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Alternative Treatments for ADHD

"Hey, doc...will pine bark extract help my child's hyperactivity?...Or, "doc, will physical therapy improve my child's low muscle tone?". I am confronted almost daily with questions like these for which there are no answers. As a pediatrician who cares for children with neurodevelopmental problems, I can't help but feel frustration and anger. These simple questions should have simple answers. But, as a society, we have failed to press for answers to key questions about the effectiveness of new and established treatments for developmental disorders and other chronic conditions.

Parents are not surprised when I express caution (and sometimes cynicism) about new "alternative" treatments. But there are also many well-established developmental therapies that lack good scientific evidence for their effectiveness. "Doctor, how dare you suggest that physical therapy may not help my child with abnormal muscle tone!"..."Heresy!"

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Every parent wants the safest, most effective treatment for their child with a developmental disability, and many standard treatments have limitations and drawbacks. Because there is an undeniable appeal to therapies that are "new", "different", and "more natural", families are increasingly turning to alternative models and providers of health care and healing for these answers. Unfortunately, too many families are gambling on "alternative" therapies and foregoing established treatments with demonstrated efficacy. This should not be the case.

No one should oppose the development of innovative therapies. Without them, there would be no medical progress. I simply urge that all interventions, new and old, be evaluated in an objective, methodologically rigorous way. We, the public, should expect no less. Without reliable clinical data, informed, meaningful comparisons between competing treatment approaches are impossible. Families should not have to make their treatment decisions in a virtual research vacuum.

Research is clearly the key. Traditionally, clinical research precedes the introduction of new treatment approaches. Before a new prescription medicine is approved by the FDA, it must be shown to be effective and relatively safe. New medications and surgical techniques are then repeatedly compared in methodologically rigorous studies, with clinicians adopting those treatment approaches shown to be superior. Although there have been missteps over the years, this process has led to the development, identification, and clinical application of increasingly effective treatments.

This Old World order, though somewhat Darwinian and paternalistic in nature, is now being threatened by the well-intentioned forces of "alternative" or "complimentary" medicine. As a physician who accepts the scientific model yet also recognizes that some alternative therapies will undoubtedly be proven superior to conventional therapies, I am concerned that new treatment approaches are being promoted in a "Madison Avenue", "free market" cyber-wired world and then embraced with little or no scientific research to support them.

If families are rejecting some of what traditional medicine has to offer, physicians and the medical establishment are partly responsible. There has historically been little interest and even less money directed to investigating alternative therapies. Although patients are always encouraged to turn to their physician for sage counsel regarding alternative treatments, most doctors lack the objective information needed to respond. Physicians and scientists, however, are not alone to blame, and remedies must come from many quarters.

With much fanfare, the National Institute of Health established the Office for Alternative Medicine in the early 1990's. Now titled the National Center for Complimentary and Alternative Medicine, this program receives much less than 1% of the total monies administered by the NIH. Unfortunately, this is an egregious example of the federal government doing "too little, too late". Funding for the NCCAM should be increased at least tenfold. It is not in our national interest to pursue ineffective treatments or forego effective therapies. Undoubtedly, billions of dollars are being spent on conventional and alternative therapies with limited or no proven value. Society does not need expensive placebos.

Legislation: Our legislators must review and modify how dietary supplements are defined, regulated, and promoted. It is unclear why some hormones (such as melatonin) are available over the counter while others require a prescription. Similarly, implied claims are made for many dietary supplements with questionable data. The double standard imposing strict marketing restrictions on prescription drugs but not dietary supplements must be acknowledged and eliminated.

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The Media: The print and broadcast media are constantly presenting stories about "new and exciting" treatment approaches. Although this may be what their readers and viewers want, it is not necessarily responsible journalism. A story about "Zen crystal therapy" as an alternative treatment for autism or diabetes does not achieve "balance" simply by quoting a physician critical of this approach. The media should provide critical thinking and analysis as it handles these topics, just as it is starting to do with politicians' claims and campaign ads.

The Public: Patients need to become more informed and more discriminating consumers of health care. Schools and the media can help tremendously in this regard. Consumers must recognize that any substance taken in pill form for a specific benefit is essentially a medication, and that "natural" does not necessarily mean safe or effective. It is amazing that millions of people who take several pills each day to help their memory, energy level, attentiveness, or sexual or athletic performance would frown at the thought of taking "medication".

Health care providers: Greater dialogue between physicians and other health care providers is needed. One or more independent organizations should be established to determine which therapies are indeed effective and thus merit reimbursement. These determinations should not be left to providers or insurers alone. Professionals who promote unorthodox therapies of unproven value need to be held more accountable; therapies of questionable or limited proven value should be described as such, with patients giving prior written informed consent.

There will always be competition between conventional and alternative therapies — with the effective "alternative" therapies becoming the conventional ones as they gain national acceptance. At this time, the pendulum has swung too far in favor of alternative therapies. Patients and their families should remain primarily responsible for their own health care decisions, but there must be considerably more meaningful information available to facilitate responsible decision-making. Parents and professionals should not have to rely on Internet chat rooms and corporate advertising to determine which new therapies are safe and effective.

In 1911, President William H. Taft noted "there are none so credulous as sufferers from disease". With a myriad array of supplements, extracts and other alternative therapies now available, the public must be careful to avoid modern-day snake oil while searching for the next penicillin.

Dr. Andrew Adesman is chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, New York. His current research focuses on attention deficit hyperactivity disorder and he is active in community outreach and parent/teacher education about ADHD.

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