Help with writing on behalf of Dr Breggin

[Guest guest]

This was sent to me about Quack watch and Dr Breggin.

It was Dr Breggin who first alerted me ten years ago

to the atrocity we call the child mental health field.

Any of you who can please write on his behalf.

The difference is between those who could not even tell Paxil causes suicide

and these are the same ones who cannot see the difference between life and

death

due to the money signs.

For those who are interested in the facts and not the self-serving hype

around Breggin.

I took one look at " Talking Back to Ritalin, " and the wacky subheadings and

willy-nilly graphic construction alone smacked of unprofessionalism, if not

sensationalism. The actual content was even worse!

Dr. Breggin is no friend to children or anyone else with ADHD. He is a menace

and a fraud.

Quackwatch Home Page

Some Notes on ADHD and

R. Breggin's Unfair Attack on Ritalin

Barrett, M.D.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a commonly diagnosed

childhood behavioral disorder whose core symptoms include inappropriate levels

of

attention, concentration, activity and distractibility. Although its cause is

unknown, considerable progress has been made in managing it. Scientific studies

have found that the single most effective treatment is medication with a

stimulant drug, of which the most commonly used has been methylphenidate

(Ritalin). Behavioral approaches that include helping parents and teachers to

deal with

the child's behavior are also important, but they are not a substitute for

medication in most cases.

These views are strongly supported in publications of the American Academy of

Pediatrics [1,2], American Academy of Child and Adolescent Psychiatry [3],

American Medical Association [4], American Psychiatric Association [5,6],

National Institutes of Health [7,8], United States Surgeon General [9], and an

international consensus of experts [10]-- all of which reflect solid agreement

within the scientific community.

In stark contrast, psychiatrist Breggin claims that ADHD is not a

genuine diagnosis and that the drugs used to treat it do far more harm than

good.

In line with these views, he has written books [11,12], testified at government

hearings [13], and served as a consultant in several lawsuits. He would like

you to believe that his clinical experiences and investigations have enabled

him to reach a level of insight that is greater than that of the majority of

mental health professionals. This article describes why I consider him

untrustworthy.

Breggin's Background

R. Breggin, M.D., is a Harvard College graduate who obtained his

medical degree from Case Western Reserve Medical School in 1962. After training

in

psychiatry at Harvard and State University of New York Upstate Medical Center

(Syracuse), he worked for two years at the National Institute of Mental Health.

Since 1968, he has practiced psychiatry in the Washington, D.C. metropolitan

area [14]. Breggin describes his private practice as " psychotherapy for

individuals, couples, and families, including children, " with " subspecialties "

in

" the adverse effects of medications, electroshock, and psychosurgery " and

" forensic psychiatry and patient rights. " [15] His online resumé states that he

has

testified as an expert in about 40 cases, many of which involved psychiatric

drugs, FDA regulations, and product liability [15]. His 18 books, most written

for the general public, attack psychosurgery, electroconvulsive therapy

( " shock treatments " ), Prozac, Ritalin, and the use of psychiatric drugs in

general.

In 1972, Breggin founded The International Center for the Study of Psychiatry

and Psychology (ICSPP), a nonprofit organization " concerned with the impact

of mental health theory and practices upon individual well-being, personal

freedom, and family and community values. " [15] ICSPP's 2000 federal tax report

states that its primary purpose is to gather and distribute information about

the " hazards of bio-medical model of psychiatry. " [16] Other information I found

on the Internet states that ICSPP had one part time employee [17] and less

than $25,000 in annual income throughout most of its existence [16]. Breggin

also launched Ethical Human Sciences and Services, a journal that began

publication in 1999. He has also been listed on the advisory board of Network

Against

Coercive Psychiatry, an anti-psychiatry organization whose home page asserts

that the " mental health establishment has conned the American people. "

Breggin's Web site states that he " has been informing the professions, media

and the public about the potential dangers of drugs, electroshock,

psychosurgery, involuntary treatment, and the biological theories of psychiatry

for over

three decades. " [14] The back cover of his Ritalin Fact Book describes him as

" the conscience of psychiatry. " [12] I believe it would be more accurate to

characterize him as a harmful nuisance whose views can undermine trust in the

medical profession and frighten people away from helpful treatment.

A Bit of Puffery?

Breggin's resumé and other biographical reports describe him as a Diplomate

of the National Board of Medical Examiners; a " Specialist in Psychiatry "

recognized by the State of land, Department of Mental Health and Hygiene,

Board

of Physician Quality Assurance; a Diplomate of the American Board of Forensic

Medicine; and a Fellow of the American College of Forensic Examiners. He also

states that he is (or has been) on the editorial board of six peer-reviewed

journals and has published more than 25 articles in peer-reviewed scientific

journals. Although these accomplishments might sound impressive, they actually

are much less than they might seem.

* Breggin is not certified by the American Board of Psychiatry and

Neurology, which is the recognized agency for certifying psychiatrists.

* Having completed three years of psychiatric training, Breggin is

entitled to call himself a psychiatrist or a " specialist in psychiatry. " Until

1996,

the land Board of Quality Assurance maintained a list of " identified "

specialists. Anyone who completed an approved training program was eligible for

listing. No special examination or additional qualifications were required.

* To become licensed in the United States, every physician must pass an

examination given by the National Board of Medical Examiners or an equivalent

examination by a state licensing board. Thus being a " diplomate " of the National

Board of Medical Examiners means nothing more than the fact that the doctor

has passed a standard licensing exam. Most resumés I have seen do not list this

credential.

* The American Board of Forensic Examiners is not recognized by the

American Board of Medical Specialties (ABMS), which is the recognized

standard-setting organization. ABMS offers subspecialty certification in

forensic psychiatry

and forensic pathology, neither of which Breggin has achieved.

* Only one of the six journals with which Breggin has been affiliated is

significant enough to be listed in MEDLINE, the National Library of Medicine's

principal online database.

* On September 5, 2002, I found that Breggin had 33 citations listed in

MEDLINE. None of these publications appears to be a research report. Eight were

letters to the editor, two were books, and most of the rest were expressions

of his opinion on various psychiatric topics.

ADHD: The Prevailing Scientific Viewpoint

The prevailing scientific viewpoint is that ADHD should be regarded as a

neuropsychiatric disorder, that it differs from simply rambunctious behavior,

and

that medication has been thoroughly studied and found to be helpful in

managing the problem. The American Psychiatric Association has published a list

of

criteria that should be used in making the diagnosis [4]. As its name implies,

ADHD is characterized by two sets of symptoms, inattention and hyperactivity.

Although these usually occur together, one may be present to qualify for a

diagnosis.

In 1997, largely in response to Breggin's writings, the American Medical

Association Council on Scientific Affairs issued a report on ADHD that was

approved by the AMA's House of Delegates. The report concluded:

Diagnostic criteria for ADHD are based on extensive empirical research and,

if applied appropriately, lead to the diagnosis of a syndrome with high

interrater reliability, good face validity, and high predictability of course

and

medication responsiveness. The criteria of what constitutes ADHD in children

have

broadened, and there is a growing appreciation of the persistence of ADHD

into adolescence and adulthood. As a result, more children (especially girls),

adolescents, and adults are being diagnosed and treated with stimulant

medication, and children are being treated for longer periods of time.

Epidemiologic

studies using standardized diagnostic criteria suggest that 3% to 6% of the

school-aged population (elementary through high school) may suffer from ADHD,

although the percentage of US youth being treated for ADHD is at most at the

lower

end of this prevalence range. Pharmacotherapy, particularly use of

stimulants, has been extensively studied and generally provides significant

short-term

symptomatic and academic improvement. There is little evidence that stimulant

abuse or diversion is currently a major problem, particularly among those with

ADHD, although recent trends suggest that this could increase with the

expanding production and use of stimulants.

Although some children are being diagnosed as having ADHD with insufficient

evaluation and in some cases stimulant medication is prescribed when treatment

alternatives exist, there is little evidence of widespread overdiagnosis or

misdiagnosis of ADHD or of widespread overprescription of methylphenidate by

physicians [3].

ADHD: What Breggin Says

The Ritalin Fact Book makes many claims that clash with the prevailing

scientific viewpoint. Among other things, it exaggerates the problem of

misdiagnosis, misrepresents what medication is likely to do, greatly exaggerates

what

non-drug treatment can accomplish, misrepresents the results of a scientific

study, uses an out-of-context quote to attack the credibility of other

professionals, and exaggerates the extent of side effects. Here are my responses

to

several such passages in the book:

What Breggin Says My Comments

Page 3: " Many children diagnosed with ADHD and treated with stimulants have

relatively benign problems. Often they simply daydream in the classroom or

dislike school a little more often than other children. Or they may be a little

bit more active and energetic than most. " Although misdiagnosis obviously can

occur, Breggin presents no data showing that this is a major problem or that

it is likely to happen when skilled professionals conduct the evaluations.

" Some children with ADHD are very angry, out of control, and difficult to be

around. When children have these more serious behavioral or emotional

problems, stimulant medication is likely to worsen their mental condition and

behavior. " This advice is extraordinarily irresponsible. The fact that

stimulant

medication can calm many hyperactive children has been known for more than 60

years and has been demonstrated by many well designed clinical studies. Breggin

has published no clinical study and provides no data to back his claim.

Page 3: " Even the most difficult and out-of-control children can be helped by

informed adult intervention without resort to drugs. " On pages 161-174,

Breggin supports this statement with passages about a nurse he met during a

train ride and two experienced teachers who told him how they dealt with

children

that were considered hyperactive. The techniques they described are standard

ones that would work with mildly disturbed children and might help but would

not be sufficient to control truly hyperactive children. Breggin assumes that

the descriptions were accurate, concludes that the techniques would work for all

hyperactive children, and treats this anecdotal evidence as more important

than well-designed studies in which children have been formally diagnosed and

their behavior carefully monitored.

Pages 36-37: " A 1997 study published in Pediatrics confirms high rates of

stimulant-induced depression in 125 children . . . who were given relatively

small doses of Ritalin or Dexedrine. Two children on Ritalin and two on

Dexedrine

developed severe enough adverse effects to be terminated from the study. One

eight-year-old became 'over-focused, extra sensitive, and increasingly

anxious,' and a five-year old became 'extremely aggressive and tearful' . . . .

Side

effects from amphetamine (Dexedrine) were higher than those from Ritalin for

'trouble sleeping, irritability, prone to crying, anxiousness,

sadness/unhappiness, and nightmares.' " Breggin's description distorts what

the study showed.

The study, which lasted two weeks, was done to compare the side effects of

Ritalin and Dexedrine and to identify which symptoms might be due to the

underlying condition rather than to the drugs. The researcher's concluded that

overall, both drugs " were well tolerated by most subjects " and that " many

symptoms

commonly attributed to stimulant medication are actually preexisting

characteristics of children with ADHD and improve with stimulant treatment. "

[18] A 3%

dropout rate caused by temporary symptoms is certainly is not reason to avoid

use of the medications. What do you think it means that Breggin uses data from

a highly favorable study to argue that stimulant drugs should be avoided?

Page 85: " Pronouncements made in public by professional advocates for

stimulants paint glowing pictures about the effectiveness of these drugs. But

professional reviews and textbooks often present a more conservative picture --

one

that hardly justifies exposing children to such great dangers. A review in the

American Psychiatric Press Textbook of Psychiatry concluded: 'Stimulants do

not produce lasting improvements in aggressivity, conduct disorder, criminality,

education achievement, job functioning, marital relationships or long-term

adjustments.' " The textbook sentence is quoted out-of-context. The paragraph

from which it comes begins: " Treatment outcome studies of ADHD have led to some

striking findings. in addition to helping reduce inattention, impulsivity, and

hyperactivity, treatment with psychostimulants can lead to enduring

improvement in social skills and attitudes toward self. " [19] The sentence is

part of a

long discussion of the benefits, risks, and limitations of various treatment

methods. The authors clearly state that stimulant drugs are likely to be useful

for the majority of children with ADHD, but that special educational or

psychological help may still be needed.

Pages 93-94: " Starting with the first dose, almost any psychiatric drug . . .

can worsen the symptoms commonly thought of as ADHD-like. . . . People who

persistently use psychiatric drugs legally or illegally for several months or

more are likely to become forgetful, overlook details, and lose their focus on

difficult tasks. Similarly, they may begin to experience " disinhibition " or

" loss of impulse control. " The earliest signs are irritability and unexpected

outbursts of anger, followed eventually by dangerous expressions of violence. I

have seen this pattern develop in dozens of clinical and legal cases involving

both adults and children. " Breggin, who states on page xvii that he never

starts anyone on psychiatric medication, cites no source for this sweeping

condemnation other than his own vaguely described observations (mostly with

people

who come to him because they are dissatisfied with their treatment). All

effective medications can produce adverse effects. However, competent

prescribers

will adjust dosage and/or change medication to produce maximum benefit with

minimum or no adverse effects. Millions of people believe they have been helped

by psychiatric drugs. Does Breggin think that they, the doctors who prescribe

the drugs, and the thousands of researchers who have studied the effects of

such drugs are dishonest or are fooling themselves?

In the book's introduction (pages xviii-xx), Breggin attempts to justify his

contrary views by portraying himself as privy to unique information.

++++++++++++++

In addition to more than three decades of clinical work, this book draws upon

the years of work required for writing dozens of scientific books and

articles; the workshops I have given for professionals and the public; teaching

I

have done in the past at universities . . . and presentations I have made at

national conferences for health professionals and attorneys. . . .

I often hear about newly discovered adverse drug reactions long before most

professionals become aware of them. . . .

I have yet another unique source of information and knowledge. For many years

I have been a consultant and medical expert in legal actions involving

psychiatric drugs, including the stimulants described in this book. . . . .

My most specialized source of information about psychiatric drugs comes from

my work as a medical expert in cases against giant pharmaceutical companies

that are charged with negligence or fraud in developing or publicizing their

products. In this fascinating legal arena, I can gain access to secret " inside

information " about psychiatric medications that is literally unavailable to any

other physician in the world. . . .

Based on my publications and consultations, a series of class-action suits

have been brought against Novartis, the manufacturer of Ritalin, charging the

company with conspiring with the American Psychiatric Association and the

parents' group Children and Adults with Attention Deficit Disorder (CHADD) to

fabricate the ADHD diagnosis and foster the overuse of Ritalin.

++++++++++

Research? Unique private communications? Access to " secret " documents? A big

conspiracy? As far as I can tell, Breggin has made no systematic clinical

reports, and the book provides no relevant " insider information " or alleged

facts

about any conspiracy. The suits to which he refers were filed during the year

2000 in California, Florida, New Jersey, Puerto Rico, and Texas and were not

legitimate. The California and Texas suits were dismissed by the courts for

failure to state a proper cause of action [20]. The New Jersey suit was

withdrawn

after the judge made it clear that he was highly skeptical of plaintiffs'

allegations of conspiracy [21], and the others were quietly withdrawn,

presumably

because the plaintiffs realized they were certain to lose. The final

withdrawal took place on August 16, 2001. Yet The Ritalin Fact Book'

(publication date

July 2002) and Breggin's Web site still portray the suits as legitimate and

pending.

A. Barkley, PhD, a university-based psychiatry professor who has

specialized in ADHD and related disorders for more than 20 years and has

published

more than 150 scientific papers, book chapters, and books, reached a parallel

conclusion about the first edition of Breggin's Talking Back to Ritalin. In a

blistering review, Barkley said:

Literally from its opening pages, this book makes contorted attempts at the

appearance of scholarship, replete with quotes, footnotes, and references to

scientific papers and other sources. Throughout, any quote is mustered from

scientific papers that can be taken out of context to support the author's

biases

along with every exaggerated fact and figure he can find to support his call

to alarm, no matter the credibility (or lack of it) of his sources. However,

the flaws of both his research methods and his arguments are evident to any

scientist even slightly familiar with the scientific literature on the topics

covered here [22].

Barkley also led a team of 75 experts who recently issued a international

consensus statement expressing concern about the " inaccurate portrayal of

attention deficit hyperactivity disorder (ADHD) in media reports. " Although the

statement did not name Breggin, it obviously referred to him in the following

passage:

Occasional coverage of the disorder casts the story in the form of a sporting

event with evenly matched competitors. The views of a handful of non-expert

doctors that ADHD does not exist are contrasted against mainstream scientific

views that it does, as if both views had equal merit. Such attempts at balance

give the public the impression that there is substantial scientific

disagreement over whether ADHD is a real medical condition. In fact, there is no

such

disagreement -- at least no more so than there is over whether smoking causes

cancer, for example, or whether a virus causes HIV/AIDS [9].

Breggin's credibility has also been skewered during three legal actions in

which judges either excluded his testimony or gave it no credibility. The first

two involved dubious claims that a medication had caused severe harm, and the

third was a contest between parents about whether or not a child with ADHD

should be treated with Ritalin.

This court finds that the evidence of Breggin, as a purported expert,

fails nearly all particulars under the standard set forth in Daubert and its

progeny. . . . . Simply put, the Court believes that Dr. Breggin's opinions do

not rise to the level of an opinion based on " good science. " The motion to

exclude his testimony as an expert witness should be granted. -- Magistrate

Judge

B. Waugh Crigler in Lam v. The Upjohn Company, No. 94-0033-H, W. Dist., of VA

(onburg Division, U.S. District Court, 1995)

The court believes not only is this gentleman unqualified to render the

opinions that he did, I believe that his bias in this case is blinding. . . . I

find that he . . . was not only unprepared, he was mistaken in a lot of the

factual basis for which he expressed his opinion. . . . The court is going to

strike the testimony of Dr. Breggin, finding that it has no rational basis. --

Judge J. Caplan in Lightner v. Alessi, No. 94013064/CL174959 (Baltimore

City Circuit Court, 1995).

Dr. Breggin's observations are totally without credibility. I can almost

declare him, I guess from statements that floor me, to say the he's a fraud or

at

least approaching that He has made some outrageous statements and written

outrageous books and which he says he has now withdrawn and his thinking is

different. He's untrained. He's a member of no hospital staff. He has not since

medical school participated in any studies to support his conclusions except

maybe

one. . . . I can't place any credence or credibility in what he has to

recommend in this case. -- Judge W. Rice in Schellinger v. Schellinger,

No.

93-FA-939-763 (Milwaukee County Circuit Court, 1997)

The Bottom Line

R. Breggin , M.D., would like you to believe that his personal

experience and judgment enable him to out-think and outperform the collective

wisdom

of the science-based mental health community. Some of the things he describes

may reflect genuine problems. However, he is prone to exaggeration and has

certainly failed to substantiate his ADHD-related criticisms. The Ritalin Fact

Book

should be classified as junk science.

For Additional Information

* Book Review: Talking Back to Ritalin

* International Consensus Statement on ADHD

* American Academy of Pediatrics

* ADHD and your school-aged child. AAP Parent Page, Oct 2001.

* Understanding ADHD: A Guide for Parents (booklet)

* ADHD: A Complete and Authoritative Guide (book, 2003)

* A trick question: A hoax that turns out to be true: Excellent article by

Fumento.

* American Psychiatric Association fact sheet

* New Zealand Guidelines for ADHD Assessment and Treatment

* Dr. Larry Silver's Advice to Parents on ADHD (book)

*

References

1. American Academy of Pediatrics. Clinical Practice Guideline: Diagnosis

and evaluation of the child with attention-deficit/hyperactivity disorder.

Pediatrics 105:1158-1170, 2000.

2. American Academy of Pediatrics. Clinical Practice Guideline: Treatment

of the school-aged child with attention-deficit/hyperactivity disorder.

Pediatrics 108:1033-1044, 2001.

3. Practice parameters for the assessment and treatment of attention

deficit/hyperactivity disorders. Journal of the American Academy of Child and

Adolescent Psychiatry 30:1-3, 1991.

4. Goldman LS and others. Diagnosis and treatment of

attention-deficit/hyperactivity disorder in children and adolescents. JAMA

279:1100-1107, 1998.

5. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR.

Washington, DC: American Psychiatric Press, 2000.

6. Attention deficit/hyperactivity disorder. American Psychiatric

Association fact sheet, March 2001.

7. Diagnosis and treatment of attention deficit hyperactivity disorder.

NIH Consensus Statement 16(2), Nov 16-18, 1998. [Download PDF]

8. Attention deficit hyperactivity disorder. NIH Publication No. 96-3572,

printed 1994, reprinted 1996. [Download PDF]

9. Attention deficit/hyperactivity disorder. In Mental Health: A Report of

the Surgeon General. Rockville, MD: U.S. Dept. of Health and Human Services,

1999, pp 142-150.

10. Barkley RA and others. International Consensus Statement on ADHD.

ADDitude magazine, Jan 2002.

11. Breggin PR. Talking Back to Ritalin: What Doctors Aren't Telling You

about Stimulants and ADHD. Cambridge, MA: Perseus Publishing, revised edition,

2001. (Previous edition published in 1998 by Courage Press, Monroe, ME.

12. Breggin PR. The Ritalin Fact Book: What Doctors Won't Tell You about

ADHD and Stimulant Drugs. Cambridge, MA: Perseus Publishing, 2002.

13. Breggin PR. Testimony at Hearing on Behavioral Drugs in Schools:

Questions and Concerns. Held by the Subcommittee on Oversight and

Investigations,

Committee on Education and the Workforce, U.S. House of Representatives, Sept

29, 2000.

14. Breggin PR. Psychiatric drug facts: Biography. Accessed Sept 6, 2002.

15. Breggin PR. R. Breggin resume. Accessed Sept 6, 2002.

16. ICSPP. Form 990-EZ for 2000.

17. Schaler JA. Double-think at the ICSPP corral: A rejoinder to R.

Breggin, M.D. Psychnews International 4(1), March 1999.

18. Efron D and others. Side effects of methylphenidate and dexamphetamine in

children with attention deficit hyperactivity disorder: a double-blind,

crossover trial. Pediatrics 100:162-166, 1997.

19. Popper C, West CA. Disorders usually first diagnosed in infancy

childhood, or adolescence. In Hales RE and others, editors. The American

Psychiatric

Press Textbook of Psychiatry, Third Edition. Washington, DC: American

Psychiatric Press, pp 825-855.

20. Hausman K. Last of Ritalin-based lawsuits against APA comes to a close

.. American Psychiatric News, April 5, 2002.

21. Dismissal of New Jersey lawsuit strengthens CHADD's Resolve: New

Jersey plaintiffs drop lawsuit after judge criticizes complaint. CHADD press

release, Feb 21, 2002.

22. Barkley RA. ADHD, Ritalin, and Conspiracies: Talking Back to

Breggin Originally posted to CHADD Web site, 1998.

Quackwatch Home Page

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[Guest guest]

,

Don't waste your time defending Breggin to Barrett. Quack as a name

representing him fits him well, though I think nut is more fitting. Check

out his own credits, there is less there than Breggin, nothing of any note

for a doctor. He is one of those people in life who makes himself look big

by making others look small. He obviously doesn't practice medicine but has

devoted his time to this blasting of others like he is saint and savior of

the exploited and represents the medical community. He does not even

express what the establishment does believe. All that education and

training, and this is what he has done with his life? He's a joke.

Someone posted on a board that he actually gets funding from the drug

companies. I would be surprised if even they would give him the time of

day, he is such a sleeze and an absolute nobody himself. He's a board

certified surgeon asking on that site for donations to cover his $4500 costs

of maintaining the site? Does that make sense? He does this to any and

everyone and everything that challenges allopathic practices and drug

companies, be it individuals like Breggin or be it supplements, alternative

treatments. He's been doing this for years. And to be frank, I think it is

to someone's credit to be specifically targeted by him.

He use to have Atkins on there. He did exactly the same ripping apart to

the low carb ideas. The last time I looked, his discounting of him had been

removed. Of well, yes funny thing about the establishment now supporting

Atkins. Barrett is just full of @#$%.

My favorite I read of his was on alternative cancer treatments. It likely is

still there. He essentially says that if your doctor tells you that you are

terminal, go home, write your will, straighten up your things, and crawl in

a hole until you die. Do not try anything to save your life because your

doctor spoke the almighty word of God that your time had come. That says

everything about his commitment to the Hippocratic Oath and his regard for

life.

Help with writing on behalf of Dr Breggin

This was sent to me about Quack watch and Dr Breggin.

It was Dr Breggin who first alerted me ten years ago

to the atrocity we call the child mental health field.

Any of you who can please write on his behalf.

The difference is between those who could not even tell Paxil causes suicide

and these are the same ones who cannot see the difference between life and

death

due to the money signs.

For those who are interested in the facts and not the self-serving hype

around Breggin.

I took one look at " Talking Back to Ritalin, " and the wacky subheadings and

willy-nilly graphic construction alone smacked of unprofessionalism, if not

sensationalism. The actual content was even worse!

Dr. Breggin is no friend to children or anyone else with ADHD. He is a

menace

and a fraud.

Quackwatch Home Page

Some Notes on ADHD and

R. Breggin's Unfair Attack on Ritalin

Barrett, M.D.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a commonly diagnosed

childhood behavioral disorder whose core symptoms include inappropriate

levels of

attention, concentration, activity and distractibility. Although its cause

is

unknown, considerable progress has been made in managing it. Scientific

studies

have found that the single most effective treatment is medication with a

stimulant drug, of which the most commonly used has been methylphenidate

(Ritalin). Behavioral approaches that include helping parents and teachers

to deal with

the child's behavior are also important, but they are not a substitute for

medication in most cases.

These views are strongly supported in publications of the American Academy

of

Pediatrics [1,2], American Academy of Child and Adolescent Psychiatry [3],

American Medical Association [4], American Psychiatric Association [5,6],

National Institutes of Health [7,8], United States Surgeon General [9], and

an

international consensus of experts [10]-- all of which reflect solid

agreement

within the scientific community.

In stark contrast, psychiatrist Breggin claims that ADHD is not a

genuine diagnosis and that the drugs used to treat it do far more harm than

good.

In line with these views, he has written books [11,12], testified at

government

hearings [13], and served as a consultant in several lawsuits. He would like

you to believe that his clinical experiences and investigations have enabled

him to reach a level of insight that is greater than that of the majority of

mental health professionals. This article describes why I consider him

untrustworthy.

Breggin's Background

R. Breggin, M.D., is a Harvard College graduate who obtained his

medical degree from Case Western Reserve Medical School in 1962. After

training in

psychiatry at Harvard and State University of New York Upstate Medical

Center

(Syracuse), he worked for two years at the National Institute of Mental

Health.

Since 1968, he has practiced psychiatry in the Washington, D.C. metropolitan

area [14]. Breggin describes his private practice as " psychotherapy for

individuals, couples, and families, including children, " with

" subspecialties " in

" the adverse effects of medications, electroshock, and psychosurgery " and

" forensic psychiatry and patient rights. " [15] His online resumé states that

he has

testified as an expert in about 40 cases, many of which involved psychiatric

drugs, FDA regulations, and product liability [15]. His 18 books, most

written

for the general public, attack psychosurgery, electroconvulsive therapy

( " shock treatments " ), Prozac, Ritalin, and the use of psychiatric drugs in

general.

In 1972, Breggin founded The International Center for the Study of

Psychiatry

and Psychology (ICSPP), a nonprofit organization " concerned with the impact

of mental health theory and practices upon individual well-being, personal

freedom, and family and community values. " [15] ICSPP's 2000 federal tax

report

states that its primary purpose is to gather and distribute information

about

the " hazards of bio-medical model of psychiatry. " [16] Other information I

found

on the Internet states that ICSPP had one part time employee [17] and less

than $25,000 in annual income throughout most of its existence [16]. Breggin

also launched Ethical Human Sciences and Services, a journal that began

publication in 1999. He has also been listed on the advisory board of

Network Against

Coercive Psychiatry, an anti-psychiatry organization whose home page asserts

that the " mental health establishment has conned the American people. "

Breggin's Web site states that he " has been informing the professions, media

and the public about the potential dangers of drugs, electroshock,

psychosurgery, involuntary treatment, and the biological theories of

psychiatry for over

three decades. " [14] The back cover of his Ritalin Fact Book describes him

as

" the conscience of psychiatry. " [12] I believe it would be more accurate to

characterize him as a harmful nuisance whose views can undermine trust in

the

medical profession and frighten people away from helpful treatment.

A Bit of Puffery?

Breggin's resumé and other biographical reports describe him as a Diplomate

of the National Board of Medical Examiners; a " Specialist in Psychiatry "

recognized by the State of land, Department of Mental Health and

Hygiene, Board

of Physician Quality Assurance; a Diplomate of the American Board of

Forensic

Medicine; and a Fellow of the American College of Forensic Examiners. He

also

states that he is (or has been) on the editorial board of six peer-reviewed

journals and has published more than 25 articles in peer-reviewed scientific

journals. Although these accomplishments might sound impressive, they actual

ly

are much less than they might seem.

* Breggin is not certified by the American Board of Psychiatry and

Neurology, which is the recognized agency for certifying psychiatrists.

* Having completed three years of psychiatric training, Breggin is

entitled to call himself a psychiatrist or a " specialist in psychiatry. "

Until 1996,

the land Board of Quality Assurance maintained a list of " identified "

specialists. Anyone who completed an approved training program was eligible

for

listing. No special examination or additional qualifications were required.

* To become licensed in the United States, every physician must pass an

examination given by the National Board of Medical Examiners or an

equivalent

examination by a state licensing board. Thus being a " diplomate " of the

National

Board of Medical Examiners means nothing more than the fact that the doctor

has passed a standard licensing exam. Most resumés I have seen do not list

this

credential.

* The American Board of Forensic Examiners is not recognized by the

American Board of Medical Specialties (ABMS), which is the recognized

standard-setting organization. ABMS offers subspecialty certification in

forensic psychiatry

and forensic pathology, neither of which Breggin has achieved.

* Only one of the six journals with which Breggin has been affiliated is

significant enough to be listed in MEDLINE, the National Library of

Medicine's

principal online database.

* On September 5, 2002, I found that Breggin had 33 citations listed in

MEDLINE. None of these publications appears to be a research report. Eight

were

letters to the editor, two were books, and most of the rest were expressions

of his opinion on various psychiatric topics.

ADHD: The Prevailing Scientific Viewpoint

The prevailing scientific viewpoint is that ADHD should be regarded as a

neuropsychiatric disorder, that it differs from simply rambunctious

behavior, and

that medication has been thoroughly studied and found to be helpful in

managing the problem. The American Psychiatric Association has published a

list of

criteria that should be used in making the diagnosis [4]. As its name

implies,

ADHD is characterized by two sets of symptoms, inattention and

hyperactivity.

Although these usually occur together, one may be present to qualify for a

diagnosis.

In 1997, largely in response to Breggin's writings, the American Medical

Association Council on Scientific Affairs issued a report on ADHD that was

approved by the AMA's House of Delegates. The report concluded:

Diagnostic criteria for ADHD are based on extensive empirical research and,

if applied appropriately, lead to the diagnosis of a syndrome with high

interrater reliability, good face validity, and high predictability of

course and

medication responsiveness. The criteria of what constitutes ADHD in children

have

broadened, and there is a growing appreciation of the persistence of ADHD

into adolescence and adulthood. As a result, more children (especially

girls),

adolescents, and adults are being diagnosed and treated with stimulant

medication, and children are being treated for longer periods of time.

Epidemiologic

studies using standardized diagnostic criteria suggest that 3% to 6% of the

school-aged population (elementary through high school) may suffer from

ADHD,

although the percentage of US youth being treated for ADHD is at most at the

lower

end of this prevalence range. Pharmacotherapy, particularly use of

stimulants, has been extensively studied and generally provides significant

short-term

symptomatic and academic improvement. There is little evidence that

stimulant

abuse or diversion is currently a major problem, particularly among those

with

ADHD, although recent trends suggest that this could increase with the

expanding production and use of stimulants.

Although some children are being diagnosed as having ADHD with insufficient

evaluation and in some cases stimulant medication is prescribed when

treatment

alternatives exist, there is little evidence of widespread overdiagnosis or

misdiagnosis of ADHD or of widespread overprescription of methylphenidate by

physicians [3].

ADHD: What Breggin Says

The Ritalin Fact Book makes many claims that clash with the prevailing

scientific viewpoint. Among other things, it exaggerates the problem of

misdiagnosis, misrepresents what medication is likely to do, greatly

exaggerates what

non-drug treatment can accomplish, misrepresents the results of a scientific

study, uses an out-of-context quote to attack the credibility of other

professionals, and exaggerates the extent of side effects. Here are my

responses to

several such passages in the book:

What Breggin Says My Comments

Page 3: " Many children diagnosed with ADHD and treated with stimulants have

relatively benign problems. Often they simply daydream in the classroom or

dislike school a little more often than other children. Or they may be a

little

bit more active and energetic than most. " Although misdiagnosis obviously

can

occur, Breggin presents no data showing that this is a major problem or that

it is likely to happen when skilled professionals conduct the evaluations.

" Some children with ADHD are very angry, out of control, and difficult to be

around. When children have these more serious behavioral or emotional

problems, stimulant medication is likely to worsen their mental condition

and

behavior. " This advice is extraordinarily irresponsible. The fact that

stimulant

medication can calm many hyperactive children has been known for more than

60

years and has been demonstrated by many well designed clinical studies.

Breggin

has published no clinical study and provides no data to back his claim.

Page 3: " Even the most difficult and out-of-control children can be helped

by

informed adult intervention without resort to drugs. " On pages 161-174,

Breggin supports this statement with passages about a nurse he met during a

train ride and two experienced teachers who told him how they dealt with

children

that were considered hyperactive. The techniques they described are standard

ones that would work with mildly disturbed children and might help but would

not be sufficient to control truly hyperactive children. Breggin assumes

that

the descriptions were accurate, concludes that the techniques would work for

all

hyperactive children, and treats this anecdotal evidence as more important

than well-designed studies in which children have been formally diagnosed

and

their behavior carefully monitored.

Pages 36-37: " A 1997 study published in Pediatrics confirms high rates of

stimulant-induced depression in 125 children . . . who were given relatively

small doses of Ritalin or Dexedrine. Two children on Ritalin and two on

Dexedrine

developed severe enough adverse effects to be terminated from the study. One

eight-year-old became 'over-focused, extra sensitive, and increasingly

anxious,' and a five-year old became 'extremely aggressive and tearful' . .

.. . Side

effects from amphetamine (Dexedrine) were higher than those from Ritalin for

'trouble sleeping, irritability, prone to crying, anxiousness,

sadness/unhappiness, and nightmares.' " Breggin's description distorts

what the study showed.

The study, which lasted two weeks, was done to compare the side effects of

Ritalin and Dexedrine and to identify which symptoms might be due to the

underlying condition rather than to the drugs. The researcher's concluded

that

overall, both drugs " were well tolerated by most subjects " and that " many

symptoms

commonly attributed to stimulant medication are actually preexisting

characteristics of children with ADHD and improve with stimulant treatment. "

[18] A 3%

dropout rate caused by temporary symptoms is certainly is not reason to

avoid

use of the medications. What do you think it means that Breggin uses data

from

a highly favorable study to argue that stimulant drugs should be avoided?

Page 85: " Pronouncements made in public by professional advocates for

stimulants paint glowing pictures about the effectiveness of these drugs.

But

professional reviews and textbooks often present a more conservative

picture -- one

that hardly justifies exposing children to such great dangers. A review in

the

American Psychiatric Press Textbook of Psychiatry concluded: 'Stimulants do

not produce lasting improvements in aggressivity, conduct disorder,

criminality,

education achievement, job functioning, marital relationships or long-term

adjustments.' " The textbook sentence is quoted out-of-context. The paragraph

from which it comes begins: " Treatment outcome studies of ADHD have led to

some

striking findings. in addition to helping reduce inattention, impulsivity,

and

hyperactivity, treatment with psychostimulants can lead to enduring

improvement in social skills and attitudes toward self. " [19] The sentence

is part of a

long discussion of the benefits, risks, and limitations of various treatment

methods. The authors clearly state that stimulant drugs are likely to be

useful

for the majority of children with ADHD, but that special educational or

psychological help may still be needed.

Pages 93-94: " Starting with the first dose, almost any psychiatric drug . .

..

can worsen the symptoms commonly thought of as ADHD-like. . . . People who

persistently use psychiatric drugs legally or illegally for several months

or

more are likely to become forgetful, overlook details, and lose their focus

on

difficult tasks. Similarly, they may begin to experience " disinhibition " or

" loss of impulse control. " The earliest signs are irritability and

unexpected

outbursts of anger, followed eventually by dangerous expressions of

violence. I

have seen this pattern develop in dozens of clinical and legal cases

involving

both adults and children. " Breggin, who states on page xvii that he never

starts anyone on psychiatric medication, cites no source for this sweeping

condemnation other than his own vaguely described observations (mostly with

people

who come to him because they are dissatisfied with their treatment). All

effective medications can produce adverse effects. However, competent

prescribers

will adjust dosage and/or change medication to produce maximum benefit with

minimum or no adverse effects. Millions of people believe they have been

helped

by psychiatric drugs. Does Breggin think that they, the doctors who

prescribe

the drugs, and the thousands of researchers who have studied the effects of

such drugs are dishonest or are fooling themselves?

In the book's introduction (pages xviii-xx), Breggin attempts to justify his

contrary views by portraying himself as privy to unique information.

++++++++++++++

In addition to more than three decades of clinical work, this book draws

upon

the years of work required for writing dozens of scientific books and

articles; the workshops I have given for professionals and the public;

teaching I

have done in the past at universities . . . and presentations I have made at

national conferences for health professionals and attorneys. . . .

I often hear about newly discovered adverse drug reactions long before most

professionals become aware of them. . . .

I have yet another unique source of information and knowledge. For many

years

I have been a consultant and medical expert in legal actions involving

psychiatric drugs, including the stimulants described in this book. . . . .

My most specialized source of information about psychiatric drugs comes from

my work as a medical expert in cases against giant pharmaceutical companies

that are charged with negligence or fraud in developing or publicizing their

products. In this fascinating legal arena, I can gain access to secret

" inside

information " about psychiatric medications that is literally unavailable to

any

other physician in the world. . . .

Based on my publications and consultations, a series of class-action suits

have been brought against Novartis, the manufacturer of Ritalin, charging

the

company with conspiring with the American Psychiatric Association and the

parents' group Children and Adults with Attention Deficit Disorder (CHADD)

to

fabricate the ADHD diagnosis and foster the overuse of Ritalin.

++++++++++

Research? Unique private communications? Access to " secret " documents? A big

conspiracy? As far as I can tell, Breggin has made no systematic clinical

reports, and the book provides no relevant " insider information " or alleged

facts

about any conspiracy. The suits to which he refers were filed during the

year

2000 in California, Florida, New Jersey, Puerto Rico, and Texas and were not

legitimate. The California and Texas suits were dismissed by the courts for

failure to state a proper cause of action [20]. The New Jersey suit was

withdrawn

after the judge made it clear that he was highly skeptical of plaintiffs'

allegations of conspiracy [21], and the others were quietly withdrawn,

presumably

because the plaintiffs realized they were certain to lose. The final

withdrawal took place on August 16, 2001. Yet The Ritalin Fact Book'

(publication date

July 2002) and Breggin's Web site still portray the suits as legitimate and

pending.

A. Barkley, PhD, a university-based psychiatry professor who has

specialized in ADHD and related disorders for more than 20 years and has

published

more than 150 scientific papers, book chapters, and books, reached a

parallel

conclusion about the first edition of Breggin's Talking Back to Ritalin. In

a

blistering review, Barkley said:

Literally from its opening pages, this book makes contorted attempts at the

appearance of scholarship, replete with quotes, footnotes, and references to

scientific papers and other sources. Throughout, any quote is mustered from

scientific papers that can be taken out of context to support the author's

biases

along with every exaggerated fact and figure he can find to support his call

to alarm, no matter the credibility (or lack of it) of his sources. However,

the flaws of both his research methods and his arguments are evident to any

scientist even slightly familiar with the scientific literature on the

topics

covered here [22].

Barkley also led a team of 75 experts who recently issued a international

consensus statement expressing concern about the " inaccurate portrayal of

attention deficit hyperactivity disorder (ADHD) in media reports. " Although

the

statement did not name Breggin, it obviously referred to him in the

following

passage:

Occasional coverage of the disorder casts the story in the form of a

sporting

event with evenly matched competitors. The views of a handful of non-expert

doctors that ADHD does not exist are contrasted against mainstream

scientific

views that it does, as if both views had equal merit. Such attempts at

balance

give the public the impression that there is substantial scientific

disagreement over whether ADHD is a real medical condition. In fact, there

is no such

disagreement -- at least no more so than there is over whether smoking

causes

cancer, for example, or whether a virus causes HIV/AIDS [9].

Breggin's credibility has also been skewered during three legal actions in

which judges either excluded his testimony or gave it no credibility. The

first

two involved dubious claims that a medication had caused severe harm, and

the

third was a contest between parents about whether or not a child with ADHD

should be treated with Ritalin.

This court finds that the evidence of Breggin, as a purported expert,

fails nearly all particulars under the standard set forth in Daubert and its

progeny. . . . . Simply put, the Court believes that Dr. Breggin's opinions

do

not rise to the level of an opinion based on " good science. " The motion to

exclude his testimony as an expert witness should be granted. -- Magistrate

Judge

B. Waugh Crigler in Lam v. The Upjohn Company, No. 94-0033-H, W. Dist., of

VA

(onburg Division, U.S. District Court, 1995)

The court believes not only is this gentleman unqualified to render the

opinions that he did, I believe that his bias in this case is blinding. . .

.. I

find that he . . . was not only unprepared, he was mistaken in a lot of the

factual basis for which he expressed his opinion. . . . The court is going

to

strike the testimony of Dr. Breggin, finding that it has no rational

basis. --

Judge J. Caplan in Lightner v. Alessi, No. 94013064/CL174959

(Baltimore

City Circuit Court, 1995).

Dr. Breggin's observations are totally without credibility. I can almost

declare him, I guess from statements that floor me, to say the he's a fraud

or at

least approaching that He has made some outrageous statements and written

outrageous books and which he says he has now withdrawn and his thinking is

different. He's untrained. He's a member of no hospital staff. He has not

since

medical school participated in any studies to support his conclusions except

maybe

one. . . . I can't place any credence or credibility in what he has to

recommend in this case. -- Judge W. Rice in Schellinger v.

Schellinger, No.

93-FA-939-763 (Milwaukee County Circuit Court, 1997)

The Bottom Line

R. Breggin , M.D., would like you to believe that his personal

experience and judgment enable him to out-think and outperform the

collective wisdom

of the science-based mental health community. Some of the things he

describes

may reflect genuine problems. However, he is prone to exaggeration and has

certainly failed to substantiate his ADHD-related criticisms. The Ritalin

Fact Book

should be classified as junk science.

For Additional Information

* Book Review: Talking Back to Ritalin

* International Consensus Statement on ADHD

* American Academy of Pediatrics

* ADHD and your school-aged child. AAP Parent Page, Oct 2001.

* Understanding ADHD: A Guide for Parents (booklet)

* ADHD: A Complete and Authoritative Guide (book, 2003)

* A trick question: A hoax that turns out to be true: Excellent article

by

Fumento.

* American Psychiatric Association fact sheet

* New Zealand Guidelines for ADHD Assessment and Treatment

* Dr. Larry Silver's Advice to Parents on ADHD (book)

*

References

1. American Academy of Pediatrics. Clinical Practice Guideline: Diagnosis

and evaluation of the child with attention-deficit/hyperactivity disorder.

Pediatrics 105:1158-1170, 2000.

2. American Academy of Pediatrics. Clinical Practice Guideline: Treatment

of the school-aged child with attention-deficit/hyperactivity disorder.

Pediatrics 108:1033-1044, 2001.

3. Practice parameters for the assessment and treatment of attention

deficit/hyperactivity disorders. Journal of the American Academy of Child

and

Adolescent Psychiatry 30:1-3, 1991.

4. Goldman LS and others. Diagnosis and treatment of

attention-deficit/hyperactivity disorder in children and adolescents. JAMA

279:1100-1107, 1998.

5. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR.

Washington, DC: American Psychiatric Press, 2000.

6. Attention deficit/hyperactivity disorder. American Psychiatric

Association fact sheet, March 2001.

7. Diagnosis and treatment of attention deficit hyperactivity disorder.

NIH Consensus Statement 16(2), Nov 16-18, 1998. [Download PDF]

8. Attention deficit hyperactivity disorder. NIH Publication No. 96-3572,

printed 1994, reprinted 1996. [Download PDF]

9. Attention deficit/hyperactivity disorder. In Mental Health: A Report

of

the Surgeon General. Rockville, MD: U.S. Dept. of Health and Human Services,

1999, pp 142-150.

10. Barkley RA and others. International Consensus Statement on ADHD.

ADDitude magazine, Jan 2002.

11. Breggin PR. Talking Back to Ritalin: What Doctors Aren't Telling You

about Stimulants and ADHD. Cambridge, MA: Perseus Publishing, revised

edition,

2001. (Previous edition published in 1998 by Courage Press, Monroe, ME.

12. Breggin PR. The Ritalin Fact Book: What Doctors Won't Tell You about

ADHD and Stimulant Drugs. Cambridge, MA: Perseus Publishing, 2002.

13. Breggin PR. Testimony at Hearing on Behavioral Drugs in Schools:

Questions and Concerns. Held by the Subcommittee on Oversight and

Investigations,

Committee on Education and the Workforce, U.S. House of Representatives,

Sept

29, 2000.

14. Breggin PR. Psychiatric drug facts: Biography. Accessed Sept 6, 2002.

15. Breggin PR. R. Breggin resume. Accessed Sept 6, 2002.

16. ICSPP. Form 990-EZ for 2000.

17. Schaler JA. Double-think at the ICSPP corral: A rejoinder to R.

Breggin, M.D. Psychnews International 4(1), March 1999.

18. Efron D and others. Side effects of methylphenidate and dexamphetamine

in

children with attention deficit hyperactivity disorder: a double-blind,

crossover trial. Pediatrics 100:162-166, 1997.

19. Popper C, West CA. Disorders usually first diagnosed in infancy

childhood, or adolescence. In Hales RE and others, editors. The American

Psychiatric

Press Textbook of Psychiatry, Third Edition. Washington, DC: American

Psychiatric Press, pp 825-855.

20. Hausman K. Last of Ritalin-based lawsuits against APA comes to a

close

.. American Psychiatric News, April 5, 2002.

21. Dismissal of New Jersey lawsuit strengthens CHADD's Resolve: New

Jersey plaintiffs drop lawsuit after judge criticizes complaint. CHADD press

release, Feb 21, 2002.

22. Barkley RA. ADHD, Ritalin, and Conspiracies: Talking Back to

Breggin Originally posted to CHADD Web site, 1998.

Quackwatch Home Page

Marhoefer

Miracles Of Hope Network®

New York City~Chicago~Los Angeles~Paris

<A HREF= " www.miracles-of-hope.com " >www.miracles-of-hope.com</A>

The Defense Foundation for children USA

~Changing The Destiny Of A Child ~

Obstruction-Of-Injustice Radio~Media and Production

Touch the Thunder Publishing & Recording Company

<A HREF= " www.on-air-live-radio.tv " >www.on-air-live-radio.tv</A>

::justice in media::

" Sometimes instead of leveling the playing field, you just have to buy the

field " DM2004®

[Guest guest]

I totally agree.....Barrett is an idiot. He discounts everything from chiro=

practics

to organic food. Even things that are fairly mainstream, he says are total =

bunk.

Therapies that i am currently having incredible success with, he says to av=

oid

at all cost!!!

I keep his page bookmarked as possible things to check into!!

> ,

>

> Don't waste your time defending Breggin to Barrett. Quack as a name

> representing him fits him well, though I think nut is more fitting. Check=

> out his own credits, there is less there than Breggin, nothing of any not=

e

> for a doctor. He is one of those people in life who makes himself look =

big

> by making others look small. He obviously doesn't practice medicine but =

has

> devoted his time to this blasting of others like he is saint and savior o=

f

> the exploited and represents the medical community. He does not even

> express what the establishment does believe. All that education and

> training, and this is what he has done with his life? He's a joke.

> Someone posted on a board that he actually gets funding from the drug

> companies. I would be surprised if even they would give him the time of

> day, he is such a sleeze and an absolute nobody himself. He's a board

> certified surgeon asking on that site for donations to cover his $4500 co=

sts

> of maintaining the site? Does that make sense? He does this to any and=

> everyone and everything that challenges allopathic practices and drug

> companies, be it individuals like Breggin or be it supplements, alternati=

ve

> treatments. He's been doing this for years. And to be frank, I think it =

is

> to someone's credit to be specifically targeted by him.

>

> He use to have Atkins on there. He did exactly the same ripping apart to=

> the low carb ideas. The last time I looked, his discounting of him had b=

een

> removed. Of well, yes funny thing about the establishment now supporting=

> Atkins. Barrett is just full of @#$%.

>

> My favorite I read of his was on alternative cancer treatments. It likely=

is

> still there. He essentially says that if your doctor tells you that you =

are

> terminal, go home, write your will, straighten up your things, and crawl =

in

> a hole until you die. Do not try anything to save your life because your=

> doctor spoke the almighty word of God that your time had come. That says=

> everything about his commitment to the Hippocratic Oath and his regard fo=

r

> life.

>

>

>

>

> Help with writing on behalf of Dr Breggin=

>

>

> This was sent to me about Quack watch and Dr Breggin.

> It was Dr Breggin who first alerted me ten years ago

> to the atrocity we call the child mental health field.

> Any of you who can please write on his behalf.

> The difference is between those who could not even tell Paxil causes

suicide

> and these are the same ones who cannot see the difference between life

and

> death

> due to the money signs.

>

>

>

> For those who are interested in the facts and not the self-serving hype

> around Breggin.

>

> I took one look at " Talking Back to Ritalin, " and the wacky subheadings a=

nd

> willy-nilly graphic construction alone smacked of unprofessionalism, if n=

ot

> sensationalism. The actual content was even worse!

>

> Dr. Breggin is no friend to children or anyone else with ADHD. He is a

> menace

> and a fraud.

>

>

>

> Quackwatch Home Page

>

>

>

>

> Some Notes on ADHD and

> R. Breggin's Unfair Attack on Ritalin

>

>

>

>

>

> Barrett, M.D.

>

>

>

> Attention-Deficit/Hyperactivity Disorder (ADHD) is a commonly diagnosed

> childhood behavioral disorder whose core symptoms include inappropriate

> levels of

> attention, concentration, activity and distractibility. Although its caus=

e

> is

> unknown, considerable progress has been made in managing it. Scientific

> studies

> have found that the single most effective treatment is medication with a

> stimulant drug, of which the most commonly used has been

methylphenidate

> (Ritalin). Behavioral approaches that include helping parents and teacher=

s

> to deal with

> the child's behavior are also important, but they are not a substitute fo=

r

> medication in most cases.

>

> These views are strongly supported in publications of the American

Academy

> of

> Pediatrics [1,2], American Academy of Child and Adolescent Psychiatry [3]=

,

> American Medical Association [4], American Psychiatric Association [5,6],=

> National Institutes of Health [7,8], United States Surgeon General [9], a=

nd

> an

> international consensus of experts [10]-- all of which reflect solid

> agreement

> within the scientific community.

>

> In stark contrast, psychiatrist Breggin claims that ADHD is not a

> genuine diagnosis and that the drugs used to treat it do far more harm th=

an

> good.

> In line with these views, he has written books [11,12], testified at

> government

> hearings [13], and served as a consultant in several lawsuits. He would l=

ike

> you to believe that his clinical experiences and investigations have enab=

led

> him to reach a level of insight that is greater than that of the majority=

of

> mental health professionals. This article describes why I consider him

> untrustworthy.

>

>

>

> Breggin's Background

>

>

>

> R. Breggin, M.D., is a Harvard College graduate who obtained his

> medical degree from Case Western Reserve Medical School in 1962. After

> training in

> psychiatry at Harvard and State University of New York Upstate Medical

> Center

> (Syracuse), he worked for two years at the National Institute of Mental

> Health.

> Since 1968, he has practiced psychiatry in the Washington, D.C.

metropolitan

> area [14]. Breggin describes his private practice as " psychotherapy for

> individuals, couples, and families, including children, " with

> " subspecialties " in

> " the adverse effects of medications, electroshock, and psychosurgery " and=

> " forensic psychiatry and patient rights. " [15] His online resumé states t=

hat

> he has

> testified as an expert in about 40 cases, many of which involved psychiat=

ric

> drugs, FDA regulations, and product liability [15]. His 18 books, most

> written

> for the general public, attack psychosurgery, electroconvulsive therapy

> ( " shock treatments " ), Prozac, Ritalin, and the use of psychiatric drugs i=

n

> general.

>

> In 1972, Breggin founded The International Center for the Study of

> Psychiatry

> and Psychology (ICSPP), a nonprofit organization " concerned with the

impact

> of mental health theory and practices upon individual well-being, persona=

l

> freedom, and family and community values. " [15] ICSPP's 2000 federal tax

> report

> states that its primary purpose is to gather and distribute information

> about

> the " hazards of bio-medical model of psychiatry. " [16] Other information =

I

> found

> on the Internet states that ICSPP had one part time employee [17] and les=

s

> than $25,000 in annual income throughout most of its existence [16].

Breggin

> also launched Ethical Human Sciences and Services, a journal that began

> publication in 1999. He has also been listed on the advisory board of

> Network Against

> Coercive Psychiatry, an anti-psychiatry organization whose home page

asserts

> that the " mental health establishment has conned the American people. "

>

> Breggin's Web site states that he " has been informing the professions,

media

> and the public about the potential dangers of drugs, electroshock,

> psychosurgery, involuntary treatment, and the biological theories of

> psychiatry for over

> three decades. " [14] The back cover of his Ritalin Fact Book describes hi=

m

> as

> " the conscience of psychiatry. " [12] I believe it would be more accurate =

to

> characterize him as a harmful nuisance whose views can undermine trust in=

> the

> medical profession and frighten people away from helpful treatment.

>

>

>

> A Bit of Puffery?

>

>

>

> Breggin's resumé and other biographical reports describe him as a

Diplomate

> of the National Board of Medical Examiners; a " Specialist in Psychiatry "

> recognized by the State of land, Department of Mental Health and

> Hygiene, Board

> of Physician Quality Assurance; a Diplomate of the American Board of

> Forensic

> Medicine; and a Fellow of the American College of Forensic Examiners. He

> also

> states that he is (or has been) on the editorial board of six peer-review=

ed

> journals and has published more than 25 articles in peer-reviewed scienti=

fic

> journals. Although these accomplishments might sound impressive, they

actual

> ly

> are much less than they might seem.

>

> * Breggin is not certified by the American Board of Psychiatry and

> Neurology, which is the recognized agency for certifying psychiatrists.

> * Having completed three years of psychiatric training, Breggin is

> entitled to call himself a psychiatrist or a " specialist in psychiatry. "

> Until 1996,

> the land Board of Quality Assurance maintained a list of " identified " =

> specialists. Anyone who completed an approved training program was

eligible

> for

> listing. No special examination or additional qualifications were require=

d.

> * To become licensed in the United States, every physician must pass a=

n

> examination given by the National Board of Medical Examiners or an

> equivalent

> examination by a state licensing board. Thus being a " diplomate " of the

> National

> Board of Medical Examiners means nothing more than the fact that the

doctor

> has passed a standard licensing exam. Most resumés I have seen do not

list

> this

> credential.

> * The American Board of Forensic Examiners is not recognized by the

> American Board of Medical Specialties (ABMS), which is the recognized

> standard-setting organization. ABMS offers subspecialty certification in

> forensic psychiatry

> and forensic pathology, neither of which Breggin has achieved.

> * Only one of the six journals with which Breggin has been affiliated is

> significant enough to be listed in MEDLINE, the National Library of

> Medicine's

> principal online database.

> * On September 5, 2002, I found that Breggin had 33 citations listed i=

n

> MEDLINE. None of these publications appears to be a research report.

Eight

> were

> letters to the editor, two were books, and most of the rest were expressi=

ons

> of his opinion on various psychiatric topics.

>

>

>

> ADHD: The Prevailing Scientific Viewpoint

>

>

>

> The prevailing scientific viewpoint is that ADHD should be regarded as a

> neuropsychiatric disorder, that it differs from simply rambunctious

> behavior, and

> that medication has been thoroughly studied and found to be helpful in

> managing the problem. The American Psychiatric Association has

published a

> list of

> criteria that should be used in making the diagnosis [4]. As its name

> implies,

> ADHD is characterized by two sets of symptoms, inattention and

> hyperactivity.

> Although these usually occur together, one may be present to qualify for =

a

> diagnosis.

>

> In 1997, largely in response to Breggin's writings, the American Medical

> Association Council on Scientific Affairs issued a report on ADHD that wa=

s

> approved by the AMA's House of Delegates. The report concluded:

>

>

> Diagnostic criteria for ADHD are based on extensive empirical research

and,

> if applied appropriately, lead to the diagnosis of a syndrome with high

> interrater reliability, good face validity, and high predictability of

> course and

> medication responsiveness. The criteria of what constitutes ADHD in

children

> have

> broadened, and there is a growing appreciation of the persistence of ADHD=

> into adolescence and adulthood. As a result, more children (especially

> girls),

> adolescents, and adults are being diagnosed and treated with stimulant

> medication, and children are being treated for longer periods of time.

> Epidemiologic

> studies using standardized diagnostic criteria suggest that 3% to 6% of t=

he

> school-aged population (elementary through high school) may suffer from

> ADHD,

> although the percentage of US youth being treated for ADHD is at most at =

the

> lower

> end of this prevalence range. Pharmacotherapy, particularly use of

> stimulants, has been extensively studied and generally provides significa=

nt

> short-term

> symptomatic and academic improvement. There is little evidence that

> stimulant

> abuse or diversion is currently a major problem, particularly among those=

> with

> ADHD, although recent trends suggest that this could increase with the

> expanding production and use of stimulants.

>

> Although some children are being diagnosed as having ADHD with

insufficient

> evaluation and in some cases stimulant medication is prescribed when

> treatment

> alternatives exist, there is little evidence of widespread overdiagnosis =

or

> misdiagnosis of ADHD or of widespread overprescription of

methylphenidate by

> physicians [3].

>

>

>

> ADHD: What Breggin Says

>

>

>

> The Ritalin Fact Book makes many claims that clash with the prevailing

> scientific viewpoint. Among other things, it exaggerates the problem of

> misdiagnosis, misrepresents what medication is likely to do, greatly

> exaggerates what

> non-drug treatment can accomplish, misrepresents the results of a scienti=

fic

> study, uses an out-of-context quote to attack the credibility of other

> professionals, and exaggerates the extent of side effects. Here are my

> responses to

> several such passages in the book:

>

>

>

> What Breggin Says My Comments

>

>

> Page 3: " Many children diagnosed with ADHD and treated with stimulants

have

> relatively benign problems. Often they simply daydream in the classroom o=

r

> dislike school a little more often than other children. Or they may be a

> little

> bit more active and energetic than most. " Although misdiagnosis obviou=

sly

> can

> occur, Breggin presents no data showing that this is a major problem or t=

hat

> it is likely to happen when skilled professionals conduct the evaluations=

..

> " Some children with ADHD are very angry, out of control, and difficult to=

be

> around. When children have these more serious behavioral or emotional

> problems, stimulant medication is likely to worsen their mental condition=

> and

> behavior. " This advice is extraordinarily irresponsible. The fact that=

> stimulant

> medication can calm many hyperactive children has been known for more

than

> 60

> years and has been demonstrated by many well designed clinical studies.

> Breggin

> has published no clinical study and provides no data to back his claim.

> Page 3: " Even the most difficult and out-of-control children can be helpe=

d

> by

> informed adult intervention without resort to drugs. " On pages 161-174=

,

> Breggin supports this statement with passages about a nurse he met during=

a

> train ride and two experienced teachers who told him how they dealt with

> children

> that were considered hyperactive. The techniques they described are

standard

> ones that would work with mildly disturbed children and might help but

would

> not be sufficient to control truly hyperactive children. Breggin assumes

> that

> the descriptions were accurate, concludes that the techniques would work =

for

> all

> hyperactive children, and treats this anecdotal evidence as more importan=

t

> than well-designed studies in which children have been formally diagnosed=

> and

> their behavior carefully monitored.

> Pages 36-37: " A 1997 study published in Pediatrics confirms high rates of=

> stimulant-induced depression in 125 children . . . who were given relativ=

ely

> small doses of Ritalin or Dexedrine. Two children on Ritalin and two on

> Dexedrine

> developed severe enough adverse effects to be terminated from the study. =

One

> eight-year-old became 'over-focused, extra sensitive, and increasingly

> anxious,' and a five-year old became 'extremely aggressive and tearful' .=

.

> . . Side

> effects from amphetamine (Dexedrine) were higher than those from Ritalin =

for

> 'trouble sleeping, irritability, prone to crying, anxiousness,

> sadness/unhappiness, and nightmares.' " Breggin's description distorts

> what the study showed.

> The study, which lasted two weeks, was done to compare the side effects o=

f

> Ritalin and Dexedrine and to identify which symptoms might be due to the

> underlying condition rather than to the drugs. The researcher's concluded=

> that

> overall, both drugs " were well tolerated by most subjects " and that " many=

> symptoms

> commonly attributed to stimulant medication are actually preexisting

> characteristics of children with ADHD and improve with stimulant treatmen=

t. "

> [18] A 3%

> dropout rate caused by temporary symptoms is certainly is not reason to

> avoid

> use of the medications. What do you think it means that Breggin uses data=

> from

> a highly favorable study to argue that stimulant drugs should be avoided?=

> Page 85: " Pronouncements made in public by professional advocates for

> stimulants paint glowing pictures about the effectiveness of these drugs.=

> But

> professional reviews and textbooks often present a more conservative

> picture -- one

> that hardly justifies exposing children to such great dangers. A review i=

n

> the

> American Psychiatric Press Textbook of Psychiatry concluded: 'Stimulants =

do

> not produce lasting improvements in aggressivity, conduct disorder,

> criminality,

> education achievement, job functioning, marital relationships or long-ter=

m

> adjustments.' " The textbook sentence is quoted out-of-context. The

paragraph

> from which it comes begins: " Treatment outcome studies of ADHD have led

to

> some

> striking findings. in addition to helping reduce inattention, impulsivity=

,

> and

> hyperactivity, treatment with psychostimulants can lead to enduring

> improvement in social skills and attitudes toward self. " [19] The sentenc=

e

> is part of a

> long discussion of the benefits, risks, and limitations of various treatm=

ent

> methods. The authors clearly state that stimulant drugs are likely to be

> useful

> for the majority of children with ADHD, but that special educational or

> psychological help may still be needed.

> Pages 93-94: " Starting with the first dose, almost any psychiatric drug .=

.

> .

> can worsen the symptoms commonly thought of as ADHD-like. . . . People

who

> persistently use psychiatric drugs legally or illegally for several month=

s

> or

> more are likely to become forgetful, overlook details, and lose their foc=

us

> on

> difficult tasks. Similarly, they may begin to experience " disinhibition " =

or

> " loss of impulse control. " The earliest signs are irritability and

> unexpected

> outbursts of anger, followed eventually by dangerous expressions of

> violence. I

> have seen this pattern develop in dozens of clinical and legal cases

> involving

> both adults and children. " Breggin, who states on page xvii that he ne=

ver

> starts anyone on psychiatric medication, cites no source for this sweepin=

g

> condemnation other than his own vaguely described observations (mostly

with

> people

> who come to him because they are dissatisfied with their treatment). All

> effective medications can produce adverse effects. However, competent

> prescribers

> will adjust dosage and/or change medication to produce maximum benefit

with

> minimum or no adverse effects. Millions of people believe they have been

> helped

> by psychiatric drugs. Does Breggin think that they, the doctors who

> prescribe

> the drugs, and the thousands of researchers who have studied the effects =

of

> such drugs are dishonest or are fooling themselves?

>

>

> In the book's introduction (pages xviii-xx), Breggin attempts to justify =

his

> contrary views by portraying himself as privy to unique information.

> ++++++++++++++

> In addition to more than three decades of clinical work, this book draws

> upon

> the years of work required for writing dozens of scientific books and

> articles; the workshops I have given for professionals and the public;

> teaching I

> have done in the past at universities . . . and presentations I have made=

at

> national conferences for health professionals and attorneys. . . .

>

> I often hear about newly discovered adverse drug reactions long before

most

> professionals become aware of them. . . .

>

> I have yet another unique source of information and knowledge. For many

> years

> I have been a consultant and medical expert in legal actions involving

> psychiatric drugs, including the stimulants described in this book. . . .=

.

>

> My most specialized source of information about psychiatric drugs comes

from

> my work as a medical expert in cases against giant pharmaceutical

companies

> that are charged with negligence or fraud in developing or publicizing th=

eir

> products. In this fascinating legal arena, I can gain access to secret

> " inside

> information " about psychiatric medications that is literally unavailable =

to

> any

> other physician in the world. . . .

>

> Based on my publications and consultations, a series of class-action suit=

s

> have been brought against Novartis, the manufacturer of Ritalin, charging=

> the

> company with conspiring with the American Psychiatric Association and the=

> parents' group Children and Adults with Attention Deficit Disorder (CHADD=

)

> to

> fabricate the ADHD diagnosis and foster the overuse of Ritalin.

>

> ++++++++++

>

> Research? Unique private communications? Access to " secret " documents?

A big

> conspiracy? As far as I can tell, Breggin has made no systematic clinical=

> reports, and the book provides no relevant " insider information " or alleg=

ed

> facts

> about any conspiracy. The suits to which he refers were filed during the

> year

> 2000 in California, Florida, New Jersey, Puerto Rico, and Texas and were =

not

> legitimate. The California and Texas suits were dismissed by the courts f=

or

> failure to state a proper cause of action [20]. The New Jersey suit was

> withdrawn

> after the judge made it clear that he was highly skeptical of plaintiffs'=

> allegations of conspiracy [21], and the others were quietly withdrawn,

> presumably

> because the plaintiffs realized they were certain to lose. The final

> withdrawal took place on August 16, 2001. Yet The Ritalin Fact Book'

> (publication date

> July 2002) and Breggin's Web site still portray the suits as legitimate a=

nd

> pending.

>

> A. Barkley, PhD, a university-based psychiatry professor who has

> specialized in ADHD and related disorders for more than 20 years and has

> published

> more than 150 scientific papers, book chapters, and books, reached a

> parallel

> conclusion about the first edition of Breggin's Talking Back to Ritalin. =

In

> a

> blistering review, Barkley said:

>

>

> Literally from its opening pages, this book makes contorted attempts at t=

he

> appearance of scholarship, replete with quotes, footnotes, and references=

to

> scientific papers and other sources. Throughout, any quote is mustered fr=

om

> scientific papers that can be taken out of context to support the author'=

s

> biases

> along with every exaggerated fact and figure he can find to support his c=

all

> to alarm, no matter the credibility (or lack of it) of his sources. Howev=

er,

> the flaws of both his research methods and his arguments are evident to

any

> scientist even slightly familiar with the scientific literature on the

> topics

> covered here [22].

>

> Barkley also led a team of 75 experts who recently issued a international=

> consensus statement expressing concern about the " inaccurate portrayal of=

> attention deficit hyperactivity disorder (ADHD) in media reports. " Althou=

gh

> the

> statement did not name Breggin, it obviously referred to him in the

> following

> passage:

>

>

> Occasional coverage of the disorder casts the story in the form of a

> sporting

> event with evenly matched competitors. The views of a handful of non-

expert

> doctors that ADHD does not exist are contrasted against mainstream

> scientific

> views that it does, as if both views had equal merit. Such attempts at

> balance

> give the public the impression that there is substantial scientific

> disagreement over whether ADHD is a real medical condition. In fact, ther=

e

> is no such

> disagreement -- at least no more so than there is over whether smoking

> causes

> cancer, for example, or whether a virus causes HIV/AIDS [9].

>

> Breggin's credibility has also been skewered during three legal actions i=

n

> which judges either excluded his testimony or gave it no credibility. The=

> first

> two involved dubious claims that a medication had caused severe harm,

and

> the

> third was a contest between parents about whether or not a child with

ADHD

> should be treated with Ritalin.

>

>

> This court finds that the evidence of Breggin, as a purported exper=

t,

> fails nearly all particulars under the standard set forth in Daubert and =

its

> progeny. . . . . Simply put, the Court believes that Dr. Breggin's opinio=

ns

> do

> not rise to the level of an opinion based on " good science. " The motion t=

o

> exclude his testimony as an expert witness should be granted. -- Magistra=

te

> Judge

> B. Waugh Crigler in Lam v. The Upjohn Company, No. 94-0033-H, W. Dist.,

of

> VA

> (onburg Division, U.S. District Court, 1995)

>

> The court believes not only is this gentleman unqualified to render the

> opinions that he did, I believe that his bias in this case is blinding. .=

.

> . I

> find that he . . . was not only unprepared, he was mistaken in a lot of t=

he

> factual basis for which he expressed his opinion. . . . The court is goin=

g

> to

> strike the testimony of Dr. Breggin, finding that it has no rational

> basis. --

> Judge J. Caplan in Lightner v. Alessi, No. 94013064/CL174959

> (Baltimore

> City Circuit Court, 1995).

>

> Dr. Breggin's observations are totally without credibility. I can almost

> declare him, I guess from statements that floor me, to say the he's a fra=

ud

> or at

> least approaching that He has made some outrageous statements and

written

> outrageous books and which he says he has now withdrawn and his

thinking is

> different. He's untrained. He's a member of no hospital staff. He has not=

> since

> medical school participated in any studies to support his conclusions exc=

ept

> maybe

> one. . . . I can't place any credence or credibility in what he has to

> recommend in this case. -- Judge W. Rice in Schellinger v.

> Schellinger, No.

> 93-FA-939-763 (Milwaukee County Circuit Court, 1997)

>

>

>

> The Bottom Line

>

>

>

> R. Breggin , M.D., would like you to believe that his personal

> experience and judgment enable him to out-think and outperform the

> collective wisdom

> of the science-based mental health community. Some of the things he

> describes

> may reflect genuine problems. However, he is prone to exaggeration and

has

> certainly failed to substantiate his ADHD-related criticisms. The Ritalin=

> Fact Book

> should be classified as junk science.

>

>

>

> For Additional Information

>

>

>

> * Book Review: Talking Back to Ritalin

> * International Consensus Statement on ADHD

> * American Academy of Pediatrics

> * ADHD and your school-aged child. AAP Parent Page, Oct 2001.

> * Understanding ADHD: A Guide for Parents (booklet)

> * ADHD: A Complete and Authoritative Guide (book, 2003)

> * A trick question: A hoax that turns out to be true: Excellent articl=

e

> by

> Fumento.

> * American Psychiatric Association fact sheet

> * New Zealand Guidelines for ADHD Assessment and Treatment

> * Dr. Larry Silver's Advice to Parents on ADHD (book)

> *

>

>

>

> References

>

>

>

> 1. American Academy of Pediatrics. Clinical Practice Guideline: Diagno=

sis

> and evaluation of the child with attention-deficit/hyperactivity disorder=

..

> Pediatrics 105:1158-1170, 2000.

> 2. American Academy of Pediatrics. Clinical Practice Guideline: Treatm=

ent

> of the school-aged child with attention-deficit/hyperactivity disorder.

> Pediatrics 108:1033-1044, 2001.

> 3. Practice parameters for the assessment and treatment of attention

> deficit/hyperactivity disorders. Journal of the American Academy of Child=

> and

> Adolescent Psychiatry 30:1-3, 1991.

> 4. Goldman LS and others. Diagnosis and treatment of

> attention-deficit/hyperactivity disorder in children and adolescents. JAM=

A

> 279:1100-1107, 1998.

> 5. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR.

> Washington, DC: American Psychiatric Press, 2000.

> 6. Attention deficit/hyperactivity disorder. American Psychiatric

> Association fact sheet, March 2001.

> 7. Diagnosis and treatment of attention deficit hyperactivity disorder=

..

> NIH Consensus Statement 16(2), Nov 16-18, 1998. [Download PDF]

> 8. Attention deficit hyperactivity disorder. NIH Publication No. 96-3572,=

> printed 1994, reprinted 1996. [Download PDF]

> 9. Attention deficit/hyperactivity disorder. In Mental Health: A Repor=

t

> of

> the Surgeon General. Rockville, MD: U.S. Dept. of Health and Human

Services,

> 1999, pp 142-150.

> 10. Barkley RA and others. International Consensus Statement on ADHD.

> ADDitude magazine, Jan 2002.

> 11. Breggin PR. Talking Back to Ritalin: What Doctors Aren't Telling Y=

ou

> about Stimulants and ADHD. Cambridge, MA: Perseus Publishing, revised

> edition,

> 2001. (Previous edition published in 1998 by Courage Press, Monroe, ME.

> 12. Breggin PR. The Ritalin Fact Book: What Doctors Won't Tell You abo=

ut

> ADHD and Stimulant Drugs. Cambridge, MA: Perseus Publishing, 2002.

> 13. Breggin PR. Testimony at Hearing on Behavioral Drugs in Schools:

> Questions and Concerns. Held by the Subcommittee on Oversight and

> Investigations,

> Committee on Education and the Workforce, U.S. House of

Representatives,

> Sept

> 29, 2000.

> 14. Breggin PR. Psychiatric drug facts: Biography. Accessed Sept 6, 20=

02.

> 15. Breggin PR. R. Breggin resume. Accessed Sept 6, 2002.

> 16. ICSPP. Form 990-EZ for 2000.

> 17. Schaler JA. Double-think at the ICSPP corral: A rejoinder to =

R.

> Breggin, M.D. Psychnews International 4(1), March 1999.

> 18. Efron D and others. Side effects of methylphenidate and

dexamphetamine

> in

> children with attention deficit hyperactivity disorder: a double-blind,

> crossover trial. Pediatrics 100:162-166, 1997.

> 19. Popper C, West CA. Disorders usually first diagnosed in infancy

> childhood, or adolescence. In Hales RE and others, editors. The American

> Psychiatric

> Press Textbook of Psychiatry, Third Edition. Washington, DC: American

> Psychiatric Press, pp 825-855.

> 20. Hausman K. Last of Ritalin-based lawsuits against APA comes to a

> close

> . American Psychiatric News, April 5, 2002.

> 21. Dismissal of New Jersey lawsuit strengthens CHADD's Resolve: New

> Jersey plaintiffs drop lawsuit after judge criticizes complaint. CHADD pr=

ess

> release, Feb 21, 2002.

> 22. Barkley RA. ADHD, Ritalin, and Conspiracies: Talking Back to =

> Breggin Originally posted to CHADD Web site, 1998.

>

> Quackwatch Home Page

>

>

>

>

> Marhoefer

> Miracles Of Hope Network®

> New York City~Chicago~Los Angeles~Paris

> <A HREF= " www.miracles-of-hope.com " >www.miracles-of-hope.com</A>

> The Defense Foundation for children USA

> ~Changing The Destiny Of A Child ~

> Obstruction-Of-Injustice Radio~Media and Production

> Touch the Thunder Publishing & Recording Company

> <A HREF= " www.on-air-live-radio.tv " >www.on-air-live-radio.tv</A>

> ::justice in media::

> " Sometimes instead of leveling the playing field, you just have to buy th=

e

> field " DM2004®

>

>

>

>

>

[Guest guest]

Hi,

I agree just on the tone of the letter. It's whinny and finger pointing. I don't

know anything about the

guy but what says rings true. This guy is no one to listen to.

Jim

Help with writing on behalf of Dr Breggin

This was sent to me about Quack watch and Dr Breggin.

It was Dr Breggin who first alerted me ten years ago

to the atrocity we call the child mental health field.

Any of you who can please write on his behalf.

The difference is between those who could not even tell Paxil causes suicide

and these are the same ones who cannot see the difference between life and

death

due to the money signs.

For those who are interested in the facts and not the self-serving hype

around Breggin.

I took one look at " Talking Back to Ritalin, " and the wacky subheadings and

willy-nilly graphic construction alone smacked of unprofessionalism, if not

sensationalism. The actual content was even worse!

Dr. Breggin is no friend to children or anyone else with ADHD. He is a

menace

and a fraud.

Quackwatch Home Page

Some Notes on ADHD and

R. Breggin's Unfair Attack on Ritalin

Barrett, M.D.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a commonly diagnosed

childhood behavioral disorder whose core symptoms include inappropriate

levels of

attention, concentration, activity and distractibility. Although its cause

is

unknown, considerable progress has been made in managing it. Scientific

studies

have found that the single most effective treatment is medication with a

stimulant drug, of which the most commonly used has been methylphenidate

(Ritalin). Behavioral approaches that include helping parents and teachers

to deal with

the child's behavior are also important, but they are not a substitute for

medication in most cases.

These views are strongly supported in publications of the American Academy

of

Pediatrics [1,2], American Academy of Child and Adolescent Psychiatry [3],

American Medical Association [4], American Psychiatric Association [5,6],

National Institutes of Health [7,8], United States Surgeon General [9], and

an

international consensus of experts [10]-- all of which reflect solid

agreement

within the scientific community.

In stark contrast, psychiatrist Breggin claims that ADHD is not a

genuine diagnosis and that the drugs used to treat it do far more harm than

good.

In line with these views, he has written books [11,12], testified at

government

hearings [13], and served as a consultant in several lawsuits. He would like

you to believe that his clinical experiences and investigations have enabled

him to reach a level of insight that is greater than that of the majority of

mental health professionals. This article describes why I consider him

untrustworthy.

Breggin's Background

R. Breggin, M.D., is a Harvard College graduate who obtained his

medical degree from Case Western Reserve Medical School in 1962. After

training in

psychiatry at Harvard and State University of New York Upstate Medical

Center

(Syracuse), he worked for two years at the National Institute of Mental

Health.

Since 1968, he has practiced psychiatry in the Washington, D.C. metropolitan

area [14]. Breggin describes his private practice as " psychotherapy for

individuals, couples, and families, including children, " with

" subspecialties " in

" the adverse effects of medications, electroshock, and psychosurgery " and

" forensic psychiatry and patient rights. " [15] His online resumé states that

he has

testified as an expert in about 40 cases, many of which involved psychiatric

drugs, FDA regulations, and product liability [15]. His 18 books, most

written

for the general public, attack psychosurgery, electroconvulsive therapy

( " shock treatments " ), Prozac, Ritalin, and the use of psychiatric drugs in

general.

In 1972, Breggin founded The International Center for the Study of

Psychiatry

and Psychology (ICSPP), a nonprofit organization " concerned with the impact

of mental health theory and practices upon individual well-being, personal

freedom, and family and community values. " [15] ICSPP's 2000 federal tax

report

states that its primary purpose is to gather and distribute information

about

the " hazards of bio-medical model of psychiatry. " [16] Other information I

found

on the Internet states that ICSPP had one part time employee [17] and less

than $25,000 in annual income throughout most of its existence [16]. Breggin

also launched Ethical Human Sciences and Services, a journal that began

publication in 1999. He has also been listed on the advisory board of

Network Against

Coercive Psychiatry, an anti-psychiatry organization whose home page asserts

that the " mental health establishment has conned the American people. "

Breggin's Web site states that he " has been informing the professions, media

and the public about the potential dangers of drugs, electroshock,

psychosurgery, involuntary treatment, and the biological theories of

psychiatry for over

three decades. " [14] The back cover of his Ritalin Fact Book describes him

as

" the conscience of psychiatry. " [12] I believe it would be more accurate to

characterize him as a harmful nuisance whose views can undermine trust in

the

medical profession and frighten people away from helpful treatment.

A Bit of Puffery?

Breggin's resumé and other biographical reports describe him as a Diplomate

of the National Board of Medical Examiners; a " Specialist in Psychiatry "

recognized by the State of land, Department of Mental Health and

Hygiene, Board

of Physician Quality Assurance; a Diplomate of the American Board of

Forensic

Medicine; and a Fellow of the American College of Forensic Examiners. He

also

states that he is (or has been) on the editorial board of six peer-reviewed

journals and has published more than 25 articles in peer-reviewed scientific

journals. Although these accomplishments might sound impressive, they actual

ly

are much less than they might seem.

* Breggin is not certified by the American Board of Psychiatry and

Neurology, which is the recognized agency for certifying psychiatrists.

* Having completed three years of psychiatric training, Breggin is

entitled to call himself a psychiatrist or a " specialist in psychiatry. "

Until 1996,

the land Board of Quality Assurance maintained a list of " identified "

specialists. Anyone who completed an approved training program was eligible

for

listing. No special examination or additional qualifications were required.

* To become licensed in the United States, every physician must pass an

examination given by the National Board of Medical Examiners or an

equivalent

examination by a state licensing board. Thus being a " diplomate " of the

National

Board of Medical Examiners means nothing more than the fact that the doctor

has passed a standard licensing exam. Most resumés I have seen do not list

this

credential.

* The American Board of Forensic Examiners is not recognized by the

American Board of Medical Specialties (ABMS), which is the recognized

standard-setting organization. ABMS offers subspecialty certification in

forensic psychiatry

and forensic pathology, neither of which Breggin has achieved.

* Only one of the six journals with which Breggin has been affiliated is

significant enough to be listed in MEDLINE, the National Library of

Medicine's

principal online database.

* On September 5, 2002, I found that Breggin had 33 citations listed in

MEDLINE. None of these publications appears to be a research report. Eight

were

letters to the editor, two were books, and most of the rest were expressions

of his opinion on various psychiatric topics.

ADHD: The Prevailing Scientific Viewpoint

The prevailing scientific viewpoint is that ADHD should be regarded as a

neuropsychiatric disorder, that it differs from simply rambunctious

behavior, and

that medication has been thoroughly studied and found to be helpful in

managing the problem. The American Psychiatric Association has published a

list of

criteria that should be used in making the diagnosis [4]. As its name

implies,

ADHD is characterized by two sets of symptoms, inattention and

hyperactivity.

Although these usually occur together, one may be present to qualify for a

diagnosis.

In 1997, largely in response to Breggin's writings, the American Medical

Association Council on Scientific Affairs issued a report on ADHD that was

approved by the AMA's House of Delegates. The report concluded:

Diagnostic criteria for ADHD are based on extensive empirical research and,

if applied appropriately, lead to the diagnosis of a syndrome with high

interrater reliability, good face validity, and high predictability of

course and

medication responsiveness. The criteria of what constitutes ADHD in children

have

broadened, and there is a growing appreciation of the persistence of ADHD

into adolescence and adulthood. As a result, more children (especially

girls),

adolescents, and adults are being diagnosed and treated with stimulant

medication, and children are being treated for longer periods of time.

Epidemiologic

studies using standardized diagnostic criteria suggest that 3% to 6% of the

school-aged population (elementary through high school) may suffer from

ADHD,

although the percentage of US youth being treated for ADHD is at most at the

lower

end of this prevalence range. Pharmacotherapy, particularly use of

stimulants, has been extensively studied and generally provides significant

short-term

symptomatic and academic improvement. There is little evidence that

stimulant

abuse or diversion is currently a major problem, particularly among those

with

ADHD, although recent trends suggest that this could increase with the

expanding production and use of stimulants.

Although some children are being diagnosed as having ADHD with insufficient

evaluation and in some cases stimulant medication is prescribed when

treatment

alternatives exist, there is little evidence of widespread overdiagnosis or

misdiagnosis of ADHD or of widespread overprescription of methylphenidate by

physicians [3].

ADHD: What Breggin Says

The Ritalin Fact Book makes many claims that clash with the prevailing

scientific viewpoint. Among other things, it exaggerates the problem of

misdiagnosis, misrepresents what medication is likely to do, greatly

exaggerates what

non-drug treatment can accomplish, misrepresents the results of a scientific

study, uses an out-of-context quote to attack the credibility of other

professionals, and exaggerates the extent of side effects. Here are my

responses to

several such passages in the book:

What Breggin Says My Comments

Page 3: " Many children diagnosed with ADHD and treated with stimulants have

relatively benign problems. Often they simply daydream in the classroom or

dislike school a little more often than other children. Or they may be a

little

bit more active and energetic than most. " Although misdiagnosis obviously

can

occur, Breggin presents no data showing that this is a major problem or that

it is likely to happen when skilled professionals conduct the evaluations.

" Some children with ADHD are very angry, out of control, and difficult to be

around. When children have these more serious behavioral or emotional

problems, stimulant medication is likely to worsen their mental condition

and

behavior. " This advice is extraordinarily irresponsible. The fact that

stimulant

medication can calm many hyperactive children has been known for more than

60

years and has been demonstrated by many well designed clinical studies.

Breggin

has published no clinical study and provides no data to back his claim.

Page 3: " Even the most difficult and out-of-control children can be helped

by

informed adult intervention without resort to drugs. " On pages 161-174,

Breggin supports this statement with passages about a nurse he met during a

train ride and two experienced teachers who told him how they dealt with

children

that were considered hyperactive. The techniques they described are standard

ones that would work with mildly disturbed children and might help but would

not be sufficient to control truly hyperactive children. Breggin assumes

that

the descriptions were accurate, concludes that the techniques would work for

all

hyperactive children, and treats this anecdotal evidence as more important

than well-designed studies in which children have been formally diagnosed

and

their behavior carefully monitored.

Pages 36-37: " A 1997 study published in Pediatrics confirms high rates of

stimulant-induced depression in 125 children . . . who were given relatively

small doses of Ritalin or Dexedrine. Two children on Ritalin and two on

Dexedrine

developed severe enough adverse effects to be terminated from the study. One

eight-year-old became 'over-focused, extra sensitive, and increasingly

anxious,' and a five-year old became 'extremely aggressive and tearful' . .

. . Side

effects from amphetamine (Dexedrine) were higher than those from Ritalin for

'trouble sleeping, irritability, prone to crying, anxiousness,

sadness/unhappiness, and nightmares.' " Breggin's description distorts

what the study showed.

The study, which lasted two weeks, was done to compare the side effects of

Ritalin and Dexedrine and to identify which symptoms might be due to the

underlying condition rather than to the drugs. The researcher's concluded

that

overall, both drugs " were well tolerated by most subjects " and that " many

symptoms

commonly attributed to stimulant medication are actually preexisting

characteristics of children with ADHD and improve with stimulant treatment. "

[18] A 3%

dropout rate caused by temporary symptoms is certainly is not reason to

avoid

use of the medications. What do you think it means that Breggin uses data

from

a highly favorable study to argue that stimulant drugs should be avoided?

Page 85: " Pronouncements made in public by professional advocates for

stimulants paint glowing pictures about the effectiveness of these drugs.

But

professional reviews and textbooks often present a more conservative

picture -- one

that hardly justifies exposing children to such great dangers. A review in

the

American Psychiatric Press Textbook of Psychiatry concluded: 'Stimulants do

not produce lasting improvements in aggressivity, conduct disorder,

criminality,

education achievement, job functioning, marital relationships or long-term

adjustments.' " The textbook sentence is quoted out-of-context. The paragraph

from which it comes begins: " Treatment outcome studies of ADHD have led to

some

striking findings. in addition to helping reduce inattention, impulsivity,

and

hyperactivity, treatment with psychostimulants can lead to enduring

improvement in social skills and attitudes toward self. " [19] The sentence

is part of a

long discussion of the benefits, risks, and limitations of various treatment

methods. The authors clearly state that stimulant drugs are likely to be

useful

for the majority of children with ADHD, but that special educational or

psychological help may still be needed.

Pages 93-94: " Starting with the first dose, almost any psychiatric drug . .

.

can worsen the symptoms commonly thought of as ADHD-like. . . . People who

persistently use psychiatric drugs legally or illegally for several months

or

more are likely to become forgetful, overlook details, and lose their focus

on

difficult tasks. Similarly, they may begin to experience " disinhibition " or

" loss of impulse control. " The earliest signs are irritability and

unexpected

outbursts of anger, followed eventually by dangerous expressions of

violence. I

have seen this pattern develop in dozens of clinical and legal cases

involving

both adults and children. " Breggin, who states on page xvii that he never

starts anyone on psychiatric medication, cites no source for this sweeping

condemnation other than his own vaguely described observations (mostly with

people

who come to him because they are dissatisfied with their treatment). All

effective medications can produce adverse effects. However, competent

prescribers

will adjust dosage and/or change medication to produce maximum benefit with

minimum or no adverse effects. Millions of people believe they have been

helped

by psychiatric drugs. Does Breggin think that they, the doctors who

prescribe

the drugs, and the thousands of researchers who have studied the effects of

such drugs are dishonest or are fooling themselves?

In the book's introduction (pages xviii-xx), Breggin attempts to justify his

contrary views by portraying himself as privy to unique information.

++++++++++++++

In addition to more than three decades of clinical work, this book draws

upon

the years of work required for writing dozens of scientific books and

articles; the workshops I have given for professionals and the public;

teaching I

have done in the past at universities . . . and presentations I have made at

national conferences for health professionals and attorneys. . . .

I often hear about newly discovered adverse drug reactions long before most

professionals become aware of them. . . .

I have yet another unique source of information and knowledge. For many

years

I have been a consultant and medical expert in legal actions involving

psychiatric drugs, including the stimulants described in this book. . . . .

My most specialized source of information about psychiatric drugs comes from

my work as a medical expert in cases against giant pharmaceutical companies

that are charged with negligence or fraud in developing or publicizing their

products. In this fascinating legal arena, I can gain access to secret

" inside

information " about psychiatric medications that is literally unavailable to

any

other physician in the world. . . .

Based on my publications and consultations, a series of class-action suits

have been brought against Novartis, the manufacturer of Ritalin, charging

the

company with conspiring with the American Psychiatric Association and the

parents' group Children and Adults with Attention Deficit Disorder (CHADD)

to

fabricate the ADHD diagnosis and foster the overuse of Ritalin.

++++++++++

Research? Unique private communications? Access to " secret " documents? A big

conspiracy? As far as I can tell, Breggin has made no systematic clinical

reports, and the book provides no relevant " insider information " or alleged

facts

about any conspiracy. The suits to which he refers were filed during the

year

2000 in California, Florida, New Jersey, Puerto Rico, and Texas and were not

legitimate. The California and Texas suits were dismissed by the courts for

failure to state a proper cause of action [20]. The New Jersey suit was

withdrawn

after the judge made it clear that he was highly skeptical of plaintiffs'

allegations of conspiracy [21], and the others were quietly withdrawn,

presumably

because the plaintiffs realized they were certain to lose. The final

withdrawal took place on August 16, 2001. Yet The Ritalin Fact Book'

(publication date

July 2002) and Breggin's Web site still portray the suits as legitimate and

pending.

A. Barkley, PhD, a university-based psychiatry professor who has

specialized in ADHD and related disorders for more than 20 years and has

published

more than 150 scientific papers, book chapters, and books, reached a

parallel

conclusion about the first edition of Breggin's Talking Back to Ritalin. In

a

blistering review, Barkley said:

Literally from its opening pages, this book makes contorted attempts at the

appearance of scholarship, replete with quotes, footnotes, and references to

scientific papers and other sources. Throughout, any quote is mustered from

scientific papers that can be taken out of context to support the author's

biases

along with every exaggerated fact and figure he can find to support his call

to alarm, no matter the credibility (or lack of it) of his sources. However,

the flaws of both his research methods and his arguments are evident to any

scientist even slightly familiar with the scientific literature on the

topics

covered here [22].

Barkley also led a team of 75 experts who recently issued a international

consensus statement expressing concern about the " inaccurate portrayal of

attention deficit hyperactivity disorder (ADHD) in media reports. " Although

the

statement did not name Breggin, it obviously referred to him in the

following

passage:

Occasional coverage of the disorder casts the story in the form of a

sporting

event with evenly matched competitors. The views of a handful of non-expert

doctors that ADHD does not exist are contrasted against mainstream

scientific

views that it does, as if both views had equal merit. Such attempts at

balance

give the public the impression that there is substantial scientific

disagreement over whether ADHD is a real medical condition. In fact, there

is no such

disagreement -- at least no more so than there is over whether smoking

causes

cancer, for example, or whether a virus causes HIV/AIDS [9].

Breggin's credibility has also been skewered during three legal actions in

which judges either excluded his testimony or gave it no credibility. The

first

two involved dubious claims that a medication had caused severe harm, and

the

third was a contest between parents about whether or not a child with ADHD

should be treated with Ritalin.

This court finds that the evidence of Breggin, as a purported expert,

fails nearly all particulars under the standard set forth in Daubert and its

progeny. . . . . Simply put, the Court believes that Dr. Breggin's opinions

do

not rise to the level of an opinion based on " good science. " The motion to

exclude his testimony as an expert witness should be granted. -- Magistrate

Judge

B. Waugh Crigler in Lam v. The Upjohn Company, No. 94-0033-H, W. Dist., of

VA

(onburg Division, U.S. District Court, 1995)

The court believes not only is this gentleman unqualified to render the

opinions that he did, I believe that his bias in this case is blinding. . .

. I

find that he . . . was not only unprepared, he was mistaken in a lot of the

factual basis for which he expressed his opinion. . . . The court is going

to

strike the testimony of Dr. Breggin, finding that it has no rational

basis. --

Judge J. Caplan in Lightner v. Alessi, No. 94013064/CL174959

(Baltimore

City Circuit Court, 1995).

Dr. Breggin's observations are totally without credibility. I can almost

declare him, I guess from statements that floor me, to say the he's a fraud

or at

least approaching that He has made some outrageous statements and written

outrageous books and which he says he has now withdrawn and his thinking is

different. He's untrained. He's a member of no hospital staff. He has not

since

medical school participated in any studies to support his conclusions except

maybe

one. . . . I can't place any credence or credibility in what he has to

recommend in this case. -- Judge W. Rice in Schellinger v.

Schellinger, No.

93-FA-939-763 (Milwaukee County Circuit Court, 1997)

The Bottom Line

R. Breggin , M.D., would like you to believe that his personal

experience and judgment enable him to out-think and outperform the

collective wisdom

of the science-based mental health community. Some of the things he

describes

may reflect genuine problems. However, he is prone to exaggeration and has

certainly failed to substantiate his ADHD-related criticisms. The Ritalin

Fact Book

should be classified as junk science.

For Additional Information

* Book Review: Talking Back to Ritalin

* International Consensus Statement on ADHD

* American Academy of Pediatrics

* ADHD and your school-aged child. AAP Parent Page, Oct 2001.

* Understanding ADHD: A Guide for Parents (booklet)

* ADHD: A Complete and Authoritative Guide (book, 2003)

* A trick question: A hoax that turns out to be true: Excellent article

by

Fumento.

* American Psychiatric Association fact sheet

* New Zealand Guidelines for ADHD Assessment and Treatment

* Dr. Larry Silver's Advice to Parents on ADHD (book)

*

References

1. American Academy of Pediatrics. Clinical Practice Guideline: Diagnosis

and evaluation of the child with attention-deficit/hyperactivity disorder.

Pediatrics 105:1158-1170, 2000.

2. American Academy of Pediatrics. Clinical Practice Guideline: Treatment

of the school-aged child with attention-deficit/hyperactivity disorder.

Pediatrics 108:1033-1044, 2001.

3. Practice parameters for the assessment and treatment of attention

deficit/hyperactivity disorders. Journal of the American Academy of Child

and

Adolescent Psychiatry 30:1-3, 1991.

4. Goldman LS and others. Diagnosis and treatment of

attention-deficit/hyperactivity disorder in children and adolescents. JAMA

279:1100-1107, 1998.

5. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR.

Washington, DC: American Psychiatric Press, 2000.

6. Attention deficit/hyperactivity disorder. American Psychiatric

Association fact sheet, March 2001.

7. Diagnosis and treatment of attention deficit hyperactivity disorder.

NIH Consensus Statement 16(2), Nov 16-18, 1998. [Download PDF]

8. Attention deficit hyperactivity disorder. NIH Publication No. 96-3572,

printed 1994, reprinted 1996. [Download PDF]

9. Attention deficit/hyperactivity disorder. In Mental Health: A Report

of

the Surgeon General. Rockville, MD: U.S. Dept. of Health and Human Services,

1999, pp 142-150.

10. Barkley RA and others. International Consensus Statement on ADHD.

ADDitude magazine, Jan 2002.

11. Breggin PR. Talking Back to Ritalin: What Doctors Aren't Telling You

about Stimulants and ADHD. Cambridge, MA: Perseus Publishing, revised

edition,

2001. (Previous edition published in 1998 by Courage Press, Monroe, ME.

12. Breggin PR. The Ritalin Fact Book: What Doctors Won't Tell You about

ADHD and Stimulant Drugs. Cambridge, MA: Perseus Publishing, 2002.

13. Breggin PR. Testimony at Hearing on Behavioral Drugs in Schools:

Questions and Concerns. Held by the Subcommittee on Oversight and

Investigations,

Committee on Education and the Workforce, U.S. House of Representatives,

Sept

29, 2000.

14. Breggin PR. Psychiatric drug facts: Biography. Accessed Sept 6, 2002.

15. Breggin PR. R. Breggin resume. Accessed Sept 6, 2002.

16. ICSPP. Form 990-EZ for 2000.

17. Schaler JA. Double-think at the ICSPP corral: A rejoinder to R.

Breggin, M.D. Psychnews International 4(1), March 1999.

18. Efron D and others. Side effects of methylphenidate and dexamphetamine

in

children with attention deficit hyperactivity disorder: a double-blind,

crossover trial. Pediatrics 100:162-166, 1997.

19. Popper C, West CA. Disorders usually first diagnosed in infancy

childhood, or adolescence. In Hales RE and others, editors. The American

Psychiatric

Press Textbook of Psychiatry, Third Edition. Washington, DC: American

Psychiatric Press, pp 825-855.

20. Hausman K. Last of Ritalin-based lawsuits against APA comes to a

close

. American Psychiatric News, April 5, 2002.

21. Dismissal of New Jersey lawsuit strengthens CHADD's Resolve: New

Jersey plaintiffs drop lawsuit after judge criticizes complaint. CHADD press

release, Feb 21, 2002.

22. Barkley RA. ADHD, Ritalin, and Conspiracies: Talking Back to

Breggin Originally posted to CHADD Web site, 1998.

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