Newsgroups: misc.kids.health,sci.med,misc.health.alternative
Subject: Re: Ritalin class action suit
From: dyer@spdcc.com (Steve Dyer)
Date: Fri, 26 May 2000 19:31:36 GMT

In article <392EA155.ACA5F678@bc.cc.ca.us>,
Chris Leithiser  <cleithis@bc.cc.ca.us> quoted someone else:
   >> I have found in some cases prescriptions
   >> are not safe under doctors supervision, for example, my mother was
   >> prescribed antibiotics and cortisone at the same time by the same doctor,
   >> a real big no no and one that nearly killed her.

This so-called contraindication between "antibiotics and cortisone" (huh?)
doesn't make any sense.  Sounds like 3rd hand information garbled and
repeated by a medically naive mother to an equally medically naive son
or daughter.

Chris Leithiser  <cleithis@bc.cc.ca.us> wrote:
   >> a drug that is as addictive as Ritalin must be supervised, especially in
   >> children.
   >
   >Ritalin is not, repeat _not_, addictive when given as prescribed.

The term "addictive" is practically useless in this context, since
it has about a dozen informal meanings, and isn't used in the scientific
literature when authors are trying to be rigorous.  Sympathomimetic CNS
stimulants like Ritalin and even d-amphetamine/d-methamphetamine
aren't "addictive" when taken orally at recommended doses.  People can stop
taking these drugs at any time without any physical withdrawal syndrome.
Retrospective studies of their chronic use in children with ADD haven't
revealed any propensity for them to be misused in that population.

    >You have to work _hard_ to get addicted to Ritalin, and once you do, you've
    >got worse problems than addiction--emphysema, for example, or possibly
    >hepatitis from dirty needles.

Just to be clear, this is referring to dissolving and injecting the oral
tablets (that contain excipients such as talc that are dangerous when
injected.)  The effects of a drug like Ritalin when administered IV
is much stronger than when taken orally.

However, even oral preparations can be abused by people who:
want to get high, and to do that, they:

	take larger than recommended doses
	steadily increase the dose when they experience
		tolerance (i.e., when a dose that previously
		got them high no longer does.)
	(and this assumes these people have more-or-less
		free access to the drug to be able to
		take large doses chronically and regularly
		increase these doses)

This is an entirely different population using much higher doses of
the drug for a very different purpose.  Even a relatively mild
CNS stimulant like Ritalin can cause some of the more extreme
symptoms of amphetamine abuse if the subject has unlimited access
to the drug in an unsupervised setting and is intent on using it
as I describe above.  Ritalin was popular in the 1960's for the
treatment of "mild depression" (a poorly-defined term that
isn't used much anymore).  I don't know the details of how it
was sold in Sweden back them (perhaps w/o a Rx), but because it
was so freely available, there was a real social epidemic of
misuse, and that led to its being removed from the market in
that country by 1968 or 1969.  (I don't know whether it's once
again sold in Sweden under more stringent WHO-inspired drug laws,
now that it's been somewhat rehabilitated.)

   >But the fact that parents should supervise their childrens' medication
   >intake is no more a reason to restrict Ritalin use than it is to
   >restrict any _other_ medication.

Indeed.

--
Steve Dyer
dyer@ursa-major.spdcc.com

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.life-extension,sci.med,rec.drugs.smart
Subject: Re: RItalin and cancer
Date: Wed, 26 Jun 2002 12:55:25 -0700
Message-ID: <afd693$6cc$1@slb2.atl.mindspring.net>

Aruno Gasman wrote in message
<4d811e1d.0206261112.62ec4270@posting.google.com>...
>Hello. This is my first post to this group. I am a 48 year old farmer
>in Oklahoma. My son takes ritalin for "ADHD" as do the vast majority
>of his friends. I just had to post this as I am very angry about this
>scandal. [cancer risk caused by Ritalin in rodents]


Except you've got the wrong scandal-- or at least just a part of it. The
real scandal is that your son and the vast majority of his friends are on
speed sold to them by the pharmacy and prescribed by the doc. The very class
of drugs we used to warm kids to stay off of. And it's pretty much the same
kind of thing that "crystal meth" is-- basically it's crystal meth lite, in
a nice pill. It's a performance-enhancer and boredom-reducer and
focus-maker, which is why crank has been so big in the trucking and
meatpacking and other blue collar industries, lo these many years. And why
the prisons are bulging with people who made and used it, in order to deal
with the stresses of their Jerry Springer lives. Without that magic
permission slip from the doctor, that is. These days you don't even have to
be hyperactive to get it-- all you need is to show an attention deficit.
Not very hard in our schools for the Nintendo generation, let me tell you.

BTW, you don't really think that Ritalin/methylphenidate is likely to have
any extra cancer risk that plain old amphetamines don't, do you? And if it
does, they'll just switch the kids to plain old dexamphetamine.

--
I welcome email from any being clever enough to fix my address. It's open
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From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.parenting.solutions,misc.kids.health,sci.med,sci.med.nutrition,
	uk.people.health
Subject: Re: Death From Ritalin
Message-ID: <clGp9.22655$OB5.2127193@newsread2.prod.itd.earthlink.net>
Date: Fri, 11 Oct 2002 20:17:12 GMT

Mark Probert wrote in message ...

>> > >There has been no substantiated documented death from using
>> > >methylphenidate as prescribed.


Well, the problem is what counts as a "document" for you. A lot of people
(160 reports) have died while taking Ritalin between 1990 and 1997, and had
their doctors suspicious enough of the role of the drug to file an adverse
reaction report with the FDA. That's a voluntary thing-- I myself in many
years of clinical practice have filed only a couple of them. Most drug
reactions, even those the doctor is reasonably sure of, go UN reported.

Here's what the opposition says, and I've no reason to think they're making
up the numbers.

"Of 2,993 adverse reaction (AR) reports concerning "Ritalin" or
"methylphenidate" listed by the FDA's Division of Pharmacovigilance and
Epidemiology (DPE), from 1990 to 1997, there were 160 deaths and 569
hospitalizations--36 of them life-threatening. One hundred twenty-six (126)
were cardiovascular occurrences, and 949 central or peripheral nervous
system occurrences. There were 6 cases of "cardiomyopathy," 12 of
"arrhythmia," 7 of "bradycardia," (slow pulse), 5 of "bundle branch block,"
(impairment of conduction apparatus of the heart), 4 of "EKG abnormality," 5
"extrasystole," (heart rhythm abnormalities), 3 "heart arrest," 2 heart
failure, right," 10 "hypotension," (low BP), 1 "myocardial infarction," 15
"tachycardia" (rapid pulse)."

It's pretty much what I'd expect of an amphetamine-like chemical.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
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From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.parenting.solutions,misc.kids.health,sci.med,sci.med.nutrition,
	uk.people.health
Subject: Re: Death From Ritalin
Message-ID: <j0Lp9.23444$OB5.2166455@newsread2.prod.itd.earthlink.net>
Date: Sat, 12 Oct 2002 01:36:15 GMT

Wyle E. Coyote, M.D. wrote in message
<7AF32C13A5DD2762.238FCD2561F2DB45.7529FCCD1723948E@lp.airnews.net>...

>> It's pretty much what I'd expect of an amphetamine-like chemical.
>
>What is the rate of each of these adverse events? What is the rate of these
>adverse events in the general population of people similar to those taking
>ritalin? Is the rate higher, lower or the same as you would expect in the
>general population?


Ah, who knows?  This is not a controlled study, it's a bunch of possible
drug reaction reports. Long term placebo-controlled studies of Ritalin which
pay careful attention to cardiovascular side effects don't exist, for some
strange reason. We just have all these reports and nobody following them up.

Of course we have no good controlled studies of the side effects of cocaine
use, either. Just a lot of case reports of people who came in full of
cocaine with bad things happening to them. IOW, very much the same kind of
data, except you believe the second, and not the first. Hmmmm.


>How do you know that any of these events were caused by Ritalin?

Why, I don't. How do you know any of the bad things you think are caused by
cocaine,  are caused by cocaine? (If you quote me animal tox studies, I get
to do that with Ritalin too-- fair?)


>Could they have been caused by drug abuse?

Why, yes. If the doctor hasn't written you a prescription, it's drug abuse,
right?  Amazing how your body knows what's on a pill bottle label, and in
the druggist's records.

Could they all have been caused by overdose, is what I think you mean. Sure,
maybe. Same for cocaine, also.  If cocaine users chewed the leaves instead
of smoking or snorting the stuff, I'm sure they'd have a much easier time
with the physical problems.


> Could the hypotension been casued by other
>drugs the patients were taking (soem of the ADHD meds can cause low blood
>pressure)?

Yep. Also cardiac dysrthymias can lower blood pressure. Also your pressure
can go down if you're used to sympathomimetics and you don't get any, as
with pheochromocytoma sufferers between bouts.


>You state that is what you would expect of an amphetamine-like chemical?
>Well,what is the effects of Ritalin on blood vessels? Does it effect them
>the same way amphetamines do? What are the similar rates for amphetamines?
>Or are you just guessing what to expect?

No, Ritalin is a Grade AAA sympathomimetic, and does everything
methamphetamine does. Really.  Recommend you try some to get a gut feel for
just what this drug is.

But then I'm always recommending that doctors try their own drugs, at least
once. Damn, they'd all be a lot wiser if they did.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.parenting.solutions,misc.kids.health,sci.med,sci.med.nutrition,
	uk.people.health
Subject: Re: Death From Ritalin
Message-ID: <Yo%p9.26446$lV3.2338152@newsread1.prod.itd.earthlink.net>
Date: Sat, 12 Oct 2002 20:14:48 GMT

Wyle E. Coyote, M.D. wrote in message
<70914A8232F74BB9.26BC60B317B20A91.6278602EFCDD91A5@lp.airnews.net>...

>Actually, careful attention to possible cardiac changes (e.g., with EKG's)
>is part of the followup on all patients on Ritalin.


That is complete nonsense, describing neither recommendations nor the
average actual clinical practice. You either make this stuff up as you go
along, describing things as you wish they were, or else you're posting from
the Wyle E. Coyote alternate 'toon universe.  You know, the one where
physics is different, and you don't actually fall until you look down and
notice that you're supported on nothing but air?

Well, right now, in case you hadn't noticed, you're supported on nothing but
air, Wylie. Don't look down.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.parenting.solutions,misc.kids.health,sci.med,sci.med.nutrition,
	uk.people.health
Subject: Re: Death From Ritalin
Message-ID: <vp6p9.18794$OB5.1840799@newsread2.prod.itd.earthlink.net>
Date: Thu, 10 Oct 2002 03:24:11 GMT

Darwin wrote in message ...

>Even if one can prove the above has an impact on 1 person that is not
>reason enough to prove the same would affect all people with AD/HD It may
>be that the people it works on never had AD/HD to begin with.  And it may
>be utter bullshit! AD/HD doesn't just affect children and not all people
>"grow" out of it. There are a great many LD's that have similar
>characteristics to AD/HD but are not AD/HD yet the medication has a
>beneficial effect.  I see no reason to change a prescription just because
>a dx is wrong but the medication works just fine

The "medication" works just fine in almost everyone. That's why they call it
speed, don't you know. The Air Force has used amphetamines for years to
improve performance in combat pilots, and nobody thinks they all have adult
ADD. There are a number of studies to show that the effects of amphetamines
are much the same in "normal children" as they are in ADD children-- and in
most adults for that matter: they focus attention and allow greater
concentration. Golly. Same as adrenaline.

The supposed "reverse effect" of amphetamines on kids with ADD is one of the
great medical myths of modern times (even a few doctors believe it). But of
course if there was anything to the idea, the reaction to amphetamines could
be used as a powerful diagnostic tool, right? A great help in diagnosing a
disease which doesn't HAVE any good differentiating chemical tests. But
there's a very good reason why they don't do a formal amphetamine challenge
to see which kids have AD/HD-- it wouldn't work. So instead, the current fad
is to make the diagnosis, then treat with the drug. And behold, a miracle!
Johnny studies better on speed! We must have been right about his problem!
What wonderful diagnosticians we are.

Of course, as with alcohol or any drug, there are people who will ruin their
lives with amphetamines.  None of which means anything with regard to the
people who are capable of using it as a tool, occasionally. But that's true
of all drugs, prescribed and not, legal and no, used to treat "disease" or
not.  There are no bad drugs; just bad combinations of particular drugs and
particular people.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.parenting.solutions,misc.kids.health,sci.med,sci.med.nutrition,
	uk.people.health
Subject: Re: Death From Ritalin
Message-ID: <fCHp9.22849$OB5.2136136@newsread2.prod.itd.earthlink.net>
Date: Fri, 11 Oct 2002 21:43:39 GMT

Wyle E. Coyote, M.D. wrote in message ...
>
>"Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com> wrote in message
>news:vp6p9.18794$OB5.1840799@newsread2.prod.itd.earthlink.net...

>> The "medication" works just fine in almost everyone. That's why they
>> call it speed, don't you know. The Air Force has used amphetamines for
>> years to improve performance in combat pilots, and nobody thinks they
>> all have adult ADD. There are a number of studies to show that the
>> effects of amphetamines are much the same in "normal children" as they
>> are in ADD children-- and in most adults for that matter: they focus
>> attention and allow greater concentration. Golly. Same as adrenaline.
>>
>
>Yeah, but people with ADHD have problems with focusing, hyperactiving
>and/or attention that most people do not.


Everybody does if you make them sit or study long enough. I'm sure YOU have,
and like me you're probably better at it than average. This is a bell curve.
But as I remarked to Mr. Probert, the fact that some kids can't do a chin-up
to save their lives, is not an excuse to give them anabolic steroids. Even
if it moves them into the normal strength range.


>> The supposed "reverse effect" of amphetamines on kids with ADD is one
>> of the great medical myths of modern times (even a few doctors believe
>> it).
>
>Actually, more than a few doctors beleive it. Most do. Because of the
>evidence that shows that it is real.

I know of no such evidence, and I've been through the literature fairly
carefully. Of course, I can't say it doesn't exist. Here's your chance to
impress me by citing it.


>I would disagree. THere are some drugs that are nearly always bad. Crack
>cocaine is one.

Council objects that "crack cocaine" is as much a delivery method and method
of use, as a drug per se. Coca leaves when chewed are rather pleasant and
not too dangerous.  On the other hand, if you free-base morphine or
methylphenidate and smoke them, you'll get quite a different effect than you
get when you use them in slower-release forms.

>And there is evidence that people with ADHD who are treated
>are less likely to use drugs recreationally than people with ADHD who are
>not treated.

Yes, if you use the word "recreational" as synonym for "unauthorized."  But
if you merely observe that people medicated or drugged by doctors are less
likely to go out and try to medicate or drug themselves, so what?  It's
probably true, but what of it? Again, no doubt it would be true for anabolic
steroids and athletics as well (that East German team only needed the team
physician, not a pusher), but you'd hardly dare use it as an argument.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
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From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.parenting.solutions,misc.kids.health,sci.med,sci.med.nutrition,
	uk.people.health
Subject: Re: Death From Ritalin
Message-ID: <3cHp9.22776$OB5.2133294@newsread2.prod.itd.earthlink.net>
Date: Fri, 11 Oct 2002 21:15:43 GMT

Mark Probert wrote in message ...

>The magnitude of the response to this type of medication is far different
>when a person has ADHD than when they do not.

COMMENT:

I'm sorry, but I'd like to see your evidence for that. I've been able to
find very few studies in which normal children were used as controls in
Ritalin performance tests, and in those that exist, it improves the normals
similarly to the kids with the attention problems. I defy you to find me ANY
well demonstrated and repeatable finding of a differential effect of this
drug on test performance of normal kids vs the hyperactive.

Now, it may be true that Ritalin moves the kids with attention problems into
the "normal" range, while moving the kids with no attention problems into
the hypervigilant range. We all squirm when we've sat in a test or studied
long enough, and many of us would then do better with a pill. But so what?
We'd do better with cocaine, too, for a while. And with methamphetamine.

Suppose I found that injecting high school boys with testosterone moved the
wimpy kids into the normal strength range, while improving the kids with
normal strength into the athletic range, and turning the already athletic
kids into animals? I have no doubt that something like this would indeed
happen. Just about everybody would improve. But the fact that this is true
(some kids ARE out of the bell curve when it comes to athletic ability) does
not justify diagnosis of a "strength deficit disorder," to be treated
routinely with a performance-enhancing drug, so that kids who are wimps can
get a better grade in P.E.. That would simply lead to the nerd and special
olympics, on steroids. Which is very much like what we see now in school,
with 6 million kids diagnosed as having "AD/HD," and taking speed to study.


J Child Psychol Psychiatry 1996 Nov;37(8):971-87

Error patterns on the continuous performance test in non-medicated and
medicated samples of children with and without ADHD: a meta-analytic
review.

Losier BJ, McGrath PJ, Klein RM.

Dalhousie University, Halifax, Nova Scotia.

We systematically reviewed the patterns of Continuous Performance Test (CPT)
errors of omission and commission exhibited by normal children and children
with Attention Deficit and Hyperactivity Disorder (ADHD) under no drug,
placebo and methylphenidate drug conditions. Findings from 26 studies were
submitted to a meta-analytic procedure. In contrast to the contradictory
findings of individual reports, our results revealed that children with ADHD
made significantly more errors of omission and commission than normal
children. As well, in children with ADHD and treated with methylphenidate,
statistically significant reductions in the rate of both error types were
noted. The effects of methylphenidate on the percentage of hits (i.e. 1 -
omissions) were greater in experiments using shorter stimulus duration,
smaller number of trials and higher probability of a target. Using Signal
Detection Theory (SDT) parameters, we found that children with ADHD were
less sensitive to the difference between targets and non-targets than their
normal counterparts, while showing a comparable response bias. Similarly,
the effects of methylphenidate were restricted to improving the sensitivity,
while not affecting response bias, in both normal children and
those with ADHD.

Publication Types:
Meta-Analysis

PMID: 9119944 [PubMed - indexed for MEDLINE]




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I welcome email from any being clever enough to fix my address. It's open
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From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Death From Ritalin
Message-ID: <aiFq9.34329$lV3.2708322@newsread1.prod.itd.earthlink.net>
Date: Mon, 14 Oct 2002 19:54:46 GMT

Keith F. Lynch wrote in message ...
>Steve Harris <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>> ... 7 of "bradycardia," (slow pulse), ... 15 "tachycardia" (rapid
>>pulse)."
>>
>> It's pretty much what I'd expect of an amphetamine-like chemical.
>
>How can the same substance cause both bradycardia and tachycardia?
>--
>Keith F. Lynch - kfl@keithlynch.net - http://keithlynch.net/


Two possibilities that come to mind are:

1) The bradycardia is simply a false association, and wasn't being caused by
the stuff. Yes, of course that implies that some of the tachycardia isn't
either, except that in controlled studies, tachycardia and increase in blood
pressure are the two most common physiological side effects of Ritalin, at
least at the higher doses (and to make things complicated there is a recent
study suggesting that low doses of Ritalin in slow release forms may not
raise BP and HR enough to worry about in most people).

2). Another possibility is that this was reactive bradycardia, of the sort
that happens in people who adapt to doses of epinephrine or amphetamine,
when the drug is withdrawn.

SBH

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I welcome email from any being clever enough to fix my address. It's open
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