Transcript An investigation of controversies around human rights of patients

An investigation of
the controversies surrounding
human rights of patients with ADHD
Dr. Pooria Sarrami Foroushani M.D.
School of Sociology & Social Policy
University of Nottingham
[email protected]
1 of 16
Attention Deficit Hyperactivity Disorder
(ADHD)
• A common psychiatric disorder
• Children and adults
• 3-5 % (potentially 3,000,000 in UK)
• Attention difficulties, hyperactivity and impulsivity
• Increase in diagnosis and treatment rate
2 of 16
Chart 1- Number of articles submitted in the `Pub Med` website in five year
intervals, search by keyword of `ADHD`
4500
4000
Number of articles
3500
3000
2500
2000
1500
1000
500
0
-1965
19661970
19711975
19811985
19761980
Year intervals
3 of 16
19861990
19911995
19962000
20012005
Why ADHD is controversial?
•
Drug treatment of children;
•
Diagnosis demanded by others;
•
No start and end;
•
Sign and symptoms could be found in
everybody;
•
It has a biological treatment; the basis (cause)
is also claimed to be biological, but no
biological diagnosis method has established
yet;
4 of 16
Why ADHD is controversial?
(continue)
•
Stimulant drugs are claimed to be safe,
but are classified as schedule II drugs;
•
Stimulant drugs are symptomatic
treatment;
•
Sign and symptoms of this disorder
might be an advantage for patients;
•
Sign and symptoms of this disorder
might decrease and even disappear.
5 of 16
Chart 2- position of web pages toward different themes of
medical model of ADHD (N = 170)
Percentage of observed pages
100
89
90
82
80
70
58
60
Disagree
Agree
50
indicator not available
40
30
23
19
20
14
10
10
1
4
0
existence of difference
application of medical
label
Different themes
6 of 16
application of drug
treatment
The right to access psychiatric evaluation
It is the formal approach and is based on medical model:
• Patients should have access to medical evaluation, to achieve
welfare and proper education;
• Patients could have the right to choose their doctors;
• Patients have the right to negotiate the offered treatment; however,
parents are sometimes legally forced to treat their children
(Charatan, 2000).
in this perspective, medical organizations are
providers of human right.
7 of 16
The right to avoid drugs
It is the idea of opponents of medical model of ADHD (e.g. Church of
scientology, etc):
• Labelling and medicating of ADHD `patients` is inappropriate;
• Health care organizations are scarifying rights of people in favour
of drug companies;
• There are better ways to provide welfare and proper education for
people.
in this perspective, human right of people is
violated by medical organizations
8 of 16
Controversies surrounding
human right of ADHD `patients`:
• Both sides agree with articles of universal
declaration of human rights on importance
of welfare, liberty, and proper education.
• However, different interpretation of ADHD
and related phenomena lead to opposite
conclusions.
9 of 16
A third perspective…
• At present, patients could have access to drugs, only if
they are diagnosed and labelled by health care
professionals.
• There are histories of cases, who desperately demand
these drugs and it seems that drugs could benefit them,
but their doctors do not agree with their diagnosis
(Wender, 2000).
• It is possible to accept the efficacy of drugs like the
medical model, and challenge the control of health care
professionals on them similar to opponents of medical
model.
10 of 16
Why labeling is used?
A historical perspective (Conrad & Schneider, 1992):
• Opiates were regularly available in pharmacies in USA till 19th century.
Addiction was prevalent, but harmless.
• In 1920, definition and moral concepts of opiate addiction changed; as a result,
opiates were not available in pharmacies, prevalence of addiction reduce since
then, but it become a social problem.
• In 1937, usefulness of amphetamines for some people was discovered, but they
could not be distributed freely, as the moral concepts were against a drug that
could be potentially addictive.
• In 1957, a label was introduced for ADHD (hyperkinetic impulse disorder),
• In 1961, FDA approved use of amphetamines as a drug for treatment of a
disorder in children (ADHD).
12 of 16
Some reasons against the necessity of labeling:
1. Practically in many cases labeling do not provide any help other
than access to drugs.
2. Health care professionals have not a biological method for
diagnosis.
3. Distribution of similar substances is done without prescriptions.
4. People can potentially access the drugs via other routes (role
playing and black market)
13 of 16
Some reasons against the necessity of labeling:
(continue)
5. There is a huge financial burden on health care system
(NHS spend annually £247 million is for treatment of
ADHD) (National Institute for clinical Excellence, 2000a; in: Blew and Kenny,
2006).
6. Labeling put the responsibility of drug consumption on
health care professionals, instead of individuals.
7. There is a force in getting the label, if somebody is
interested to use these `drugs`.
14 of 16
Freedom to access the drugs?
• Freedom of choice,
• Avoiding unnecessary labelling.
• People would be still free to get help and
guidance, if they wish.
15 of 16
Suggestions for future studies
• Biological method for diagnosis of ADHD.
• Investigating safety and benefits of
amphetamines for `ordinary` people.
16 of 16
Thank you!
Dr. Pooria Sarrami Foroushani M.D.
School of Sociology & Social Policy
University of Nottingham
[email protected]