Is Amphetamine Truly the Solution For Managing Rambunctious Children?

 

https://www.additudemag.com/misunderstood-adhd-in-the-classroom/

Imagine yourself as a parent, receiving a call from school because your child keeps interrupting class and will not sit still. You think to yourself, “But aren’t kids always bursting with energy?” The teacher urges you to put your child on medication to calm him or her down. You are not sure, but you decide to accept. Everything will go back to normal with a handful of pills, no? Or is the problem something deeper?

All About ADHD

Attention Deficient Hyperactive Disorder, shortened to ADHD, is a neurodevelopmental disorder that impairs the brain’s executive functions. Organization, planning, time management, and paying attention becomes extremely difficult for those with ADHD. You may know a friend or parent with an ADHD kid. ADHD is a relatively common disorder, affecting 11% of children and 5% of adults (1). Even I have ADHD and can relate to all these symptoms. I best described my struggles to a friend as, “Having a hundred computer tabs open and rattling around in your head but you can’t close any of them”. Not only does the condition impact your personal or social life, it can detrimentally affect your work or schooling. Being forced to sit still in class while a teacher is lecturing about some uninteresting topic is agony. Back in the early 20^th century, unruly students would be kicked out of class or smacked with rulers, but there is a modern solution: Medication.

Prescription Problems

There are many different types of ADHD medication. Some act instantly and allow for powering through a morning test and some are slow acting and facilitate survival of the school day. The most commonly used drug are stimulants which increase the neurotransmitters dopamine and norepinephrine in the central nervous system. Because dopamine is in short supply in those with ADHD, they struggle with mood and concentration (6). In the United States, 8.5% of children, about 1 in 12 children, are on some form of medication to treat ADHD (1). And with the whirlwind of COVID causing kids to be cooped indoors, ADHD prescriptions are at an all-time high (7). These medications are not without their problems. As some medications use amphetamines, they are tightly regulated, punishing the absentminded for forgetting their refills. Medications are also expensive and difficult to force children to take. Finding the correct type of prescription is an added challenge. Not enough dosage and the children are bouncing off the walls, too much dosage and the children are mindless drones. It is a nightmare for everyone involved. Maybe ADHD is not the fault of the children, but of the school system.

https://www.additudemag.com/slideshows/how-can-we-improve-education-for-students-with-adhd/

Schooling Situation

Public or private, children are in school for eight hours a day. They have many classes, but not a lot of free time. According to the National Association of Early Childhood Specialists, 40% of schools have removed or are considering removing recess. Removing a well needed break for children is problematic. Stewart Trost, a kinesiologist, believes kids who have recess have improvements in staying on task, are less fidgety in the classroom, and are more well behaved (3). Participating in sports have the same beneficial effects. Physical exercise raises those needed dopamine levels and clears the mind to improve students’ social skills and focus in the classroom (2, 5). There are many more ways the United States’ school system could be improved. ADDitude, a magazine devoted to understanding and triumphing over ADHD, provides solutions. Teachers should be trained in recognizing ADHD symptoms instead of considering it as unruly behavior. Class lessons could be more interactive which decrease the amount of time required for students to sit quietly at a desk. Recess breaks should be non-negotiable (4). So the next time little Timmy is squirming in his seat, don’t throw pills at the problem, let him be a kid! Exercise and fresh air are far less expensive.

By Carmen Harper, a Master's of Medical Science student at the University of Kentucky

References:

ADDitude Editors. “What Is ADHD? Attention Deficit Hyperactivity Disorder in Children and Adults”. ADDitude. 2019. https://www.additudemag.com/what-is-adhd-symptoms-causes-treatments/

ADDitude Editors. “Exercise and the ADHD Brain: The Neuroscience of Movement”. ADDitude. 2022. https://www.additudemag.com/exercise-and-the-adhd-brain/

Silver, Larry. “No Recess for Recess”. ADDitude. 2017. https://www.additudemag.com/benefits-of-recess-for-adhd/

ADDitude Editors. “10 Ways We Would Fix the U.S. School System”. ADDitude. 2021. https://www.additudemag.com/slideshows/how-can-we-improve-education-for-students-with-adhd

Stewart, Kristen. “How Exercise Works Like A Drug for ADHD”. Everyday Health. 2013. https://www.everydayhealth.com/add-adhd/can-you-exercise-away-adhd-symptoms.aspx

Cochrane, Zara. “ADHD Medications List”. Healthline. 2023. https://www.healthline.com/health/adhd/medication-list

Kritz, Fran. “The Adderall Shortage: Why It’s Still Happening and What to Do if You Can’t Get Your Meds”. Everyday Health. 2023. https://www.everydayhealth.com/adhd/the-adderall-shortage-why-its-still-happening-and-what-to-do/

 

To Live or to Die by BMI Anti-Black Racism and the Black Community’s Struggle with Obesity

 Let’s Have an Uncomfortable Conversation

There is no debate that obesity is a serious condition that disproportionately impacts the Black community in America. In 2018, Black Americans were found to be 1.3 times more likely to experience obesity and 20 percent less likely to participate in consistent exercise compared to white people.¹ Black women are 50 percent more likely to experience obesity compared to their white counterparts. However, the tools we use to classify obesity are a little out of date.

What is BMI?

Body Mass Index is the measurement of weight (kg) divided by the square of height (m).² BMI is a tool that is used to detect possible risks associated with high body fat and to categorize patients by weight. BMI is used by life insurance companies, electronic health records, and healthcare providers to quantify disease risk.³

Let’s Take a Closer Look at the Origins of BMI

Adolphe Quetelet was a mathematician from Belgium who became very interested in using statistics to define the “average man,” an idealized concept of physicality.⁴ Quetelet found that using a ratio of weight and squared height was the best way to quantify body size and growth. This number was named the Quetelet Index in 1832. Weight tables came into the picture as a result of observations by life insurance companies in the early 20th century. Louis Dublin, vice president of Metropolitan Life Insurance Company, noticed an increase in deaths of policyholders who were obese. He collected data on the matter and found that people of the same height and sex exhibited a vast range of weights. To account for this, he took that range of weights and divided them into small, medium, and large. Insurance companies then decided what weight category was “desirable” and used this number to inform their policies and payouts. The topic of obesity was of growing concern, and by the time of World War II, medical professionals needed a reliable index of weight for clinical and epidemiological studies. In 1972, Ancel Keys, an American physiologist, performed a study that compared the different weight indexes available to clinicians and decided that the Quetelet Index was the most accurate. He then renamed that index to the Body Mass Index, and this ratio was then adopted by medicine.

One of the main criticisms of the Body Mass Index at the time was its ability to be generalized to other populations.⁴ Studies on BMI relied on data from white populations, therefore it did not account for any physical differences in frame and weight distribution for other ethnic groups.

This shortcoming has several serious implications, especially for Black Americans.^3,4

 BMI, Eugenics, and Racism

Discrimination against Black people for their body size originated during chattel slavery when Europeans “observed” enslaved Africans and presumed that they were more sensuous and that they ate too much.⁵ Sabrina Strings, author of Fearing the Black Body: The Racial Origins of Fat Phobia, is an expert on the topic of obesity science and anti-Blackness. In an interview with NPR, Dr. Strings discusses how slave owners differentiated between the enslaved and the free.
After centuries of slavery, it became difficult to tell who was enslaved just by their skin tone, so “they decided to articulate new aspects of racial identity.” Dr. Strings elaborates that appetite and size were two key indicators of a person undeserving of freedom.

 BMI and racism were brought together by Francis Galton, known as the Father of Eugenics.⁶ Galton used the Quetelet Index as the basis for his theories about eugenicist breeding practices - he was concerned with turning Quetelet’s “average man” into an extraordinary one, and this vision did not include people of color or obese bodies.

 Charles Davenport came shortly after Galton and was convinced that there was some racial component to obesity.^6,7 His research conflated a “healthy” body with an attractive body, thus promoting the concept that Black people are “unhealthy” and therefore undesirable. A key component of eugenics is associating physicality with moral value, demoralizing bodies that do not fit within the established aesthetic.

From Strings, S. (2023a, July 1)7

BMI is not a one-size-fits-all solution

The problem with BMI lies within its ability to serve as a “catchall proxy for body fat, nutritional status, and health risk.”8 Relying too much on BMI may unfairly inform diagnoses and exacerbate pre-existing stigma and distrust between Black Americans and the medical community.
 
Given how deeply ingrained BMI is within our healthcare system, it might not be realistic to just do away with it altogether, but adjusting the cut points for ethnicity and educating providers on diagnosing and treating obesity in the Black community is a good start. Dr. Fatima Stanford, an obesity medicine physician-scientist at Harvard Medical School, proposed new BMI cut points that are adjusted for both ethnicity and gender.⁹ These new BMI thresholds are a better predictor of future morbidity and mortality associated with obesity because they are “based on association with metabolic disease” relative to each subgroup, allowing for a more personalized assessment of risk.

 

Obesity in the Black community is a sensitive, nuanced topic that requires special attention from healthcare providers to ensure that Black patients are being treated holistically. BMI may be a useful tool for assessing populations and providing a metric that predicts health risks and disease, but we must all be careful to only see BMI as a part of the picture.

 

By Alexis Jackson, A Master’s of Medical Science student at the University of Kentucky

Sources

1.     Department of Health and Human Services. (2022). Obesity and African Americans. Office of Minority Health. https://minorityhealth.hhs.gov/obesity-and-african-americans

2.     Centers for Disease Control and Prevention. (2022, June 3). About adult BMI. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

3.     Centers for Disease Control and Prevention. (2022, June 3). About adult BMI. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html\

4.     Eknoyan, G. (2007). Adolphe Quetelet (1796 1874) the average man and indices of obesity. Nephrology Dialysis Transplantation, 23(1), 47–51. https://doi.org/10.1093/ndt/gfm517

5.     NPR. (2020, July 21). Fat phobia and its racist past and present. NPR. https://www.npr.org/transcripts/893006538

6.     Farber, S. A. (2008). U.S. Scientists' Role in the Eugenics Movement (1907–1939): A Contemporary Biologist's Perspective. Zebrafish, 5(4), 243-245. https://doi.org/10.1089/zeb.2008.0576

7.     Strings, S. (2023a, July 1). How the use of BMI fetishizes white embodiment and racializes fat phobia. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/how-use-bmi-fetishizes-white-embodiment-an d-racializes-fat-phobia/2023-07

8.     Stern, C. (2021, May 8). Why BMI is a flawed health standard, especially for people of color. The Washington Post.https://www.washingtonpost.com/lifestyle/wellness/healthy-bmi-obesity-race-/2021/05/0 4/655390f0-ad0d-11eb-acd3-24b44a57093a_story.html

9.     Race, ethnicity, sex, and obesity: Is it time to personalize the scale? (n.d.). https://www.mayoclinicproceedings.org/article/S0025-6196(18)30807-3/pdf

DRUG, DUPE! SAVE YOUR MONEY AND GO WITH GENERIC

     What do the words generic and ineffective have in common? Absolutely nothing! It is a common misconception that generic brands are less effective than name brand products, due to the gain of negative connotation surrounding the terms in society. The brand effect is studied by large pharmaceutical companies to understand what convinces consumers to buy their drug products and how that can be incorporated into gaining business and recurring sales. The difference in advertising and drug packaging from company to company can be enough to persuade consumers into purchasing their products. Society tends to be easily influenced in today's market, especially with the growth of social media presence amongst the general population. The strategic advertising that name brand companies put out onto online platforms is meant to introduce and familiarize us with their products hoping to make consumers more susceptible to purchasing their products. When describing drugs, patients tend to associate price with efficiency, meaning the more expensive the drug the better it will work. I mean, who doesn’t want to feel better, faster? The name on the box does not have any correlation as to how well a drug works, nor does the price tag! Next time you find yourself in the drugstore medicine aisle, look at the similarities between name brand products and generic products. Being an educated and informed consumer is important and will save you time and money, especially when you reach for the generic brands.   

https://soieric.com/generic-vs-branded-medicines-in-india-a-quick-differentiation/

WHAT IS THE DIFFERENCE?

    According to the Food and Drug Administration, “generic medicines work in the same way and provide the same clinical benefits and risks as their brand-name counterparts. A generic medicine must be the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, and in the way it is taken. Generic medicines also have the same risks and benefits as their brand-name counterparts.” (5) These generic medicines are required to go through the same strict pre-approval process that name brand products do. This protects the consumer from purchasing a less effective drug due to reasons including financial restrictions, limited access to health care or knowledge.   

https://www.ideagen.com/thought-leadership/blog

SAVE OR SPLURGE?

    What makes generic brands more affordable? The lower cost is attributed to not having to repeat animal and clinical studies required of the brand-name medicines to demonstrate safety and effectiveness. (4) Research can be costly and is not always guaranteed a successful outcome. The ability to skip the research portion of drug development saves cost and time. The estimated cost of research and development can range from $1-2 billion per drug. (4) The amount of time these medications also take to develop is also considered when determining a price point in drug stores. The development process can take on average 10+ years and the pharmaceutical company does not receive a financial return on its investment. (4) Generic medicines cannot get final FDA approval until protective patents of name brand drugs have expired. (1) This causes a delay in the timing of distribution to drug stores; however, these generic drugs applications are typically approved within 6 months of submission to the FDA. (3) The time and money saved by companies producing these generic drugs is a direct reflection into how they price their products and can sell to a wide demographic of customers. These drugs provide a more affordable option for patients who may have limited resources giving them access to pharmaceutical care.  

https://www.vecteezy.com/vector-art/340554-piggy-bank

SHOW ME THE STUDIES

    Multiple studies have been conducted to evaluate the influence branding and marketing have on consumers, specifically related to drug products. Authorized generic (AG) drugs, name brand drugs that are marketed as generic drugs, were used as an experimental control group, and name brand drugs of identical composition were compared to observe the bias consumers have towards favoring brand name drugs versus generic drugs to treat chronic diseases. “After analyzing data from more than 3.5 million patients, the authors (of the research study) observed that use of generics provided comparable clinical outcomes to those of the brand-name products for chronic conditions including diabetes (glipizide), hypertension (amlodipine, amlodipine-benazepril, and quinapril), osteoporosis (alendronate and calcitonin salmon), and depression and anxiety (escitalopram and sertraline).” (2) Another study was conducted to measure the effectiveness of antiepileptic drug (AED) therapy in terms of persistence and rate of seizures in epileptic patients, comparing generic versus name brand drug therapies. The results showed that 31 patients on the generic AEDs had hospitalizations and ER visits while there were 47 incidents recorded of patients that were on the brand name AEDs. The gap rate of which patients experienced seizure-like symptoms was an average of 124.2 days (about 4 months) for patients on the name brand AED, while the average gap rate for patients on the generic brand AED was 137.9 days 

(about 4 and a half months). In other words, the generic brand medication outperformed the name brand medication, as it resulted in less hospitalizations and provided patients with relief from symptoms for a longer time. (1) Both studies present compelling data that supports the idea that generic drugs do not necessarily mean less effective. In fact, certain experimental data results favor the generic brand in terms of efficacy. Looking at the research, we should not write off generic brands!  

https://www.scripthero.com/articles/brand-vs-generic-prescriptions

WHAT SHOULD YOU DO?

    Educating yourself about branding, marketing, and taking the time to read the labels can save you money and change your perspective on purchasing drugs in the future. Consulting with a pharmacist may also be helpful, as they provide insightful information regarding questions you may have about different branded medications. Although brand name drugs seem to appeal to consumers more than the generic brand, make the choice and switch to generic. The higher price does not constitute for the quality and efficacy of the medication. You are spending your extra money on the name, the packaging costs, and the developmental debt of the pharmaceutical company. Generic brands are equally as effective and cost less, so why wouldn’t they be the better choice? Physicians can do their part to encourage patients to do their own research to make informed and educated decisions. Educated consumers should feel confident about the quality and efficiency of the products that you are using. So read the labels, do your research, save your money, and reach for the bottom shelf generics.  

REFERENCES

1. Gagne JJ, Kesselheim AS, Choudhry NK, et al. Comparative effectiveness of generic versus brand-name antiepileptic medications. Epilepsy Behav. 2015;52(Pt A):14-18.

doi:10.1016/j.yebeh.2015.08.014

2. Desai RJ, Sarpatwari A, Dejene S, et al. Comparative effectiveness of generic and brand-name medication use: A database study of US health insurance claims. PLoS Med.

2019;16(3):e1002763. Published 2019 Mar 13. doi:10.1371/journal.pmed.1002763

3. Ted Sherwood, The generic drug approval process, Food and drug administration website, https://www.fda.gov/drugs/news-events4.

4.     David Austin and Tamara Hayford prepared the report with guidance from Joseph Kile, Lyle Nelson, and Julie Topoleski, Research and development in the pharmaceutical industry, Congress budget office website, https://www.cbo.gov/publication/57025, April 2021, accessed on October 26th, 2023.

5. Generic drug facts, Food and drug administration website, https://www.fda.gov/drugs/generic-drugs/generic-drug-facts, updated on November 11th, 2021, accessed on October 23rd, 2023.

-human-drugs/generic-drug-approval-process, updated March 17th, 2022, accessed on October 26th, 2023.

By Karly Brungs 

A Master's of Medical Sciences Student at the University of Kentucky