Tuesday, March 27, 2007

Dealing with Perceptions

Media Frenzy
An interesting situation occurred this past week involving the anti-psychiatry groups (those who deny the existence of mental illness and mental disorders). A British newspaper reported that Dr. Robert Spitzer of Columbia University, chairman of the task force that created the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), supposedly stated that between 20 and 30 percent of persons with AD/HD may have an incorrect diagnosis. News outlets around the globe repeated the supposed statement. The anti-psychiatry groups claimed that this affirms that AD/HD is a "fraud," that it is a "made-up" diagnosis, and that medication treatment for AD/HD leads to "dependency on toxic drugs" and "cardiac death." (The only factual statement in these declarations is that for persons with cardiac problems, stimulant medications may create serious side effects. One needs to discuss this possibility with one's physician and other prescribing medical professionals.)

Now the really interesting development: Media Watch reported that Dr. Spitzer never said this (see the story titled "Fact Deficit Disorder"). Dr. Spitzer was speaking to the British reporter about adult anxiety disorders, not AD/HD. And he never used the figure 20 to 30 percent; rather, the reporter used the 20 to 30 percent figure in Dr. Spitzer's presence. Most of the anti-psychiatry crowd has remained silent on what Dr. Spitzer actually said. One anti-psychiatry group stated that they merely used the British press report—and besides, maybe adult anxiety disorders don't exist, and these folks may be prescribed "psychotropic drugs with no justification."

This reinforces for me the need for people facing possible AD/HD in their families to dialogue with medical professionals who practice evidence-based AD/HD diagnosis and treatment guidelines, such as those used by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. There are side effects, some serious for some people, with medications used to treat AD/HD. Previous CHADD CEO blogs have addressed some of these dilemmas and science-based conclusions, such as the Surgeon General's Report on Mental Health. Potential users of these medications need to research the medications on the U.S. Food and Drug Administration Web site, and related Web sites such as the National Institute of Mental Health, and the Centers for Disease Control and Prevention.

It also teaches me the lesson of not being sucked in by media hype spurred by anti-psychiatry media machines. These are serious challenges for many people. These are serious decisions by all families. The science tells us that multimodal treatment works for between 75 and 90 percent of children with AD/HD. Rely on your medical professional, assuming you have confidence that they practice evidence-based medicine, and don't get wrapped up in media frenzies.

Insurance Policy Established by Perceptions
Last week we received a complaint from a physician whose health plan had denied an adult patient with AD/HD medication on the basis that the patient was not a child. This is a decision based on perceptions from a decade ago that AD/HD disappears at some magical adolescent age. This perception does not recognize the evidence that AD/HD is a life-span disorder and continues into adulthood for many, but not all, people with the diagnosis in childhood. I wrote the health plan and encouraged its medical advisory panel to examine the National Resource Center's "What We Know" information sheets on adult issues (papers 9 and 10). An effective approach to changing health plan benefit programs is frequently a discussion of the science with the plan's medical advisory board. Before going to health insurance regulations, legislators, professional societies, and the media, CHADD hopes a discussion of the science with the plan will change benefit design. I won't reveal the health plan until our efforts to discuss the science have concluded. This usually takes months of discussion. If unsuccessful, we will engage in direct public advocacy efforts.

If you experience health plan discrimination, please let us know.

Coming Soon—Comedy Movie on Suicide
CHADD has joined with the Suicide Prevention Action Network (SPAN USA) and 14 other national mental health associations, in writing Liongate Entertainment Corporation and After Dark Films to object to their planned marketing campaign showing graphic depictions of suicide to advertise their forthcoming movie, Wristcutters. One of the most devastating occasions of my life was when my best man's wife, an active member of our church, concluded that her depression was so grave and prolonged that she gave up the will to live, and committed suicide. I try not to think about this, for when I do I become very upset. I have known this couple since 1973. This is not a comedy. This is not behavior to encourage. This is perception at its worst, with the most serious consequences.

This week has been a difficult one for me, dealing with public perceptions that undermine the health and welfare of persons with difficult challenges. CHADD is here to build a social movement to articulate and defend the needs of persons with AD/HD and related disorders. Thanks for listening. Thanks for supporting our efforts.


1 comment:

Anonymous said...

Good article... thanks!