Tuesday, June 28, 2011

Speed Up & Sit Still by Martin Whitely – a review

I’d like to say “God bless Martin Whitely for writing this book”, but unfortunately I’m an atheist. The Western Australian politician and former school teacher clearly is most concerned about the thousands of Australian children who are being put onto psychiatric drugs because of their behaviour. I thought it was only sentimental oddballs like myself who cared about such issues. Consistent with Whitely's apparent committment to protecting children, in June 2011 he was one of the WA ALP MPs who opposed plans by the federal government to send unaccompanied children to Malaysia under an asylum seeker deal.

This book is an authoritative account of the politics, the history, the science and the players in the story of ADHD and ADHD drugs in the US and Australia, most specifically in Perth, Western Australia. The author is an ALP member of the Western Australian Legislative Assembly. Western Australia is the Australian state which had the nation’s highest rate of amphetamine prescription during the 1990s to the early 2000s, with a corresponding highest rate of amphetamine abuse. In 2004 there was a Western Australian parliamentary inquiry into ADHD. Rates of prescribing of ADHD drugs to children in WA have fallen, but have apparently risen in NSW in recent years. Whitely reports two very concerning findings of the Western Australian Ministerial Implementation Committee on ADHD Raine Study Review (MICADHD). The Raine Study from Perth provided the world’s first independent data on the long term effects of psycho-stimulant medication.

A number of Australian politicians from both major parties are mentioned in this book, and not for good reasons. Those names include Nicola Roxon, Tony Abbott, Nicola Roxon, Christopher Pyne, Kevin Rudd and Nicola Roxon. Whitely has been ignored or fobbed-off by an impressive list of big names in Australian politics. To be fair to Rudd, Whitely’s April 2010 letter to Kevin Rudd was badly timed, just a couple of months in advance of the coup that removed Rudd from the position of Prime Minister. The commercial ties to pharmaceutical companies of Professor Ian Hickie from the Brain and Mind Research Institute are noted in this book and detailed in the notes section.

While the ADHD controversies are covered in a fair amount of detail in this book, the importance of this book certainly isn’t limited to questions about the ADHD label, the drugs prescribed as treatments for ADHD, or the broader controversies surrounding the psychiatric labelling of children. Anyone considering using any of the newer psychiatric drugs should be interested in this book , because it exposes the crooked tricks of major drug companies and the lack of effective government control of their activities, and the failings of the TGA (Therapeutic Drugs Administration, Australia's regulatory authority for medicines). Flaws and failings of medical research are exposed, and the issue of influential or powerful medical professionals having conflicts of interest involving drug companies is also explored. Taxpayers should be interested to know that their taxes are used for drug research that is very likely to be biased and influenced by drug companies, and some apparently dodgy drugs are subsidized by the PBS. The lack of openness of the process behind the PBAC researching taxpayer subsidies for drugs is also worth reading about. Western Australian readers might be interested to read about the ethical concerns associated with the 2004 Curtin University study of the ADHD drug Strattera with child subjects, which had Associate Professor Heather Jenkins as the principal investigator. The Children’s Hospital Education Research Institute in Sydney withdrew from this study due to objections from their ethics committee. A question about this sorry episode that interests me is why was this story covered by The Australian but apparently not WA’s local daily The West Australian?

I was a little disappointed that some topics were not covered or barely covered in this book: the controversial diagnosis of juvenile bipolar that has become very popular in the United States with accompanying prescription of psychiatric drugs for children, and the huge international upswing in diagnosis rates of autistic spectrum conditions including Asperger syndrome. The very scientifically suspect concept of childhood schizophrenia even appears to be gaining a higher profile in the US, a trend that I hope never spreads to Australia. While he probably doesn’t have the first-hand knowledge of these matters that he evidently has about ADHD, I would still be interested in Martin Whitely’s views on these events, and this would place the ADHD history into context. My only objection to this book is that there isn’t more of it.

Some quotes from the book:

“It is extremely worrying that old, specious, discredited research can be recycled by the highest levels of government and the medical profession.”

Jon Jureidini quoted in the book:

“When you have got a kid with ADHD and oppositional defiance disorder and depression and anxiety disorder...what this says is not that he has got four disorders, but that there is something wrong with the kid and people haven’t properly understood what it is yet.”

“The most startling finding was that past stimulant use increased the probability of an ADHD child falling behind at school by a massive 950 percent.”

“Roxon has allowed the response to concerns about misdiagnosis and over-prescription to remain delegated to the ADHD industry.”

“Sceptics are generally not motivated to specialise or become ‘expert’ in conditions they don’t believe in.”

“All of the participants declared their connections to drug manufacturers, but astonishingly claimed there were no conflicts of interest.”

“If the history of the stimulants is any guide, we can expect to receive the first meaningful data in relation to the long-term safety and efficacy of Strattera in about 2080.”

Speed Up & Sit Still (website by Martin Whitely MLA)

Whitely, Martin (2010) Speed Up and Sit Still: The Controversies of ADHD Diagnosis and Treatment. UWA Publishing, 2010.

Labor MPs oppose Malaysian deal.
by Alisha O'Flaherty
June 3rd 2011
ABC News

Curtin University misled about ADHD drug.
Julie-Anne Davies
The Australian
January 10, 2009

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