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Adult ADD: Common disorder or marketing ploy?

Critics say ad campaign on condition raises ethical question

From Elizabeth Cohen
and Debra Goldschmidt
Monday, July 21, 2003

(CNN) -- Feeling distracted, disorganized? Trouble waiting your turn in line? Fidgety? Maybe you have adult attention deficit disorder, or adult ADD, and need to see a doctor.

That's the new marketing message from pharmaceutical giant Eli Lilly and Co., which has the only drug with Food and Drug Administration approval to treat adults with ADD.

Some see the national ad campaign as a way to educate the public about a little-known condition; others said Eli Lilly is trying to convince members of the public that they have the disorder to increase demand for its new medication.

"We're very concerned that folks have a disorder that is impairing and limiting their life," said Dr. Calvin Sumner, senior clinical research physician for Eli Lilly. "It affects many people, and it's treatable."

ADD is usually associated with children, but health officials said it is present among adults. The neurobiological disorder, characterized by a person's inability to pay attention and concentrate, affects an estimated 2 percent to 4 percent of adults, according to the nonprofit group CHADD, or Children and Adults with Attention-Deficit/Hyperactivity Disorder.

One of the most common diagnosed disorders in children, it affects 3 percent to 5 percent of all kids, reports the National Institute of Health.

Eli Lilly's TV and radio ads about adult ADD and its drug Strattera center around screening questions. They include ones such as "How often are you distracted by activity or noise around you?" and "How often do you feel restless or fidgety?"

Responses of "sometimes" to the questions on the company's Web site prompts a message that the symptoms may be consistent with adult ADD and a visit to the doctor is recommended.

Sumner said the company is working with doctors to help them understand the disorder and to get treatment to those who need it.

"Many people have lived with ADD all of their lives, and they accept it as part of who they are," Sumner said. "They have no idea that the pattern of problems they have may be related to a treatable disorder."

'A severe case of modern life'

But some ethicists said the ad campaigns, paired with education programs for physicians, may result in people receiving drugs who don't really need them.

"I am worried that what you're going to do is generate a disease rather than respond to a problem," said Art Caplan, a bioethicist at the University of Pennsylvania.

Some experts said they find at least parts of the screening tool too broad, with questions such as, "How often do you have difficulty waiting your turn in situations when turn taking is required," asking respondents to choose never, rarely, sometimes, often or very often.

"I've yet to meet the person who says, 'Oh, I really love waiting in line. The longer the line the better,' " said Dr. Edward Hallowell, a psychiatrist and author of the best-seller "Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder From Childhood Through Adulthood."

Caplan said, "Trying to hook a potential user of your drug by this type of questionnaire technique just strikes me as ethically suspicious."

But Sumner said Eli Lilly's tool is valid, has been tested and verified, and is meant to screen people, not diagnose them.

"Answering positively on the Web-based quiz doesn't mean you have ADD, it suggests that you might, and you might benefit by talking to your doctor about it," he said.

In addition to the consumer marketing, Lilly has aimed an ADD education campaign at internists and family physicians, who often know little about diagnosing and treating adult ADD.

Hallowell said he is concerned that general practitioners, who often have just minutes with patients, will misdiagnose ADD.

"It is impossible to diagnose attention deficit disorder properly [in minutes]," he said. "Absolutely impossible."

Hallowell, who previously has been a paid consultant to Eli Lilly, said many people in today's hurried world may look like they have ADD when they really don't.

"The symptoms of ADD can look just like the symptoms of modern life," he said. "I would speculate that 55 percent of the population has what I call pseudo-ADD, sort of a severe case of modern life. They're going so fast, they're doing so much, they're so saturated with information overload that they look distracted, impulsive and restless."


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