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MDs and Truth in Advertising, err Blogging

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Isn’t it great when psychiatrists publish websites or blogs that help you decide if they might be the right (or very wrong) choice for you? Isn’t it really great when their guest comments on other blogs provide an entirely different picture of their approach than you would get by reading the pro forma info on their websites?  Buyer beware!

Readers nationwide often write to me asking for referrals to psychiatrists or therapists in their area who are competent in treating ADHD.  I do my best to help, still emphasizing the importance of patients being pro-active. No matter how good the expert, it’s important to take a team approach. I routinely recommend a Google search for the professional’s website or blog to learn more about approach, training, and so forth. Even Yelp.com reviews might provide some inkling of a physician’s or therapist’s reputation.

Never have I seen such a clear case of “truth in advertising” about a psychiatrist’s approach to ADHD, however, than this blog post from a David Allen, MD (it’s unclear where he is practicing now but he received his medical degree at UCSF, a local medical school that will receive future attention in my blog).

To partially quote Allen’s manifesto at the top of his blog:

“It discusses how family systems issues have been denigrated in psychiatry in favor of a disease model for everything by a combination of greedy pharmaceutical and managed care insurance companies, naïve and corrupt experts, twisted science, and desperate parents who want to believe that their children have a brain disease to avoid an overwhelming sense of guilt.”

Never mind that the “family systems model” obscured multi-generational ADHD for so many years and postponed true help for millions of people affected by ADHD. Some ideas die hard. And when you’ve staked your career on it  but can’t adapt your specialty to include evolving science, well, I guess bitterness can ensue. Especially if the goal is to be “right” rather than helpful.

Anyway, here is a snippet of Allen’s recent post about ADHD:

Here’s a song I wrote for some of my symptom-obsessed fellow psychiatrists who are – what’s the word? – oh, yes – incompetent:

Take some of these and you’ll feel better

Forget about those hippies who claimed, “speed kills”
You’ve got ADHD and just a touch of bipolar
Things are always better when you’re taking pills

Also not to be missed: one of the comments to this post, from a fellow psychiatrist, Steve Malt:

Here’s my idea. Let’s just stop calling ADHD a “disorder,” thereby giving it credence it doesn’t deserve (at least not yet).

I’m serious. We can still prescribe ADHD meds to people if they say they help– along with the proper safeguards, of course– in the name of “cosmetic pharmacology.” Heck, dermatologists, plastic surgeons, and bariatric specialists do procedures for more dubious “conditions” all the time.

In the meantime, we should continue to do genetic, neuroimaging, psychological investigations to determine the root cause of inattention & hyperactivity– and, perhaps, to determine whether a sub-population of our “ADHD” people actually have a biologically based disorder, and if so, how best to treat them.

If you seek help from this psychiatrist then, you should know that any prescribing will be done with a placating attitude and not one of informed skill.

Was I surprised to learn that this came from a psychiatrist in San Rafael, California? No, such attitudes in Northern California are more the rule than the exception. I also see that this psychiatrist did his residency at Stanford. (Stanford is another  veritable hotbed of ignorance about Adult ADHD, according to all the reports I’ve received over the years. That’s not to say that some competent psychiatrists don’t hail from the medical school there but I suspect they learned about ADHD afterwards or elsewhere.)

Between UCSF grad David Allen’s sarcastic, demeaning attack on ADHD as a legitimate diagnosis and this Stanford grad’s arrogant denial of the huge body of evidence documenting ADHD as a legitimate condition, you can see why I often despair of the San Francisco Bay Area’s support for the ADHD community.

People are always surprised to hear me say this; isn’t the Bay Area supposed to be a technological forefront? Yes, if you like gadgets. Aren’t there lots of Nobel Laureates at both Stanford and UCSF? Yes, both are widely respected universities and not without reason. But when it comes to ADHD, I don’t know what can account for the obstinate, even cruel refusal to give ADHD its due.  I have some ideas, but I’m more interested in hearing yours.

By the way, if you read only Steve Balt’s website, you would not know his true attitudes towards ADHD. This is what he writes there:

I am a psychiatrist practicing in San Rafael, California, and specializing in comprehensive, individualized care for adults with a variety of mental health conditions, including mood disorders such as depression and bipolar disorder; anxiety; PTSD; obsessive-compulsive disorder; attention deficit/hyperactivity disorder (ADHD); eating disorders; addictions to alcohol, drugs, food, and behaviors; and lifestyle problems pertaining to relationships, life transitions, grief and loss, and inability to achieve one’s personal goals.

My Approach

I believe in developing an individualized treatment plan for each patient, which capitalizes upon each person’s distinct strengths while identifying the areas in which further growth is necessary or desired.  I provide medication management as well as ongoing psychotherapy.  I absolutely respect each individual’s feelings regarding medications, and I will work with each patient to establish a treatment plan that is acceptable to both patient and physician, as I believe this is essential for treatment success.  When medications are prescribed, I wish to help the patient understand the impact of such interventions on his or her life, as well as the areas in which medications will have little or no effect.

As I said, buyer beware.

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  1. Janet F.’s avatar

    Thank you, Gina, for beginning to expose this systemic problem in Northern California. My husband received AD/HD treatment in two different US regions before we relocated to Northern California. Finding a new medical practitioners of every stripe is always a challenge; most doctors don’t have blogs or even web pages to aid patient research. I have transitioned from being aghast to terrified over what appears to be a regional dedication to witch doctor- like ignorance with regard to AD/HD. It’s frightening because few options exist. Those specialists that are available appear to be determined to ignore national, collective wisdom. I can only speculate that they live in a bubble and are informing and reinforcing each other. Is competition between researchers and research centers a culprit, making it undesirable to embrace knowledge gained by a competitor? In the meantime, people’s lives are going down the tubes while these hucksters debunk AD/HD and try to sell their patients snake, er, fish oil and endless Cognitive Behavioral Therapy sessions, which will be unsuccessful until underlying medical issues are addressed, as their sole treatment.

    Reply

    1. Gina Pera’s avatar

      Thanks for your support, Janet.

      I’m sure posts on this topic might fall in the “kill the messenger” department. Some people just can’t believe that renowned institutions such as Stanford University and UCSF could be so abysmally ignorant — almost willfully so — about ADHD.

    2. Gina Pera’s avatar

      Janet wrote: “I can only speculate that they live in a bubble and are informing and reinforcing each other. Is competition between researchers and research centers a culprit, making it undesirable to embrace knowledge gained by a competitor?”

      Good theory about the “bubble.” One older gentleman at the local ADHD meeting had this theory: “Gina, it all goes back to the hippie days here, and the taboo on ‘labeling’ people and putting them into boxes.” To the simple-minded among us, ADHD is dismissed as a “simple” condition. As you, I, and millions of others know, there is nothing simple about ADHD. :-)

      No doubt competition is an issue, but thus far I’ve seen it more as a cross-disciplinary problem. For example, Stanford’s Sleep Center (from all reports I’ve received and from attending a public forum with its directors) absolutely refuses to cede ground to psychiatry and ADHD. Time and again, not just Stanford but other sleep researchers as well will insist that sleep apnea CAUSES ADHD-like symptoms. They remain blind (willfully so, it seems to me) to the fact that ADHD can co-exist with sleep problems such as sleep apnea and restless-legs syndrome. We are learning that RLS and sleep apnea have clear connections to dopamine, so you’d think this would convince them. But last I heard, they want to develop their own dopamine-based medication for RLS, ignoring the full pharmacopia already available to patients with ADHD. That, to me, smacks of “grant wars.”

  2. Felipe Sparks’s avatar

    ADHD is not always solvable by loading kids up with pills. Its also a behavioral change that may take a while to accomplish but is a great way to train one’s brain to act in a different way. Think differently. Act differently.

    Reply

    1. Gina Pera’s avatar

      Hi Felipe,

      Thanks for stopping by.

      Did I miss something, or did I actually say or imply somewhere that “ADHD is always solvable by loading kids up with pills”?

      I’m fairly sure I’ve never said something of the sort because I don’t think in that black-white way.

      Behavioral strategies can help some people with ADHD — and they can frustrate others. Because admonishing a person to “think differently” when their brain is not cooperating is sometimes tantamount to abuse.

      I’ve just met a man who has been receiving costly, weekly cognitive-behavioral therapy FOR TWENTY YEARS. It has barely kept him afloat until he was recently diagnosed with ADHD. Now perhaps he can start making some lasting changes without the dependence and expense on weekly therapy. In fact, I encourage him to look into a malpractice lawsuit, given that this “therapist” never even mentioned ADHD.

      Cheers,
      Gina

  3. Dr Charles Parker’s avatar

    Hey g,
    - So clear that brain science has not yet crossed over to academia, often not to the public, and way to often not down to front-line, trench psychiatrists focused on psychodynamic interpretations of biologically related data. Categorical thinking: the idea that the present psychodynamic reality is the only reality, is the essence of the problem.

    These folks don’t understand multivariate thinking.

    This kind of denial reminds me of the Galileo, Copernicus problem: If you are frighted of the telescope, you might not want to look down that tube and see another reality. Both the tool and the data are intimidating when you could see the sun rise and “obviously” rotate around the earth.

    Brain scans and neurotransmitter testing, as well as the measurement of trace elements and heavy metals can spell recovery – but one must first look at the data to see and understand it.

    A person can be a warm, intuitive, nice guy and still suffer from profound intellectually egocentric assessments. Let’s all call for more Critical thinking! Summary ref: http://www.corepsychblog.com/2011/10/mind-science-critical-thinking/

    Interestingly this phenom seems directly related to fear based academia… we have the same problem out here with the U of VA, – as a group they are stuck on borderline and bipolar, and think ADHD is an attempt to feed amphetamine addiction – the Dark Ages linger.

    Titration strategies and trust of the patient simply don’t work within linear, CYA vertical treatment systems – participation is out, admonition is in.
    cp

    Reply

  4. anonymous’s avatar

    I think you missed the point of his post.
    While I am sorry for the people with adhd who suffer from going undiagnosed, there are many people who suffer from being diagnosed when they are NOT adhd. (A friend of mine is paying dearly because of the drugs he was given as a child because he wasn’t perfect enough in school for his parents)
    There is much laziness going on in psychiatry. Doctors are haphazardly labeling people adhd, bipolar, depressed etc… and putting them on pills when what their patients really need is to solve problems that are in their lives and minds. Many people who are suffering are not suffering from a biological problem, but from problems caused by their lives, families and experiences.
    I don’t see Dr. “Mallen” as you called him saying that no one ever has adhd and no one should ever be medicated.
    People suffer for different reasons. While you were rabidly defending where no defending was needed you trampled all over that fact.

    Reply

    1. Gina Pera’s avatar

      No, I didn’t miss the point. It was an extreme skewering of physicians who DO recognize ADHD and treat it as the medical condition it is.

      It is you who are changing the point, from this blatant skewering to “overdiagnosis.”

      You don’t need to tell me or most anyone else affected by ADHD about laziness in psychiatry: We see it every day.

      It is you who misses the point. By a mile.

    2. Gina Pera’s avatar

      Anonymous wrote: I don’t see Dr. “Mallen” as you called him saying that no one ever has adhd and no one should ever be medicated.

      You are correct. It’s David M. Allen. I read his blog on a small screen, and the blog letters used for his name all ran together. I corrected it in the post.

    3. anonymous’s avatar

      This is late, but I agree with you. I think Gina missed the point of his post. We really don’t know that much about ADHD. It’s a collection of symptoms that could be caused by anything. I thought his post was more about rebelling against “checklist” psychiatry and knee jerk prescribing. Stimulants may help you focus, but they don’t tell us why the person is not focusing.

      Steve Balt has written that he wants to get rid of the ADHD diagnosis, and make ADHD a symptom that can be treated with stimulants, because then it will encourage people to look for reasons for why the person is not focusing–especially for children. The kid could have sleep apnea, allergies, a learning disability, terrible parents, or any number of things that cause an ADHD “symptom”.

    4. Gina Pera’s avatar

      No, I did not miss the point. Perhaps you are reading into the post what you want to read, whereas I read exactly what was there.

      We know a great deal about ADHD and its treatment strategies. But the general standard of care is quite poor because too many physicians see ADHD as a “simple” condition.

      As an aside, all those “alternatives” you list at the end have direct associations with ADHD, and they are often focused on instead of the underlying ADHD. Hence no progress.

  5. anonymous’s avatar

    Gina,

    I did not write that comment because I expected or wanted a response. You’re behavior is completely inappropriate. It sounds like you don’t like it when people disagree with you. This is what you cited from the David Allen blog:

    “Take some of these and you’ll feel better
    Forget about those hippies who claimed, “speed kills”
    You’ve got ADHD and just a touch of bipolar
    Things are always better when you’re taking pills”

    He was referring to a theme on his blog about bipolar disorder (he has written many times that he thinks it is overdiagnosed). There is an older post he wrote about a psychiatrist who claimed that the majority of kids with ADHD also have bipolar disorder and should be given a stimulant as well as an anitpsychotic or mood stabilizer.

    “Your family life’s a mess but that we won’t mention
    What’s crucial is your trouble paying attention
    You say bad memories make you a sad girl
    If your ma drank too much, that’s ‘cause you were a bad girl”

    It is a running theme on his blog (and on Steve Balt’s), that most psychiatrists no longer practice psychotherapy, spend very little time with their patients, and appear to be diagnosing in a “checklist” style straight from the DSM. And they have both complained that you don’t even need a doctor to do that if that is really all that is necessary to diagnose someone. You could have your secretary do that.

    This is not my words. This is their words that I can see just from checking out their blogs for the past year or so. Steve really did write an entire post about making ADHD a symptom, as opposed to a disorder, because then it will encourage people to look for a root cause of the problem (whether it be social or biological). That was not my interpretation of his words. That is almost verbatim what he actually wrote.

    Reply

    1. Gina Pera’s avatar

      Oh, so I’m inappropriate, am I? lol!

      You tell me I missed the point, I disagree, and you attempt to pull what seems to be a “power trip” on me.

      Feel free to disagree with me, but don’t expect my opinion to conform to your misreading of the data.

      Perhaps you are a psychologist who also thinks that ADHD is overdiagnosed and is simply the result of family-of-origin dysfunction. Your ignorance about the condition and its treatment is evident in every sentence. Moreover, you have grossly misread Allen’s words and intent. I suggest that you re-read. Especially if you agree with Allen that ADHD and other conditions can be diagnosed by physicians’ secretaries.

    2. Gina Pera’s avatar

      Anonymous wrote: Steve really did write an entire post about making ADHD a symptom, as opposed to a disorder, because then it will encourage people to look for a root cause of the problem (whether it be social or biological). That was not my interpretation of his words. That is almost verbatim what he actually wrote.

      Yes, I read that post, too. It was as willfully misguided as the other posts where Allen mentions ADHD. In fact, we know the “root cause” of ADHD (when it is legitimately and carefully assessed and diagnosed).

      If you find that Allen makes legitimate points, I would encourage you to keep studying the topic – and using solid information sources, not the blog of a psychiatrist with obvious bias against the body of evidence on ADHD. I would think that a blog post headlined “Adult ADHD: Another Dubious Hyped Disorder” would be enough to discourage serious people from believing anything that follows it.

  6. anonymous’s avatar

    Gina, What power trip? You said I was reading whatever I wanted into his post. So I showed you that I was not reading into it. I was actually using a lot of their own words.

    My original comment was directed at someone else. Your response was aggressive. Your comment, “Oh, so I’m inappropriate, am I? lol!” is again indicative of inappropriate behavior. It is not polite to laugh at other people. Your tone is very condescending. I did revisit the David Allen blog, and I was shocked at your behavior. I actually didn’t notice it until I read the comments to see what exactly happened on there.

    “Wait, you must be a psychologist who thinks that ADHD is overdiagnosed and is simply the result of family-of-origin dysfunction. Your ignorance about the condition and its treatment is evident in every sentence. There is nothing more to say here.”

    Actually, I am not a psychologist. But I do have ADHD PI. I have taken Strattera and I have taken Ritalin, but I could not tolerate their side effects. Ritalin was easier on me, but my psychiatrist and I both agreed that it took too much of a toll on my body and it was time to stop. I have also tried many antidepressants. I have also received CBT and been to group therapy. However, I don’t think that means I can behave however and say whatever I want.

    I have no clue why you are so hostile towards the doctors that were on that blog, and I don’t really care (I’m not a psychologist), but you are a poor representative for those with the disorder. Your behavior is more like someone with a personality disorder. I know lots of people with ADHD besides myself, and I don’t know that any of them talk about the disorder the way that you do.

    Though I do think it is interesting that you assumed I must be a psychologist who believes ADHD stems from family dysfunction…I NEVER said even once that it stems from family dysfunction. Though I definitely wouldn’t rule it out. If family dysfunction can cause major depression, panic attacks, and whole range of psychological problems, I don’t see why it couldn’t bring on ADHD either.

    Reply

    1. Gina Pera’s avatar

      It sounds as thought you don’t even realize that yours is a prime example of poor medical treatment for ADHD. You will find no one who has been a stronger or smarter advocate for better medical treatment. So, you are really attacking the wrong person. Moreover, you seem not to be accurately following the details here. I wish you luck in finding treatment.

    2. anne’s avatar

      yeah you can’t be condescending and passive-agressive and angling for people to get mad, without people getting mad. You are obnoxious. Who cares if we’re being appropriate? YOU are goading people. It’s the impropriety attack and it is inappropriate

    3. Gina Pera’s avatar

      Hi Anne, I’m not sure who is the “you” you are referring to.
      Gina

  7. L.Friesen’s avatar

    I can tell you that Gina is no poor representative. Gina, I’m so sorry you get attacked like this.

    Thank you for your continued efforts, I and many others with ADHD appreciate you and all that you do. And it’s considerable!

    Reply

    1. Gina Pera’s avatar

      Thank you, L.Friesen. :-)

  8. Collin Smith’s avatar

    Friends,

    I just created a petition: Director NIMH: Meaningful NIMH recognition of ADHD as a lifelong disorder, because I care deeply about this very important issue.

    I’m trying to collect 100 signatures, and I could really use your help.

    To read more about what I’m trying to do and to sign my petition, click here:
    http://www.change.org/petitions/director-nimh-meaningful-nimh-recognition-of-adhd-as-a-lifelong-disorder?share_id=ArUbFifAIApe=d2e

    It’ll just take a minute!

    Once you’re done, please ask your friends to sign the petition as well. Grassroots movements succeed because people like you are willing to spread the word!

    Collin

    Reply

    1. Gina Pera’s avatar

      Hi Collin,

      Good for you. ADHD advocacy has always depended on grass-roots efforts.

      I would point out that at least one important study on Adult ADHD was funded by NIMH:

      http://www.nimh.nih.gov/science-news/2006/harvard-study-suggests-significant-prevalence-of-adhd-symptoms-among-adults.shtml

  9. Collin Smith’s avatar

    I am glad they have funded research in this area, however it is concerning to me that NIMH still states: “Some children with ADHD continue to have it as adults.”

    Reply

    1. Gina Pera’s avatar

      Yes, I saw that, Collin. That page really isn’t of much consequence, though. It’s just a general overview.

      And it IS true that not all kids with ADHD still have it into adulthood. The figure it anywhere from 70 to 90 percent.

  10. Collin Smith’s avatar

    “And it IS true that not all kids with ADHD still have it into adulthood. “

    It is true that it is the official position of NIMH, but I don’t buy that at all…

    It is a genetically inherited disorder. If it “goes away” they either were misdiagnosed or they have learned to adapt. Unfortunately, without treatment they will most likely never reach there full potential. Just think what Einstein might have been able to accomplish if he had more support.

    Reply

    1. Gina Pera’s avatar

      Collin, it’s not the official position of NIMH. It is the “official position” of the research.

      Genetics are not carved in stone; there is an interplay over time with development and environment.

      Moreover, a child who has ADHD is not a clone of the parent, insofar as ADHD or anything else. The child will have genes from both parents, sometimes augmenting ADHD qualities (especially if both parents have ADHD) and sometimes mitigating.

      It used to be thought that most children outgrew ADHD, but science has shown us otherwise. It is Russell Barkley and his team that gave us the latest data on ADHD persisting into adulthood. Ninety percent is a lot higher than previous years’ 0 percent. ;-)

      g

  11. Collin Smith’s avatar

    The scientific community is global, however what is supported in any particular country is political. Like all federal agencies the NIMH’s position is going to be based on research and a very healthy dose of politics. It is simply unavoidable. The research the NIMH (NIH) chooses to support will affect policy. Thankfully, the research is changing to support a lifelong condition. While, not all children will have ADHD passed to them by their parents. If they do have the genes that cause ADHD, it does not “go away”. No one would ever suggest that a child with Type I diabetes would “get over it”. Anyway, this is not a petition to get the scientific community as a whole to agree with me, just the policy makers.

    Collin

    Reply

    1. Gina Pera’s avatar

      Points well taken, Collin. All the more reason to pay attention to our political candidates. Chuck Grassley, for example, has led a one-man campaign to attack psychiatric researchers (no big surprise that Blue Cross/Blue Shield number among his top 5 campaign donors, last I checked).

      But I will have to correct one point again. There are no “ADHD genes.” All the genes associated with ADHD are widely distributed in the human population. It is the combination and number of certain genes that conspire to create ADHD in an individual.

      As I said, even when parent and child have ADHD, it is not necessarily the same gene constellation that creates the condition. Parent and child are not clones. This is very important to understand.

      And yes, some children DO grow out of it. Their brains mature, connections are made, other brain areas compensate. It happens.

  12. Collin Smith’s avatar

    I do not live in Iowa, but if I did, Chuck Grassley would not get my vote. Elected officials of his ilk are proof that Congress is no longer representative of the People. I am sure BCBS has a nice package waiting for him if he is unseated.

    Reply

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