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I get really skeptical whenever someone uses the term "Big Pharma". 99% of the time the person using it is selling something (hey, look, a $28 book). How dare

I get really skeptical whenever someone uses the term "Big Pharma". 99% of the time the person using it is selling something (hey, look, a $28 book). How dare a pharmaceutical company sell a product? How dare doctors decide to prescribe medicine? While that was slightly melodramatic, here is a quote from the article: Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real suffering and deserves real treatment, as he makes clear in the first two sentences of the book: “Attention deficit hyperactivity is real. Don’t let anyone tell you otherwise.” But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta. ... Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? But it's their fault that there are too many drugs? I am not particularly impressed, and to me it feels like the author is just manufacturing conflict for the sake of selling a book.

DanBC 10y ago
> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? No, some people will benefit from parenting classes or therapy as well as meds. The author is saying that meds alone are not enough for some people.
throwaway729 10y ago
>> "...But he believes that those who are disabled by the condition deserve a wider range of treatment options" > so it all boils down to the pharma companies not creating enough drugs for ADHD? Conflating "treatment options" with "drugs" is kind of the central thesis of Schwarz's critique... > to me it feels like the author is just manufacturing conflict for the sake of selling a book. If you've ever worked in or around a private practice doctor's office, you're aware of the pressure to proscribe. Many, many doctors are high-quality professionals who make decisions solely in the best interest of the patient. Many other doctors are only interested in pushing as many people through the office as possible, spending less than a minute per customer and quickly writing a script for whatever the pharma rep is selling. A little bit for the perks, but mostly because it's a way to push as many people through the office as possible. The pharma rep provides fantastic marketing and "educational" material that does the doctor's job for him, allowing him to push more people through than if he had to sit down and discuss an array of treatment options with the patient. Regardless of the author's motivations, his critique isn't without merit (and certainly isn't specific to ADHD).
dlandis 10y ago
> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? By "wider range of treatment options" he doesn't mean more drugs, he means nonpharmaceutical methods as well.
dragonwriter 10y ago
> But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta. > ... Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? "a wider range of treatment options than an endless litany of stimulants" is not the same as "more drugs". Now, that could include non-stimulant drugs if those would be effective treatments for the condition, but the obvious meaning seems to be that the excessive pushing of stimulant drugs as a treatment has swamped non-pharmacological treatment options for ADHD.
daeken 10y ago
I 100% agree. We use the drugs we do because they're effective, they're cheap, and they're relatively safe. If he thinks that we should be using non-stimulant drugs, then what classes of drugs should we be looking into? Is there (at least preliminary) research to show that another class of drugs is effective for treating ADHD? This sounds like "I don't like the way things are, so buy my book and you can read all about how I don't propose a solution!"
ap22213 10y ago
It upsets at how anti-science and anti-technology some of my friends have become. Some of them believe that vaccines shouldn't be used. Some of them reject medicine and medications. Some of them avoid GMO foods. They use essential oils and 'natural' products that may potentially cause more harm than good. But, it makes sense. I guess they fear what they don't understand, and others take advantage of that fear. That isn't to say that we shouldn't be extremely careful with new technology and inventions. But, we also shouldn't be scared.
pyre 10y ago
The quote says: > a wider range of treatment options than an endless litany of stimulants Notice the "than an endless litany of stimulants" part. Saying something like: > so it all boils down to the pharma companies not creating enough drugs for ADHD? afterwards almost seems like you are intentionally misconstruing this. Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments rather than just cranking out "yet another stimulant?" Is it not possible that the author wants more non-medicinal treatments to be explored? --- That said, I think that "Big Pharma" has earned its negative moniker. Just look at the front-page story from yesterday about EpiPen prices being jacked up to the point where people may not be able to afford them. I don't think that being against price gouging a "captive audience" in a way that possibly threatens their health is the same thing as being against "a pharmaceutical company selling a product."
- dragonwriter 10y ago
  > Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments Or society to do that; relying on Big Pharma to spend money directly contrary to Big Pharma's interests doesn't seem like it makes a lot of sense.
  - pyre 10y ago
    Whether you consider the opinion right or wrong is beside the point that I was making (that the parent to my post seemed to be "tilting at windmills"). Saying that the author has an inconsistent position of "there are too many drugs" and "there need to be more drugs" seems like a poor reading of that sentence.
    - chris_va 10y ago
      I understand the point you are making, but in reality drugs will get developed based on their likely risk/reward ratio only. If you want more diversity, unless there is a non-market force (which honestly shouldn't be needed here, there is high demand), pharma companies will just keep picking at the lowest hanging fruit. Eventually, they'll get up to the non-stimulant variety, but developing an entirely new class of drugs is a Herculean effort with very low likelihood of payoff. To make it work, you need more data on the disease (e.g. more time), and some luck out of academia (which is where 99% of drugs come from anyway). They will also need a lot of money to do it, so anything they can produce in the meantime is essentially on that track. Thus, the wording "even more drugs".
pboutros 10y ago
No, the problem is that 'wide range of treatment options' != 'wide range of drugs'. Without reading the book, I'm certain that it has to do with the pharmaceutical industry's interest in having doctors prescribe medicine more frequently than might be in their patient's best interest, instead of adequately considering non-pharmacological treatment.

DanBC 10y ago

> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? No, some people will benefit from parenting classes or therapy as well as meds. The author is saying that meds alone are not enough for some people.

throwaway729 10y ago

>> "...But he believes that those who are disabled by the condition deserve a wider range of treatment options" > so it all boils down to the pharma companies not creating enough drugs for ADHD? Conflating "treatment options" with "drugs" is kind of the central thesis of Schwarz's critique... > to me it feels like the author is just manufacturing conflict for the sake of selling a book. If you've ever worked in or around a private practice doctor's office, you're aware of the pressure to proscribe. Many, many doctors are high-quality professionals who make decisions solely in the best interest of the patient. Many other doctors are only interested in pushing as many people through the office as possible, spending less than a minute per customer and quickly writing a script for whatever the pharma rep is selling. A little bit for the perks, but mostly because it's a way to push as many people through the office as possible. The pharma rep provides fantastic marketing and "educational" material that does the doctor's job for him, allowing him to push more people through than if he had to sit down and discuss an array of treatment options with the patient. Regardless of the author's motivations, his critique isn't without merit (and certainly isn't specific to ADHD).

dlandis 10y ago

> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? By "wider range of treatment options" he doesn't mean more drugs, he means nonpharmaceutical methods as well.

dragonwriter 10y ago

> But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta. > ... Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? "a wider range of treatment options than an endless litany of stimulants" is not the same as "more drugs". Now, that could include non-stimulant drugs if those would be effective treatments for the condition, but the obvious meaning seems to be that the excessive pushing of stimulant drugs as a treatment has swamped non-pharmacological treatment options for ADHD.

daeken 10y ago

I 100% agree. We use the drugs we do because they're effective, they're cheap, and they're relatively safe. If he thinks that we should be using non-stimulant drugs, then what classes of drugs should we be looking into? Is there (at least preliminary) research to show that another class of drugs is effective for treating ADHD? This sounds like "I don't like the way things are, so buy my book and you can read all about how I don't propose a solution!"

ap22213 10y ago

It upsets at how anti-science and anti-technology some of my friends have become. Some of them believe that vaccines shouldn't be used. Some of them reject medicine and medications. Some of them avoid GMO foods. They use essential oils and 'natural' products that may potentially cause more harm than good. But, it makes sense. I guess they fear what they don't understand, and others take advantage of that fear. That isn't to say that we shouldn't be extremely careful with new technology and inventions. But, we also shouldn't be scared.

pyre 10y ago

The quote says: > a wider range of treatment options than an endless litany of stimulants Notice the "than an endless litany of stimulants" part. Saying something like: > so it all boils down to the pharma companies not creating enough drugs for ADHD? afterwards almost seems like you are intentionally misconstruing this. Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments rather than just cranking out "yet another stimulant?" Is it not possible that the author wants more non-medicinal treatments to be explored? --- That said, I think that "Big Pharma" has earned its negative moniker. Just look at the front-page story from yesterday about EpiPen prices being jacked up to the point where people may not be able to afford them. I don't think that being against price gouging a "captive audience" in a way that possibly threatens their health is the same thing as being against "a pharmaceutical company selling a product."

dragonwriter 10y ago
> Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments Or society to do that; relying on Big Pharma to spend money directly contrary to Big Pharma's interests doesn't seem like it makes a lot of sense.
- pyre 10y ago
  Whether you consider the opinion right or wrong is beside the point that I was making (that the parent to my post seemed to be "tilting at windmills"). Saying that the author has an inconsistent position of "there are too many drugs" and "there need to be more drugs" seems like a poor reading of that sentence.
  - chris_va 10y ago
    I understand the point you are making, but in reality drugs will get developed based on their likely risk/reward ratio only. If you want more diversity, unless there is a non-market force (which honestly shouldn't be needed here, there is high demand), pharma companies will just keep picking at the lowest hanging fruit. Eventually, they'll get up to the non-stimulant variety, but developing an entirely new class of drugs is a Herculean effort with very low likelihood of payoff. To make it work, you need more data on the disease (e.g. more time), and some luck out of academia (which is where 99% of drugs come from anyway). They will also need a lot of money to do it, so anything they can produce in the meantime is essentially on that track. Thus, the wording "even more drugs".

pboutros 10y ago

No, the problem is that 'wide range of treatment options' != 'wide range of drugs'. Without reading the book, I'm certain that it has to do with the pharmaceutical industry's interest in having doctors prescribe medicine more frequently than might be in their patient's best interest, instead of adequately considering non-pharmacological treatment.