ADHD, Big Pharma, and The Non-Science of Denial

In this Thanksgiving dialogue with Madelyn Griffith-Haynie, MCC, SCAC author of the blog ADD And So Much More I hit some of the high spots regarding my take on why Big Pharma has taken so much heat in ADHD land. See this quick review from my experience, stumping on the national pharma circuit:

Full disclosure, I’ve been on the “inside” with Big Pharma, lived with them for many years, found that experience both helpful to my practice and exceedingly educational. Their economic support of personalized training meetings proved beneficial to many medical folk throughout the land, as those dinner and lunch meetings cleared considerable street confusion about stimulant meds.

But, yes, there have been a few problems…

The pharma bashing we so often hear in psych/ADHD treatment offices arises from several different sources of misinformation:

From The Past – The Relevance of Transference: The residua of the influence of psychoanalysis as the preeminent psychiatric treatment for challenged mind states remains remarkably pervasive, both nationally and internationally. Freud’s intelligent understanding of the relevance of transference leaves some of the most careful coaches and therapists mixed up about passivity vs activity during the hour, leaving the concern that – activity [read in this case, meds] – could “distort the transference and impede interpretation of the unconscious.” In psychoanalysis meds have been verboten for years, and recent, hesitant loosening of those uncompromising activity rules [that stand in the face of modern neuroscience] is regretfully slow. The transference phenomenon in the therapeutic hour, from my many years of actually practicing psychoanalysis, seems quite indestructible, and expresses it’s presence quite impervious to most therapist activity. From my own vantage point: transference can be corrupted by overindulgent, repetitive direct advice [“do it my way”] – seen far too often in my second opinions following other “classical” psychoanalytic misadventures. The contributory admonition in psychoanalysis, and predominantly in traditional psychodynamic therapy: remain active in your own care, don’t become passive with meds = “Take care of yourself.” Too many classically oriented psychiatric fellowships and senior practitioners continue to espouse this limited, passive, non-biomedical view of therapy and recovery. Classical psychoanalysis is intellectually egoistic, anti-biomedical, anti-neuroscience, beyond critical thinking. Been there

From The New Attention To Addictions – Stimulants and the Addiction Process. As a psych certified [in past for 10 yrs] in Addiction Medicine, treating substance abuse for more than 22 years, I can report with great certainty that addiction-folk [both professionals and those in recovery] still harbor considerable disdain for any med intervention process even antidepressants – again demonstrating a belief system resistant to change, and tediously slow to consider contemporary biologic neurophysiology as relevant to the process of mind function. Of course, stimulants do more harm if they are not administered properly – an absolutely pervasive problem – as capricious medical practice is the unwritten standard of care in ADHD. Far too many write for ADHD meds who have no clue about how stimulants work or what to expect from their usage. This current “Biomedical Recovery Disbelief” system appears to result from some of those medication mistakes, and partially from the philosophic resistance to “other care [passive]” vs.”self care [active].” Again. the admonition for that recovery culture: take care of yourself, no “pill magic.” Their view: far too often anti-intellectual, anti-scientific, and anti-medical. Been there, repeatedly.

From the Psych Speakers for Pharma – Pharma Misrepresentation: Physician/psychiatrist speakers for pharma, seeking more speaking gigs [from more than 15 years of direct observation], have blown that important method of teaching by misrepresenting the science in categorical positive ways, without addressing relevant cautionary materials. Too many mixed speaking gratuities with the mission as “sales gigs” with real medical education. This unhappy circumstance arises from two distinct sources: 1. The pharma company sales team making decisions based upon consultant/academic insights that completely fail to review important literature – e.g. drug/drug interactions. 2. Physicians basing clinical judgements on appearances, the DSM-4r, not on brain function assessments or neurophysiologic inquiries. The Diagnostic Manual, based upon appearances, encourages studies based upon those appearances, not upon real brain science [more coming soon here at CorePsych Blog]. These misadventures occur following the process of simply not thinking about thinking. Metacognition, as a process of self-and-other observation, especially regarding how the meds should and do work in the office, is now, quite shamefully, out, but will soon be in. New neuroscience does change thinking. The regrettable problem encouraged by some speakers: advocacy for “pill magic,” – by default against “pill science.” Their imprecision: “The pill will do it.” The public reaction to sloppy medical recommendations = the current Big Pharma controversy. Been there, for years.

From Uninformed Public Opinion – The New Biology Seems Unreal: Casual armchair psychodynamic interpretations, based upon populist psychiatric rim-shots [read “gossip”] – now appear too often as the agreed standard of most public insight. Even many of the well read love to talk about ADHD relationships and recognize that biology occurs beyond their scope of understanding. This vagary of information encourages additional energy for pervasive biologic denial. “What you don’t know can’t hurt you – and don’t tell me I have a biologic problem.” Further, public opinion exists in a corruption of all three of the first challenges, – as the public is well aware that 1. transference offers some help as a tool, 2. addictions are possible with stimulants and imprecise care, and 3. some speakers have indeed encouraged the imprecise use of stimulant meds. “Don’t trust the medical profession unless it’s life or death.” See this repeatedly everyday.

My take on these four perspectives: The denial, the belief, the hope that Simple Solutions may apply to biologically Complex Problems derives more from culturally biased misinformation than downstream from the the mismanagement of Big Pharma. Big Pharma provides remarkably predictable solutions if we simply take predictable imprecision out of the medical equation. All of these observations arise from limited, uniformed perspectives – grasping only a piece of the big picture for ADHD recovery.

The CorePsych Perspective

Our ADHD Medication perspective at CorePsych: Take care of yourself, advocate for yourself medically, use medications in the context of the best information, find a medical practitioner who thinks like Russell Barkley PhD… who understands metacognition – thinking about thinking. This new complexity of the mind does require a coalescence of thinking – consilience as reviewed by E.O. Wilson in Consilience: The Unity of Knowledge.

PS: – And do tune in tonight, Nov 27, to the Coffee Klatch as these weighty ADHD medication and assessment matters translate into specific medical care for Special Needs Children. [The link for that excellent ADHD Meds program with Marianne Russo serving as the remarkable hostess is here].

Thanks again, talk soon,
cp