Scientists' letters to the Department of Health and Human Services
Letter from CSPI to HHS Secretary Shalala

October 25, 1999

Hon. Donna Shalala, Secretary
U.S. Department of Health and Human Services
200 Independence Ave. SW Room 615F
Washington, DC 20201

Dear Secretary Shalala:

    The Center for Science in the Public Interest has published a report,
"Diet, ADHD, and Behavior", that reviews studies on the effect of diet on
behavior (including ADHD) and touches on side effects of the stimulant drugs
that have been used to treat behavior disorders in millions of children. I
have
enclosed our report and letters from doctors and scientists that urge HHS to
take a variety of actions. I hope that you will give our recommendations
serious consideration.

    CSPI's report reviews more than 20 controlled studies of diet and
behavior. Most of the studies found that food dyes and, in some cases, other
additives and foods provoked symptoms of ADHD or other behavior problems in
some children. In light of that evidence, HHS should inform parents, school
officials, and health-care providers that some children are affected by diet
and that dietary therapy should be considered as a first course of
treatment.
We further recommend a broad research agenda to better understand foods'
effects on behavior, several regulatory measures (including more routine
testing for behavioral effects of food additives and consideration of a ban
on
food dyes in foods and other products widely consumed by children), and
educational efforts (revising literature and web sites, including a pamphlet
that FDA cosponsors with a food-industry association, that deny that diet
affects behavior).

    Maximizing the use of non-pharmacologic treatments is particularly
important because the stimulant drugs commonly used to treat ADHD have side
effects, including insomnia, loss of appetite (and failure to grow),
stomachache, and, possibly, Tourette's syndrome. Importantly, a 1995 study
by
the National Toxicology Program found that methylphenidate (Ritalin), the
most
commonly used drug, caused liver tumors in mice. The NTP categorized that
drug
as a "possible human carcinogen." When that study was published, the FDA
said it would sponsor additional research, but little such research has been
done. The package insert for methylphenidate notes the cancer study, but
many
doctors are unaware of or belittle that information, and, of course,
patients
or their parents never see the package insert. It is critical that a
potentially carcinogenic drug that is used by a large number of children
over
many months or even years be well tested and found to be appropriately safe
and
that doctors and patients be aware of possible risks. Amphetamines,
increasingly used to treat ADHD, did not cause cancer in an NTP study, but
also
need to be tested for long-term effects, particularly because its usage
appears
to be skyrocketing: Until additional safety tests are done -- we recommend
several kinds of studies -- it is all the more important for HHS to urge
physicians to consider alternative approaches to treating patients.

    Thank you for your attention to this important issue. I look forward to
your response.

    LadyLollipop   May 28, 1:12 am     show options

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           From: "LadyLollipop" <LadyLolli...@insightbb.com> - Find
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           Date: Sat, 28 May 2005 05:12:33 GMT
           Local: Sat,May 28 2005 1:12 am
           Subject: The Lingering Legacies of ADHD
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     http://www.businessweek.com/pr­int/bwdaily/dnflash/may2005/nf­20050527_...

     MAY 27, 2005

     NEWS ANALYSIS
     By Carol Marie Cropper

           The Lingering Legacies of ADHD
           Youngsters with attention disorders run a higher risk of
depression,
     mental illness, and drug dependence, researchers say
     Two new studies of girls and boys with attention deficit hyperactivity
     disorder (ADHD) indicate a dramatic increase in their risk of
acquiring such
     afflictions as major depression, bipolar disorder, and drug addiction.

     The longitudinal studies took place at Massachusetts General Hospital
in
     Boston, a teaching facility for Harvard Medical School. They tracked
the
     development of various disorders in boys ages 12 to 22, over 10 years,
and
     in girls between 12 and 17 for for 5 years. The results of the studies
were
     presented on May 26 at the American Psychiatric Assn. annual meeting
in
     Atlanta.

     BIPOLAR RISK.  Compared with a control group, girls with ADHD showed a
     nineteenfold increase in the odds of experiencing a major depression
by age
     17. About 46% of the 123 girls with ADHD had a depressive episode,
compared
     with only about 3% of a 112-member control group. The girls with ADHD
were
     15 times as likely to have developed bipolar disorder, and more than 4
times
     as likely to suffer from drug dependency.

     Meanwhile, about 46% of the 112 boys with ADHD in a separate study
     experienced major depression by age 22, vs. 7% of a 105-member control
     group. They were about 8 times more likely to have developed bipolar
     disorder and twice as apt to have become dependent on drugs.

     "Children with ADHD, when they reach adult shores, have a very high
risk for
     a wide range of adverse outcomes," says Dr. Joseph Biederman, a
Harvard
     Medical School professor and lead researcher in the studies.

     GIRLS, TOO.  Adult attention disorders cost the U.S. $77 billion
annually,
     Biederman says. (See BW Online, 5/24/05, "ADHD: The $77 Billion
Curse".)

     In the U.S., about 5% of girls, and 10% of boys, ages 5 to 18 suffer
from
     ADHD, Biederman says. Many observers had assumed that girls did not
develop
     some of the problems boys did, according to Biederman. "Girls with
ADHD tend
     to be underdiagnosed and undertreated." But, he says, people should
consider
     ADHD a serious problem for juvenile females as well as males. It's not
just
     a question of why "Johnny" can't sit still anymore.