The Situation
About the Book
About the Authors
Reader Responses
Audio and Other Resources
News and Links
Ordering Information

Pencils, pens, meds

As kids head to class, pharmaceutical companies ramp up their drug marketing

-- and it works.

http://www.latimes.com/news/opinion/la-oe-klein20aug20,0,6706516.story?coll=la-opinion-center

The Los Angeles Times

By Karin Klein

August 20, 2007

Back-to-school season is in full swing. Time to pick out a backpack,

sneakers and a stimulant medication for attention-deficit hyperactivity

disorder.

Nearly 2 million children in the United States are diagnosed with ADHD,

which is marked by poor concentration, lack of self-control and/or

hyperactivity. Besides time off from school, many kids with ADHD get a

summer "vacation" from the prescription medications that help them focus in

class.

So August has become a prime time to market the idea that a change in drug

for the new school year (Concerta to Adderall?) might help the kids focus

better, keep them going longer or have fewer side effects. Direct-to-parent

marketing of ADHD drugs -- most of which are stimulants -- has grown

pervasive over the last few years, despite a United Nations treaty banning

most of it. Use of such medications increased by more than 60% from 2001 to

2005, according to the International Narcotics Control Board.

This month's homemaker-targeted magazines, such as Family Circle, Woman's

Day and Redbook, feature advertising spreads for Vyvanse, Shire US Inc.'s

new entry in the growing stable of ADHD medications. The ads show

"Consistent Kevin through the day, even through homework," picturing a

well-groomed boy smiling as he wields his pencil through a work sheet, and

"Consistent Sarah," who even at 6 p.m. contentedly pecks away at the piano

keys.

ADDitude magazine, published for people with ADHD, has ads for four

medications. One ad touts a flavored, chewable form of methylphenidate with

the slogan, "Give me the grape." (Methylphenidate is best known under the

trade name Ritalin, which is not among those drugs advertised.)

Ads for candy-flavored methylphenidate are a far cry from the vision set

forth in 1971 by the Convention on Psychotropic Substances. So far, 159

countries, including the U.S., have agreed to ban consumer-targeted

marketing of psychotropic medications -- which all these ADHD drugs are --

that carry the potential for addiction or dependency. For decades,

pharmaceutical companies abided by its provisions.

But in 2001, one company began buying ads in the September issue of women's

magazines in the U.S. to draw attention to Metadate CD, a long-acting form

of methylphenidate. Other companies quickly followed suit.

Called on the carpet by the U.S. Drug Enforcement Administration, lawyers

for the drug companies vowed to defend themselves under the umbrella of 1st

Amendment speech rights. According to former DEA officials, the Department

of Justice was unwilling to test this one in court.

Six years later, the results are dramatic. Doctors and therapists

increasingly see parents seeking to change their child's medication or

coming in with their own diagnosis of ADHD and suggestions for medications

they have seen advertised. Many of the companies offer coupons for a free

trial supply.

Children in the U.S. are 10 times more likely to take a stimulant medication

for ADHD than are kids in Europe. In fairness, children in Europe are also

somewhat less likely to be diagnosed with ADHD because of a stricter set of

criteria. But that doesn't nearly account for the difference in prescription

rates. The U.S., the only nation to violate the U.N. treaty, consumes about

85% of the stimulants manufactured for ADHD.

Though the drugs do not appear to be habit-forming in children with ADHD,

there's a rising black market for methylphenidate and similar drugs. A

report last year by the National Institute on Drug Abuse found that teenage

abuse of prescription stimulants was rising.

Drug companies would argue that increased production and use of ADHD drugs

are the result of better diagnosis and treatment. But the International

Narcotics Control Board holds advertising responsible. In a report earlier

this year, the board noted that from 2001 -- when the ads first appeared --

to 2005, medical consumption of methylphenidate increased by 64%.

"That large increase was mainly a result of developments in the United

States, where the substance is advertised in the media, directly to

potential customers," according to the report.

The Food and Drug Administration should move forward with rules to bring the

U.S. into compliance -- in conjunction with the Justice Department. There's

legitimate debate about Americans' rush to diagnose and medicate children

who fall problematically outside the norm. In some cases, the drugs are the

only thing that keeps a child from being expelled for aggressive behavior,

or falling into the foster-care system, or believing that he is an

impossibly bad or stupid kid. Yet other countries are making do with far

less of the medications.

Powerful psychotropic medications should be an option of last resort and

uninfluenced deliberation, not another brand-name product to add to the

back-to-school shopping list.