Recently, sensationalized reports of health problems associated with the use of some medications used to treat ADHD have appeared in the media. Check out some of the stories here:
It can be frightening to read about incidents of severe adverse effects to medication, but it's important to keep a critical perspective when reading about these sensational stories.
Do medical treatments have risks? Absolutely! Every treatment does. What must happen when a treatment is prescribed is that the patient, parent and health provider must agree that the benefit is likely to be greater than the risk. For some treatments, risks can range from mild to severe, or either common or uncommon. For example, the risk of a heart attack may be 1/10,000 as a side effect of that medication, while the risk of a stomach ache may be 1/100 or a headache 1/10. Compare that to the risk of dying by being struck by lightning (1/79,700), dying in a bicycle accident (1/5,000) or dying in a car accident (1/84).Check out the annual risk of death during one's lifetime.
Determining whether the benefit is greater than the risk is the key issue to almost everything we do. Indeed, this is part of the government’s assessment of regulated treatments, such as medications (through institutions such as Health Canada), whether they be deemed safe and therefore available as self-selection products (such as over-the-counter medications and natural health products) or deemed to require the opinion of a “learned intermediary” (such as a licensed prescriber) to support their necessary and judicious use. It’s the latter group of prescription medications that carry more risk, but are still considered potentially helpful when used by the right person.
In order for the patient and parent to be properly informed, they need good and valid information to be able to make a decision about accepting the treatment recommendation or not. Many of the adverse effects reported recently in the media may not be caused by ADHD medication. That’s the difference between correlation and proven cause and the only evidence that’s able to tell us if the medication is causing the adverse effect is solid scientific research. This can be a problem. Sometimes the right information is hard to find. The information can be confusing or even contradictory. There tend to be a lot of misinformation or even disinformation out there. Sometimes the health provider does not give you the information needed. So what is the patient or parent to do?
It’s essential that all legitimate health providers use the best evidence available to suggest treatments to patients. Patients however need to have a high degree of comfort that what is being suggested is driven by credible evidence, not anecdote, conjecture or simple association. And, they need transparent, clear information. It can be difficult getting that information and it can be hard ensuring that your health provider is giving you what’s needed. You may require additional help in getting all the information you need.
This is why I suggest young people and parents use guides and health related tools to help them in interacting with health providers. It’s important to know what questions to ask to help ensure that they get the best possible care. We have created a number of useful aids for youth and parents. They fall under the rather boring heading of “Evidence Based Medicine”. Boring name, but crucial stuff to countering sensational and uncritical assertions and inferences. It may be a good idea to use them in order to ensure that you get the information needed to make better judgments about the potential risks and potential benefits of any treatment! Click here to view an outline on what you should ask health care providers.
Another good resource is a mental health medications guide and treatment tracking booklet, called Med-Ed. It was specifically developed to support patients, parents and health providers do a better job in choosing and monitoring medication treatments – checking on their risks and benefits carefully and consistently. The tool promotes something very important - open, clear communications about the benefits and risks of medication treatment between the patient and their prescriber.
Oh yes – one other thing. The media stories suggest that regulatory agencies are not doing a good enough job to monitor possible adverse outcomes of regulated treatments. I, for one, would agree, and so do many others who’ve examined Canada
The reports in media may not turn out to be scientifically valid in the long term, but perhaps they will generate some positive benefits if patients begin to ask their health provider some hard questions – not just about their ADHD medications, but about all the treatments that they’re getting. This would be in the best interest for the health of all Canadians.
-Stan
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