View Full Version : Question about Dr. Leonard Sax?


Sandy4957
07-16-12, 04:43 PM
A friend of mine with an ADHD son (who is treated with stimulant medications) posted this on her Facebook page. She's pretty even-keeled, and very mainstream in her views about medicine (her mom is a nurse), so she's not freaking out, or anything. But I've never heard of this guy and wonder if the far-smarter people who post in this board know anything about him?

Pediatrician and/or ADHD friends (or those who love them): Has anyone heard of this Dr. Leonard Sax dude who has written books and says that long-term use of stimulants to treat ADHD MAY damage the nucleus accubens, thereby potentially destroying the "motivation center" of the brain, particularly in boys? He was on MPR this morning and I note that he's been in the Times. As you can probably tell, I'm skeptical. Reminds me of the fervor some had around vaccinations and autism.....

TYIA

Amtram
07-16-12, 05:38 PM
Well, looking at his CV and some of the things he's written, I don't know that he appears completely reliable. He's a psychologist, not a psychiatrist or neuroscientist, and his primary area seems to be gender inequality. There are some hints underlying his writing that he is skeptical of the existence of ADHD in the first place, with statements about boys being distracted by video games and such. The piece he wrote about this is supported by studies no more recent than 2003 (and he wrote it this year) and no human studies are included. To prove that these studies are unquestionably correct, he quotes a single scientist who disagrees with him and points out that this specific individual got lots of money from a pharmaceutical company.

There are just too many signs that are typical indications of conspiracy theorist argument style to think he's entirely above-board on this.

He could potentially have referenced some valid information, but the way he combines and presents it makes me think that he had to ignore a lot of other things that didn't line up with his confirmation bias.

Drewbacca
07-16-12, 06:22 PM
Never heard of him. But, the things he says have been studied with mixed results. What I see over and over in the scientific literature is a statement along the lines of "no long term studies have been performed." So, while there is a possibility that he is correct, there is no evidence for it. Take anyone who speaks of long term with a huge grain of salt. Notice all the possiblys and maybes in there.

It's not exactly an unfounded opinion, but it isn't fact based. Sounds like he's just trying to sell books.

Drewbacca
07-16-12, 06:47 PM
This article is a good summary of possible longterm outcomes, based on methamphetamine abuse. It's not a direct comparison with dextroamphetamine, but it's a good start for finding the right search-terms. Just to emphasize, this is a paper concerning abusive levels and not therapeutic levels. http://www.ncbi.nlm.nih.gov/pubmed/19328213

This abstract briefly describes the difference between meth and dextro amphetamine damage.
http://www.ncbi.nlm.nih.gov/pubmed/21858431

This abstract talks about exercise to counteract damage (again, from methamphetamine, which seems to be better studied regarding cell and terminal damage). http://www.ncbi.nlm.nih.gov/pubmed/21953518

I'm sure I'll stumble across some more. My guess is that Dr. Sax is referencing studies on methamphetamines and ecstasy (MDMA) interchangeably with the dextroamphetamines and methylphenidates as they are all related. If so, it's a stretch, especially at the levels being tested.

ginniebean
07-16-12, 06:50 PM
http://www.leonardsax.com/stimulants.html

http://www.nytimes.com/roomfordebate/2012/06/09/fewer-prescriptions-for-adhd-less-drug-abuse/adhd-drugs-have-long-term-risks

well found some stuff and just with even a quick perusal this guy appears to have an agenda of some sort.

Drewbacca
07-16-12, 07:09 PM
Well, looking at his CV and some of the things he's written, I don't know that he appears completely reliable. He's a psychologist, not a psychiatrist or neuroscientist, and his primary area seems to be gender inequality. There are some hints underlying his writing that he is skeptical of the existence of ADHD in the first place, with statements about boys being distracted by video games and such.

Just a few things I got out of reading through his material just now,
He is also an MD, so despite not being a psychiatrist, he seems to meet most of the criteria. While his academic contributions seem to be primarily focused on gender studies, his day job seems to be an MD at a family practice near Philadelphia.
He doesn't strike me as skeptical of the existence of ADHD, rather, he is critical of MDs with no psychology background prescribing stimulants.

mildadhd
07-16-12, 07:57 PM
A friend of mine with an ADHD son (who is treated with stimulant medications) posted this on her Facebook page. She's pretty even-keeled, and very mainstream in her views about medicine (her mom is a nurse), so she's not freaking out, or anything. But I've never heard of this guy and wonder if the far-smarter people who post in this board know anything about him?

Pediatrician and/or ADHD friends (or those who love them): Has anyone heard of this Dr. Leonard Sax dude who has written books and says that long-term use of stimulants to treat ADHD MAY damage the nucleus accubens, thereby potentially destroying the "motivation center" of the brain, particularly in boys? He was on MPR this morning and I note that he's been in the Times. As you can probably tell, I'm skeptical. Reminds me of the fervor some had around vaccinations and autism.....



TYIA


Without commenting directly,

about someone I don't know much about.


The main questions I get are...



What are the long term effects of taking,

daily recommended amounts ADHD stimulant medication,

at different stages of development?


If the person has ADHD,

verses a person who does not have ADHD?


.

mildadhd
07-16-12, 08:32 PM
These data suggest that clinical doses of stimulant drugs may be acting as a trophic support at the glutamatergic synapses, thereby enhancing dopamine-glutamate interactions in the prefrontal cortex.

http://www.ncbi.nlm.nih.gov/pubmed/14686913


I found the research above at Dr.Sax's Web Site.



I am not a professional.


To me the question is does the person need the medication?


If the person needs the medication it helps.


If the person doesn't need the medication it may cause damage.


I started taking medication at 35 years old.

Guessing from my own experience.

My school results show I could probably have benefited from at least grade one.

I think ADHD medication would have been good for me around grade 4 or 5.

This is the age I started to remember craving to get "high".

For me.

What I think would be the pro's and con's,

of the effects on my young developing brain,

with and without medication,

hard decide what would be best.


Its hard for me to comprehend taking ADHD medication at a young age.

But I am not really sure about all people?

.

Sandy4957
07-16-12, 10:20 PM
Thanks, guys. I appreciate the feedback. You guys know way more of the science than I do. :):o

Drewbacca
07-17-12, 12:59 AM
Thanks, guys. I appreciate the feedback. You guys know way more of the science than I do. :):o

We try...
But then, we'd make terrible expert-witnesses. Still much to be learned. ;)

Drewbacca
07-17-12, 04:11 AM
It's not exactly an unfounded opinion, but it isn't fact based. Sounds like he's just trying to sell books.

Actually, I changed my mind. I think what he is doing is attempting to raise awareness and encourage more studies. When you read through his material, he is presenting a very objective view which is carefully worded and not misleading at all. To a point, he may even be playing devil's advocate for a position that is generally understudied.

It really boggles my mind how little we know about the human body. Modern science is trying to reverse-engineer it, but there are so many things that we don't know. If I didn't struggle so much with biology (physics/engineering is more my thing), I'd jump at the opportunity to do academic research simply because there is so much to learn in the field of biology.

Amtram
07-17-12, 11:16 AM
Unfortunately, when I looked at the studies he referenced (mostly abstracts for those of us without subscription access) they all looked like they were studying the medications at abuse levels. This is not the same as looking at long-term use at therapeutic levels. I have another window open to PubMed and am still looking at "nucleus accumbens +methylphenidate". The first 20 abstracts aren't addressing long-term therapeutic doses, I still have to look at the last 63 and then change methylphenidate to amphetamine salts. . .

TygerSan
07-17-12, 01:42 PM
If these are rat studies, there are a couple of things that can affect the generalizability of the studies to human subjects.

One, it's very hard to get a dose, in rats, of the stimulants that approximates the human dose. This is due to a number of factors, not the least of which being that they have such short half-lives (the drugs leave the body very quickly; that's why there's been such a push to develop the long-acting forms of the drugs, otherwise people need to re-dose every 3-4 hrs depending on formulation). What is in humans a slight problem becomes magnified in rats because they metabolize drugs even faster than we do. That means that a drug that has a half-life of around 3-4 hrs in humans has a half-life of 1-2 hrs tops in rats.

So what do you do experimentally? One way of getting around this hurdle is to essentially overdose the animal, so you start with a higher than therapeutic dose, but b/c it's cleared faster (and also reaches the brain more quickly) your *average* dose falls within the therapeutic range. That approach obviously has its pitfalls, though, as you are actually overdosing the animal. Other ways of dealing with the issue either involves giving the drug for days at a time via osmotic pump (essentially the same technology that Concerta uses for its sustained release), or administering it in the drinking water. All of those methods obviously mean that the rat has no break from the drug like a human would (we at least get evenings off, otherwise we wouldn't sleep . . . )

The other big confound with all of these studies is that I'd be willing to bet that a lot of them deal with so-called normal animals; clearly giving drugs that affect the dopamine system is going to have an effect on development, especially if you are taking the drug during adolescence (this is when the dopamine system comes into maturity) but the nature and direction of that effect will depend on your baseline state. Simply put, most of the rat studies are conducted in normal animals, but we don't give stimulants to children who aren't struggling already, so the two groups aren't necessarily comparable.

One potential solution to the above problem is to administer the drugs to animals which supposedly exhibit signs of ADHD (an animal model). Unfortunately, and believe me I've looked *hard* at the literature, rodent models of ADHD are sorely lacking, and those that do exist either tend to model primarily hyperactive symptoms, or don't really respond to the drugs as one might expect them to do if they were a good model. Additionally, in order to study the developmental effects of the stimulants, the model has to be *developmental*, i.e. the animals have to show the symptoms during adolescence, which is not generally a timepoint at which the assessment is done. In short, in my not so humble opinion, there is not a good rodent model of ADHD.

mildadhd
07-17-12, 02:45 PM
If these are rat studies, there are a couple of things that can affect the generalizability of the studies to human subjects.

One, it's very hard to get a dose, in rats, of the stimulants that approximates the human dose. This is due to a number of factors, not the least of which being that they have such short half-lives (the drugs leave the body very quickly; that's why there's been such a push to develop the long-acting forms of the drugs, otherwise people need to re-dose every 3-4 hrs depending on formulation). What is in humans a slight problem becomes magnified in rats because they metabolize drugs even faster than we do. That means that a drug that has a half-life of around 3-4 hrs in humans has a half-life of 1-2 hrs tops in rats.

So what do you do experimentally? One way of getting around this hurdle is to essentially overdose the animal, so you start with a higher than therapeutic dose, but b/c it's cleared faster (and also reaches the brain more quickly) your *average* dose falls within the therapeutic range. That approach obviously has its pitfalls, though, as you are actually overdosing the animal. Other ways of dealing with the issue either involves giving the drug for days at a time via osmotic pump (essentially the same technology that Concerta uses for its sustained release), or administering it in the drinking water. All of those methods obviously mean that the rat has no break from the drug like a human would (we at least get evenings off, otherwise we wouldn't sleep . . . )

The other big confound with all of these studies is that I'd be willing to bet that a lot of them deal with so-called normal animals; clearly giving drugs that affect the dopamine system is going to have an effect on development, especially if you are taking the drug during adolescence (this is when the dopamine system comes into maturity) but the nature and direction of that effect will depend on your baseline state. Simply put, most of the rat studies are conducted in normal animals, but we don't give stimulants to children who aren't struggling already, so the two groups aren't necessarily comparable.

One potential solution to the above problem is to administer the drugs to animals which supposedly exhibit signs of ADHD (an animal model). Unfortunately, and believe me I've looked *hard* at the literature, rodent models of ADHD are sorely lacking, and those that do exist either tend to model primarily hyperactive symptoms, or don't really respond to the drugs as one might expect them to do if they were a good model. Additionally, in order to study the developmental effects of the stimulants, the model has to be *developmental*, i.e. the animals have to show the symptoms during adolescence, which is not generally a timepoint at which the assessment is done. In short, in my not so humble opinion, there is not a good rodent model of ADHD.

I Agree.

All of these rats live in cages.

My normal physiology,

would not be "normal",

if I was raised in a cage.