Dr Caroline Leaf – stop spreading ADHD stigma and ignorance

“Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.” ~ Martin Luther King Jnr.

Sincere ignorance … conscientious stupidity – I’m struggling to know which category to put Dr Leaf’s latest e-mail newsletter into.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist and self-titled mental health expert.  She is not a doctor.  She is not a psychologist.  She does not work for a university.  She hasn’t published any peer reviewed medical papers for two decades.  She is not accountable to any peak professional body.

Yet the Christian church gives her unfettered access to their pulpits despite the ignorance and stigma she enthusiastically promotes.

Take the “Mental Health News” e-mail that she posted today for example.  Dr Leaf seamlessly moves from one misrepresentation to another, weaving a narrative that unfairly undermines scientifically proven treatments for mental illness, eroding confidence and destroying hope.

She starts with the story of Michelle and Carter, although it wasn’t Michelle and Carter as her e-mail newsletter stated. It was Michelle Carter and Conrad Roy, something which Dr Leaf got right in her blog post dated 1 August 2017 (see the image at the bottom of the page), but then got wrong in her e-mail newsletter on 30 August 2017. Dr Leaf says that Michelle texted Conrad to kill himself, and he did. Michelle and Conrad were on “brain-disabling” (psychiatric) drugs. Therefore, psychiatric drugs killed Michelle and Conrad. In my opinion, that Dr Leaf would stoop so low as to use the suicide of a teenager to try and push her own ideological barrow says much about her character, but then I shouldn’t be surprised as she did the same thing when Carrie Fisher died earlier this year. It’s sick, and it’s low, and it’s something that Dr Leaf should apologise for.

It’s also incredibly disingenuous, drawing a conclusion from incomplete evidence. Dr Leaf has no experience with the case. Instead, the source of this information is Dr Peter Breggin, himself an outspoken and discredited critic of psychiatric medication with a penchant for cherry picking and bias. Dr Leaf has used the story of Michelle and Conrad based on the tainted recall of half a story. She has no idea what really contributed to Michelle and Conrad’s tragedy. Her statement, “Yet, as is often the case, there is a large and dreadful disparity between what actually happened and what we are told happened” is therefore sadly ironic.

Dr Leaf then moves on to ADHD and drugs. Dr Leaf treats the concepts of ADHD and its treatment with the same respect as she gave Michelle and Conrad. She makes statement after misleading statement which do nothing but demonstrate her myopic bias.

Let’s just take one sentence: “These drugs create, rather than cure, chemical imbalances in the brain, are difficult to come off and can have terrible side-effects that last for years, including suicide and homicide.”

ADHD is often misunderstood and almost always stigmatised.  ADHD is more than just being an active child who likes to play.  ADHD is a dysfunctional lack of control that’s abnormal compared to other children the same stage of development, is long standing and affects their entire lives.

ADHD is caused by an abnormal pattern of genes, the expression of which are triggered by environmental conditions in pregnancy and early childhood, resulting in slower maturation of the brain and an uncoordinated network of “connectomes”, which disrupts the attention and planning processes of the brain.

We know that children with ADHD have slower maturation of the grey matter [1] and structural changes in the frontal regions and deeper parts of the brain [2].  In more recent times, modern brain imaging techniques have been able to show differences in the way that the regions of the brain link together to form networks.

Think of the brain networks as a tug-o-war team.  When all the members of a tug-o-war team work in unison, they increase their collective strength, but if the different team members don’t co-ordinate their efforts properly, the strength is lost.  The same goes for the brain.  Modern neuroscientists have discovered that the function of the brain relies on physical networks within the brain, called “connectomes” and how these connectomes co-ordinate with each other.

In the ADHD brain, the connections between the different connectomes are immature [3].  These immature connections weaken the collective strength of the network, because they aren’t synchronously “pulling” together.

What’s better understood is that the neurotransmitter called dopamine is crucial to the ADHD disease process [4].  Medications such as Ritalin which enhance the dopamine signals in the brain significantly reduce the symptoms of ADHD [5].

So Ritalin and other drugs like it actually balance the neurotransmitters in the brain.  Dr Leaf’s argument that they “create … chemical imbalances in the brain” is as misleading as trying to argue that diabetic treatments are creating an “insulin imbalance”.

“These drugs … are difficult to come off” is also misleading.  Once the brain eventually matures as it does in most children with ADHD, the drug is simply weaned.  Dr Leaf doesn’t seem to understand that some children with ADHD will grow into adults with ADHD who will still need medication.  This isn’t because the drugs are hard to come off, they are simply treating an ongoing condition.

“These drugs … can have terrible side-effects that last for years, including suicide and homicide.”  Actually, the effects of Ritalin last less than a day because the drug is rapidly metabolised, and ‘homicide’ is not listed anywhere in the official product information.  Suicide has been reported in patients taking the Ritalin although the official product information notes that, “Adverse events reported since market introduction in patients taking methylphenidate include suicide, suicide attempt and suicidal ideation. No causal relationship between methylphenidate and these events has been established.”  Even so, medications like Ritalin are not meant to be given to people who have severe depression, anorexia, psychotic symptoms or suicidal tendency, just in case Ritalin might worsen these conditions.

Indeed, a Cochrane Review as recently as November 2015 said, “The evidence in this review of RCTs suggests that methylphenidate does not increase the risk of serious (life threatening) harms when used for periods of up to six months. However, taking methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite.” [6]

So “these drugs” don’t have side effects for years, don’t make people homicidal, don’t make people addicted and don’t unbalance their brain chemicals.  It’s amazing how much profound mistruth Dr Leaf was able to pack into one littlesentence.

Then Dr Leaf goes on to attack the concept of ADHD itself – “Unfortunately, there is little scientific evidence for these labels … the very idea of ADHD, which includes vague operational definitions such as ‘often fidgets with hands or feet or squirms in seat,’ is subjective and defined by what society currently deems as ‘normal’ or ‘abnormal’”.

Denying the existence of ADHD is an old trick used by medication critics and the ignoranti for decades, but it’s like denying the existence of rain so you don’t have to buy an umbrella.  Dr Leaf’s assertion that the diagnosis of ADHD includes ‘vague operational definitions’ is just a strawman, because ADHD diagnosis is rigorous and relies on more than just a single characteristic like fidgeting.  I have listed the diagnostic criteria for ADHD at the end of this post, or you can look it up here: http://www.cdc.gov/ncbddd/adhd/diagnosis.html

In all of Dr Leaf’s railing against medications for ADHD, she fails to cite the evidence that shows that medications for ADHD improves the lives of those with ADHD [6], more than restrictive diets or cognitive retraining or neurofeedback [7].

Dr Leaf may like to think of herself as an expert, but her claims on ADHD and it’s treatment do not hold up under scrutiny.  She may think she’s acting benevolently but the promotion of her Dunning-Kruger style ignorance erodes the enormous hope that medications like Ritalin give to people who, without it, are held back by the mental and physical chaos that ADHD causes.

Dr Leaf, please, stop spreading the ADHD stigma and ignorance.  We already have to put up with enough suffering from the disease itself and the social stigma without you adding to it.

References

[1]       Shaw P, Lerch J, Greenstein D, et al. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Archives of general psychiatry 2006 May;63(5):540-9.
[2]       Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.
[3]       Cao M, Shu N, Cao Q, Wang Y, He Y. Imaging functional and structural brain connectomics in attention-deficit/hyperactivity disorder. Mol Neurobiol 2014 Dec;50(3):1111-23.
[4]       Wu J, Xiao H, Sun H, Zou L, Zhu LQ. Role of dopamine receptors in ADHD: a systematic meta-analysis. Mol Neurobiol 2012 Jun;45(3):605-20.
[5]       Reichow B, Volkmar FR, Bloch MH. Systematic review and meta-analysis of pharmacological treatment of the symptoms of attention-deficit/hyperactivity disorder in children with pervasive developmental disorders. Journal of autism and developmental disorders 2013 Oct;43(10):2435-41.
[6]       Storebo OJ, Ramstad E, Krogh HB, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane database of systematic reviews 2015 Nov 25;11:CD009885.
[7]       Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. The American journal of psychiatry 2013 Mar 1;170(3):275-89.

ADHD Diagnostic Criteria

The current criteria that must be matched to qualify for a diagnosis of ADHD is:

(1) Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
* Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
* Often has trouble holding attention on tasks or play activities.
* Often does not seem to listen when spoken to directly.
* Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
* Often has trouble organizing tasks and activities.
* Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
* Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
* Is often easily distracted
* Is often forgetful in daily activities.

(2) Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
* Often fidgets with or taps hands or feet, or squirms in seat.
* Often leaves seat in situations when remaining seated is expected.
* Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
* Often unable to play or take part in leisure activities quietly.
* Is often “on the go” acting as if “driven by a motor”.
* Often talks excessively.
* Often blurts out an answer before a question has been completed.
* Often has trouble waiting his/her turn.
* Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:
– Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
– Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
– There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
– The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
– The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
(http://www.cdc.gov/ncbddd/adhd/diagnosis.html)

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Kintsukuroi Christians

When I was a kid growing up, there wasn’t much that my father couldn’t repair.

Dad was extremely gifted with his hands, a talent that I certainly didn’t inherit. He was able to take a problem, come up with a practical solution in his mind’s eye, then build it out of whatever scraps of wood, metal or plastic he could lay his hands on. It was the ultimate expression of frugality and recycling that comes from a limited income and four growing children.

Dad was also able to resurrect nearly everything that broke in our house. Plates, cups, teapots, toys, tools … it seemed there wasn’t anything that couldn’t be fixed by the careful application of Araldite.

Araldite, for those unfamiliar with it, is some sort of epoxy resin that, in the right hands, possesses mystical properties of adhesion. It would stick anything to anything.

Dad’s gift for repairing things with Araldite meant that a lot of our things were patched up. Some of our most loved possessions were the most cracked. Despite being glued together several times, each item was still functional. Maybe not as pretty as it may have once been, but still useful, and more importantly, still treasured. Each time the Araldite came out, it taught me that whilst all things have the capacity to be broken, they also have the capacity for redemption.

There’s an ancient Japanese tradition that shares the same principles. For more than 400 years, the Japanese people have practiced kintsukuroi. Kintsukuroi (pronounced ‘kint soo koo ree’) is the art of repairing broken pottery with gold or silver lacquer, and the deep understanding that the piece is more beautiful for having been broken.

The edges of the broken fragments are coated with the glue made from Japanese lacquer resin and are bonded back into place. The joints are rubbed with an adhesive until the surface is perfectly smooth again. After drying, more lacquer is applied. This process is repeated many times, and gold dust is also applied. In kintsukuroi, the gold lacquer accentuates the fracture lines, and the breakage is honoured as part of that piece’s history.
Mental illness is a mystery to most people, shrouded by mythology, stigma, gossip or Hollywood hype. It’s all around us, affecting a quarter of the population every year, but so often those with mental illness hide in plain sight. Mental illness doesn’t give you a limp, a lump, or a lag. It affects feelings and thoughts, our most latent personal inner world, the iceberg underneath the waters.

On the front line of medicine, I see people with mental health problems every day, but mental health problems don’t limit themselves to the doctor’s office. They’re spread throughout our everyday lives. If one in four people have a mental health problem of one form or another, then one in four Christians have a mental health problem of one form or another. If your church experience is anything like mine, you would shake hands with at least ten people from the front door to your seat. Statistically speaking, two or three of them will have a mental illness. Could you tell?

It’s a fair bet that most people wouldn’t know if someone in their church had a mental illness. Christians battling with mental illness learn to present a happy façade, or face the judgment if they don’t), so they either hide their inner pain, or just avoid church altogether.
Experiencing a mental illness also makes people feel permanently broken. They feel like they’re never going to be whole again, or good enough, or useful, or loved. They’re often treated that way by well-meaning but ill-informed church members whose idea’s and opinions on mental illness is out-of-date.

The truth is that Christians who have experienced mental ill-health are like a kintsukuroi pot.

Mental illness may break them, sure. But they don’t stay broken. The dark and difficult times, and their recovery from their illness is simply God putting lacquer on their broken pieces, putting them back together, and rubbing gold dust into their cracks.
We are all kintsukuroi Christians – we’re more beautiful and more honoured than we were before, because of our brokenness, and our recovery.

I’m pleased to announce that my book, Kintsukuroi Christians, is now available. I’ve written this book to try and bring together the best of the medical and spiritual.
Unfortunately, good scientific information often bypasses the church. The church is typically misled by Christian ‘experts’ that preach a view of mental health based on a skewed or outdated understanding of mental illness and cognitive neuroscience. I want to present a guide to mental illness and recovery that’s easy for Christians to digest, adopting the best spiritual AND scientific perspective.

In the book, I look at some scientific basics. Our mental world is based on the physical world. Our mind is a function of the brain, just like breathing is a function of our lungs. Just as we can’t properly understand our breathing without understanding our lungs, so it is that if we’re going to understand our thinking and our minds, we are going to have to understand the way our brain works. So the first part of this book will be an unpacking of the neurobiology of thought.

We’ll also look at what promotes good mental health. Then we’ll look at what causes mental illness, specifically looking at the most common mental health disorders. I will only look at some of the most common disorders to demonstrate some general principles of psychiatric illnesses and treatments. This book won’t be an encyclopaedia, and it doesn’t need to be. I hope to provide a framework so that common and uncommon mental health disorders can be better understood. I also discuss suicide, which is sadly more common than most people realise, and is rarely discussed.

I know mental illness is difficult, and we often look at ourselves or others as though the brokenness is abhorrent, ugly and deforming.
My hope is that through Kintsukuroi Christians, you’ll see the broken pieces are mended with gold, and realise that having or recovering from a mental illness doesn’t render someone useless or broken, but that God turns our mental brokenness into beauty.

Kintsukuroi Christians is available to purchase from good Christian bookstores around the world including:

Kooyong = https://www.koorong.com/search/product/kintsukuroi-christians-christopher-pitt/9780994596895.jhtml

Amazon US = https://www.amazon.com/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Amazon UK = https://www.amazon.co.uk/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Smashwords = https://www.smashwords.com/books/view/720425

~~

Mental illness can be challenging. Sometimes learning about mental illness can bring up difficult feelings or emotions, either things that you’ve been through yourself, or because you develop a better understanding of what a loved one is going through or has been through. Sometimes old issues that have been suppressed or not properly dealt with can bubble up to the surface. If at any point you feel distressed, I strongly encourage you to talk to your local doctor, psychologist, or pastor. If the feelings are so overwhelming that you need to talk to someone quickly, then please don’t delay, but reach out to a crisis service in your country

In Australia
Lifeline 13 11 14, or
BeyondBlue
Call 1300 22 4636
Daily web chat (between 3pm–12am) and email (with a response provided within 24 hours)  https://www.beyondblue.org.au/about-us/contact-us.

USA = National Suicide Prevention Lifeline 1-800-273-TALK (8255)

New Zealand = Lifeline Aotearoa 24/7 Helpline 0800 543 354

UK = Samaritans (24 hour help line) 116 123

For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Prescribing dangerous drugs for a made up disease

Honestly, I don’t know if I can go on much longer.

I feel like every time I approach the wild waters of social media, I find myself drowning in a sea of shameless ignorance.  It’s like a post-modern intellectual zombie apocalypse where brainless morons roam cyberspace, relishing the opportunity to infect the minds of the innocent and gullible with their delusions of expertise.

As I’m sitting here writing, the little angel on my right shoulder is trying to get my attention.  “Everyone’s entitled to their own opinion,” she whispers softly.

Except it’s hard to hear when the little devil on my other shoulder is digging his pitch-fork in my brain and twisting it to make a point.  “But their opinion is crap,” he angrily retorts.

Tonight, the subject of my inner voice’s great debate was the Facebook headline, “ADHD: Drugs to treat disorder could create heart problems for children, researchers say.  Children under 18 who had ADHD and were prescribed methylphenidate were more likely to get an irregular heartbeat in the first two months, researchers said.”

Screen Shot 2016-06-07 at 9.49.38 PM

The little paragraph on Facebook didn’t mention any important facts, like what the article was that they quoted, or that the actual number of events linked with drug were miniscule.

That didn’t stop some clearly stupid people from publically venting their rancid opinions all over social media.

There were the usual paranoid delusions claiming that ADHD is over-diagnosed so that the American Psychiatric Association could get more funding from pharmaceutical companies.  Or that Ritalin has never been properly tested, and that children on Ritalin have been human experiments for the last 30 years.

Then there were all of the old chestnuts too, like ADHD is because of poor parenting or poor diet, or teachers with sub-par intelligence who aren’t challenging their pupils enough.  And who needs Ritalin anyway when all you have to do is stop feeding them artificial flavours and colours, high fructose corn syrup, GMO’s and fast foods.  Better yet, treat them with cannabis.

There were also some brazen displays of intellectual impotence within the heady mix of stupidity, like the people who suggested that children shouldn’t be given ANY drugs unless they’ve got diseases like cancer.  ‘Cause, clearly, paracetamol and penicillin are just as toxic as Ritalin.

Then there was the cherry on top:

“The doctor who came up with ‘ADHD’ and ‘ADD’ confessed on his deathbed that they were made-up diseases.”

Really??  Oh, come on, that’s both pathetic and grossly insulting.  ADHD is a real disease.  It’s been proven by real scientists and real doctors working in real labs and real hospitals.  Yet in the post-modern mind-bubble, an unverified viral meme on social media carries more weight than decades of scientific enquiry by some of the worlds smartest people.

For those of us who aren’t intellectual zombies, there was no death-bed confession about ADHD’s concoction.  According to a fact-check by Snopes.com, the doctor who ‘made up’ ADHD never said ADHD wasn’t real, but only that he thought the biological cause of ADHD was over-estimated.

Those who clearly knew nothing about ADHD or its treatment decided to further perpetuate their ignorance by embellishing and catastrophizing the “heart problems” that the Facebook headline alluded to.  Except that if they had bothered to review the article Facebook was referring to, they would have seen that there really wasn’t anything going on.

According to the article “Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study” [1], the only significant heart issue with Ritalin is a condition broadly classified as ‘arrhythmia’, which is medical speak for an irregular heart beat.  However, the peak risk for arrhythmia in the study was in children with congenital heart defects in the first few days of treatment.  For this, the relative risk was 3.49.  That means that a child with an already dodgy heart will have a three and a half times greater risk of an irregular heart rhythm than a child with a normal heart who’s not on Ritalin.  This sounds terrible, but “lies, damn lies and statistics” – in reality, the overall number of children who will actually get an arrhythmia because of Ritalin is still incredibly low because the total number of children who get arrhythmias is incredibly low.  Mathematically speaking, 3.49 x diddly-squat is still diddly-squat.

Besides, all of this is old news.  The current study was simply trying to use a larger source of data to get better statistics on case-reports of the possible effects of Ritalin.  But in the product information of methylphenidate, heart problems are clearly listed as a possible complication.  Because of this, and to ensure that Ritalin isn’t thrown around like candy, only medical specialists like paediatricians and child psychiatrists can start a child on medications like Ritalin.

So the reaction to the new study is nothing more than a storm in a tea-cup, but it clearly demonstrates the stigma and ignorance towards ADHD that, I’m ashamed to say, still exists in our modern, progressive society.

Is it any wonder then that parents actively avoid getting an assessment for their struggling children, or do everything they can to avoid Ritalin even when they have a clear-cut diagnosis of ADHD?  ADHD causes enough suffering by itself, but the baseless and incoherent ranting of the uninformed masses adds stifling layers of unnecessary stigma and misery to those who deserve our support, not misleading advice or irrational judgement.

References

[1]        Shin JY, Roughead EE, Park BJ, Pratt NL. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. BMJ 2016;353:i2550.

Let boys be non-stigmatised boys

Boys will be boys ...

“When I was a boy …”

Many a stirring yarn has been started with those exact words, as aging men relive their childhood adventures with sentimental grandiosity increasingly taking over from detail as each passing year blends in with the blur of distant memories.

Ps Greg Gibson wrote an article that caught my attention as it floated across my Facebook feed last night.  Gibson is a pastor in Knoxville, Tennessee.  His “when I was a boy” story recalled his happy times as an energetic child, a serene innocence punctuated by two years of Ritalin-induced misery.

His point: “I think we should let boys be boys, and non-medicated ones at that. Therefore, parents, if at all possible, don’t medicate your boys.”

I think I understand what he’s trying to say, that it’s ok to be an energetic child and to see the extra energy as a strength to harness, not a weakness to control.

That would be fine, except that in trying to normalise energetic behaviour, he also winds up demonising Ritalin.  It may not have been his intention, but whenever someone respected in the community says something negative about stimulant medication or ADHD, it reinforces the oppressive stigma attached to those who suffer from it.

Ps Gibson’s fundamental assumption, that normal but energetic children are being misdiagnosed as ADHD and therefore unnecessarily medicated, happens far less often than the opposite – children with ADHD are misdiagnosed as energetic children that just need to be taught how to control themselves.

Personally, I don’t know of any parent who ever wanted to medicate their child with Ritalin.  If anything, it’s the opposite, because if your child’s on Ritalin, then you must be a lazy parent, or given them too much sugar, or too much screen time, or not hugged them enough as babies, or didn’t practice vaginal seeding, or whatever other form of parent-guilt is being perpetrated by the media at the time. Parents will do everything they can in their power to avoid using Ritalin, because of a culture that blames and shames.

Unfortunately, this means that children who could be helped by Ritalin or other stimulant medication are left behind, because ADHD isn’t the mislabeling of normal energetic children who just need better structure, or better posture, or who learn differently.  ADHD is a real disability, a dysfunctional lack of planning and control that’s abnormal compared to other children, affecting their entire lives.

For example, these children find it hard to play with other kids because they can’t follow basic social rules like the rules of games, or waiting their turn.  These children find school difficult, because they can’t concentrate for long enough to focus on completing a multi-step task, or have a long enough attention span to make new memories for words or facts.

One of my patients, a little boy about seven years old, was brought in by his mother because a chiropractor wanted me to arrange a blood test on his behalf.  When I asked why, the mother said the little boy had dyslexia which the chiropractor was ‘treating’ (actually, this chiropractor was blaming a disease that didn’t exist, and wanted me to arrange a test that was resigned to the pages of history, but that’s another story).  When I talked to the mother about the child’s symptoms, it was pretty obvious that he had ADHD, amongst other things.  After seeing a developmental paediatrician to confirm the diagnosis, and taking Ritalin for just one week, his reading improved three whole reading levels, and after a month, he had not only caught up, but had passed a number of his class-mates.

This is a real life example of how ADHD can hold children back, and how stimulant medication can help.  While there are always exceptions to the rule, stimulant medications help more often than they hinder.  They’re sometimes the difference between a child meeting his full learning potential, or being unnecessarily held back, languishing at the bottom of his class as his peers go further ahead in leaps and bounds.

Our culture needs to move on.  We need to stop our social prejudices making life more difficult than it already is for children and their families who battle with ADHD.  We need to see that medications for ADHD can be the difference between a life of learning and a life unfairly held back.

Let’s change the tune.  Rather than saying, “Let boys be non-medicated boys”, how about we say, “Let boys be non-stigmatised boys.”  It’s only through the break-down of the stigma surrounding ADHD and stimulant medications, that all boys (and girls) can truly meet their full potential, whether they have ADHD or are just a bit more energetic.

If you want more information on ADHD and its treatments, this is a good place to start: http://www.rch.org.au/kidsinfo/fact_sheets/ADHD_an_overview/

If you are concerned that you or your child might have ADHD, talk to your local GP or paediatrician.

Ritalin may not help children with ADHD?

A few days ago, the media had a frenzy over a new study about the use of Ritalin (methylphenidate – a stimulant medication) for Attention Deficit Hyperactivity Disorder (ADHD) (http://goo.gl/Ht9GKF).

ADHD is always good for a headline grab because it is so polarizing. It’s like the new HIV – everyone’s got an opinion on ADHD, and most of them are facile or just plain ignorant. That doesn’t stop the armchair experts from sharing their opinions, and this new Cochrane review into the studies of Ritalin for ADHD just gives them another chance to vent their fatuous spleens.

Like a couple of the comments posted at the end of The Australian article. One suggested that ADHD was a disease invented so they could find another drug to treat it, and suggested that mobile phone games were the problem. Another thought he was rather humorous when he trotted out the tired old chestnut that it’s all the parents fault: “ADHD has been nicnamed {sic} ‘Absent Dad At Home’ syndrome!”  Sorry, but no one’s laughing. 

We need to take a step back from the uneducated and unwarranted opinion of the self-titled experts, and look at what the study actually said. To do that, lets have a look at what the study was, what it looked at, and what the results were. We’ll then compare the results with some of the other options available for treating ADHD, so we can make an informed decision about how to best manage ADHD.

First, what study are we talking about? The study in question is a Cochrane Review lead by Storebo, titled “Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)” [1]. (You can read the official press release here: http://www.cochrane.org/news/researchers-urge-caution-prescribing-commonly-used-drug-treat-adhd or the abstract here: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009885.pub2/abstract)

Cochrane reviews are scientific works that pool the best research on a particular topic and combine it into a mega-study, to get the best results available for a particular topic. First, all the papers written about the topic in question are found. The poorest quality studies are discarded, leaving studies that are suitable quality and are fairly uniform in how they did their research, so that the results from each study can be combined into one uniform result.

This process of meta-analysis increases the statistical power of the results enormously. The Cochrane Collaboration has been at the forefront of meta-analysis and has developed specific rules about the quality of evidence it accepts for its reviews, making a Cochrane review as trustworthy as medical research can be.

So what did the meta-analysis of methylphenidate for children with ADHD actually show? In short,

  • A strong improvement in the Teacher-Rated Symptoms score,
  • A strong improvement in the Teacher-Rated Behaviour score,
  • Small-to-moderate improvement in the ADHD rating scale,
  • Small increase in minor side effects such as poorer sleep and appetite, and
  • No increase in serious harm from methylphenidate.

So … that sounds pretty positive overall. Why the big hullabaloo? Why are these experts supposedly urging caution?

The concerns the researchers had was with the quality of the studies. Overall, the research that’s been done thus far has been deemed low quality by Cochrane’s standards. So they were cautious about suggesting that the results were reliable given the quality of the studies they had to work with. And that’s fair enough. Better quality studies are required to confirm the findings of the current Cochrane review, and this should be done as a matter of priority.

Unfortunately, the reviewer’s cautious approach to the research has been misinterpreted as a concern about the drug itself.

There are two important points here: 1. Accepting the limitations of the quality of the research it’s based on, the review still found a moderate effect of methylphenidate, and 2. Other “treatments” for ADHD have been proven in separate meta-analyses to be wholly ineffective.

There’s a little bit of statistical interpretation required here, but the Standardised Mean Difference (SMD, or sometimes called Cohens d) for the Teacher-Rated Symptoms score and Teacher-Rated Behaviour score was -0.77 and -0.87 respectively. The negative value here doesn’t mean that it’s bad; it’s just the arbitrary direction the reviewers chose to show improvement favouring Ritalin. Then there’s the SMD itself. The SMD takes into account the variability of the results overall, using a specific formula to take that into account.

The SMD used here doesn’t equate to the other value the reviewers used for the side effect statistics, which they expressed as a relative risk. So you can’t look at the numbers given and directly equate the power of the improvements with the chance of side effects of the medication.

However, it’s been said that an SMD of 0.2 is a small effect size, 0.5 is moderate, and 0.8 is large [2], so the effect of Ritalin given by the study was actually a strong effect. In comparison, the relative risk of minor adverse effects given by the review was 1.29, or a 29% increased risk, which is relatively small.

Then there’s the important consideration of the effects of other treatments for ADHD. The effect of Ritalin maybe backed by low quality evidence, but there’s no evidence of any effect for the other so-called ‘treatments’ for ADHD. As per the review by Sonuga-Barke (2013), there is a tiny amount of evidence for supplementation with omega-3 and 6 fatty acids, but none for:

  1. Elimination diets (including those for ‘antigenic’ foods, specific provoking foods, general elimination diets and ‘oligoantigenic’ diets)
  2. Food colouring (including certified food colours, Fein-gold diets and tartarazine)
  3. Cognitive training (including working memory specific, and attention specific training)
  4. Neurofeedback, and
  5. Behavioural intervention [3]

So no matter how inane or facile the arm-chair experts may be, there is no evidence that Ritalin for ADHD is harmful. There is a small risk of minor effects such as reduced appetite and sleep, but there is evidence (albeit low quality evidence) that it has a strong positive effect. In comparison, there’s no evidence of improvement from any other treatment that’s been adequately studied.

No drug is perfect, and that includes Ritalin. But it’s certainly not the devil in pill form either. It’s time to stop demonizing it, and ignorantly criticizing those children and their families who need it.

References

[1]       Storebo OJ, Ramstad E, Krogh HB, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane database of systematic reviews 2015 Nov 25;11:CD009885.
[2]       Faraone SV. Interpreting estimates of treatment effects: implications for managed care. P & T : a peer-reviewed journal for formulary management 2008 Dec;33(12):700-11.
[3]       Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. The American journal of psychiatry 2013 Mar 1;170(3):275-89.

Dr Caroline Leaf and the Myth of the Chemical Imbalance Myth

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There are lots of medical myths that people believe.

“I have acne because I eat too much chocolate, or my face isn’t clean enough”

“Stomach ulcers are because of stress”

“I coughed up some yellow phlegm, so I must need antibiotics right?”

“My baby’s fevers are because of teething.”

Is the “chemical imbalance” theory one of them?

Dr Leaf is a communication pathologist and self-titled cognitive neuroscientist. A couple of weeks ago she opened a proverbial can of worms by quoting the out-spoken Peter Gøtzsche, claiming that psychiatric drugs are the third leading cause of death after heart disease and cancer. This did not go down well, and Dr Leaf had to issue three separate statements on social media to try and justify herself and attempt to rescue her rapidly deteriorating credibility.

Not that she issued an apology, mind you, or retracted her statement.

Today, Dr Leaf published a blog on psychiatric medications … but again, not to apologise but to further justify why she’s right, and nearly every other doctor and scientist in the world is not. Worse than that, she went so far as to accuse doctors of deliberately prescribing “clearly dangerous” drugs, which she claims have no therapeutic effects, just because of some overcooked drug-company sponsored dinner and a few pens. More on that later.

Her post is a defiant deflection, a logically flawed and factually inaccurate criticism of modern psychiatry and psychopharmacology – not fueled by research, but largely based on the books of disgruntled fringe psychiatrists and researchers with an axe to grind.

Dr Leaf doesn’t discuss the actual science of the medications that she’s so against, but simply tries to create a smokescreen of distrust.

A good example of all that is wrong with this post is contained in the opening paragraph.

Today, it has become commonplace to say that people have chemical imbalances in their brain, most notably a disruption in the proper production of dopamine (for “diseases” like ADHD) and serotonin (for “diseases” like depression). These people, it is supposed, need drugs to “cure” these chemical imbalances, hence the terms “antipsychotics” or “antidepressants”.

The first thing to note is how Dr Leaf uses the term “cure”. No doctor ever uses the word “cure”, especially when talking about complex diseases. This is a pejorative term implying that modern medicine is only interested in permanently fixing things. But it’s a straw man fallacy, a false premise that Dr Leaf then uses to cast the medical model as impotent and futile. Nice try, but no one in medicine ever promises cure, and no doctor in their right mind would ever be so narrow-minded as to suggest that drugs are the only treatment for every condition. That doesn’t mean that drugs aren’t useful, nor that the medical model is broken. As we’ll discuss soon, medications are extremely helpful for certain conditions, when used carefully, as are non-drug treatments like CBT.

Dr Leaf also puts inverted commas around the word “diseases” as if to suggest that ADHD and depression aren’t diseases, an act which smacks of petulance and willful ignorance, and is insulting to those who have or who have ever suffered from ADHD and depression.   Last week, Dr Leaf was happy to share that her eldest daughter suffered from bulimia and depression, but now she’s suggesting that depression isn’t really a disease. So what is it then? Malingering? Personal weakness? Bad parenting?

It’s really surprising that someone claiming to be a cognitive neuroscientist would ignore strong scientific evidence.  For example, ADHD is associated with dopamine dysfunction as well as the dysfunction a number of other neurotransmitters [1-3]. And depression is associated with a decrease in the growth factor BDNF, (known as the neurotrophic hypothesis of depression) [4-6]. Schizophrenia, which Dr Leaf conveniently failed to mention, is clearly related to dopamine dysfunction in nerve cells of the pre-frontal cortex and the striatum, two parts of the brain that are incredibly important for how your brain processes incoming and outgoing signals [7-9].

There’s nothing to suppose here .. there’s ample evidence that psychiatric diseases are related to dysfunction within the brain, commonly with the function of neurotransmitters among other things. Call it whatever you like, the truth doesn’t change. “Chemical imbalance” is just an easy phrase for the general public to remember.

Dr Leaf then tries to suggest that psychiatric drugs don’t fix chemical imbalances but create them, citing the 1950’s observations of French researchers Deniker and Delay who noted that the first anti-psychotic, chlorpromazine, caused symptoms of Parkinson’s Disease. And indeed it did, but this wasn’t a new disease, just evidence that it worked.

Psychosis, a pathological state involving hallucinations and delusions, is because of an excess of the neurotransmitter called dopamine. Dopamine is the neurotransmitter that’s used by the nerve cells deep in the brain in a part called the basal ganglia, which acts like a central mail delivery centre for incoming and outgoing signals from other parts of the brain. The function of the nerves in one part of the basal ganglia are responsible for sending sensory signals to the frontal lobes of the brain. In another part, the signals are important for smooth movements of our muscles. Proper function depends on just the right amount of dopamine – too much and you get psychosis. Not enough and you get Parkinson’s disease symptoms.

The French researchers were simply noting the side-effects of too much medication blocking the action of dopamine in the basal ganglia – the psychosis had improved, but the blockade of dopamine was just too much in some patients, who had the opposite symptoms.

Again, Dr Leaf’s position is diametrically opposed to the published science [10, 11], and if anything, her claim contradicts her fundamental argument. After all, if chemical imbalances are myths, then how can chlorpromazine create a “new neurological syndrome” because of a chemical imbalance?

Dr Leaf then launches into a discussion on the history of the DSM and psychiatric medications. This is just the first in her ad hominem attacks on the medical profession –  playing the man, not the ball if you will. If she can discredit the doctors that prescribe the medication, then she indirectly discredits the medications.  This appears desperate and ultimately serves to weaken her case.

“It was just assumed that since these drugs affected brain chemistry in a certain way, the opposite reaction must be the result of the disease, notwithstanding the fact that this has never been adequately proven.”

The history of medicine is littered with cures being found without the disease being fully understood. Take Edward Jenner, for example, who is the founder of the modern technique of vaccination. He didn’t know why his smallpox vaccine worked, only that it did. Electron microscopes and a modern understanding of the immune system were centuries away, but Jenner saved billions of lives through his observation that prior vaccination with a small sample of cowpox virus would protect against smallpox [12].

When amphetamines, known to increase dopamine concentrations in the brain, caused psychotic symptoms and reserpine, a dopamine blocker, improved psychosis, it stood to reason that dopamine was a good candidate as a cause of psychosis and schizophrenia. Decades of research have gone on to further confirm and delineate the link [7]. Again, this is not “an overly simplistic explanation of chemical imbalances”. It is well proven, and rather complex.

Dr Leaf also makes the astounding accusation that psychiatrists inflicted suffering and caused “a public health disaster” by creating the DSM. The DSM, the ‘Diagnostic and Statistical Manual’ is an agreed-upon standard classification for psychiatric diagnoses. It is nothing more than a system of classification. It allows psychiatrists and researchers to speak a common language and attempt some coherence among their diagnoses.

Dr Leaf wrote, “… institutions like the American Psychiatric Association and the DSM would define what is normal, in turn telling us what it means to suffer and, essentially, what it means to be human. They medicalized misery, and today millions are suffering because of their actions, creating a public health disaster.”

That’s like saying that classifying the different types of cancer causes cancer. And that millions of people are suffering from cancer because doctors know to call it ‘cancer’. People have been suffering long before the DSM came along. The DSM doesn’t tell people they’re suffering, and it certainly doesn’t define what it is to be human. Such statements are disingenuous and melodramatic.

But wait, there’s more. “Today a psychiatrist can be praised for drugging a depressed person with mind-altering substances and, if these do not work, institutionalizing them and shocking their brain with ECT (electroconvulsive therapy). It is even an acceptable and commonplace practice to imprison mentally ill persons, drug them and lock them in solitary confinement, compelling them to live their days marinating in their own excrement.”

Dr Leaf is again playing to the fears of the public who have watched too many movies and only think of ‘One Flew Over the Cuckoo’s Nest’, ‘Shutter Island’ or scenes from ’12 Monkeys’. There are more oversight boards and lawyers than there are psychiatric patients, and the only people who are institutionalised are those who are clearly a danger to themselves or others. And while institutionalised, they are not subjected to random bouts of electrical shock as if some doctor is wandering around with a medical grade cattle prod, zapping people and laughing maniacally. Nor is anyone locked in solitary confinement and forced “to live their days marinating in their own excrement”.

The paranoid accusations continue some more. Dr Leaf accuses all psychiatrists of ignorance, and then accuses primary care physicians of negligence, by claiming that we prescribe medications that we do not understand because of the bribes and a pretty smile from a pharmaceutical rep.

Again, Dr Leaf contradicts her own argument:

Despite the recognition amongst many psychiatrists and medical health professionals that the chemical imbalance theory is not valid, drug companies like Eli Lilly still claim that ‘antipsychotic medicines are believed to work by balancing the chemical found naturally in the brain’.

Except that antipsychotic medications DO balance the naturally occurring chemical in the brain (dopamine) as we discussed earlier. What the … a drug company telling doctors how their drug works! How dare they tell the truth!

I find it disturbing that Dr Leaf would stoop so low as to insult the entire medical profession, especially every GP and family physician the world over.

Hey, I’m not above criticism. It’s important to have a good long look at ourselves from time to time, to review our practice, and make sure we’re treating our patients in the best possible way. The RACGP, the peak body of Australian GP’s, invited Prof Gøtzsche to present his opinions on anti-depressant medications so that GP’s could decide for themselves if they should adjust their prescribing.

But to suggest that primary care physicians are stupid, ignorant, incompetent and money hungry … that we would sell our soul for a drug company branded pen … is insulting. Though the irony of her statement, “we do not ask ourselves if these doctors really understand all the implications of using these substances. Not even the psychiatrists understand these drugs” is clearly lost on Dr Leaf.  It’s certainly clear from the rest of her essay that Dr Leaf has no idea how these medications work or what benefits they have for those who suffer from mental ill-health.

There’s a lot more to discuss in response to Dr Leaf’s diatribe, but for the sake of brevity, I’ll try and discuss just a couple of other important themes.

Dr Leaf continues to try to make the medications sound useless and poisonous. She has several paragraphs on the placebo effect, making the false argument that the effect of the medications is just because someone tells you it will work. Of course, the placebo effect is part of the therapeutic effect, but that’s the same for all treatments, even Dr Leaf’s programs … “So, if the pastor or cell-group leader says that these programs are safe and will fix your toxic thinking, even though they get most of their information from the author, we believe wholeheartedly in what he or she may say and are more inclined to believe the program will work for us. These beliefs, which ignore actual scientific results, are buttressed by a flood of distorted and biased news reports, press releases and scientific journal articles on supposed toxic thoughts, and have transformed the theory into church dogma. So, obviously, if we experience negative side effects and do not feel the program is working, it must be something wrong with us, not the program.” Is that a fair statement?

Dr Leaf then plays the fear card again by listing all of the potential side effects from psychiatric medications. Dr Leaf is right in saying that psychiatric medications have serious proven long term side effects, and we should be careful.

For instance, if you knew that thrombocytopenia, anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angioedema and Stevens Johnson syndrome, bronchospasm and hepatic dysfunction were the potential side effects for a medication, would you take it? Most people wouldn’t.  Reading the list makes that drug sound really dangerous.  We should be up in arms about such a potentially harmful drug being put up for sale … except that this list of side effects isn’t a psychiatric drug at all, but’s actually the side effect profile of paracetamol (acetaminophen in the US). People take paracetamol all the time without even thinking about it.

Saying that we shouldn’t take medications because of potential side effects is a scarecrow argument, a scary sounding straw man fallacy. All drugs have serious proven long term side effects. Licencing and prescribing a medication depends on the overall balance of the good and the harm that a medication does. And no one has ever hidden these side effects from the public as if there is a giant conspiracy from the doctors and the pharmaceutical companies. They’re right there in the product information (here is the product information for fluoxetine. See for yourself).

Whilst it’s true that these side effects do happen, we know that they happen infrequently, just like we know that people win lotteries infrequently. Even so, the medications are not just doled out like sweets at a candy store. You require a minimum of ten years of university level education to be able to prescribe them.

Patients ALWAYS have a right to ask questions about possible benefits and side effects, and in my practice, I tell my patients the pros and the cons before prescribing, and I give them the choice of whether they want them or not. No one is ever forced into taking them.

Finally, Dr Leaf makes a number of irrational statements and flawed arguments in her final page of ranting. Let me quickly go through some of the honourable mentions:

* “Most people recover from depression without antidepressants” – true, because most cases of depression are mild. That doesn’t mean to say that antidepressants shouldn’t be used for severe depression, just like most people recover from upper respiratory infections without antibiotics, but that doesn’t mean that we shouldn’t use antibiotics for severe tonsillitis or pneumonia.
* “Antidepressants are no better than placebos” – It’s a controversial topic right now. There are many pushing the barrow that SSRI medications are no better than a sugar pill. But Dr Leaf has conveniently ignored several Cochrane reviews (the best of medical evidence) that shows anti-depressants work for a variety of disorders [13-15], but that psychological therapy might not [16].
* Equating antidepressants and antipsychotics with illicit drugs, and claiming that “more people die from overdoses of psychiatric drugs than illicit drugs” – This is Reductio ad absurdum – the logical conclusion from this argument is that illicit drugs are safer than psychiatric drugs. And therefore we should not give people psychiatric drugs since we don’t give people the ‘safer’ illicit drugs. But that conclusion is absurd, and when you think about it, the whole thing is based on hidden false premises – people rarely die of illicit drug overdoses because they’re illegal and are hard to come by. And also, people who use illicit drugs are not usually suicidal, whereas those given psychiatric medications sometimes are suicidal, and sometimes use them to try and commit suicide. But modern psychiatric drugs are much less dangerous in overdose than their old counterparts.  It should also be noted here that more overdose suicide attempts are with paracetamol or ibuprofen than with psychiatric medications [19], but I don’t see paracetamol or ibuprofen being demonised.
* Psychiatric medications are part of a neo-liberal capitalist plot to keep the rich, richer and the poor, poorer – To me, this looks like Dr Leaf clutching at straws. Her statement, “By emphasizing that the problem lies within an individual’s biology, we are less inclined to look at their experiences and the social context of why they are feeling the way they feel. We look at the mythical chemical imbalance instead of economic exploitation, violence and inept political structures” is false.   Schizophrenia is often seriously discussed in terms of neurodevelopment and not just ‘chemical imbalances’ [17, 18]. So it’s just plain wrong to suggest that researchers don’t look at the “economic exploitation, violence and inept political structures”. Oh, and Dr Leaf suggests that foster children are abused because they’re all forced to take psychiatric medication, and implies that ADHD children are abused by being force-fed Ritalin because they “move a lot in class”. Again, these are emotional over-generalisations that have no basis in reality.

Dr Leaf seems lost.  She’s ignored solid published medical and scientific evidence in coming to an opinion based on the discontented rumblings of a few vocal but outspoken critics. In order to make her arguments, she has had to resort to borderline-slanderous ad hominem attacks on scientists and the medical profession, and purely emotional arguments based on fear and mistrust.

And this was only part one.  If Dr Leaf’s promised second part is anything like the first, we’re in for a real treat.

Though as if that wasn’t enough, by suggesting that psychiatric drugs cause changes in your brain, cause chemical imbalances, and cause that slew of negative side effects, Dr Leaf is admitting that it’s your brain that changes your thought life, which directly contradicts her most recent teachings. After all, if thought was the dominant force in your neurology and your mind controlled your brain, then the medications would have no effect since they’re physical and aren’t connected to our mind.

So which is it? Because if the brain controls our mind, then her best-seller needs to be pulped and refunds offered to the hundred of thousands of people who bought it. But on the other hand, if the mind really does control the brain, then her entire argument against psychiatric medications implodes.

Dr Leaf has painted herself into a corner and there’s still part two to come.

References

[1]        Prince J. Catecholamine dysfunction in attention-deficit/hyperactivity disorder: an update. J Clin Psychopharmacol 2008 Jun;28(3 Suppl 2):S39-45.
[2]        Del Campo N, Chamberlain SR, Sahakian BJ, Robbins TW. The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biological psychiatry 2011 Jun 15;69(12):e145-57.
[3]        Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.
[4]        Haase J, Brown E. Integrating the monoamine, neurotrophin and cytokine hypotheses of depression–a central role for the serotonin transporter? Pharmacol Ther 2015 Mar;147:1-11.
[5]        Bus BA, Molendijk ML, Tendolkar I, et al. Chronic depression is associated with a pronounced decrease in serum brain-derived neurotrophic factor over time. Molecular psychiatry 2015 May;20(5):602-8.
[6]        Sousa CN, Meneses LN, Vasconcelos GS, et al. Reversal of corticosterone-induced BDNF alterations by the natural antioxidant alpha-lipoic acid alone and combined with desvenlafaxine: Emphasis on the neurotrophic hypothesis of depression. Psychiatry research 2015 Sep 1.
[7]        Howes OD, Fusar-Poli P, Bloomfield M, Selvaraj S, McGuire P. From the prodrome to chronic schizophrenia: the neurobiology underlying psychotic symptoms and cognitive impairments. Curr Pharm Des 2012;18(4):459-65.
[8]        Williams GV, Castner SA. Under the curve: critical issues for elucidating D1 receptor function in working memory. Neuroscience 2006 Apr 28;139(1):263-76.
[9]        Der-Avakian A, Markou A. The neurobiology of anhedonia and other reward-related deficits. Trends Neurosci 2012 Jan;35(1):68-77.
[10]      Leucht S, Tardy M, Komossa K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 2012 Jun 2;379(9831):2063-71.
[11]      Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.
[12]      Riedel S. Edward Jenner and the history of smallpox and vaccination. Proc (Bayl Univ Med Cent) 2005 Jan;18(1):21-5.
[13]      Arroll B, Elley CR, Fishman T, et al. Antidepressants versus placebo for depression in primary care. The Cochrane database of systematic reviews 2009(3):CD007954.
[14]      Soomro GM, Altman D, Rajagopal S, Oakley-Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). The Cochrane database of systematic reviews 2008(1):CD001765.
[15]      Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder. The Cochrane database of systematic reviews 2003(2):CD003592.
[16]      Jakobsen JC, Lindschou Hansen J, Storebo OJ, Simonsen E, Gluud C. The effects of cognitive therapy versus ‘treatment as usual’ in patients with major depressive disorder. PloS one 2011;6(8):e22890.
[17]      van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L. A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological medicine 2009 Feb;39(2):179-95.
[18]      Howes OD, Murray RM. Schizophrenia: an integrated sociodevelopmental-cognitive model. Lancet 2014 May 10;383(9929):1677-87.
[19]     Prescott K, Stratton R, Freyer A, Hall I, Le Jeune I. Detailed analyses of self-poisoning episodes presenting to a large regional teaching hospital in the UK. Br J Clin Pharmacol 2009 Aug;68(2):260-8.

Disclaimer

  1. Do not abruptly stop any medications that you are taking. Talk to your licenced physician first. They’re not all money-hungry, imbecilic drug-company bitches. Most of them actually know what they’re talking about.
  2. For the record, I declare that I have no connection with any pharmaceutical company. I do not accept gratuities of any form from any sales representative. I don’t eat their food, I don’t take their pens, and I don’t listen to their sales pitches

Update – 8 August 2016.

Dr Leaf has since taken the offending post from her blog page, and re-gifted it as an answer on her “Scientific” FAQ page (“Chemical Imbalances and Mental Health” http://drleaf.com/about/scientific-faqs/).  It remains as unbalanced and inaccurate as it’s former iteration.  It’s unfortunate that Dr Leaf continues to make such preposterous claims in the face of overwhelming scientific evidence to the contrary.

Different strokes for different folks? Why vaccinations don’t lead to mini-strokes

Screen Shot 2015-05-31 at 4.46.48 pmOne of my Facebook friends messaged me a link the other day. It was to an article that had been popping up on his Facebook feed, originally published by Health Impact News (http://goo.gl/V3A5Mb).

The article is a report by John P. Thomas, building on the previous work of Andrew Moulden. Moulden failed his medical residency in Canada (http://goo.gl/BBKG5z), but used his doctorate in psychology to promote himself as a doctor.

Moulden believed that “Multiple factors can work together to trigger a single type of reaction in the body, which can then produce various sets of symptoms. Even though there were different sets of symptoms and different disease names given to each one, they were actually all part of a spectrum of diseases that he called Moulden Anoxia Spectrum Syndromes. Learning disabilities, autism, Alzheimer’s, irritable bowel disease, Crohn’s disease, colitis, food allergies, shaken baby syndrome, sudden infant death, idiopathic seizure disorders, Gulf War syndrome, Gardasil adverse reactions, schizophrenia, Tourette’s syndrome, chronic fatigue syndrome, fibromyalgia, expressive aphasia, impaired speech skills, attention deficit disorders, silent ischemic strokes, blood clots, idiopathic thrombocytopenia purpura, Parkinson’s disease, and other modern neurodevelopmental disorders are closely related in many ways, and are part of a larger syndrome.” (http://goo.gl/kTNRMV)

Moulden Anoxia Spectrum Syndromes isn’t found in any medical textbook, and there is no evidence that Autism, Alzheimer’s, Gulf War Syndrome, food allergies and Shaken Baby Syndrome are at all causally related.

Besides, the term ‘anoxia’ is a medical term meaning ‘without oxygen’. Moulden is obviously suggesting that every one of those disparate conditions is fundamentally caused by a lack of oxygen to somewhere, and while his logic has many flaws, this is the fatal one. Food allergies are not related to lack of oxygen. Neither are reactions to the Gardasil vaccine. And we know that Autism is defined by structural and functional changes in the brain that occur in the womb, and can be detected as early as a month after birth [1]. Autism is primarily genetic – autistic brains have excess numbers of dysfunctional nerve cells that are unable to form the correct synaptic scaffolding, leaving a brain that’s large [2, 3], but out-of-sync. There is nothing about autism that’s related to low oxygen. ADHD is similarly genetic and neurodevelopmental in origin [4]. The only thing suffering from lack of oxygen is Moulden’s theories.

Thomas then tries to extend this already tenuous medical hypothesis by claiming that vaccines cause damage to capillaries in ‘watershed’ areas which, according to his definition (not the medical definition), are “very small areas of tissue (groups of cells) that are served by a single blood vessel called a capillary” (http://goo.gl/4IlUI7) He suggests that certain cranial nerves are vulnerable to these ‘watershed’ injuries, which then result in changes in the way the face moves.

The cause for these ‘watershed’ injuries? “The blood is being sludged up in multiple areas of the body, which is causing ischemia, damage to tissue, functional disorders, and disease. This is not genetic. It is acquired. The drop in the corner of the mouth is the result of low zeta potential and the MASS process. People with autism spectrum disorders, neurodevelopmental disorders, ADHD, and those who are having adverse effects from vaccines such as hepatitis, flu, anthrax, Gardasil, DPT, MMR, etc. are having a generic response. The body is reacting to having foreign matter put into it.”

In other words, he’s suggesting that vaccinations essentially cause strokes.

From here, the article becomes a bamboozling cacophony of legitimate but irrelevant facts, diagrams, factoids, and recommendations. For example, Thomas explains the signs of damage to the third, fourth, sixth and seventh cranial nerves, and cites the damage by actual strokes as examples. Well, that’s fine, except that real strokes don’t involve damage to capillaries, but blockage of arteries, and have nothing to do with vaccination.

He also makes statements that are simply wrong, like “The seventh cranial nerve primarily controls the lower half of the face” (actually the seventh cranial nerve, also called the facial nerve, controls the muscles of the whole face – http://goo.gl/m9S7Gd). And, “When we see seventh cranial nerve damage, we can be sure that the damage is not isolated to the seventh cranial nerve – the damage is happening everywhere” (except in Bells Palsy … and some parotid tumours … and some strokes … and lots of other things).

He also makes the ridiculous claim that autism causes facial droop without explaining why, suggests that weakness of the muscles of the eyes controlled by the sixth cranial nerve is often the first sign of vaccine damage, and that ‘watershed’ damage to the brainstem from vaccination is the cause of SIDS.

Thomas then attempts to justify his conjecture by describing the case of a single baby boy whom he claims died from sudden infant death post vaccination – “His family and his physicians watched him slowly die while the respirator did his breathing for him. Basically they were watching his brain as he went through the stages of sudden infant death after vaccine exposure”. Except that death after nineteen days is not ‘sudden’, and the description of this child’s tragic death is nothing like SIDS. And his only reference to this case? Not an official forensic report, but a ‘report’ written by Andrew Moulden, which was simply an offensive and detestable attempt to leverage the heart-wrenching death of a fifteen month old boy to push his idealistic agenda (http://goo.gl/ysoCtQ).

I could go on. There are pages of material that simply defy rational thinking. He even goes on to question germ theory, and states that “Vaccines are one of the largest triggers of excessive non-specific immune hyperstimulation, which ultimately leads to blood sludging, clotting, and loss of negative zeta. The combined effect of all these factors produce illness, disability, and death.”

There is no credible medical evidence to back up any of Thomas’s claims, nor the claims of Moulden before him. Together, they openly defy centuries of scientific knowledge, modern science, and the observations of every parent whose children have been vaccinated.

Lets face it – if vaccines really caused mini-strokes, we wouldn’t need the dubious work of Moulden and his disciples to discover it. We would have all seen it.

There are a lot of very questionable theories that get promoted on the internet as valid science. Don’t fall for it. There’s no evidence for Moulden Anoxia Spectrum Syndromes, and the only connection between conditions like Irritable Bowel Syndrome, Shaken Baby Syndrome and Chronic Fatigue Syndrome is not vaccination, but the pathetic attempt to try and connect them by pseudoscientists with an idealistic barrow to push.

References

[1]        Pierce K. Exploring the Causes of Autism – The Role of Genetics and The Environment (Keynote Symposium 11). Asia Pacific Autism Conference; 2013 10 August; Adelaide, Australia: APAC 2013; 2013.

[2]        Courchesne E, Carper R, Akshoomoff N. Evidence of brain overgrowth in the first year of life in autism. JAMA : the journal of the American Medical Association 2003 Jul 16;290(3):337-44.

[3]        Shen MD, Nordahl CW, Young GS, et al. Early brain enlargement and elevated extra-axial fluid in infants who develop autism spectrum disorder. Brain : a journal of neurology 2013 Sep;136(Pt 9):2825-35.

[4]        Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.