Newspaper: ADHD drugs suspected of hurting kids

[ConcertaParent]

Canada's #1 newspaper has published several sensationalist articles regarding ADHD.

"ADHD drugs suspected of hurting Canadian kids"
"Side effects of ADHD drugs shock parents"
"ADHD drugs are beneficial to most users"

The author neglected to mention the website of the Adverse Reaction Database that he kept referring to. I was able to find that database to search for adverse reactions, and will report my child's reactions to her ADHD medications.

... nearly 600 cases of Canadian kids suffering serious, sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years.
:
The Star’s data analysis revealed 7-year-olds were most likely to suffer a serious side effect.
Ten per cent, or nearly 60 cases, of the nearly 600 reviewed involved boys and girls 7 years old.
:
In 52 of these suicidal ideation reports, the attention deficit drug Strattera is listed as the suspected cause of the side effect. In 12 of the reports, Concerta is listed as the suspected cause.
:
The Star conducted data analysis and made an unexpected discovery: ADHD medications Strattera and Concerta were the second- and third-highest suspected causes of reported serious side effects suffered by Canadian kids taking any drug in the past 10 years.
More than any cancer drug.
More than any powerful antipsychotic for kids with serious mental illness.
More than nearly 1,800 other drugs reported to have been the suspected cause of a serious side effect in a Canadian youth since 2001.
In more than 40 per cent of all cases where a youth thought about suicide, an ADHD drug is listed as the suspected cause.
:
Strattera is listed as a “suspect” drug in the highest number of reports of serious side effects in children and teens, with 174. Yet it is among the least prescribed, say several ADHD doctors in the Greater Toronto Area.

[Geno]

To be honest, no pill could ever possibly hurt me as badly as ADHD has unless the pill was filled with cyanide :P

[Retromancer]

Here is the print version (sans advertising) of one of the articles in question:

ADHD drugs suspected of hurting Canadian kids

(I have never had a problem here using links to reputable news sources, with or without advertising.)

[Geno]

Meh, I'm not reading it because I don't care how dangerous it is. I put things in to my body on a regular basis that are far more damaging than medical doses of adderall and ritalin could ever be hahaha

[Flory]

Pesky strattera

[namazu]

I have mixed feelings about these articles.

It's of utmost importance that adults and parents of kids with ADHD have the information they need to weigh risks and benefits appropriately.

There are problems with under-reporting of side effects, because (in the U.S. and apparently also Canada) such reporting is generally voluntary on the part of the doctor (or others who suspect an adverse drug reaction). People do sometimes suffer from heart attacks or psychotic episodes triggered by ADHD meds -- often (but not always) if there is some underlying condition that went undetected, or if the meds are being prescribed less-than-carefully. It is important that people know it can happen.

However, the way these stories were reported was, as ConcertaParent noted, sensationalized. (I'm sure if it were my kid who'd been harmed I wouldn't see it as sensational, but...)

The Toronto Star reporter specifically put out this call for stories: "Strokes. Convulsions. Hallucinations. Depression. Suicide. All serious side effects suffered by Canadian children as young as 6 taking drugs that treat ADHD.
[...] If you know of any serious side effects suffered by children on ADHD medications, the Star would like to hear your story. Please contact [the reporter]..."

While I think it is a noble endeavor to bring to light serious problems that have gone undetected, the reporting is focused wholly on harm, and not at all on the potential benefits (and avoidance of other serious harms) that cause people to choose medication for themselves or their children.

The other problem, which is closely related, is that these stories (and the side effects databases maintained by the U.S. and Canadian governments) lack a denominator and a sense of perspective.

In other words, we hear that 600+ kids have suffered from awful things like crying spells, hallucinations, or circulatory problems. But we don't know a) out of how many kids taking these medications? and b) how common are these problems in the general population, and in the population of kids with psychiatric problems who aren't taking ADHD meds?

That is critical information that the reporter in the Toronto Star has glossed over (or is choosing to omit).

Unless we know how many kids have had these side effects, out of how many are taking the drugs, we can't get a good idea if these reports reflect a rate similar to the general population, or the unmedicated ADHD population (who are more prone to psychiatric comorbidities, impulsive suicide, and other serious problems in the first place). Not all problems are necessarily attributable to medications. We can't say, from the numerator alone, how concerned we should be.

Meds are certainly not risk-free. They do cause side effects, sometimes severe ones, and sometimes even in people without "predisposing" factors. Meds do sometimes get approved without full understanding of the potential for side effects. It's important to realize that, and to weigh it carefully against the (sometimes greater) risks of not treating the ADHD on safety, mood, learning, social development, etc.

Anyone who experiences feeling "not right" (or sees their child behaving in a new, worrisome manner) should contact the prescribing doctor ASAP. Most prescribers will start out with a low dose and titrate (change the dose) cautiously, which can help avoid problems or allow them to be detected early and fixed (by lowering the dose, changing or discontinuing a medication, treating a co-existing condition, etc.).

I do hope there will be changes in the way side effects are monitored and reported in drug trials. I hope there will be longer-term studies of the effects of ADHD medications on the brain and other parts of the body. I certainly hope that doctors will be more motivated to diagnose ADHD carefully, to avoid reaching for medications where they aren't indicated, to screen medication candidates for pre-existing conditions, and to report side effects that they believe to be related to medications. (And any patient who experiences an adverse reaction to any med can and should take advantage of the ability to report it, if the doctor does not.)

But I am concerned that articles like this won't really bring about any of those changes. Instead, they have the effect of scare-mongering, of increasing the stigma of ADHD medication use for kids and adults, and of making it more difficult to have a genuine discussion of the potential for risks and benefits.

[happytexas]

Originally Posted by namazu

But I am concerned that articles like this won't really bring about any of those changes. Instead, they have the effect of scare-mongering, of increasing the stigma of ADHD medication use for kids and adults, and of making it more difficult to have a genuine discussion of the potential for risks and benefits.

I agree. It's not helpful to just say "Boo! side effects, side effects!"

When my ds had unacceptable negative side effects from Concerta, we (parents/doctor) stopped giving it to him; same with Intuitiv. However, ds has been on Vyvanse for close to 2 years without negative side effects and is far, far better off than unmedicated.

We all suffered longer than necessary due, in part, to the negative publicity surrounding ADHD diagnosis and medication.

[Amtram]

I would like to link to the websites that show the horrifying results of lack of treatment or treatment with "alternative medicine" as a response, but the images are usually a bit too graphic.

[ccom5100]

Unfortunately most (if not all) medications have side effects; however, not all people are affected by them, or the effects are not severe enough to avoid the medication. The good thing about it is that you can stop a medication if the side effects are undesirable. We found this to be the case with ds when he tried concerta. It was enough to keep us from trying another stimulant.

I think it is important to publish side effects of meds and leave it up to the individual to decide whether or not it is worth the risk. I didn't find that the article was overly sensationalizing the data.

[Drewbacca]

Originally Posted by ccom5100

I didn't find that the article was overly sensationalizing the data.

Sensationalizing... no.

Biased, subjective, persuasive, one-sided, and fear-mongering... absolutely.

[Fuzzy12]

Originally Posted by ccom5100

Unfortunately most (if not all) medications have side effects; however, not all people are affected by them, or the effects are not severe enough to avoid the medication. The good thing about it is that you can stop a medication if the side effects are undesirable. We found this to be the case with ds when he tried concerta. It was enough to keep us from trying another stimulant.

I think it is important to publish side effects of meds and leave it up to the individual to decide whether or not it is worth the risk. I didn't find that the article was overly sensationalizing the data.

I haven't read the article but I agree with Ccom on that it's important to publish side effects (though in an informative, unbiased manner) and I think that doctors should educate their patients on what side effects can be expected, or do something like a risk-assessment or a risk-benefit assessment. If nothing else, at least so that people are prepared.

All meds have side effects. The question when you take any kind of medication is if the benefits outweigh the side effects or the potential risks. And like Ccom said that's a decision that the individual (or their parents) has to make, unfortunately often after a lot of trial and error.

[ccom5100]

Originally Posted by Drewbacca

Sensationalizing... no.
Biased, subjective, persuasive, one-sided, and fear-mongering... absolutely.

How can it be all those things, if it is merely reporting statistical data? The article basically reported statistics found on a Canadian Government database.

[Amtram]

However, statistical data can be misrepresented, too. I can't tell you how many times I've seen people get all worked up because such-and-such medication is "known to cause" such-and-such horrible life threatening side effect, only to discover that the statistics show it happening only among people with a specific pre-existing condition, or in only .04% of the entire population of users of the medication.

Numbers can lie when they're taken out of context, and when it comes to journalists' reports on science, they usually are.

[LynneC]

Originally Posted by Amtram

Numbers can lie when they're taken out of context, and when it comes to journalists' reports on science, they usually are.

Good point. If at all possible, it's always a wise idea to pull up the original study to get the full picture. Might not be a bad idea on this one, if I can find it.

[ccom5100]

Originally Posted by LynneC

Good point. If at all possible, it's always a wise idea to pull up the original study to get the full picture. Might not be a bad idea on this one, if I can find it.

Apparently, the article was published in the Toronto Star on September 26th. According to the article, no studies have been made (which is one of their points) of the statistics in the Government database, and so the newspaper actually did an analysis of the statistical information in the government database.

"....Health Canada, which collects these adverse reaction reports, does not alert the public to the magnitude of these side effects. This is because the regulator has not analyzed the data it collects. It has allowed the industry to largely police itself.

“It is primarily the (drug company’s) responsibility to monitor the safe use of their products,” Health Canada told the Star.


.......Though Health Canada told the Star it does not have the technical expertise to analyze the adverse reaction reports, the regulator said it does monitor drug safety by reading the reports and scientific literature and gathering updates from other regulatory agencies.


The regulator — which a 2011 federal audit found “does not take timely action” and is “slow to assess potential safety issues” — told the Star it has not investigated whether ADHD drugs are leading to a disproportionately high number of suicide-related side effects."

I think the article's main revelation is that while the public believes medications and their side effects are closely supervised by regulatory agencies, there is not enough money, personnel, or time to actually do so. The Government relies on what the drug companies report and then, they don't even have the means to analyze the data they do receive.

I still don't see how this article can be classified as "Biased, subjective, persuasive, one-sided, and fear-mongering" I thought it was quite informative.