http://www.nytimes.com/2013/12/15/magazine/googles-plan-for-global-domination-dont-ask-why-ask-where.html?src=un&feedurl=http%3A%2F%2Fjson8.nytimes.com%2Fpages%2Fmagazine%2Findex.jsonp

http://www.nytimes.com/2013/12/17/business/glaxo-says-it-will-stop-paying-doctors-to-promote-drugs.html?src=me&ref=general

http://www.nytimes.com/2013/12/17/business/whole-foods-finds-success-in-smaller-cities.html?src=me&ref=general

http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?src=me&ref=general

http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?src=me&ref=general

http://www.motherjones.com/tom-philpott/2011/09/meat-industry-antibiotic-resistance

http://www.motherjones.com/tom-philpott/2011/09/meat-industry-antibiotic-resistance

http://evolution.berkeley.edu/evolibrary/news/130501_superbugs

Antibiotic resistant bacteria at the meat counter
May 2013

The pork chops you buy in the supermarket neatly packaged in plastic and styrofoam may look completely sterile, but are, in fact, likely to be contaminated with disease-causing bacteria — and not with just any old bugs, but with hard-to-treat, antibiotic resistant strains. In a recently published study, researchers with the National Antimicrobial Resistance Monitoring System bought meat from a wide sampling of chain grocery stores across the country and analyzed the bacteria on the meat. Resistant microbes were found in 81% of ground turkey samples, 69% of pork chops, 55% of ground beef samples, and 39% of chicken parts. Of course, thoroughly cooking the meat will kill the germs, but if the meat is undercooked or contaminates other food with its bacteria — perhaps via a shared cutting board — the result could be an infection that can’t be cured with common medications. Such infections are a serious health concern — a strain of antibiotic resistant staph was recently estimated to cause nearly 20,000 deaths per year in the U.S. — and the problem seems to be getting worse. An evolutionary perspective helps us understand how antibiotic resistance arises in the first place and why the prevalence of resistant bugs in livestock has health professionals and scientists worried.
Where’s the evolution?
It should be no surprise that antibiotic resistant bacteria are the products of evolution via natural selection: as bacteria reproduce, small, random errors (i.e., mutations) occur as their DNA is copied. Just by chance, some of those mutations may help their bearers survive and reproduce better and so will increase in frequency in the bacterial population. Other mutations may be detrimental and will be weeded out of the population. Still others may have no impact at all to the bacterium’s fitness (i.e., neutral mutations) and will change in frequency through genetic drift. When antibiotics flood the environment of the bacteria, individuals that happen to carry random mutations that allow them to survive and reproduce despite the drug will be favored. Eventually, the entire lineage of bacteria may carry genes that confer antibiotic resistance.

This process seems to be inevitable. If a bacterial lineage is consistently exposed to a particular antibiotic, it will eventually evolve resistance to that drug, and this will occur in the soil, in livestock, in the human body — wherever bacteria are exposed to antibiotics. This same basic process is responsible for the evolution of advantageous traits in familiar organisms, like a hawk’s keen eyesight or a polar bear’s insulating fur. However, bacteria have a leg up on birds and bears when it comes to evolution. Most species rely on mutations somewhere in their historical lineage for their genetic variation — that is, an improved ability to spot prey will evolve in a lineage of hawks only if mutations conferring keener sight occurred somewhere in the hawk lineage and were then passed down to the generation of hawks experiencing natural selection. Bacteria, on the other hand, get their genetic variation both from their ancestral lineage and through a process known as horizontal transfer.

In horizontal transfer, organisms share genetic material with one another directly, as opposed to passing genetic material only to their offspring. In this way, genes from distantly related lineages of bacteria can wind up in the same individual. A gene version that first arose in Escherichia coli could easily be passed on to Salmonella.

Horizontal transfer represents a special danger when it comes to the evolution of resistance because, through gene sharing, antibiotic resistance genes that evolve and become common in one lineage of bacteria that is exposed to a particular antibiotic can be passed to distantly related bacterial lineages. In other words, a bacterial lineage can evolve resistance to a particular antibiotic even if its ancestors never carried a mutation that conferred resistance to that drug. With all this genetic variation being shared, antibiotic resistant bacterial strains can evolve quickly. Furthermore, different antibiotics often have similar modes of action (e.g., amoxicillin and methicillin both work by preventing bacteria from forming cell walls), so resistance to one drug often means partial resistance to a host of other medications. To make matters even worse, bacteria often transfer multiple genes for resistance to different antibiotics on the same piece of DNA. Since the genes are physically attached to one another, selecting for one of those resistance genes lets the others hitchhike to high frequency. So exposing a bacterial population to say, streptomycin, may also unintentionally favor the evolution of a strain that resists many other antibiotics as well — making for a particularly hard-to-cure infection.

Bacteria have many characteristics that allow them to evolve resistance to whatever antibiotics we throw their way — short generation times, high mutation rates, and horizontal transfer — and current agricultural practices (in particular, the heavy use of antibiotics in livestock) seem destined to speed this process even further. In the U.S., around 80% of antibiotics are destined for farm animals, not for treating human disease. The majority of those animal antibiotics are used preventatively and to promote faster growth and speed meat production, not to treat sick individuals. Unfortunately, this approach also encourages the evolution and proliferation of antibiotic resistant strains on factory farms. So, it should come as no surprise that a large percentage of supermarket meat carries antibiotic resistant bugs!

Clearly, the ubiquity of antibiotic resistant bacteria in livestock has implications far beyond highlighting the need to cook meat thoroughly. It suggests that, lurking in farm animals, is a vast pool of dangerous resistance genes that could easily make their way out of the bacteria in which they currently reside and into strains that would represent an even more significant human health threat. We have many lines of evidence suggesting that horizontal transfer of genes, including resistance genes, is commonplace among bacteria. What we have not had is a major outbreak of an antibiotic resistant infection that has been definitively linked to resistance from bacteria inhabiting livestock — yet. If the American Medical Association, the World Health Organization, and the National Academy of Sciences have their way, we may be able to avoid that fate, at least for certain antibiotics. These groups have all signed on to support new legislation that would prevent widespread use of certain antibiotics on livestock, helping to protect the effectiveness of these drugs in humans.

The Selling of Attention Deficit Disorder
The Number of Diagnoses Soared Amid a 20-Year Drug Marketing Campaign
“This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels,” Keith Conners, a psychologist and early advocate for recognition of A.D.H.D., said of the rising rates of diagnosis of the disorder.Karsten Moran for The New York Times
The Selling of Attention Deficit Disorder
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By ALAN SCHWARZ DECEMBER 14, 2013
After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder, Keith Conners could be celebrating.

Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurological problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic A.D.H.D., helping youngsters succeed in school and beyond.

But Dr. Conners did not feel triumphant this fall as he addressed a group of fellow A.D.H.D. specialists in Washington. He noted that recent data from the Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

billion
Sales of prescription stimulants have more than quintupled since 2002.
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$8
6
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Source: IMS Health
Stimulant Sales
The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.

But even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.

Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.

A 2002 ad for Adderall showed a mother playing with her son and saying, “Thanks for taking out the garbage.”

The Food and Drug Administration has cited every major A.D.H.D. drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.

Sources of information that would seem neutral also delivered messages from the pharmaceutical industry. Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often that discredit growing concerns about overdiagnosis.

Many doctors have portrayed the medications as benign — “safer than aspirin,” some say — even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction. Patient advocacy groups tried to get the government to loosen regulation of stimulants while having sizable portions of their operating budgets covered by pharmaceutical interests.

VIDEO
How Drug Companies
Sell A.D.H.D.
What makes A.D.H.D. ads so effective? Dr. Aaron Kesselheim, a Harvard professor, analyzes several ads and discusses how many of them play on parents’ common fears about their children.

Poh Si Teng and Alan Schwarz

Companies even try to speak to youngsters directly. Shire — the longtime market leader, with several A.D.H.D. medications including Adderall — recently subsidized 50,000 copies of a comic book that tries to demystify the disorder and uses superheroes to tell children, “Medicines may make it easier to pay attention and control your behavior!”

Profits for the A.D.H.D. drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health.

Even Roger Griggs, the pharmaceutical executive who introduced Adderall in 1994, said he strongly opposes marketing stimulants to the general public because of their dangers. He calls them “nuclear bombs,” warranted only under extreme circumstances and when carefully overseen by a physician.

Psychiatric breakdown and suicidal thoughts are the most rare and extreme results of stimulant addiction, but those horror stories are far outnumbered by people who, seeking to study or work longer hours, cannot sleep for days, lose their appetite or hallucinate. More can simply become habituated to the pills and feel they cannot cope without them.

Tom Casola, the Shire vice president who oversees the A.D.H.D. division, said in an interview that the company aims to provide effective treatment for those with the disorder, and that ultimately doctors were responsible for proper evaluations and prescriptions. He added that he understood some of the concerns voiced by the Food and Drug Administration and others about aggressive ads, and said that materials that run afoul of guidelines are replaced.

“Shire — and I think the vast majority of pharmaceutical companies — intend to market in a way that’s responsible and in a way that is compliant with the regulations,” Mr. Casola said. “Again, I like to think we come at it from a higher order. We are dealing with patients’ health.”

A spokesman for Janssen Pharmaceuticals, which makes Concerta, said in an email, “Over the years, we worked with clinicians, parents and advocacy groups to help educate health care practitioners and caregivers about diagnosis and treatment of A.D.H.D., including safe and effective use of medication.”

Now targeting adults, Shire and two patient advocacy groups have recruited celebrities like the Maroon 5 musician Adam Levine for their marketing campaign, “It’s Your A.D.H.D. – Own It.” Online quizzes sponsored by drug companies are designed to encourage people to pursue treatment. A medical education video sponsored by Shire portrays a physician making a diagnosis of the disorder in an adult in a six-minute conversation, after which the doctor recommends medication.

Like most psychiatric conditions, A.D.H.D. has no definitive test, and most experts in the field agree that its symptoms are open to interpretation by patients, parents and doctors. The American Psychiatric Association, which receives significant financing from drug companies, has gradually loosened the official criteria for the disorder to include common childhood behavior like “makes careless mistakes” or “often has difficulty waiting his or her turn.”

The idea that a pill might ease troubles and tension has proved seductive to worried parents, rushed doctors and others.

“Pharma pushed as far as they could, but you can’t just blame the virus,” said Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek, Calif. “You have to have a susceptible host for the epidemic to take hold. There’s something they know about us that they utilize and exploit.”

Selling to Doctors

Modern marketing of stimulants began with the name Adderall itself. Mr. Griggs bought a small pharmaceutical company that produced a weight-loss pill named Obetrol. Suspecting that it might treat a relatively unappreciated condition then called attention deficit disorder, and found in about 3 to 5 percent of children, he took “A.D.D.” and fiddled with snappy suffixes. He cast a word with the widest net.

All.

For A.D.D.

A.D.D. for All.

Adderall.

“It was meant to be kind of an inclusive thing,” Mr. Griggs recalled.

Roger Griggs, who introduced Adderall in 1994 before ads portraying medication as a way to improve grades and behavior were allowed, said, “There’s no way on God’s green earth we would ever promote” stimulants directly to consumers.Karsten Moran for The New York Times

Adderall quickly established itself as a competitor of the field’s most popular drug, Ritalin. Shire, realizing the drug’s potential, bought Mr. Griggs’s company for $186 million and spent millions more to market the pill to doctors. After all, patients can buy only what their physicians buy into.

As is typical among pharmaceutical companies, Shire gathered hundreds of doctors at meetings at which a physician paid by the company explained a new drug’s value.

Such a meeting was held for Shire’s long-acting version of Adderall, Adderall XR, in April 2002, and included a presentation that to many critics, exemplifies how questionable A.D.H.D. messages are delivered.

Dr. William W. Dodson, a psychiatrist from Denver, stood before 70 doctors at the Ritz-Carlton Hotel and Spa in Pasadena, Calif., and clicked through slides that encouraged them to “educate the patient on the lifelong nature of the disorder and the benefits of lifelong treatment.” But that assertion was not supported by science, as studies then and now have shown that perhaps half of A.D.H.D. children are not impaired as adults, and that little is known about the risks or efficacy of long-term medication use.

The PowerPoint document, obtained by The Times, asserted that stimulants were not “drugs of abuse” because people who overdose “feel nothing” or “feel bad.” Yet these drugs are classified by the government among the most abusable substances in medicine, largely because of their effects on concentration and mood. Overdosing can cause severe heart problems and psychotic behavior.

Slides described side effects of Adderall XR as “generally mild,” despite clinical trials showing notable rates of insomnia, significant appetite suppression and mood swings, as well as rare instances of hallucinations. Those side effects increase significantly among patients who take more pills than prescribed.

Another slide warned that later in life, children with A.D.H.D. faced “job failure or underemployment,” “fatal car wrecks,” “criminal involvement,” “unwanted pregnancy” and venereal diseases, but did not mention that studies had not assessed whether stimulants decreased those risks.

Dr. Conners of Duke, in the audience that day, said the message was typical for such gatherings sponsored by pharmaceutical companies: Their drugs were harmless, and any traces of A.D.H.D. symptoms (which can be caused by a number of issues, including lack of sleep and family discord) should be treated with stimulant medication.

In an interview last month, Dr. Dodson said he makes a new diagnosis in about 300 patients a year and, because he disagrees with studies showing that many A.D.H.D. children are not impaired as adults, always recommends their taking stimulants for the rest of their lives.

He said that concern about abuse and side effects is “incredibly overblown,” and that his longtime work for drug companies does not influence his opinions. He said he received about $2,000 for the 2002 talk for Shire. He earned $45,500 in speaking fees from pharmaceutical companies in 2010 to 2011, according to ProPublica, which tracks such payments.

“If people want help, my job is to make sure they get it,” Dr. Dodson said. Regarding people concerned about prescribing physicians being paid by drug companies, he added: “They like a good conspiracy theory. I don’t let it slow me down.”

Many of the scientific studies cited by drug company speakers involved Dr. Joseph Biederman, a prominent child psychiatrist at Harvard University and Massachusetts General Hospital. In 2008, a Senate investigation revealed that Dr. Biederman’s research on many psychiatric conditions had been substantially financed by drug companies, including Shire. Those companies also paid him $1.6 million in speaking and consulting fees. He has denied that the payments influenced his research.

Dr. Conners called Dr. Biederman “unequivocally the most published psychopharmacology maven for A.D.H.D.,” one who is well known for embracing stimulants and dismissing detractors. Findings from Dr. Biederman’s dozens of studies on the disorder and specific brands of stimulants have filled the posters and pamphlets of pharmaceutical companies that financed the work.

Those findings typically delivered three messages: The disorder was underdiagnosed; stimulants were effective and safe; and unmedicated A.D.H.D. led to significant risks for academic failure, drug dependence, car accidents and brushes with the law.

Dr. Biederman was frequently quoted about the benefits of stimulants in interviews and company news releases. In 2006, for example, he told Reuters Health, “If a child is brilliant but is doing just O.K. in school, that child may need treatment, which would result in their performing brilliantly at school.”

This year, Dr. Biederman told the medical newsletter Medscape regarding medication for those with A.D.H.D., “Don’t leave home without it.”

Dr. Biederman did not respond to requests for an interview.

Most of Dr. Biederman’s critics said that they believed his primary motivation was always to help children with legitimate A.D.H.D. and that risks of untreated A.D.H.D. can be significant. What concerned them was how Dr. Biederman’s high-profile and unwavering promotion of stimulants armed drug companies with the published science needed to create powerful advertisements — many of which cast medications as benign solutions to childhood behavior falling far short of legitimate A.D.H.D.

“He gave them credibility,” said Richard M. Scheffler, a professor of health economics and public policy at the University of California, Berkeley, who has written extensively on stimulants. “He didn’t have a balance. He became totally convinced that it’s a good thing and can be more widely used.”

Building a Message

Drug companies used the research of Dr. Biederman and others to create compelling messages for doctors. “Adderall XR Improves Academic Performance,” an ad in a psychiatry journal declared in 2003, leveraging two Biederman studies financed by Shire. A Concerta ad barely mentioned A.D.H.D., but said the medication would “allow your patients to experience life’s successes every day.”

Some studies had shown that stimulant medication helped some elementary school children with carefully evaluated A.D.H.D. to improve scores in reading and math tests, primarily by helping them concentrate. The concern, some doctors said, is that long-term, wider academic benefits have not been proved — and that ads suggesting they have can tempt doctors, perhaps subconsciously, to prescribe drugs with risks to healthy children merely to improve their grades or self-esteem.

Advertising Disorder
Drug companies have shifted marketing for A.D.H.D. medication through the years. Most recently, problems like divorce and auto accidents have been used to appeal to adults. Ads in the 1990s advertised improved grades at school as a central benefit. Early ads focused on depression and “the problem child.”

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CIBA

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CIBA

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CIBA

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Medeva Pharmaceuticals

2005
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Shire

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Shire

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Shire

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Shire

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Shire

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Shire

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Source: Various medical journals and consumer magazines
“There are decades of research into how advertising influences doctors’ prescribing practices,” said Dr. Aaron Kesselheim of Brigham and Women’s Hospital in Boston, who specializes in pharmaceutical ethics. “Even though they’ll tell you that they’re giving patients unbiased, evidence-based information, in fact they’re more likely to tell you what the drug company told them, whether it’s the benefits of the drugs or the risks of those drugs.”

Drug company advertising also meant good business for medical journals – the same journals that published papers supporting the use of the drugs. The most prominent publication in the field, The Journal of the American Academy of Child & Adolescent Psychiatry, went from no ads for A.D.H.D. medications from 1990 to 1993 to about 100 pages per year a decade later. Almost every full-page color ad was for an A.D.H.D. drug.

As is legal and common in pharmaceutical marketing, stimulants’ possible side effects like insomnia, irritability and psychotic episodes were printed in small type and dominated by other messages. One Adderall XR brochure included the recording of a man’s voice reassuring doctors: “Amphetamines have been used medically for nearly 70 years. That’s a legacy of safety you can count on.” He did not mention any side effects.

Drug companies used sales representatives to promote the drugs in person. Brian Lutz, a Shire salesman for Adderall XR from 2004 to 2009, said he met with 75 psychiatrists in his Oakland, Calif., territory at least every two weeks — about 30 to 40 times apiece annually — to show them posters and pamphlets that highlighted the medicine’s benefits for grades and behavior.

If a psychiatrist asked about issues like side effects or abuse, Mr. Lutz said, they were played down. He said he was told to acknowledge risks matter-of-factly for legal reasons, but to refer only to the small print in the package insert or offer Shire’s phone number for more information.

“It was never like, ‘This is a serious side effect, you need to watch out for it,’ ” Mr. Lutz recalled. “You wanted to give them more information because we’re talking about kids here, you know? But it was all very positive.”

A Shire spokeswoman said the company would not comment on any specific employee and added, “Shire sales representatives are trained to deliver fair and balanced presentations that include information regarding the safety of our products.”

Mr. Lutz, now pursuing a master’s degree and hoping to work in mental health, recalled his Shire work with ambivalence. He never lied or was told to lie, he said. He said he still would recommend Adderall XR and similar stimulants for A.D.H.D. children and adults.

What he regrets, he said, “is how we sold these pills like they were cars, when we knew they weren’t just cars.”

Selling to Parents

In September 2005, over a cover that heralded Kirstie Alley’s waistline and Matt Damon’s engagement, subscribers to People magazine saw a wraparound advertisement for Adderall XR. A mother hugged her smiling child holding a sheet of paper with a “B+” written on it.

“Finally!” she said. “Schoolwork that matches his intelligence.”

When federal guidelines were loosened in the late 1990s to allow the marketing of controlled substances like stimulants directly to the public, pharmaceutical companies began targeting perhaps the most impressionable consumers of all: parents, specifically mothers.

A magazine ad for Concerta had a grateful mother saying, “Better test scores at school, more chores done at home, an independence I try to encourage, a smile I can always count on.” A 2009 ad for Intuniv, Shire’s nonstimulant treatment for A.D.H.D., showed a child in a monster suit taking off his hairy mask to reveal his adorable smiling self. “There’s a great kid in there,” the text read.

“There’s no way in God’s green earth we would ever promote” a controlled substance like Adderall directly to consumers, Mr. Griggs said as he was shown several advertisements. “You’re talking about a product that’s having a major impact on brain chemistry. Parents are very susceptible to this type of stuff.”

The Food and Drug Administration has repeatedly instructed drug companies to withdraw such ads for being false and misleading, or exaggerating the effects of the medication. Many studies, often sponsored by pharmaceutical companies, have determined that untreated A.D.H.D. was associated with later-life problems. But no science determined that stimulant treatment has the overarching benefits suggested in those ads, the F.D.A. has pointed out in numerous warning letters to manufacturers since 2000.

Shire agreed last February to pay $57.5 million in fines to resolve allegations of improper sales and advertising of several drugs, including Vyvanse, Adderall XR and Daytrana, a patch that delivers stimulant medication through the skin. Mr. Casola of Shire declined to comment on the settlement because it was not fully resolved.

He added that the company’s current promotional materials emphasize how its medications provide “symptom control” rather than turn monsters into children who take out the garbage. He pointed to a Shire brochure and web page that more candidly than ever discuss side effects and the dangers of sharing medication with others.

However, many critics said that the most questionable advertising helped build a market that is now virtually self-sustaining. Drug companies also communicated with parents through sources who appeared independent, from support groups to teachers.

The primary A.D.H.D. patient advocacy group, Children and Adults with Attention-Deficit/Hyperactivity Disorder, or Chadd, was founded in 1987 to gain greater respect for the condition and its treatment with Ritalin, the primary drug available at the time. Start-up funding was provided by Ciba-Geigy Pharmaceuticals, Ritalin’s primary manufacturer. Further drug company support helped create public service announcements and pamphlets, some of which tried to dispel concerns about Ritalin; one Chadd “fact sheet” conflicted with 60 years of science in claiming, “Psychostimulant drugs are not addictive.”

The program from the 2000 annual convention of the patient advocacy group Chadd thanked its 11 primary sponsors, all drug companies.

A 1995 documentary on PBS detailed how Chadd did not disclose its relationship with drug companies to either the Drug Enforcement Administration, which it was then lobbying to ease government regulation of stimulants, or the Department of Education, with which it collaborated on an A.D.H.D. educational video.

Chadd subsequently became more open in disclosing its backers. The program for its 2000 annual convention, for example, thanked by name its 11 primary sponsors, all drug companies. According to Chadd records, Shire paid the group a total of $3 million from 2006 to 2009 to have Chadd’s bimonthly magazine, Attention, distributed to doctors’ offices nationwide.

Chadd records show that the group has historically received about $1 million a year, one-third of its annual revenue, from pharmaceutical company grants and advertising. Regarding his company’s support, Mr. Casola said, “I think it is fair to call it a marketing expense, but it’s an arm’s-length relationship.”

“We don’t control what they do,” he said. “We do support them. We do support broadly what they are trying to do in the marketplace — in society maybe is a better way to say it.”

Advocates Answer

The chief executive of Chadd, Ruth Hughes, said in an interview that most disease-awareness groups receive similar pharmaceutical support. She said drug companies did not influence the group’s positions and activities, and noted that Chadd receives about $800,000 a year from the C.D.C. as well.

“One pharma company wanted to get Chadd volunteers to work at their booth to sort of get peer counseling, and we said no, won’t do that, not going there,” Dr. Hughes said, adding, “It would be seen as an endorsement.”

A.D.H.D. patient advocates often say that many parents resist having their child evaluated because of the stigma of mental illness and the perceived risks of medication. To combat this, groups have published lists of “Famous People With A.D.H.D.” to reassure parents of the good company their children could join with a diagnosis. One, in circulation since the mid-1990s and now posted on the psychcentral.com information portal beside two ads for Strattera, includes Thomas Edison, Abraham Lincoln, Galileo and Socrates.

The idea of unleashing children’s potential is attractive to teachers and school administrators, who can be lured by A.D.H.D. drugs’ ability to subdue some of their most rambunctious and underachieving students. Some have provided parents with pamphlets to explain the disorder and the promise of stimulants.

Susan Parry, with her son, Andy, 30. When Andy was a boy, Mrs. Parry felt pressured to put him on stimulants.Rick Scibelli Jr. for The New York Times
Susan Parry, who raised three boys in a top public school system on Mercer Island, outside Seattle, in the 1990s, said teachers pushed her into having her feisty son Andy evaluated for A.D.H.D. She said one teacher told her that her own twins were thriving on Ritalin.

Mrs. Parry still has the pamphlet given to her by the school psychologist, which states: “Parents should be aware that these medicines do not ‘drug’ or ‘alter’ the brain of the child. They make the child ‘normal.’ ” She and her husband, Michael, put Andy on Ritalin. The Parrys later noticed that on the back of the pamphlet, in small type, was the logo of Ciba-Geigy. A school official told them in a letter, which they provided to The Times, that the materials had been given to the district by a Ciba representative.

“They couldn’t advertise to the general public yet,” said Michael Parry, adding that his son never had A.D.H.D. and after three years was taken off Ritalin because of sleep problems and heart palpitations. “But somebody came up with this idea, which was genius. I definitely felt seduced and enticed. I’d say baited.”

Although proper A.D.H.D. diagnoses and medication have helped millions of children lead more productive lives, concerns remain that questionable diagnoses carry unappreciated costs.

“They were telling me, ‘Honey, there’s something wrong with your brain and this little pill’s going to fix everything,’ ” said Micaela Kimball, who received the diagnosis in 1997 as a high school freshman in Ithaca, N.Y., and is now a freelance writer in Boston. “It changed my whole self-image, and it took me years to get out from under that.”

Today, 1 in 7 children receives a diagnosis of the disorder by the age of 18. As these teenagers graduate into adulthood, drug companies are looking to keep their business.

The New Frontier: Adults

The studio audience roared with excitement two years ago as Ty Pennington, host of “The Revolution” on ABC, demonstrated how having adult A.D.H.D. felt to him. He staged two people struggling to play Ping-Pong with several balls at once while reciting the alphabet backward, as a crowd clapped and laughed. Then things got serious.

The television host Ty Pennington has been featured in advertisements in which adult A.D.H.D. has been marketed by pharmaceutical companies.Michael Buckner/Getty Images

A psychiatrist on the program said that “the prison population is full of people with undiagnosed A.D.H.D.” He told viewers, “Go get this diagnosis” so “you can skyrocket.” He said that stimulant medication was effective and “safer than aspirin.”

No one mentioned that Mr. Pennington had been a paid spokesman for Shire from 2006 to 2008. His Adderall XR video testimonials – the medication “literally changed my life” and “gave me confidence,” he said in a 2008 ad — had drawn an F.D.A. reprimand for overstating Adderall’s effects while omitting all risks.

Mr. Pennington said through a spokeswoman: “I am not a medical expert. I am a television host.”

Many experts agree that the disorder was dismissed for too long as affecting only children. Estimates of the prevalence of adult A.D.H.D. in the United States — derived through research often backed by pharmaceutical companies — have typically ranged from 3 to 5 percent. Given that adults far outnumber children, this suggests that the adult market could be twice as large.

Because many doctors and potential patients did not think adults could have A.D.H.D., drug companies sold the concept of the disorder as much as their medications for it.

change from 2008
Younger
than 20
Aged 20
and older
+60%
40
20
’08
’09
’10
’11
’12
Marketing to Adults
Prescriptions for adults are growing more quickly than for children.
Source: IMS Health
“The fastest-growing segment of the market now is the new adults who were never diagnosed,” Angus Russell told Bloomberg TV in 2011 when he was Shire’s chief executive. Nearly 16 million prescriptions for A.D.H.D. medications were written for people ages 20 to 39 in 2012, close to triple the 5.6 million just five years before, according to IMS Health. No data show how many patients those prescriptions represent, but some experts have estimated two million.

Foreseeing the market back in 2004, Shire sponsored a booklet that according to its cover would “help clinicians recognize and diagnose adults with A.D.H.D.” Its author was Dr. Dodson, who had delivered the presentation at the Adderall XR launch two years before. Rather than citing the widely accepted estimate of 3 to 5 percent, the booklet offered a much higher figure.

“About 10 percent of adults have A.D.H.D., which means you’re probably already treating patients with A.D.H.D. even though you don’t know it,” the first paragraph ended. But the two studies cited for that 10 percent figure, from 1995 and 1996, involved only children; no credible national study before or since has estimated an adult prevalence as high as 10 percent.

Dr. Dodson said he used the 10 percent figure because, despite several studies estimating adult rates as far lower, “once a child has A.D.H.D., he does for life. It doesn’t go away with age.”

The booklet later quotes a patient of his named Scarlett reassuring doctors: “If you give me a drink or a drug, I’ll abuse it, but not this medication. I don’t consider it a drug. Drugs get abused. Medication helps people have satisfying lives.”

Shire’s 2008 print campaign for adult A.D.H.D. portrayed a gloomy future to prospective patients. One ad showed a happy couple’s wedding photo with the bride airbrushed out and “DIVORCED” stamped on it. “The consequences may be serious,” the ad said, citing a study by Dr. Biederman supported in part by Shire. Although Dr. Biederman’s study showed a higher rate of divorce among adults with the disorder, it did not assess whether stimulant treatment significantly deterred such consequences.

Questionable Quizzes

Adults searching for information on A.D.H.D. encounter websites with short quizzes that can encourage normal people to think they might have it. Many such tests are sponsored by drug companies in ways hidden or easily missed.

“Could you have A.D.H.D.?” beckons one quiz, sponsored by Shire, on the website everydayhealth.com. Six questions ask how often someone has trouble in matters like “getting things in order,” “remembering appointments” or “getting started” on projects.

A user who splits answers evenly between “rarely” and “sometimes” receives the result “A.D.H.D. Possible.” Five answers of “sometimes” and one “often” tell the user, “A.D.H.D. May Be Likely.”

In a nationwide telephone poll conducted by The Times in early December, 1,106 adults took the quiz. Almost half scored in the range that would have told them A.D.H.D. may be possible or likely.

About 570,000 people took the EverydayHealth test after a 2011 advertisement starring Mr. Levine of Maroon 5 sponsored by Shire, Chadd and another advocacy group, according to the website Medical Marketing & Media. A similar test on the website for Concerta prompted L2ThinkTank.com, which assesses pharmaceutical marketing, to award the campaign its top rating, “Genius.”

John Grohol, a Boston-area psychologist who licensed the test to EverydayHealth, said such screening tools do not make a diagnosis; they merely “give you a little push into looking into” whether you have A.D.H.D. Other doctors countered that, given many studies showing that doctors are strongly influenced by their patients’ image of what ails them, such tests invite too many patients and doctors to see the disorder where it is not.

Online Test Asks Whether You Could Have A.D.H.D., Too
A web page sponsored by the drug maker Shire features this quiz, which encourages adults with what many would consider common behavior to think they might have A.D.H.D. In a Times poll of 1,106 American adults asking the same questions by telephone, nearly half got a result of “A.D.H.D. Possible” or “A.D.H.D. May Be Likely.” Only 5 percent said they had received an A.D.H.D. diagnosis from a medical professional.

Try this six-question quiz to see how you score — then see how you compare with other Americans.
1. How often do you have trouble wrapping up the final details of a project once the challenging parts have been done?
NeverRarelySometimesOftenVery Often
“I think it is misleading,” said Dr. Tyrone Williams, a psychiatrist in Cambridge, Mass. “I do think that there are some people out there who are really suffering and find out that maybe it’s treatable. But these symptoms can be a bazillion things. Sometimes the answers are so simple and they don’t require prescriptions – like ‘How about eight hours of sleep, Mom, because four hours doesn’t cut it?’ And then all their A.D.H.D. symptoms magically disappear.”

Because studies have shown that A.D.H.D. can run in families, drug companies use the children’s market to grow the adult one. A pamphlet published in 2008 by Janssen, Concerta’s manufacturer — headlined “Like Parent, Like Child?” — claimed that “A.D.H.D. is a highly heritable disorder” despite studies showing that the vast majority of parents of A.D.H.D. children do not qualify for a diagnosis themselves.

A current Shire manual for therapists illustrates the genetic issue with a family tree: three grandparents with the disorder, all six of their children with it, and seven of eight grandchildren, too.

Insurance plans, increasingly reluctant to pay for specialists like psychiatrists, are leaving many A.D.H.D. evaluations to primary-care physicians with little to no training in the disorder. If those doctors choose to learn about the diagnostic process, they can turn to web-based continuing-education courses, programs often subsidized by drug companies.

A recent course titled “Unmasking A.D.H.D. in Adults,” on the website Medscape and sponsored by Shire, featured an instructional video of a primary-care physician listening to a college professor detail his work-related sleep problems. After three minutes he described some attention issues he had as a child, then revealed that his son was recently found to have the disorder and was thriving in college on medication.

Six minutes into their encounter, the doctor said: “If you have A.D.H.D., which I believe you do, family members often respond well to similar medications. Would you consider giving that a try?”

The psychiatrist who oversaw the course, Dr. David Goodman of Johns Hopkins and the Adult Attention Deficit Disorder Center of Maryland, said that he was paid several thousand dollars to oversee the course by Medscape, not Shire directly, and that such income did not influence his decisions with patients. But as he reviewed the video in September, Dr. Goodman reconsidered its message to untrained doctors about how quickly the disorder can be assessed and said, “That was not an acceptable way to evaluate and conclude that the patient has A.D.H.D.”

A Shire spokeswoman declined to comment on the video and the company’s sponsorship of it.

Mr. Casola said Shire remains committed to raising awareness of A.D.H.D. Shire spent $1 million in the first three quarters of 2013, according to company documents, to support A.D.H.D. conferences to educate doctors. One this autumn found J. Russell Ramsay, a psychologist at the University of Pennsylvania’s medical school, who also serves as a consultant and speaker for Shire, reading aloud one of his slides to the audience: “A.D.H.D. – It’s Everywhere You Want to Be.”

“We are a commercial organization trying to bring health care treatments to patients,” Mr. Casola said. “I think, on balance, we are helping people.”

The British drug maker GlaxoSmithKline will no longer pay doctors to promote its products and will stop tying compensation of sales representatives to the number of prescriptions doctors write, its chief executive said Monday, effectively ending two common industry practices that critics have long assailed as troublesome conflicts of interest.
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Neil Hall/Reuters
Andrew Witty, Glaxo’s chief executive, said the changes are part of an effort to “to try and make sure we stay in step with how the world is changing.”
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The announcement appears to be a first for a major drug company — although others may be considering similar moves — and it comes at a particularly sensitive time for Glaxo. It is the subject of a bribery investigation in China, where authorities contend the company funneled illegal payments to doctors and government officials in an effort to lift drug sales.

Andrew Witty, Glaxo’s chief executive, said in a telephone interview Monday that its proposed changes were unrelated to the investigation in China, and were part of a yearslong effort “to try and make sure we stay in step with how the world is changing,” he said. “We keep asking ourselves, are there different ways, more effective ways of operating than perhaps the ways we as an industry have been operating over the last 30, 40 years?”

For decades, pharmaceutical companies have paid doctors to speak on their behalf at conferences and other meetings of medical professionals, on the assumption that the doctors are most likely to value the advice of trusted peers.

But the practice has also been criticized by those who question whether it unduly influences the information doctors give each other and can lead them to prescribe drugs inappropriately to patients. All such payments by pharmaceutical companies are to be made public next year under requirements of the Obama administration’s health care law.

Under the plan, which Glaxo said would be completed worldwide by 2016, the company will no longer pay health care professionals to speak on its behalf about its products or the diseases they treat “to audiences who can prescribe or influence prescribing,” it said in a statement. It will also stop providing financial support directly to doctors to attend medical conferences, a practice that is prohibited in the United States through an industry-imposed ethics code but that still occurs in other countries. In China, the authorities have said Glaxo compensated doctors for travel to conferences and lectures that never took place.

Mr. Witty declined to comment on the investigation because he said it was still underway.

Glaxo will continue to pay doctors consulting fees for market research because Mr. Witty said it was necessary for the company to gain insight from doctors about their products, but he said that activity would be limited in scope. A Glaxo spokesman said that each year the company spends “tens of millions” of dollars globally on the practices that it was ending, but declined to be more specific.

Glaxo is among the largest drug companies in the world, reporting global third-quarter sales of 6.51 billion pounds, or $10.1 billion, a 1 percent rise from the same period a year ago. Sales fell markedly in China as the investigation proceeded.

The move won qualified praise from Dr. Jerry Avorn, a professor at Harvard Medical School who has written critically about the industry’s marketing practices.

“It’s a modest acknowledgment of the fact that learning from a doctor who is paid by a drug company to give a talk about its products isn’t the best way for doctors to learn about those products,” Dr. Avorn said. But he noted that Glaxo would continue to provide what the company described in a statement as “unsolicited, independent educational grants” to continue educating doctors about their products.

He said that in the past the grants had often been provided to for-profit companies that rely on such payments from drug companies, raising questions about whether they were providing truly independent information.

Mr. Witty said while the details were still being worked out, the company intended to provide such grants to respected educational institutions and medical societies. “I’d like to look for those sorts of partners, and I do not envision these partners being companies or pseudocompanies,” he said.
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Glaxo is first among its peers to announce a plan to end paid-speaker programs, but it is not the only one considering such a move, said Pratap Khedkar, who oversees the pharmaceutical practice at ZS Associates, a global sales and marketing firm.

He said a handful of drug makers were weighing similar actions for several reasons, including concerns about the reaction to the required disclosure of such payments that will begin next fall under a provision of the health care law. Glaxo and several other major companies already report many such payments, but Mr. Khedkar said the new requirements may go farther than what some companies are reporting, and will be accessible on a searchable government website.

Previously, “It wasn’t really made public in some big, splashy way,” he said.

Jeff Francer, vice president and senior counsel at the Pharmaceutical Research and Manufacturers of America, the industry trade group, said many other companies were looking for ways to better reach increasingly busy doctors — who may not have time to travel to a conference in the first place — and Glaxo’s actions represent just one example.

“Of course all of our companies are looking for ways in which they can refine their relationship with physicians to make sure they’re making the best use of physicians’ time,” he said.

Beginning in 2015, Glaxo will also no longer compensate sales representatives based on the number of prescriptions doctors write, a standard practice that some have said pushed pharmaceutical sales officials to inappropriately promote drugs to doctors. In 2012, Glaxo paid a record $3 billion in fines to resolve charges that it had marketed drugs for unapproved uses. It is one of several major companies to have settled such cases in recent years.

Glaxo said its sales representatives worldwide would instead be paid based on their technical knowledge, the quality of service they provided to clients to improve patient care, and the company’s business performance. The company made such changes in the United States in 2011 — and is required to continue the new program under a corporate integrity agreement with the Justice Department — but will now extend the practices to its global business.

Mr. Khedkar said some other companies were also experimenting with ways to compensate sales representatives, but they must tread carefully.

“You remove the incentive to do anything inappropriate, but you also remove the incentive to do what is appropriate, which is to promote the on-label use of your product,” he said.

Mr. Witty said the experience in the United States had been positive and had improved relationships with doctors and medical institutions.

Dr. Raed Dweik, the new chairman of the innovation management and conflict of interest committee at the Cleveland Clinic, said he hoped other companies would follow suit.

“As a physician, I periodically meet with these sales reps and they usually come in armed with information about me that I don’t even know,” he said, like the number of prescriptions he writes for the drug company’s product. “I feel that’s not really a comfortable interaction to have.”

http://www.nytimes.com/video/2013/12/14/us/100000002574787/how-pharmaceuticals-sell-adhd.html?src=recg

http://www.nytimes.com/roomfordebate/2013/12/15/is-the-drug-industry-developing-cures-or-hyping-up-demand

The Monsanto articles were in response the the comment below yours, they were all just posted together- along with research on NIH.gov (which is quite a bit more than just “views”) and I included material both listing why antibiotics and hormones should not be used from the CDC. If you look at the first page of comments, you’ll see that use of hormones is already being curtailed by farms and these products aren’t even sold in most local stores. So farmers are already realizing it’s unwise to use hormones- and if you read the Times piece there were multiple causes listed under early onset of puberty, obesity was just one HOWEVER, estrogen from the environment (food sources- such as pesticides and hormones in meat/dairy) were also an important source of these excess hormones. The Times cited studies within the article, so while the article itself isn’t a scientific source it is considered highly reputable and there are scientific sources cited within the article. The point with posting the material on pharmaceutical drugs, is the same cast of characters that develop the hormones also develop the pharmaceutical, it points to a larger picture of corruption and deceit. This is normal for corporate psychopathy- something well documented in psychiatry journals as being a major problem with relying on these companies to conduct their own “safety” studies- like Merck a la Vioxx (just one example).

I do completely support organic farming, where no hormones, dangerous pesticides or antibiotics are used. I have one of these myself.

http://evolution.berkeley.edu/evolibrary/news/130501_superbugs

Antibiotic resistant bacteria at the meat counter
May 2013

The pork chops you buy in the supermarket neatly packaged in plastic and styrofoam may look completely sterile, but are, in fact, likely to be contaminated with disease-causing bacteria — and not with just any old bugs, but with hard-to-treat, antibiotic resistant strains. In a recently published study, researchers with the National Antimicrobial Resistance Monitoring System bought meat from a wide sampling of chain grocery stores across the country and analyzed the bacteria on the meat. Resistant microbes were found in 81% of ground turkey samples, 69% of pork chops, 55% of ground beef samples, and 39% of chicken parts. Of course, thoroughly cooking the meat will kill the germs, but if the meat is undercooked or contaminates other food with its bacteria — perhaps via a shared cutting board — the result could be an infection that can’t be cured with common medications. Such infections are a serious health concern — a strain of antibiotic resistant staph was recently estimated to cause nearly 20,000 deaths per year in the U.S. — and the problem seems to be getting worse. An evolutionary perspective helps us understand how antibiotic resistance arises in the first place and why the prevalence of resistant bugs in livestock has health professionals and scientists worried.
Where’s the evolution?
It should be no surprise that antibiotic resistant bacteria are the products of evolution via natural selection: as bacteria reproduce, small, random errors (i.e., mutations) occur as their DNA is copied. Just by chance, some of those mutations may help their bearers survive and reproduce better and so will increase in frequency in the bacterial population. Other mutations may be detrimental and will be weeded out of the population. Still others may have no impact at all to the bacterium’s fitness (i.e., neutral mutations) and will change in frequency through genetic drift. When antibiotics flood the environment of the bacteria, individuals that happen to carry random mutations that allow them to survive and reproduce despite the drug will be favored. Eventually, the entire lineage of bacteria may carry genes that confer antibiotic resistance.

This process seems to be inevitable. If a bacterial lineage is consistently exposed to a particular antibiotic, it will eventually evolve resistance to that drug, and this will occur in the soil, in livestock, in the human body — wherever bacteria are exposed to antibiotics. This same basic process is responsible for the evolution of advantageous traits in familiar organisms, like a hawk’s keen eyesight or a polar bear’s insulating fur. However, bacteria have a leg up on birds and bears when it comes to evolution. Most species rely on mutations somewhere in their historical lineage for their genetic variation — that is, an improved ability to spot prey will evolve in a lineage of hawks only if mutations conferring keener sight occurred somewhere in the hawk lineage and were then passed down to the generation of hawks experiencing natural selection. Bacteria, on the other hand, get their genetic variation both from their ancestral lineage and through a process known as horizontal transfer.

In horizontal transfer, organisms share genetic material with one another directly, as opposed to passing genetic material only to their offspring. In this way, genes from distantly related lineages of bacteria can wind up in the same individual. A gene version that first arose in Escherichia coli could easily be passed on to Salmonella.

Horizontal transfer represents a special danger when it comes to the evolution of resistance because, through gene sharing, antibiotic resistance genes that evolve and become common in one lineage of bacteria that is exposed to a particular antibiotic can be passed to distantly related bacterial lineages. In other words, a bacterial lineage can evolve resistance to a particular antibiotic even if its ancestors never carried a mutation that conferred resistance to that drug. With all this genetic variation being shared, antibiotic resistant bacterial strains can evolve quickly. Furthermore, different antibiotics often have similar modes of action (e.g., amoxicillin and methicillin both work by preventing bacteria from forming cell walls), so resistance to one drug often means partial resistance to a host of other medications. To make matters even worse, bacteria often transfer multiple genes for resistance to different antibiotics on the same piece of DNA. Since the genes are physically attached to one another, selecting for one of those resistance genes lets the others hitchhike to high frequency. So exposing a bacterial population to say, streptomycin, may also unintentionally favor the evolution of a strain that resists many other antibiotics as well — making for a particularly hard-to-cure infection.

Bacteria have many characteristics that allow them to evolve resistance to whatever antibiotics we throw their way — short generation times, high mutation rates, and horizontal transfer — and current agricultural practices (in particular, the heavy use of antibiotics in livestock) seem destined to speed this process even further. In the U.S., around 80% of antibiotics are destined for farm animals, not for treating human disease. The majority of those animal antibiotics are used preventatively and to promote faster growth and speed meat production, not to treat sick individuals. Unfortunately, this approach also encourages the evolution and proliferation of antibiotic resistant strains on factory farms. So, it should come as no surprise that a large percentage of supermarket meat carries antibiotic resistant bugs!

Clearly, the ubiquity of antibiotic resistant bacteria in livestock has implications far beyond highlighting the need to cook meat thoroughly. It suggests that, lurking in farm animals, is a vast pool of dangerous resistance genes that could easily make their way out of the bacteria in which they currently reside and into strains that would represent an even more significant human health threat. We have many lines of evidence suggesting that horizontal transfer of genes, including resistance genes, is commonplace among bacteria. What we have not had is a major outbreak of an antibiotic resistant infection that has been definitively linked to resistance from bacteria inhabiting livestock — yet. If the American Medical Association, the World Health Organization, and the National Academy of Sciences have their way, we may be able to avoid that fate, at least for certain antibiotics. These groups have all signed on to support new legislation that would prevent widespread use of certain antibiotics on livestock, helping to protect the effectiveness of these drugs in humans.

http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?src=me&ref=general

After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder, Keith Conners could be celebrating.

Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurological problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic A.D.H.D., helping youngsters succeed in school and beyond.

But Dr. Conners did not feel triumphant this fall as he addressed a group of fellow A.D.H.D. specialists in Washington. He noted that recent data from the Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

billion
Sales of prescription stimulants have more than quintupled since 2002.
’07
’02
’12
$8
6
4
2
Source: IMS Health
Stimulant Sales
The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.

But even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.

Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.

A 2002 ad for Adderall showed a mother playing with her son and saying, “Thanks for taking out the garbage.”

The Food and Drug Administration has cited every major A.D.H.D. drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.

Sources of information that would seem neutral also delivered messages from the pharmaceutical industry. Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often that discredit growing concerns about overdiagnosis.

Many doctors have portrayed the medications as benign — “safer than aspirin,” some say — even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction. Patient advocacy groups tried to get the government to loosen regulation of stimulants while having sizable portions of their operating budgets covered by pharmaceutical interests.

http://www.nytimes.com/2013/12/17/business/glaxo-says-it-will-stop-paying-doctors-to-promote-drugs.html?pagewanted=2&ref=general&src=me

Obesity is only the answer in SOME cases, if you read the case studies obviously you are going to jump to obesity as the main cause because that is in the vested interests of your industry and your lobbying groups and I am going to come at this from the medical profession’s viewpoint which is that there are a large percentage of extremely young children (starting at age 5) developing early puberty who are no where close to being obese:

Obviously a long term study is needed

http://thegrio.com/2013/02/12/hormones-in-food-may-lead-to-early-puberty/2/

Tropez-Sims oversaw Meharry’s participation in a national study, published by Pediatrics last November, of more than 4,000 boys, showing that they too are entering puberty earlier. As a physician and researcher, she agrees with most scientists that more study is needed on why increasingly younger children are growing breasts, pubic hair and so forth, and whether hormone-infused foods play a role.

Absent any rock-solid answers on that front, researchers have explored other causes. Some studies, including one in the February 2008 issue of Pediatrics, have suggested that obesity is a driver of early onset puberty. But that doesn’t explain what transpired with Kayla, who was a reed-thin second-grader. Now 15 and a liturgical dancer at her family’s church, she stands at 5’ 6” and weighs a lean 120 pounds.

“In the 19th Century, the age of menarche was 15,” Tropez-Sims said. “Today, we may be looking at environmental chemicals, steroids and so on that are causing puberty to begin in progressively younger kids. And it seems reasonable to ask this question: If they’re feeding pigs and cows and chickens growth hormones and other chemicals to make them plumper, bigger, is that also making our kids plumper, making them mature faster? … There’s not been enough science to fully link hormones in the meat, but some of us are extrapolating that that’s just what may be happening.”

Tracking children who eat no hormone-laden foods against those whose diets are full of them would provide the most conclusive proof of what’s going on, she said. But such a study has never been conducted. And doing one raises ethical concerns, given what some consider the potential risks faced by children in the latter group, Tropez-Sims added.

from an MD website (which proves my point about multiple causes)

http://avivaromm.com/preventing-early-puberty-and-hormone-problems-in-our-daughters-heres-the-why-and-how

The 3 biggest contributors to early puberty are:

1. Obesity: About 20% or more of US kids are now obese. This rate has tripled in the past 30 years, and this trend corresponds to earlier puberty.

2. Exposure to environmental toxins that act as estrogen in the body: Many substances used in flame retardant fabrics, cosmetics, plastics, pesticides, detergents and other common household and industrial products can mimic the effect of estrogen in our bodies. The CDC has linked a solvent used in some mothballs and solid blocks of toilet bowl deodorizers and air fresheners to earlier menstruation – they also found it in the bodies of nearly all the people tested in the U.S.! It doesn’t take much exposure to cause health effects, which may include increased risk of early puberty, diabetes, and cancer. These environmental chemicals accumulate over time and because they accumulate and are stored in fat cells, may be even more of a problem for overweight girls.

3. Stress: Stress can wreak havoc on the endocrine system. And most of us suffer from stress starting at any earlier age than ever. Inadequate sleep, school pressures, stress at home, peer pressure and bullying are just a few of the major stressors to which our girls are regularly exposed. Stress can also make us fatter; more fat means more estrogen and this can lead to earlier puberty.

While government, food companies, and industry also need to tackle these issues on a global scale, the factors leading to early puberty and endocrine disruption in our daughters can be prevented or mitigated through the diet and lifestyle choices we make and teach them.

http://www.huffingtonpost.com/christina-pirello/is-the-early-onset-of-pub_b_677424.html

Dr. Stanley Korneman, an endocrinologist at the University of California, Los Angeles says that environmental exposure to estrogens in plastics, chemicals and foods has been going up and that estrogens stimulate breast development. And he says that could be the link to early onset of puberty. Makes sense.

What is really going on here? I can just imagine that the smoky back rooms in Washington where meat, dairy and poultry lobbyists make their dirty little deals and hide the real facts about what is in our food are in hyper-drive. The information in this study, if people connect the dots, could blow up in their faces, and who could afford that? Not the politicians on both sides of the aisle and certainly not their clients, those pirates who peddle hormone, antibiotic and steroid-laced food to our children. And we wonder why little girls look like very big girls far before their time.

The solution to this problem is easy and obvious. Our children are being destroyed in the name of profit by big industry and factory farms who feed their animals steroids, growth hormones and antibiotics to make them fatter, faster. More and more yield of meat from an animal means more and more profit, and if we need to sacrifice a generation of children along the way, so be it. And these are not just the rantings of some liberal, tree-hugging vegan. According to Cornell University, hormones “reduce the waiting time and the amount of feed eaten by an animal before slaughter in meat industries.” And that means bigger profit… faster.

While the childhood obesity problem is linked to the overconsumption of processed food, drive-through, dinner in a bucket and the sheer volume of sugar and other junk our kids are eating, we must also look at the role growth hormones play in the size of our kids and the age they reach puberty.

Wake up, people. If hormones can make an animal fat, what do you think will happen to us? We have always had access to junk food, but never in human history have we been the subjects of such an intense ingestion of chemicals and hormones. Dr. Andrew Weil states that more than two-thirds of the cattle raised in the U.S. are given hormones, usually testosterone and estrogen to boost growth. According to Cornell, there are actually six hormones commonly used in meat and dairy production: estradiol and progesterone (natural female sex hormones); testosterone (natural male sex hormone); zeranol, trenbolone acetate and melengesterol (synthetic growth promoters that make animals grow faster). Not used on poultry or pigs, (but only because they don’t promote meaningful growth in these animals), the FDA also allows the use of rbGH, another growth hormone, to promote more milk production in dairy cows.

And here’s where it gets really creepy. There is no monitoring of the female and male hormones, according to Cornell, because they are naturally produced by the animals so in theory, they can’t really tell what hormones were produced and which were administered, so why have limits? But they set tolerance levels for the synthetic hormones. I feel safer; how about you?

And finally, according to Cornell, the declining age in puberty’s link to hormones in meat and dairy has been of concern to experts for some time now because of the possible links to breast cancer.

What is it going to take for us to demand accountability from the people who produce our food and those government agencies that supposedly protect the health of the public? When will we pull our heads out of the sand and see the reality we face?

Cheap, commercially produced meat may be affordable, but the cost is far too high. Now hang on. I am not going all vegan on you. But this study is a reality check for us, to be sure. Early onset of puberty is no joke. Our girls are at greater risk of breast cancer, obesity and other life-threatening conditions. And while the environment and plastics may contribute to this problem, as may the overall abundance of food, the reality is that the growth hormones, steroids and antibiotics in our meat and dairy are the major players in this tragedy.

Dr. Biro suggests that families eat more produce (ya’ think?) and more family meals together as a way to begin to solve this very real crisis, along with regular physical activity. There is also the option of choosing certified, grass-fed organic meat and dairy as a way to avoid the ingestion of hormones, which also supports a sustainable way to produce healthy animal products for us to consume. And you get to support small family ranches that, along with family farms, are the backbone of this country’s food supply.

Good ideas all, but we also have to look at other options and invest in the health of our children before we lose an entire generation because we just want cheap, fast food. There are alternatives to meat and dairy that can nourish our families and children healthfully and affordably … and leave a lighter footprint on the planet in the process. A well-balanced, plant-based diet can provide all the nutrients our children need to thrive and to live in healthy, normal bodies. Yes, it’s more work and maybe even a bit more money, but these are our children — our future.

This kind of blog gets people’s noses out of joint. From cattle farmers to burger lovers who say they prefer a juicy steak to tofu, all the rationalizations come out. Ranchers need to make money to survive. People want what they want … and they want meat! But in the end, the truth cannot be denied.

We live in a culture of profit-seeking leeches that are only too happy to sell us compromised foods and line their pockets with the profits gained from pillaging our health. When are we going to stop them? All we need to do is say no. Vote with your dollar; demand better quality. Remember that they want your money. They do not care about the health of our young girls. It’s up to us. A collective voice demanding accountability and better food is the only way to reverse the trends that threaten to swallow and entire generation.

http://www.huffingtonpost.com/2013/12/16/60-minutes-nsa_n_4452568.html

The pediatrician’s first reaction to then second-grader Kayla Haye’s budding breasts—a sign of the child’s premature puberty—was to consider placing her on therapeutic hormones.

“A 7-year-old on hormone medication? Well that’s not gonna happen,” said Adriane McDonald-Haye, Kayla’s mom, recalling her response to that suggestion eight years ago. “Just the idea of putting my child on hormones triggered all kinds of concerns.”

So the Brooklyn, N.Y. mother took a different course of action, scouring the web and probing other parents on the topic. Ultimately, she was persuaded by claims—including from some physicians—that consumption of hormone-laden meat and poultry was linked to early-onset puberty, which is on the rise in general and more prevalent among black children.

“I changed Kayla’s diet to one that is as organic as possible,” McDonald-Haye said. “I actually have a pack of organic chicken wings in my fridge right now. We cheat every so often, eating fast food. But, overall, I try to stay as natural as possible.”

McDonald-Haye is aware of the continuing debate over the effects of hormone-infused meat and dairy products on growing bodies. Nevertheless, she credits her better-safe-than-sorry dietary overhaul with delaying Kayla’s first period, which she got when she was 10. That’s roughly 2.5 years ahead of the national average.

http://pediatrics.aappublications.org/content/126/3/e583.full?sid=7f548e01-c073-4ec0-b7a9-a498344ddfaf

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7924542&fulltextType=RA&fileId=S1368980010001461

http://thegrio.com/2013/02/12/hormones-in-food-may-lead-to-early-puberty/2/

The case study of the girl who was underweight mentioned on grio.com (read the full story on the link, it covers multiple pages), not only proved that the cause of her early onset of puberty at the tender age of 7 wasn’t weight related, but her mother refused hormone regulation drugs and instead changed her little girl’s diet and her daughter’s breast growth ceased.

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