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In her opinion piece in the New York Observer "How Esquire Got ADHD Wrong," Gina Pera gets it wrong. Ms. Pera's critique of Ryan D'Agostino's article in Esquire "The Drugging of the American Boy" falls short, if her intent was to cast doubt on the validity of the facts reported in Mr. D'Agostino's article.


Ms. Pera writes, "Never considered by the editors or the writer, Ryan D’Agostino: the story’s compounding of stigma already suffered by millions of children, teens, and adults with ADHD and the people who love them." To make her point, Ms. Pera then proceeds to ridicule a person with ADHD, writing, "Only one man, Esquire reports, bravely says, 'Stop drugging our boys!' He learned about ADHD not by studying it (that’s obviously the girly way) but by having it himself." Ms. Pera sticks up for stigmatized people diagnosed with ADHD everywhere by making fun of someone with ADHD, joining the irrational ranks of death penalty proponents who advocate killing people to show people that killing people is wrong. Irony abounds in Ms. Pera's piece, as she then goes on to accuse Esquire and Mr. D'Agostino of siding with “deniers of ADHD – the anti-vaxxers of psychiatry” while citing 10,000 unnamed studies that she claims substantiate ADHD as a valid diagnosis, yet have inexplicably failed to prove chemical imbalance theory despite massive Big Pharma underwriting, much to the disappointment of ADHD-hockers – the snake oil salespeople of modern pseudo-science.


Ms. Pera, whose livelihood presently depends on you believing that ADHD is real, is intellectually dishonest when she characterizes Mr. D'Agostino's exhaustive effort, sarcastically or not, as relying solely on the word of one ostensibly uneducated man with ADHD. It is not entirely clear to this reader whether Ms. Pera was deriding Howard Glasser in her piece, who Mr. D'Agostino reports as having ADHD-like symptoms during childhood but never definitively says was diagnosed with the condition, or Dr. Ned Hallowell, a psychiatrist also cited in Mr. D'Agostino's article, who was reportedly diagnosed with ADHD. If she was referring to Mr. Glasser, then Ms. Pera, a self-styled expert on ADHD with no alphabet soup after her name, has armchair diagnosed Mr. Glasser with ADHD, as proponents of the condition often do, and has also omitted that Mr. Glasser has a bachelor's degree in psychology and a master's in counseling. If Ms. Pera was referring to Dr. Hallowell, then she is just plain confused. Moreover, whereas Mr. D'Agostino cites multiple studies, psychologists and a psychiatrist by name in his article, Ms. Pera cites no study, no psychologist, and no psychiatrist by name. To her credit, though, she does cite one fellow blogger by name.


In defense of ADHD drugs, Ms. Pera writes, "With careful trial and error over time, the medications can be adjusted to maximize positive effect and minimize negative effect." Perhaps Ms. Pera should tell that to the relatives of the 531 who have reportedly died, or to the 691 who had life-threatening emergencies, or the 3,737 who were hospitalized on ADHD medications (Source: Food and Drug Administration Adverse Event Reporting System Q1 2004 – Q3 2012). Trial and error is what one does with lab rats and guinea pigs, not children. Unfortunately, since the passage of the Prescription Drug User Fee Act (PDUFA) in 1992, Big Pharma has been allowed to fast-track FDA approval of drugs without adequate clinical trials upon payment of a bribe – scratch that – fee to the FDA. Post-marketing surveillance, when unproven and potentially dangerous drugs are unleashed on the unsuspecting public, has become the new clinical trial, with the FDA leveraging the AERS to manage the clinical trial on a national scale with our children as test subjects, issuing drug warnings only after children needlessly suffer and even die. For instance, after reviewing AERS data in 2006 – long after the drugs had been approved for use on the general population – the FDA's Division of Drug Risk Evaluation (DDRE) issued a report recommending changes in ADHD drug prescribing information to include warnings about psychosis, mania, hallucinations, aggression, and violent behavior; and recommended further evaluation regarding suicidality.


The FDA wrote in its post-marketing review, “The most important finding of this current review is that signs and symptoms of psychosis or mania, particularly hallucinations, can occur in some patients with no identifiable risk factors at usual doses of any of the drugs currently used to treat ADHD. The predominance in young children of hallucinations, both visual and tactile, involving insects, snakes and worms is striking...”


While Lilly's drug Strattera already contains a black-box warning – the strongest possible – regarding suicidality, other ADHD drugs carry no warnings about suicidal ideation, despite at least 707 completed suicides, 731 suicide attempts and 1,567 occurrences of suicidal ideation reported to the FDA involving those medications (Note: Strattera reports not included in count). Presumably, the FDA is still conducting a post-marketing review of the suicidiality risk of the other ADHD drugs, some eight years after their initial post-marketing recommendation for further evaluation. Tick tock goes the clock.


In addition to the overwhelming empirical data casting doubt on the safety of ADHD drugs, there has been a steady stream of anecdotal media reports of children with no prior history harming others while reportedly on ADHD medications, which are known to increase the likelihood of aggression and violent behavior. Meanwhile, the media have been bereft of any serious inclination to investigate what the public-at-large has already figured out on its own. If a junior high school gymnasium roof collapsed killing hundreds of kids at once, the media would be camped outside with satellite trucks for weeks covering the story. Instead, our nation's drugged youth are dying in the hundreds one by one in silence: drip drop, drip drop.


While Ms. Pera recommends trial and error with medications over time, time does not favor ADHD medication efficacy, as supported by the authoritative three-year and eight-year follow ups to the fourteen-month Multimodal Treatment Study of Children With ADHD (MTA). Ms. Pera would have people run the risk of serious adverse effects without any demonstrable long-term benefit versus not taking medication. The eight-year follow up to the MTA further revealed that those continuing to take medication over time had to take on average a roughly forty-five percent higher daily dose than at fourteen months to achieve an equivalent level of functioning to those not taking medication. Yes, you read correctly, over time you will need to take more medication to have the same effect as not taking medication.


It is important to note that the above referenced adverse reports do not even include anti-psychotics such as Seroquel, Risperdal and Abilify which are increasingly prescribed off-label for ADHD at an alarming rate, and carry with them equally troubling side effects and warnings. Ms. Pera, along with other ADHD diagnosis and drug proponents, may seek to attack the data cited herein, but at least this writer is offering data, rather than mere platitudes. The reader is encouraged to consider how the aforementioned may attempt to distort the data, excluding preexisting conditions and concomitant drug use, which has the effect of understating the risks of ADHD medications and ignores the realities of everyday life and poly-pharmacy in America. Drug advocates will downplay the role of ADHD medication, for example, if an autopsy uncovers a congenital heart defect, even though the patient did not expire from the preexisting condition prior to taking a stimulant drug bearing a warning of higher risk of serious cardiovascular adverse events, and notwithstanding the fact that people with congenital heart defects can live a long life without ever experiencing any symptoms or requiring treatment. Likewise, if a patient taking stimulants is also prescribed a Benzodiazepine in order to counteract the known side effect of insomnia associated with ADHD drugs, and/or is prescribed an anti-psychotic to negate the known side effect of psychosis related to ADHD drugs, and then ends up committing suicide, the respective drug manufacturers will point the finger at one another while the FDA quietly applies an algorithm to minimize the weight of the drug-induced death in their risk calculations.


Perhaps the most outlandish rebuttal that Ms. Pera offers to Mr. D'Agostino's article highlighting the very real over-diagnosis and over-medication of American boys is when she writes, "In children and teens, males are diagnosed at greater rates than females. But by adulthood, the number is more even." First, and most obviously, Mr. D'Agostino's article is entitled “The Drugging of the American Boy,” not “The Drugging of American Men.” As such, statistics relating to women with so-called Adult ADHD, undoubtedly a target demographic for growth-hungry pharmaceutical companies, are irrelevant to Mr. D'Agostino's topic. Besides, even if the adult diagnosis ratio is 1:1 for men and women, that means there are still six times more males diagnosed with ADHD than females in their lifetime. Women would have to be diagnosed at a rate of 6 to 1 in adulthood to catch up to men, making the over-diagnosis of boys with ADHD obvious to anyone with basic math skills and an open mind. For Ms. Pera's argument to have any validity whatsoever, girls would have to be going undiagnosed with ADHD 6 to 1 over boys in childhood, or perhaps even more since some chemical imbalance flat-earthers would still illogically argue that many boys are going undiagnosed to this day. If such were the case, it would seriously invalidate the already questionable diagnostic tests (e.g. Conners Behavior Rating Scale, Vanderbilt Assessment Scale, Achenbach Child Behavior Checklist, etc.) long touted by the Psycho-Pharma industry as being scientific, but recognized by most as nothing more than subjective checklists blissfully unencumbered by etiology. Of course, the idea pushed by Ms. Pera and her ilk that ADHD is still under-diagnosed strains credulity, in light of Dr. Stephen Hinshaw and Dr. Richard Scheffler's recent contributions. How anyone could say with a straight face that a sizeable percentage of school children in America today continue to go undiagnosed is beyond comprehension.


Lastly, Ms. Pera leaves us with the parting reassurance that, despite the lack of evidence of long term benefits of ADHD medications and in spite of compelling evidence of the serious health risks they pose, many automobile accidents and sports injuries have been avoided thanks to ADHD medications. Ms. Pera's claims bear an eerily striking resemblance intellectually to the oft-trumpeted justification of the erosion of our civil rights in order to protect us from external threats. Like the hawks who justify eavesdropping because of countless, albeit undisclosed, terror plots thwarted; Ms. Pera would tell us how many accidental deaths have been averted by ADHD medications if she could, but she cannot.