there is some problem out
there?
Dr. Nakamura. We can initiate studies on our own.
Mr. Gilman. Well, I suggest that maybe you ought to take a
look at the mercury or lead toxicity on your own rather than
waiting for an application.
Is any of the research evaluating alternative therapies
such as acupuncture, neurofeedback, massage, cranial
sacraltherapy, and special dietary approaches--is there any
research now looking at any of those?
Dr. Nakamura. I understand that the National Center for
Complementary and Alternative Medicine is pursuing all of
those.
Mr. Gilman. They are----
Dr. Nakamura. Yes.
Mr. Gilman [continuing]. Undertaking that?
I just have one or two other questions, Doctor. In a 1995
background paper from the Drug Administration, DEA, the
following statement was made. ``It has recently come to the
attention of the DEA that CIBA/Geigy, the manufacturer of
Ritalin marketing under the brand name Ritalin contributed
$748,000 to CHADD from 1991 to 1994. The DEA has concerns that
the depth of the financial relationship with the manufacturer
was not well known to the public, including CHADD members that
have relied upon CHADD for guidance as it pertains to the
diagnosis and treatment of their children.''
In a recent communication from United Nations International
Narcotics Board, INCB, expressed concern about non-governmental
organizations and parental associations in the United States
that are actively lobbying for the medical use of Ritalin for
children with ADHD. The U.N. organization further stated that
financial transfer from a pharmaceutical company with the
purpose to promote sales of an internationally controlled
substance would be identified as hidden advertisement and in
contradiction with the provisions of the 1971 convention.
In fact, a spokesman for CIBA/Geigy stated that ``CHADD is
essentially a conduit for providing information to the patient
population.'' That's a direct quote from them. The relationship
between CIBA/Geigy, which is now Novartis, and CHADD raises
serious questions about CHADD's motive in proselytizing the use
of Ritalin.
This is what DEA had to say. This same DEA paper states
that CHADD, in conjunction with the American Academy of
Neurology, submitted a petition to reschedule Ritalin from
Schedule II to Schedule III under the Controlled Substances Act
because controls are unduly burdensome for the manufacturer and
for physicians who prescribed it and patients who needed it.
CHADD denied that the financial contributions received from
CIBA/Geigy have any relationship to their action.
And the DEA went on to note that of particular concern to
them was that most of ADHD material prepared for public
consumption by CHADD and other groups and made available to
parents does not address the above potential or actual abuse of
Ritalin. Instead, it is portrayed as a benign, mild substance
that's not associated with abuse or any serious side effects.
The DEA went on to note in their report, ``In reality,
however, there is an abundance of scientific literature which
indicates that Ritalin shares the same abuse potential as other
Schedule II stimulants. Case reports document that Ritalin
abuse, like any other Schedule II stimulant, can lead to
tolerance and severe psychological dependence. A review of the
literature and examination of current abuse and trafficking
indicators reveals a significant number of cases where children
are abusing Ritalin.''
So what is your comment with regard to DEA's report?
Dr. Nakamura. The key comment is it's very important to
realize that when ADHD is properly diagnosed there seems to be
very little problem with substance abuse and even diversion.
The GAO recently put out a report on attention disorder drugs
and reported that there were few incidents of diversion or
abuse identified by schools.
And it is the experience that we have so far which
indicates that there is not an increase in abuse by those with
ADHD who are taking Ritalin; rather, there is either a normal
amount or a reduced amount of abuse by those kids.
We do know that untreated ADHD kids go on to abuse drugs at
high proportions.
Mr. Burton. The gentleman's time has expired.
Mr. Gilman. I just have one more.
Mr. Burton. Sure. OK. Go ahead. Yield to me for just 1
second?
Mr. Gilman. Sure.
Mr. Burton. Was that the only study that was done on that,
that said that there was no increased abuse?
Dr. Nakamura. No. There were three studies.
Mr. Burton. OK. Tell me about the other two studies real
quick. Weren't there other studies that showed that there was
increased use?
Dr. Nakamura. There was one study----
Mr. Burton. And did the--there was one study. You didn't
mention that. It's interesting that you mention the one that
says what you want but you don't mention the one that says what
you don't want. This Congress up here doesn't want you to come
up here and shade things the way that the health agencies want.
We want you to tell the truth for the American people. It
really bothers me that you guys do this all the time. You do it
all the time. Tell the whole truth, not just the part that you
want told.
And the pharmaceutical companies--Congressman Gilman just
made a strong point. The pharmaceutical companies fund an awful
lot of this stuff, these studies and other things that you're
talking about. You said the GAO said that there was no problem
with this. You didn't quote the DEA. The DEA is the agency that
we charge to go after the drug dealers and the drug abusers and
the drug problems in this country. Why is it you didn't quote
the DEA instead of just the GAO study that you asked for?
Dr. Nakamura. I had just been given the information about
DEA, and----
Mr. Burton. You mean to tell me you guys don't have access
to that over there?
Dr. Nakamura. No. I just pointed out that there was other
information, as well.
Mr. Gilman. Thank you. I'll yield in just a moment. But,
Doctor, are you concerned about the relationship between CHADD
and the pharmaceutical company? Is there any concern by NIH
with regard to that?
Dr. Nakamura. That is not an area of--I don't believe that
the NIMH has a right to interfere with that transaction. What
we try and do at NIMH, is very carefully make certain that
there is no interaction with drug companies that could
influence our decisions.
Mr. Gilman. But here we have a drug company that is
influencing a parental group, and that drug company has some
financial motivation. Isn't there any oversight by NIH of that
kind of a relationship?
Dr. Nakamura. No, there's no oversight that I'm aware of,
by NIH. NIH's job is to do good research, and that's what we
try and do.
Mr. Gilman. Well, I hope that NIH would do more than just
do research, and make certain that the information given to the
public is factual and not motivated by any financial interests.
I'll be please, Mr. Chairman, to yield the balance of my
time.
Mr. Burton. Mr. Horn.
Mr. Horn. Dr. Nakamura, a study conducted at Georgetown
found that children with ADHD are seven times more likely to
have food allergies than other children. Isn't it true that
children in an allergic state would be adversely affected in
their ability to focus and concentrate? What has NIMH and NIH
done to evaluate the correlation between food allergies and
attention disorders?
Dr. Nakamura. My understanding is that we have had some
earlier studies in which we looked for allergies as related to
ADHD and other kinds of externalizing or disruptive behavior
disorders and found that a small proportion, about 5 percent,
could be accounted for by those allergies. And certainly we
believe that, where they exist, you take care of those before
you develop a diagnosis.
Mr. Horn. Are you concerned that children may be
misdiagnosed with ADHD?
Dr. Nakamura. Absolutely.
Mr. Horn. Well, that's good to know.
Dr. Nakamura. We would very much like to see children
properly diagnosed. In our current system, physicians are
compensated inadequately for doing a full work-up. It is hard
for physicians, as we understand it, to get more than a certain
amount of time and money per patient. This might have a
tendency to cause them to move a little too fast and maybe not
have enough time to come up with alternative conclusions about
a disease process.
Mr. Horn. Dr. Nakamura, in the Novartis PDR in Ritalin
there's a warning that Ritalin should not be used in children
under the age of 6 years because the safety and efficacy had
not been established. I'm troubled that the National Institutes
of Health would offer to pay parents of 3-year-olds over $600
to test Ritalin on their children, and there's apparently a--
let's see here--it was the APA meeting quote, and is the
Federal Government testing psychotropic drugs in children under
the age of 6?
Dr. Nakamura. Let me tell you how this study is being
conducted.
Mr. Horn. Go ahead.
Dr. Nakamura. Because of the reports that so many children
are being provided with Ritalin at younger ages, the National
Institute of Mental Health decided that it needed to do a study
on the safety of such drugs at those lower ages. Our review
board, or IRB looked at this issue very carefully, and we did
the following. We have run the most rigorous study possible to
exclude children from this study in the sense that we do a very
vigorous examination of whether or not there are alternative
possibilities for explaining the behavior of the children.
We require that the children go through a full behavioral
therapy session that is really a set of sessions before they
are accepted for the trial, and only then is there a final
getting the parents' permission to go ahead with a trial of
Ritalin.
Mr. Horn. How many children are under 6 years of age?
Dr. Nakamura. I believe that the design is to get 100
children.
Mr. Horn. In your testimony you talk about the studies that
have been conducted on individuals with ADHD have ``less brain
electrical activity and show less reactivity to stimulation in
one or more of these regions.'' Are you still standing by that?
Can you please tell us if any of these tests were conducted on
individuals diagnosed with ADHD who had never been treated with
psychotropic drugs?
Dr. Nakamura. In those studies, no. We are about to see a
study come out in which that specific comparison has been made.
Mr. Horn. Please explain how the drugs can affect these
same activities in the brain.
Dr. Nakamura. Pardon me. I don't understand.
Mr. Horn. Please explain how the drugs can affect these
same activities in the brain.
Dr. Nakamura. I'm sorry. It's--which same activities in the
brain?
Mr. Horn. We'll submit it to you and put it at this point
in the hearing record.
Dr. Nakamura. I apologize for not understanding.
Mr. Burton. He's talking about the brain activity, less
brain electrical activity.
Dr. Nakamura. And the drug stimulating it?
Mr. Burton. Yes. He's talking about how would it affect it.
Go ahead.
Dr. Nakamura. OK. So let me explain what we believe is
going on with stimulant medications. That is, that certain
portions of the brain show reduced activity compared to normal
children, and this is in the area of executive function,
particularly in the frontal lobes.
Unlike an earlier statement, it isn't because blood is
going slower. Blood is going at the normal rate. It is the
activity and the oxygen pickup of those neurons which is
different, which means that the frontal lobes aren't using as
much energy as those in normal. And, a small amount of Ritalin,
selectively increases the amount of energy and the activity of
neurons in the frontal lobes, which provides the executive
function these kids need in order to control their behavior
better.
Mr. Horn. I yield back my time to the chairman.
Mr. Burton. Thank you, Mr. Horn. We are not through
questioning Dr. Nakamura, so you'll have another chance.
Mrs. Davis.
Mrs. JoAnn Davis of Virginia. Thank you, Mr. Chairman.
If I just heard you correctly, you said the Ritalin speeds
up the activity in the frontal lobe. Did you hear me give the
explanation earlier to the first panel about the blood flow in
the frontal lobe of the brain?
Dr. Nakamura. Yes.
Mrs. JoAnn Davis of Virginia. Can you comment on that?
Dr. Nakamura. Yes. When you do certain studies in order to
look at the activity of the brain, what it actually does is
looks at the flow of oxygen through the brain, or sometimes
called ``blood flow.'' What you're really concerned about is
the activity of the neurons in the brain, and so it isn't so
much a problem of slow blood, it's a problem of neural
activity, for which the blood is a surrogate measure.
What we have been finding is that frontal lobe activity in
those with ADHD is reduced and that the Ritalin helps increase
it. Because frontal lobes are responsible for executive
function, that makes it easier for self control and for self-
directed activity to go on.
Mrs. JoAnn Davis of Virginia. Based on that, and to go back
to--I forget who asked the question about the possible
addiction of Ritalin because it has similar characteristics of
cocaine. It was my understanding that if you put a child--and
I'd like you to comment on it--put a child on Ritalin who is
not ADHD, it has a different effect on that child than the
child who has ADHD. For instance, our son, when we put him on
Ritalin, became normal, had normal behavior, not, you know,
slowed down, dead, lethargic, or a zombie, or what have you,
but actually became what you would call normal. But if you put
a child who was not ADHD on Ritalin it was like giving them
speed and they actually become the opposite and become hyper.
Can you comment on that?
Dr. Nakamura. In general, if children, normal children, use
Ritalin at normal doses through normal pathways--that is,
ingestion--they might have side effects of losing sleep and
losing weight, but at those levels it shouldn't become
addictive. And cocaine has much less addictive properties when
ingested in a slow way. If you change the way it is delivered
to the body, for example if you figure out a way of injecting
it, a way of snorting it or sniffing it, that speed can
increase the addictive properties.
I understand that one of the things the drug companies are
trying to do is create a form of methylphenidate which is less
able to be ground up and used in any form other than the
appropriate ingested form. So I believe the drug companies are
trying to solve the problem, and the potential addictive
properties if you misuse these chemicals.
Mrs. JoAnn Davis of Virginia. Is there any validity to
giving Ritalin to a child who is not ADHD and giving it to one
who is, that there's difference in the behavior?
Dr. Nakamura. I'd like to liken it to a bell-shaped curve
in the sense that if performance is optimal at the peak of the
curve for a normal child who is at the peak of the curve,
you're going to push them past optimal performance. There may
be some gains in terms of being able to stay up late or to do a
short-term sports event, but there are more penalties to be had
for those children. For those with ADHD, it appears that they
are to the left of the curve and can be pushed up to normal
performance by these drugs.
Mrs. JoAnn Davis of Virginia. Thank you, Mr. Chairman.
Thank you, Doctor.
Mr. Burton. Judge Duncan.
Mr. Duncan. Thank you, Mr. Chairman.
Dr. Nakamura, you may have heard me this morning when I
stated this morning or quoted one article in which the just-
retired Deputy Director of the Drug Enforcement Administration
said that Ritalin is prescribed six times as much in the United
States as in any other industrialized nation, six times as much
as in Canada and Great Britain, other countries like that. Does
that concern you?
Dr. Nakamura. I certainly----
Mr. Duncan. Do you know of any reason why that would make
any sense at all? And also ``Time Magazine'' said that
production of Ritalin has increased sevenfold in the past 8
years, and that 90 percent of it is consumed in the United
States--90 percent?
Dr. Nakamura. Yes, this is of concern; however, the United
States is often at the leading edge of a number of things, and
so it is not completely surprising that it should be happening
more in the United States. I do know that the use of Ritalin is
up strongly in Europe and that it is perceived as being safe
and effective, and the experience of the United States is being
taken into consideration there.
Mr. Duncan. I have an article here that says--an article
last year in the ``Journal of the American Medical
Association'' said that ``psychotropic medications have tripled
in preschoolers ages 2 to 4 during the previous 5 years, the
past 5 years. More disturbing is that during the last 15 years
the use of Ritalin increased by 311 percent for those ages 15
to 19, and 170 percent for those ages 5 to 14.'' That's from
the ``Journal of the American Medical Association.'' And this
``Insight Magazine'' that I quoted earlier this morning says
that, ``Of approximately 46 million children in kindergarten
through grade 12, 20 percent have been placed on Ritalin at
some point.''
Your figures are much, much lower than that.
Dr. Nakamura. Yes. All the figures that we have on national
prevalence of the use would make us very surprised if the
figure surpassed 5 percent.
Mr. Duncan. But you don't question these figures from the
``Journal of the American Medical Association'' that say that
psychotropic medications have tripled in preschoolers during
the previous 5 years?
Dr. Nakamura. We accept that and we are very concerned
about what that means and how practice is being changed. Our
previous director, Steve Hyman, was not convinced that we knew
enough about diagnosis of some of our disorders at those ages
to be prescribing medications. One of the----
Mr. Duncan. It says in this article here, it says, ``This
can be good news only for investors in the Swiss-based
pharmaceutical company Novartis, which makes Ritalin. For
instance, if the number of children taking the drug increased
five-fold, so did the drug company's resultant profits and
presumably stock value.''
In a June 28, 1999, article, ``Dope and Kids,'' it was
estimated that Novartis generated an increase in the stock
market value of $1,236 per child prescribed Ritalin. Based on
these evaluations, the drug company would have enjoyed an
increased stock market value of approximately $10 billion or
more since 1991.
Dr. Nakamura. I can assure you that I haven't shared in any
of that. It's----
Mr. Duncan. You know, I know you meant that to be humorous,
but I think this is very sad that we may be drugging or doping
children and that it is all about helping a big drug giant make
whopping profits.
Let me ask you this. Getting more directly into your
field--and I'm just curious about this. I know nothing about
it--is there a real difference or are there significant
differences between the brains of small boys and small girls?
Dr. Nakamura. There are some differences.
Mr. Duncan. The way they operate?
Dr. Nakamura. Yes.
Mr. Duncan. That might cause this? Because everybody said
that there are many more small boys that are being prescribed
this medication than small girls. Is there anything in your
research on the brain that would help explain that?
Dr. Nakamura. There's no question that the hormone
differences between boys and girls, which increases at early
adolescence, creates differences in behavior.
Mr. Duncan. Early adolescence, though. Most of these kids
are being prescribed this before early adolescence.
Dr. Nakamura. Yes. There are hormone differences that start
from birth, and one important point is that there are some who
feel that attention deficit is much more prevalent in girls
than we have measured, and that girls have simply not been
identified because they are not seen as a problem. They simply
sit in a classroom and fail quietly, whereas boys tend to act
out at the same time, so they come to the attention of teachers
and the girls are ignored.
Mr. Duncan. My time is up, but let me just ask one more
quick question. I spent 7\1/2\ years before coming to Congress
as a State trial judge trying the felony criminal cases, the
most serious criminal cases, and the first day I was judge they
told me that 98 percent of the defendants in felony cases came
from broken homes. And I went through, because 96 or 97 percent
of the people plead guilty and apply for probation, I went
through about 10,000 cases, and I can't tell you how many
thousands of times I read, ``Defendant's father left home when
defendant was two and never returned. Defendant's father left
home to get a pack of cigarettes and never came back.'' And I
can tell you this--crime goes back, it's caused by drugs and
alcohol and running with the wrong crowd and all that, but you
can trace all the felony crimes, with very few exceptions, back
to this broken home situation.
I remember reading one article that said that I think 90
percent of these children that were being prescribed Ritalin
were in homes from very successful two-parent families, but
where both parents were working.
I'm wondering--and I don't have any doubt that some
children really benefit from Ritalin and really need it, but
I'm also wondering is somebody studying where there may be some
sort of a social cause of this, that maybe this is in some way
a voice crying out for attention that they're not getting?
Dr. Nakamura. There is----
Mr. Duncan. Because there sure is a cause of the serious
crime in this country, I can tell you that.
Dr. Nakamura. There are a lot of social changes that are
going on in our country and----
Mr. Duncan. Wouldn't that also help explain why possibly
that some of these other industrialized nations are not seeing
nearly as much of this as we are, because they don't have as
much of the breakdown of the family as we do?
Dr. Nakamura. We don't know the answer to that. There are
social changes that are going on with great rapidity in our
country, and we are trying to figure out ways with which we
might measure what effect these might have on subsequent
behaviors. There is a proposal for a large-scale study of a
birth cohort by the National Child Health Institute in which
they would propose to look at 100,000 births following these
children, understanding everything that they are consuming,
their vaccinations, how the family is structured, etc., to see
how those might relate ultimately to disease and other
behavioral problems, as well as medical problems. So there are
proposals to do that. This would be extremely expensive.
Mr. Duncan. Thank you.
Mr. Burton. Let me just followup. You said that you thought
3 million children or thereabouts was on Ritalin or similar
products?
Dr. Nakamura. Yes.
Mr. Burton. We've been told it's 6 million. Why is it you
don't have some idea? Can't you find out from the drug company
how many prescriptions are being written for that?
Dr. Nakamura. Yes. We do--we are aware of how many
prescriptions. Relating that to the number of individuals is a
little trickier. I'm sure I could get you the information that
we have for the record on what is the number that we are able
to document.
Mr. Burton. OK. Now, Novartis gave $748,000 plus $100,000
last year to this organization called CHADD. You don't see
anything wrong with that?
Dr. Nakamura. Organizations which--many organizations
receive money from companies, and I guess my feeling is that
with much of it, as long as that's revealed, it is----
Mr. Burton. It's OK, even though they're touting their own
product? What about the $750,000 that the FDA gave to them for
the same reason?
You know, I hope, if one thing comes out of this, that
you'll get information to all of the school boards in the
country and the State school superintendents saying that there
is a prescribed policy that should be followed before you put
children on these drugs, not just some checklist that a teacher
comes up with. That's very important.
You think that needs to be done, but most people out there
in the hinterlands don't know that.
Now, my grandson--and we all talk about our personal
experiences--he got nine shots in 1 day and got 47 times the
amount of mercury that was tolerable in an adult, and 2 days
later he became autistic. Like I told you earlier, we've gone
from 1 in 10,000 to 1 in 250 kids, according to our health
agencies, your health agencies, that have autism, they're
autistic, so it is an absolute epidemic.
I wanted to show you, since you weren't familiar with this,
a tape we got from Canada on what happens when mercury is
introduced into the neurons of the brain.
Can you roll that tape real quick.
[Videotape presentation.]
Male Voice. How mercury causes brain neuron degeneration:
mercury has long been known to be a potent neurotoxic
substance, whether it is inhaled or consumed in the diet as a
food contaminant. Over the past 15 years, medical research
laboratories have established that dental amalgam tooth
fillings are a major contributor to mercury body burden.
In 1997, a team of research scientists demonstrated that
mercury vapor inhalation by animals produced a molecular lesion
in brain protein metabolism which was similar to a lesion seen
in 80 percent of Alzheimer-diseased brains.
Recently completed experiments by scientists at the
University of Calgary's faculty of medicine now reveal, with
direct visual evidence from brain neuron tissue cultures, how
mercury ions actually alter the cell membrane structure of
developing neurons.
To better understand mercury's effect on the brain, let us
first illustrate what brain neurons look like and how they
grow. In this animation, we see three brain neurons growing in
a tissue culture, each with a central cell body and numerous
neurite processes. At the end of each neurite is a growth cone
where structural proteins are assembled to form a cell
membrane. Two principal proteins involved in growth cone
function are actin, which is responsible for the pulsating
motion seen here, and tubulin, a major structural component of
the neurite membrane.
During normal cell growth, tubulin molecules link together
end to end to form micro-tubules, which surround neurofibros,
another structural protein component of the neuronal axon.
Shown here is the neurite of a live neuron isolated from
snail brain tissue displaying linear growth due to growth cone
activity. It is important to note that growth cones in all
animal species, ranging from snails to humans, have identical
structural and behavioral characteristics and use proteins of
virtually identical composition.
In this experiment, neurons also isolated from snail brain
tissue were grown in culture for several days, after which very
low concentrations of mercury were added to the culture medium
for 20 minutes. Over the next 30 minutes the neurite membrane
underwent rapid degeneration, leaving behind the denuded
neurofibrils seen here.
In contrast, other heavy metals added to this same
concentration, such as aluminum, lead, cadmium, and manganese,
did not produce this effect.
To understand how mercury causes this degeneration, let us
return to our illustration. As mentioned before, tubulin
proteins link together during normal cell growth to form the
micro-tubules which support the neurite structure. When mercury
ions are introduced into the culture medium, they infiltrate
the cell and bind themselves to newly synthesized tubulin
molecules.
More specifically, the mercury ions attach themselves to
the binding site reserved for guanicine triphosphate, or GTP,
on the beta sub-unit of the affected tubulin molecules. Since
bound GTP normally provides the they which allows tubulin
molecules to attach to one another, mercury ions bound to these
sites prevent tubulin proteins from linking together.
Consequently, the neurite's micro-tubules begin to disassemble
into free-tubulin molecules, leaving the neurite stripped of
its supporting structure.
Ultimately, both the developing neurite and its growth cone
collapse and some denuded neurofibrils form aggregates or
tangles, as depicted here.
Shown here is a neurite growth cone stained specifically
for tubulin and actin before and after mercury exposure. Note
that the mercury has caused disintegration of tubulin
microtubule structure.
These new findings reveal important visual evidence as to
how mercury causes neurodegeneration. More importantly, the
study provides the first direct evidence that low-level mercury
exposure is, indeed, a precipitating factor that can initiate--
--
[End of videotape presentation, stopped mid-sentence.]
Mr. Burton. OK. Here's the point--and you're talking to a
layman, not a scientist, but I can see, and we've looked at
these things before, and I've had the finest minds around the
world before this committee. Mercury causes a degeneration in
the brain tissues. It's a contributing factor, according to
many, many scientists, in Alzheimer's and autism and other
neurological problems in children.
Now, it doesn't take a rocket scientist to be able to see
that we need to get that substance out of anything going into
the body. You in health agencies took it out of mercurochrome.
You took it out of topical dressings. The reason you did that
was because you said it leaches into the skin and can cause
neurological problems.
Yet, you're still sticking it into our kids and we have an
epidemic that has gone from 1 in 10,000 to 1 in 250 kids in
this country, and we're going to have to take care of those
people. It's going to be a nuclear bomb on our economy at some
point in the future.
Now, you're talking about today Ritalin and how we need
Ritalin and how all these kids in schools and these young kids
are having to get it because of the way they act. A lot of that
may be caused by the introduction of mercury and other toxic
substances into the body, so it seems to me logically that the
first step you take in the health agencies is get mercury and
these toxic substances out of our vaccines.
We have not done that here in the United States, and
really, much to my chagrin, in most of the vaccines we're
exporting to Third World countries we're keeping it in there.
We're not even trying to take it out, which means we're going
to be causing these problems all around the world.
Now, all I'd like to end up saying to you, from my
perspective, is: let's get mercury out of all of these
vaccines. Let's look at whether or not the amalgams, as was
indicated--we all have fillings in our teeth, and these
amalgams--and I've already had my mouth tested. I had five of
these amalgams taken out. But I had a very high rate of mercury
vapor when I chewed and everything that was getting out in my
mouth, and that would leach into the brain. Maybe that's part
of my problem. I don't know.
But the point is: why don't we start, as our health
agencies, to look at getting mercury out of any substance that
goes into the human body or is in close proximity to it? And
then, after we do that, we may not need to be giving these kids
these mind-altering drugs, because many of them may not be
adversely affected.
Now, if you do that and you start informing our educational
institutions of the criteria that should be used before you
start giving these kids Ritalin, I think you'll solve a lot of
these problems. And I also think our health agencies ought to
take a hard look at whether or not pharmaceutical companies
should have influence on the dispersion of these things and the
usage of these things by using their money to create a wider
body of users, which is what they're doing.
I know that a lot of--there's a revolving door over at the
health agencies where people go to the pharmaceutical
companies, come over to health agencies, and go back, and we've
looked at their financial disclosure forms and we've seen some
things that were very curious there--people on Advisory
Committees that have a vested interest in getting products
passed into the mainstream of use here in this country.
I'm not going to talk any more about this, but I hope that
those of you from our health agencies who have heard what we
had to say today, what I had to say, will take that message
back, because it is going to be a broken record. It ain't going
to go away as long as I am in Congress and as long as we have
committees like this.
I've talked enough. Do any of my colleagues have any more
questions for this gentleman?
Mrs. JoAnn Davis of Virginia. Just one quick question, Mr.
Chairman.
In your research, have you found any difference in--any
discrepancies in boys versus girls with ADHD?
Dr. Nakamura. There are differences in behavior, but they
both respond to Ritalin.
Mrs. JoAnn Davis of Virginia. I guess ``discrepancy'' is
not the word I wanted. Do there seem to be more boys, more
girls?
Dr. Nakamura. Definitely more boys.
Mrs. JoAnn Davis of Virginia. By a wide majority?
Dr. Nakamura. Four to one.
Mrs. JoAnn Davis of Virginia. Thank you.
Mr. Burton. Mr. Gilman.
Mr. Gilman. Just one question, Mr. Chairman.
Doctor, would your NIH consider a long-term study, a study
of the long-term effects of Ritalin? I don't think any study
has been undertaken, from the testimony we've heard.
Dr. Nakamura. Right. We have an ongoing study of Ritalin
which is anticipated to be long term--that is, we will follow
children for many years.
Mr. Gilman. That's encouraging. Thank you very much. Thank
you, Mr. Chairman.
Mr. Burton. Mr. Horn, anything else?
Mr. Horn. No. Just on the last point made by Mr. Gilman,
have you got the National Academy of Science and Medicine? Are
they doing it, or is it simply done within the NIH?
Dr. Nakamura. It's being funded by the NIH. The National
Academy of Science doesn't actually conduct studies, they
review studies.
Mr. Horn. Well, it might be worthwhile to get some people
that are not completely involved within NIH and take a look.
That's exactly what they're there for. We use them all the time
here.
Dr. Nakamura. OK.
Mr. Burton. Thank you, Dr. Nakamura. We have some questions
we'd like to submit for the record. If you'd consent to answer
those and send them back to us, we'd appreciate it.
Dr. Nakamura. Absolutely.
Mr. Burton. OK. Thank you very much.
Dr. Nakamura. Thank you.
Mr. Burton. We have one more panel, and this last panel
consists of: E. Clarke Ross, CEO of Children and Adults with
Attention Deficit Hyperactivity Disorder; David Fassler, a
doctor who is a representative of the American Psychiatric
Association and American Academy of Child and Adolescent
Psychiatry.
Do you gentleman have an opening statement? Let me swear
you in.
Do you swear to tell the whole truth and nothing but the
truth so help you God?
Mr. Ross. Yes.
Mr. Fassler. Yes.
Mr. Burton. Do you want to start, Mr. Ross?
Mr. Gilman. Mr. Chairman, if I might interrupt, I have to
go to another meeting. Could I ask just one question of Mr.
Ross before I have to leave?
Mr. Burton. Sure.
Mr. Gilman. Mr. Ross, isn't it true that CHADD received a
grant award of $750,000 from the CDC to establish and operate
the National Resource Center on ADHD?
Mr. Ross. Yes. We were awarded a $750,000 grant from the
Centers for Disease Control and Prevention to operate a
National Resource Center on ADHD.
Mr. Gilman. And have your membership been made aware that
those funds came from a pharmaceutical company?
Mr. ross. The money did not come from pharmaceutical
companies. The CDC funds came from an appropriation of Congress
administered by the Centers for Disease Control and Prevention.
Mr. Burton. If the gentleman would yield----
Mr. Gilman. I would be pleased to.
Mr. Burton. If the gentleman would yield, you did get
$748,000 from Novartis.
Mr. Ross. Of our budget, 18 percent currently----
Mr. Burton. No. You got that money?
Mr. Ross. Over a 3-year period in the mid-1990's before I
was there we did.
Mr. Burton. Did you get $100,000 last year?
Mr. Ross. We got $700,000 from the pharmaceutical industry
in its entirety in the last year, which is 18 percent of our
budget. I didn't bring a breakout of each company, but it is on
our Web site, it is in our IRS returns, and I'm happy to
provide it to the committee. But 18 percent of our budget is
derived, like most every other voluntary health agencies in
America, whether it's the Epilepsy Foundation, diabetes,
cancer, heart, or the National Health Council, which is the
umbrella group. We try to diversify our funding and we try to
receive corporate funding as well as membership donations and
Federal funds.
Mr. Gilman. One last comment on that. The DEA stated that
$748,000 to CHADD from 1991 to 1994 came from the manufacturer
of Ritalin; is that correct?
Mr. Ross. The then owner, which has subsequently become
Novartis, gave CHADD roughly that amount of money in that 3-
year period. Yes.
Mr. Gilman. Was that made known to your membership?
Mr. Ross. Yes. It is on our Web site. You'll see who all
our corporate donors are, how much they give, and the totality
of our budget.
Mr. Gilman. Thank you.
Thank you, Mr. Chairman.
Mr. Burton. Proceed, Mr. Ross.
STATEMENTS OF E. CLARKE ROSS, CHIEF EXECUTIVE OFFICER OF
CHADD--CHILDREN AND ADULTS WITH ATTENTION DEFICIT/HYPERACTIVITY
DISORDER, LANDOVER, MD; AND DAVID FASSLER, M.D.,
REPRESENTATIVE, AMERICAN PSYCHIATRIC ASSOCIATION, AND AMERICAN
ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, WASHINGTON, DC
Mr. Ross. I'm here today to talk not only as the CEO of
CHADD, but as the father of an 11-year-old son with inattentive
type ADHD, anxiety disorder, and a variety of other challenges
and learning disorders, and a boy who has a history of
challenges. He had seizures, unprovoked seizures, when he was
21 months old. At Johns Hopkins University at Kennedy Krieger
we've had a complete blood metabolic workup when he was 3 or 4
years old to try to determine things like mercury, lead, and
other possible contributions to his challenges. Andrew has a
series of developmental problems. Inattentive ADHD was not
recognized until he was 4 in his first group learning
situation, and teachers noticed that he was inattentive. He did
not pay any attention to what was going on around him.
So I'm here to speak as a parent of an 11-year-old son that
we deal with daily with major challenges, and that experience,
as well as the CEO of CHADD.
What CHADD does--and I do have a written statement that I'd
like to have in the record--what CHADD does is disseminate the
science-based information, and that's why the Centers for
Disease Control and Prevention have given us a grant to do
that, and we rely on things like the U.S. Surgeon General
Report on Mental Health and the ADHD, and Dr. Nakamura and
NIMH, and the National Institutes of Health, and the
professional societies like American Psychiatric Association,
American Academy of Child and Adolescent Psychiatry, the
American Academy of Pediatrics. That's what 20,000 family
members of CHADD rely on the science, the Federal agencies and
the professional community.
The highest importance at the moment are guidelines that
have been mentioned before. The American Academy of Pediatrics
and the American Academy of Child and Adolescent Psychiatry
have issued best practice treatment guidelines on how to assess
and treat ADHD, and the recommendation of the Surgeon General,
the recommendation of NIMH, and the recommendation of the two
professional academies is what's called a multimodal treatment.
It is not medication as a first entry, it is a multimodal
treatment, which are behavioral interventions, counseling
interventions, special education interventions, and, if needed,
medication use. We've done all of that in our family with our
son, Andrew.
We have also tried a variety of other complementary or so-
called ``alternative interventions.'' None of them have done
harm, but none of them have had any impact, and medication
actually did have an impact on Andrew, our son.
Andrew's life is filled with dedicated clinicians, from a
pediatrician to a child psychiatrist to a child psychologist to
a neurologist to a speech pathologist and to a team of
educators. Without their collective support, I cannot imagine
where Andrew would be today. Andrew is making steady progress.
He is dealing with his anxiety. He is dealing with his
inattentiveness. He's dealing with his learning challenges, but
he has major challenges, and for those who want to dismiss the
professional community, the 20,000 family members in CHADD rely
on the psychiatrist and the pediatrician and the psychologist
for their professional advice, and my wife and I rely on our
clinical team and we appreciate our clinical team, and they've
made a huge difference in Andrew's quality of life and his
future.
So we didn't fabricate disorders in Andrew. At age 11
months he broke his ankle, and was put in a cast. When the cast
came off we all--I've had a couple broken ankles in my life.
When the cast comes off we all have pain and stiffness as we
try to push that ankle down. Andrew's ankle never went down.
Andrew's ankle stayed in the position of the cast. And so we
went to Johns Hopkins University Medical Center. Andrew has
some developmental challenges, and he happens to have
inattentive type of ADHD.
The multimodal treatment study of NIMH showed that 69
percent of children with ADHD have co-occurring disorders, so
this complicates the entire picture. Is it ADHD? Is it bipolar
disorder? Is it anxiety disorder? Is it learning disabilities?
Is it a reaction to allergies and mercury? These are very
complex assessments to be made in a child, and the reason we at
CHADD and the 20,000 members of CHADD advocate the pediatrician
and child and adolescent psychiatry guidelines, which Dr.
Fassler will talk about, is that they are a comprehensive
assessment. It's not a 10-minute review and then medication.
At age 4, when teachers told us Andrew was not paying
attention in the class and was very distractible, we went to a
psychiatrist. The psychiatrist recommended Ritalin. We were not
prepared to do that at age 4 and we said, ``No, we're going to
try other interventions,'' and we tried a whole host of other
interventions.
By age 7, with all these other interventions tried, Andrew
was still inattentive, he was still easily distractible, and so
we tried Ritalin, which actually didn't even work, and we tried
Dexedrin, which also didn't work. Then we tried Adderall, and
Adderall had an immediate impact on Andrew's ability to attend
to his day, to use a checklist so he can organize his immediate
day, whether it's getting ready for school, going to bed at
night, or in school. Parents don't rush--some may, but
parents--the 20,000 members of CHADD--don't rush in and say,
``Give us medication. We just want medication.'' Their children
have functional challenges in their child in their daily life
and they want help and they rely on the professional community
and they rely on the science.
In our case, we took 3 years of reluctance to medicate, but
when we medicated we had this immediate impact that was
positive.
So the question is: should we have medicated at age 4 or
should we have waited until age 7? That's every family's
individual decision in consultation with their doctor. We
waited, and that was our decision, and Andrew had a lot of
problems from age 4 to 7 but that's hindsight. Every family has
to figure that out.
The statistics show that stimulant medication works in 25
to 90 percent of children, so if you reverse that it doesn't
work in 10 to 25 percent of children and there are going to be
side effects, and you have to seriously think about that and
know that. Ms. Weathers' point about informed consent is basic
to a family. We need to know what the positive attributes of an
intervention are, including medication, and we need to know the
possible side effects, and communicate not every 4 months with
your doctor, but communicate a couple times a month with the
doctor on dose level, side effects. And we have that
relationship in our family with our clinical team.
Mr. Burton. Mr. Ross, would it be possible for you to sum
up so we can get on with the questions?
Mr. Ross. Yes.
Mr. Burton. I know you have a lot that you want to tell us
about, and we'll be glad to get to that.
Mr. Ross. I've made all the major points I want to make--
the importance of the science, the importance of a clinical
team, the
importance of comprehensiveness, the importance of the
pediatricians and child and adolescent psychiatry guidelines
and how complex this is, because many of the children have co-
occurring disorders. So I'll rest.
Mr. Burton. Thank you, Mr. Ross.
[The prepared statement of Mr. Ross follows:]
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Mr. Burton. Dr. Fassler.
Dr. Fassler. Thank you.
My name is David Fassler. I'm a Board-certified child and
adolescent psychiatrist practicing in Burlington, Vermont. I'm
a clinical associate professor in the Department of Psychiatry
at the University of Vermont College of Medicine. I currently
serve as the president of the Vermont Association of Child and
Adolescent Psychiatry. I'm also a trustee of the American
Psychiatric Association and a member of the Governing Council
of the American Academy of Child and Adolescent Psychiatry.
First of all, let me thank Representative Burton and the
committee for the opportunity to appear here today. My
testimony is on behalf of the APA and the Academy, and I'd
appreciate if my written remarks are entered into the record.
The American Psychiatric Association is a medical specialty
society representing over 38,000 psychiatric physicians. The
American Academy of Child and Adolescent Psychiatry is a
national professional association representing over 65,000
child and adolescent psychiatrists who are physicians with at
least 5 years of specialized training after medical school
emphasizing the diagnosis and treatment of mental illness in
children and adolescents.
I'm happy to be able to talk to you about the diagnosis and
treatment of attention deficit hyperactivity disorder, or ADHD,
and to underscore some of the comments that you've already
heard.
As a psychiatrist, when I think of ADHD, I think first of
the faces of children and families who I've seen over the
years. I think, in particular, of a 7-year-old boy who was
about to be left back in second grade due to his disruptive
behavior. The teachers have labeled him ``difficult to
control.'' The other kids just call him weird. He has few
friends and he's already convinced that he's bad and different.
And I think of a 12-year-old girl with an IQ of 130. She's not
disruptive, but she's failing seventh grade. And I think of a
28-year-old administrative assistant who was relieved and
appreciative when he received an accurate diagnosis and
appropriate treatment for his longstanding condition. But I
also remember his anger and frustration because, in his words,
he missed out on 20 years of his life.
As you've already heard, according to NIMH, the National
Institute of Mental Health, attention deficit hyperactivity
disorder, or ADHD, is the most commonly diagnosed psychiatric
disorder of childhood. It's estimated to affect approximately 5
percent of school-aged children, although published studies
have identified a prevalence rate as high as 12 percent in some
populations. As you've heard, it occurs between three and four
times more often in boys than in girls.
We also know that ADHD does run in families and, contrary
to previous beliefs, it doesn't always go away as you grow up.
In fact, the latest research indicates that as many as half of
all kids with ADHD continue to have problems into adulthood.
This is actually one of the reasons we see an increase in the
overall use of medication. We are now recognizing and treating
more adults with ADHD.
I've brought for the committee the Diagnostic and Statistic
Manual of Mental Disorders, the DSM-IV, which you've heard
discussed today and which is central to our understanding of a
formal diagnosis of ADHD.
The key features, as has been explained, include
inattention, hyperactivity, and impulsivity. I want to
underscore one of the other elements that Dr. Nakamura spoke
about, and that's that the symptoms must be interfering in the
child's life at home, at school, or at work, or at work for an
adult, or with their friends, with their peers, in two of those
settings. So it's not just that you're agitated or you're
active, but that it is really interfering with your life, with
your ability to function in those settings.
The diagnostic criteria are quite specific and they are
well established within the field. They are the product of
extensive and numerous research studies conducted at academic
centers and clinical facilities throughout the country. I've
brought a number of the studies which have already been
mentioned from the AMA, the Academy, Academy of Pediatrics, and
the Surgeon General's report.
In addition, we now have a substantial body of research
literature about both the genetic markers and the
neuroanatomical abnormalities associated with this disorder,
and you started to hear about some of it, some of the MRI, the
CAT scan, the PET scan studies, and I think within the next
year or two we will even be able to use some of these in a more
diagnostic way.
Let me be very clear. ADHD is not an easy diagnosis to make
and it's not a diagnosis that can be made in a 5 or a 10 or a
15-minute office visit. Many other problems, including hearing
and vision problems, anxiety disorders, depression, learning
disabilities, toxicity with heavy metals, can all present with
signs and symptoms which look similar to ADHD. There's also a
high degree of comorbidity, meaning that over half of the kids
who have ADHD also have a second psychiatric problem.
As we heard this morning, the diagnosis of ADHD really
requires a comprehensive assessment by a trained clinician. I
don't think any of us you've heard today would disagree with
that.
In addition to direct observation, the evaluation includes
a review of the child's developmental, social, academic
history, medical history, including evaluating the child for
other medical conditions, including things like
hyperthyroidism, the toxicities. We really need to rule those
things out. It also should include input from the child's
parents and teachers and a review of the child's records.
Schools play a critical role in identifying kids who are
having problems, but, as you've heard already today, schools
should not be making diagnoses and they should not be dictating
treatment.
ADHD is also a condition which should not be taken lightly.
Without proper treatment, a child with ADHD may fall behind in
school work, may have problems at home and with friends. It can
have long-term effects on the child's self esteem. It can lead
to other problems in adolescence, including an increased risk
of substance abuse that you've heard about, increased risk of
adolescent pregnancy, increased risk of accidents including car
accidents in adolescence, school failure, and an increased risk
of trouble with the law.
The treatment of ADHD should be comprehensive and
individualized to the needs of the child and the family.
Medication, including methylphenidate or Ritalin, can be
extremely helpful to many children, but, consistent with the
opening comments from Mrs. Davis, medication alone is rarely
the appropriate treatment for complex child psychiatric
disorders such as ADHD. Medication should only be used as part
of a comprehensive treatment plan, which will usually include
individual therapy, family support and counseling, and work
with the schools.
In terms of methylphenidate, we have literally hundreds of
studies over 30 years clearly demonstrating the effectiveness
of this medication on many of the target symptoms of ADHD. As
you've also heard, it is generally well tolerated by children
with minimal side effects. Nonetheless, I share the concern
that some children may be placed on medication without a
comprehensive evaluation, an accurate and specific diagnosis,
or an individualized treatment plan.
Let me also be very clear that I am similarly concerned
about the many children with ADHD and other psychiatric
disorders who would benefit from treatment, including treatment
with medication, if appropriate, but who go unrecognized and
undiagnosed and who are not receiving the help that they need.
Let me turn specifically to the question of over-diagnosis
and over-treatment.
Just last week, a review article written by Peter Jenson
was published which addressed this issue in detail. I have
included Dr. Jenson's article in the background materials. Dr.
Jenson is currently at Columbia University. He was formerly the
associate director for child and adolescent research at the
National Institute of Mental Health. He reviews all of the
available scientific studies on this issue. He notes that most
studies and media reports have not been based on actual
diagnostic data, where people actually sat and interviewed
children and reviewed records, but they've relied, instead, on
information from an HMO or Medicaid medication data base.
Dr. Jenson and his colleagues actually performed
comparative evaluations on 1,285 children in four communities--
Atlanta; New Haven; Westchester; and San Juan, Puerto Rico--to
determine the prevalence of ADHD, as well as the forms of
treatment utilized. The results were that 5.1 percent of
children and adolescents between the ages of 9 and 17 met the
diagnostic criteria for ADHD, yet only 12.1 percent of these
children, or approximately 1 in 8, were being treated with
medication. So the majority of children with ADHD in this
carefully controlled study were not being treated with
medication, suggesting that, at least in these communities,
medication is currently under-prescribed.
These authors also found 8 children out of these 1,285 who
were receiving medication who did not meet the full diagnostic
criteria for ADHD, although they did have high levels of ADHD
symptoms.
Dr. Jenson concludes--and I would concur--that on the basis
of these results there is no evidence of widespread over-
treatment with medication. On the contrary, it appears that, at
least in these communities, the majority of children with ADHD
are not receiving what we would consider to be appropriate and
effective treatment.
There's a second study from the Mayo Clinic in Rochester,
Minnesota, which is in the background materials. In the
interest of time, I will skip the details, other than to
mention that in that study of all children on medication for
ADHD, only 0.2 percent, which is 2 children in 1,000, had no
evidence of the disorder whatsoever. So, again, the second
study, carefully conducted study, simply doesn't support the
argument that ADHD is generally over-diagnosed or over-treated.
This is not to say that over-diagnosis or over-treatment
doesn't happen in any areas or any communities, which is why we
all need to continue our collective efforts to improve public
awareness and to ensure access to comprehensive assessment
services and individualized treatment using the kinds of
evidence-based guidelines which you have been hearing about and
which have now been developed.
Mr. Burton. Dr. Fassler, can you summarize? We have some
votes on the floor.
Dr. Fassler. I am summarizing with my recommendations.
The APA and the Academy would offer the following specific
recommendations for your consideration.
First, we fully support and would underscore the importance
of accurate diagnosis and treatment which requires access to
clinicians with appropriate training and expertise and
sufficient time to permit a comprehensive assessment.
Next, we fully support the increased emphasis of the FDA
and the NIMH on research on the appropriate use of medication
in the psychiatric treatment of children and adolescents, and
we welcome the expanded clinical trials and the longitudinal
studies which you have been hearing about.
We also fully support the passage of comprehensive parity
legislation at both the State and the Federal level.
We fully support and welcome all efforts to sustain and
expand training programs for all child mental health
professionals, including programs for child and adolescent
psychiatrists.
And, finally, we fully support and appreciate the efforts
of the current Administration, through the New Freedom
Commission on Mental Health, to focus increased attention on
the diagnosis and treatment of all psychiatric conditions,
including those which affect children and adolescents.
In summary, let me emphasize that child psychiatric
disorders, including ADHD, are very real and diagnosable
illnesses which affect lots of kids. The good news is that they
are also highly treatable. We can't cure all the kids we see,
but with comprehensive, individualized intervention we can
significantly reduce the extent to which their conditions
interfere with their lives.
The key for parents and teachers is to identify kids with
problems as early as possible and to make sure that they get
the help that they need.
Thank you.
Mr. Burton. Thank you, Doctor.
[The prepared statement of Dr. Fassler follows:]
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Mr. Burton. I'd like to ask you a whole bunch of questions,
but, unfortunately, we've got two votes on the floor, and
you've been here all day. I don't want to keep you all any
longer than we have to.
We have 6 million children that are using these drugs right
now. I don't know how we got through all this when I was
younger, but we did, and the society did fairly well.
Did you find any mercury in your son's blood work?
Mr. Ross. No. We were hoping to find some toxic element so
that we could have a simple explanation for the fact that he
was having seizures and that he had hypertonia and a lot of
problems.
Mr. Burton. OK. But you----
Mr. Ross. No, we did not find.
Mr. Burton [continuing]. Found no mercury?
Mr. Ross. No.
Mr. Burton. Had he had all of his childhood vaccines?
Mr. Ross. Yes. We contracted with our pediatrician 2 months
before we delivered Andrew, and he has had the same
pediatrician and----
Mr. Burton. So he had all of his childhood vaccinations?
Mr. Ross. He had all of his childhood vaccinations. Now, he
was tested when he was 3 or 4, and he's had subsequent
vaccinations.
Mr. Burton. Well, but the thing is, I wonder if you could
contact your pediatrician and find out the lot numbers of those
vaccinations. I am just curious. I would just like to see
those, because mercury has been in these childhood vaccinations
for 30, 40 years, and if he got a number of these vaccinations,
as my grandson did, it's hard for me to believe that he didn't
get some mercury injected into him.
Mr. Ross. Well, what the doctor would have told me is not
there wasn't some; he would have told me if it was abnormal. We
were told there was not abnormal levels of mercury, lead, and a
whole bunch of things. So I don't know. I don't know. I didn't
see the actual test results and I'm not a physician.
Mr. Burton. I think most parents who have had these shots
given to their children and who have autistic children would
really argue with what is an acceptable level of mercury in the
body. That's a subjective thing, and it may vary from person to
person, so that's something that I'm sure would be debated.
You agree, Dr. Fassler, that there ought to be a thorough
analysis of a child before they go on medication?
Dr. Fassler. Yes. My bottom line would be that kids need a
comprehensive evaluation before there is any treatment plan in
place, and that parents need to be advocates for kids to try to
make sure that----
Mr. Burton. I don't think anybody disagrees with that.
Dr. Fassler. Right.
Mr. Burton. And your organization also agrees with that?
Mr. Ross. Yes. Every child should have a complete and----
Mr. Burton. Well, why is it then----
Mr. Ross [continuing]. Comprehensive assessment.
Mr. Burton. Why is it then that around the country we have
school corporations that have this checklist where a teacher
checks off the problems with the child, the child is taken to a
doctor, and it is a perfunctory thing for the doctor to say,
``Well, it appears as though he needs Ritalin,'' and they write
out a prescription for that. That's not a thorough examination.
Dr. Fassler. And that's not something that I think either
of us or any of us who you've heard would support. There are
checklists where teachers report what they're seeing in the
classroom, but there shouldn't be a diagnosis made just on the
basis of reviewing that checklist.
Mr. Burton. My grandson never had a complete psychological
analysis. He became autistic, as I said, right after getting
all these shots. And yet the school recommended, because he was
difficult--he was in a special ed class--that he should be put
on Ritalin, and they had a doctor also subscribe to that. Of
course, he wasn't put on Ritalin. We didn't allow that, and he
seems to be doing all right on other ways that we're dealing
with him. But the fact of the matter is, in my own personal
experience that was the case--recommendation by the teacher and
the doctor went along with that.
How do we educate our educators around the country to
understand that this has to be something that's done in a very
thorough manner before you start putting these kids on these
drugs?
Dr. Fassler. I think it is an excellent point and I think
collectively we need to work on getting that message to the
schools, and part of it is our job going into the schools,
teaching teachers about the kinds of things to look for and
when kids should be referred.
I think we need to do a better job at recognizing the signs
and symptoms earlier and getting help for kids before they have
major problems, because often we all wait too late, and we may
see things in adolescence that we may have been able to help
earlier in life.
Mr. Burton. Let me just say that I hope you and CHADD and
our health agencies will figure out some way--I don't know how
much time is left--will figure out a way to make sure that
every school corporation, every superintendent of public
instruction in all 50 States understands that there should be a
thorough analysis before they put these kids on these drugs.
Dr. Fassler. I don't think----
Mr. Burton. If you would do that, I think you would
eliminate a lot of the problems.
The other thing is I hope you'll all agree that we
shouldn't be introducing mercury or other toxic substances into
people's bodies, whether they're kids or adults. If we could
get that point across, we might solve a lot of these problems.
I have a lot of questions I'd like to submit to you for the
record, Dr. Fassler and Mr. Ross.
I would also like to end by saying, Mr. Ross, I do--we had
what was called the ``Keating Five'' here in Washington. We had
five Senators that met with Mr. Keating on the savings and loan
crisis, and I don't believe any of those Senators really
intentionally did anything wrong, but the appearance of
impropriety was very great and they got a heck of a lot of bad
publicity when the savings and loan debacle took place. And for
you to get hundreds of thousands of dollars from Novartis,
which manufactures Ritalin, and your organization does advocate
that children should use that, it gives the appearance----
Mr. Ross. We do not advocate any brand drug.
Mr. Burton. Well, I----
Mr. Ross. We advocate a multimodal treatment which may
include medication----
Mr. Burton. I understand.
Mr. Ross [continuing]. And the products are never
discussed.
Mr. Burton. Regardless--I understand, but the appearance is
that they're feeding you to deal with this problem in that way,
and I would just suggest, if there was a better way to fund
your organization, even if it is only 18 percent, it would be
helpful, because if you were in the U.S. Senator or the House
and that happened, you would have a heck of a problem.
With that, let me just say to you I really appreciate your
being here. We will submit questions for the record and we
would appreciate your response.
Thank you.
Mr. Ross. Thank you.
Dr. Fassler. Thank you very much.
Mr. Burton. We are adjourned.
[Whereupon, at 2:26 p.m., the committee was adjourned, to
reconvene at the call of the Chair.]
[The prepared statements of Hon. Constance A. Morella, Hon.
Dennis J. Kucinich, Hon. Marge Roukema, and additional
information submitted for the hearing record follows:]
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