Q. What is
A. Ritalin, Manufactured
by Ciba-Geigy, is a stimulant and its effects are similar to the
effects of other stimulants including amphetamine, methamphetamine,
Q. What does
A. Ritalin is used
to treat Attention Deficit and Hyperactive Disorder ( ADHD ).
ADHD is a central nervous
system problem of unknown causes that occurs in children of both
sexes, but is diagnosed four times more frequently in boys. ADHD
Is defined by the Merck Manual as "develop mentally inappropriate
inattention and impulsivity, with or without hyperactivity."
Symptoms include distraction. impatience and difficulty concentrating.
Q. How often
is Ritalin prescribed?
A. There are six million
prescriptions for Ritalin filled annually. The U.S. pharmacists
distribute five times more Ritalin than the rest of the world
combined; no other nation prescribes stimulants for its children
in such volume. In fact, the United Nations International Narcotics
Control Board has on two recent occasions written to U.S. officials
expressing concern about the six-fold increase in Ritalin usage
since 1990. Approximately 3 to 5 or more percent of U.S. children
and teenagers have been or are being prescribed Ritalin.
Q. What are
the side effects of Ritalin?
A. As a stimulant of
the central nervous system, Ritalin's side effects include increased
blood pressure, increased heart rate, increased body temperature,
increased alertness and suppressed appetite. Ritalin is typically
used on a daily basis with a hiatus on weekends or during the
summer. Because it is ingested almost daily for a period of years,
there are major concerns over chronic health effects.
Q. Is Ritalin
A. After more than
forty years of prescribing Ritalin, the FDA along with the National
Cancer Institute called for more testing "because of its
widespread use in human medicine and -- lack of data on its potential
carcinogenicity". The National Toxicology Program accepted
responsibility for conducting trials on carcinogenicity and in
June 1993 released results showing that feeding mice Ritalin induced
liver tumors including very rare and highly malignant cancers.
These results were found at levels close to those routinely prescribed
for children. More studies are being planned for testing Ritalin,
but the evidence is strong. Animal tests are very good predictors
of human health effects. In fact, the International Agency for
Research on Cancer suggests that if a chemical is proven to cause
cancer in animals, it should be treated as it it were cancer-causing
in humans as well.
Q. How did
Ciba-Geigy and the FDA respond to Information that Ritalin is
A. The response of
the FDA and Ciba-Geigy to the cancer test results were not adequately
protective of child's health. The FDA deputy drug director said,
"We felt physicians and parents should know this. But it's
not enough of a signal that we think kids should be taken off
the drug". Ciba-Geigy wrote to 100,000 physicians informing
them ofthe National Toxicology Program's study and reassured them
that Ritalin is believed to be "safe and effective"
by the FDA. But with information that Ritalin does cause cancer
in laboratory animals, it can not be deemed "safe".
Animal tests are very reliable predictors of human effects. Of
the 23 known human carcinogens, all were identified as carcinogens
in animals first, sometimes decades earlier. It is disconcerting
that the FDA is not making a move to ban or limit the use of this
Q. Are there
Alternatives to Ritalin In the treatment of ADHD?
A. Yes. While Ritalin
is the most commonly used drug for attention deficit disorders,
now prescribed to 60 to 90 percent of American children with such
disorders, there are Pharmacological alternatives. There are also
non-drug therapies for ADHD and related mental health problems.
For example, behavior modification therapy has been particularly
effective with ADHD cases. The treatment recommendations for stimulants
like Ritalin almost always recommend concurrent behavioral therapy
or psychotherapy. This is particularly important when a child
is being treated for ADHD. Diagnosis of ADHD is often made in
cases where other problems are prevalent and a comprehensive mental
health examination has not been conducted. Poor hearing, learning
disabilities, and stress at home may be factors in such misdiagnosis.
In one known case, a child was prescribed Ritalin after a five
minute examination and was subsequently taken off the medication
when it was discovered that he was borderline mentally retarded.
The causes of childhood impulsivity and hyperactivity must he
carefully explored before an ADHD diagnosis is made.