Comment by erlich | Hacker News Reader

Comment by erlich | Hacker News Reader

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Amphetamine used to be legal.

As an example, President JFK received regular injections containing high doses of amphetamines from his personal physician.

Then the risk of abuse and side-effects in the population were observed and it was banned.

Did JFK have ADHD? No, it just helped him with energy levels. Like it would anyone.

There are no conclusive bio-markers for ADHD. Therefore its not possible to say who doesn't have it and should not get stimulant medication.

The only commonality is that there is an impairment. It's not possible to say: this person has difficulty focusing and has ADHD but this person has difficulty focusing but doesn't have ADHD.

The board of psychiatrists who decide what symptoms constitute it just essentially make it up.

The only thing that is real and measurable is the level of impairment to someone's life.

Stimulant medications works, but it would work for anyone regardless of an ADHD cause. ADHD is like a catch-all for people who can't focus that doesn't match any other condition that could be resolved differently.

Stimulant medication definitely carries risks and health impacts. This is black and white.

You seem to have your mind made up, so just gonna say that for anyone else reading this, this is not accurate or scientific information. Lacks an understanding of how the medication works, the differences in kinds of medications. The fact it used to be legal is not relevant. Misrepresents how ADHD is diagnosed, the criteria for it (by professionals), and even to a lesser extent the biomarkers statement.

Everything I have said is explained with citations here: https://pmc.ncbi.nlm.nih.gov/articles/PMC9189308/

I skimmed over that paper, and may do a deeper dive later, although doesn't really seem worth it. I thought it was going to be a scientific study, but it reads more like a essay from two authors with a specific viewpoint trying to convince others, via slanted/biased text, that other text and language is baising an entire industry and population? I find that questionable at best.

And while the authors made a lot of claims, and cited some other studies, they don't really, IMO, prove their point in any scientifically valid way, or even as a solid, well-formed argument. Add in that the authors are sociologists, not neuroscientists or psychiatrists/psychologists, and it makes me question both their claims and understanding of the topic.

I did catch that one of their main points (that you mentioned as well) boils down to not having a physical test or clear biomarker. But that applies to nearly all psychiatric conditions. Saying the absence of those kinds of tests is the same as the absence of a real condition ignores the research that has been done demonstrating functional impairment (including twin studies, some indications of genetic heritability). The paper presents a specific sociological viewpoint, and that isn't the current scientific consensus.

Like I said, probably not gonna convince you, just dropping this for others that might see the essay link and think it might actually provide validity when it does not. That essay does not really make significant arguments against ADHD.

It does present good warnings to be aware of pressures that would distort diagnosis and I do think there is good reason to be cautious about over diagnosing, or diagnosing by unqualified personnel, both of which do happen of course. But the article goes too far beyond that.

Because others can say this much better and with better sources and citation than I can, both directly address many of the criticisms made in the essay shared and the faulty reasoning based on it.

International Consensus Statement on ADHD: https://www.russellbarkley.org/factsheets/Consensus2002.pdf

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder: https://pubmed.ncbi.nlm.nih.gov/33549739/

Why should 6 symptoms constitute ADHD while 5 don't?

The person with only 5 doesn't have it?

This is not science.

Change the diagnostic criteria to a blood test or brain scan and then we are in the realm of proper science. But until then the burden of proof should be on the ADHD community not on those trying to dispute it. It's like having to use proper science to disprove something that is not conclusively proved in science.

It's fine to publish all this science and evidence, but it all comes back to the diagnostic criteria which is so wishy washy. The diagnostic criteria has evolved from a completely arbitrary definition. There is no reason the DSM stuff should be used at all, and trying to find science to support a diagnostic criteria that was arbitrary to begin with is silly.

That's why, after all this, the main point I make is that the boundary between ADHD and non-ADHD is arbitrary and will always be and its more about having a disorder to point to to be able to prescribe stimulants to "people it would help".

Mark my words: there will never be a biomarker or test used to diagnose this condition because it would only reduce the number of people who can access treatment.

It's an elaborate exercise on how to be allowed to use a scheduled medication as treatment. If the government didn't ban drugs then all this ADHD diagnosis stuff wouldn't exist at all. It would be the reverse exercise: which people should not be allowed it because they abuse it and it negatively impacts them.

Your (and the authors of your paper) reliance on biomarkers are not how most psychiatric conditions are diagnosed. The fact you even ask about 5 vs 6 demonstrates a lack of understanding (or willful ignorance of) of how and why the diagnostic criteria are what they are.

Completely disagree with your conspiracy theory about the drugs. That's just laughable. Obviously need to prevent abuse, but there are both legitimate uses of and reasons to restrict general use of the drugs. Not to mention there are non-stimulant drugs as well, which kinda stomps on that argument.

We are just talking past each other now.

> not how most psychiatric conditions are diagnosed

Psychiatry as a whole is questionable. https://en.wikipedia.org/wiki/Psychiatry#Controversy_and_cri...

Read about the history of the DSM regarding ADHD. You can look at all the versions/volumes and how and why it evolved over time. Ask yourself if you think it is actually good science.

I have done exactly that. I've seen your bias re: psychology as a whole and it appears to color your research and information gathering. I hope, like I have been doing even if not apparent from my replies, that you are able to consider your viewpoints and whether they actually hold true.

Along those lines, I do appreciate this conversation. I do like questioning what I believe, and I had to steelman some of the views you put forth and then see where they then didn't hold up. I do that while being willing to change my own mind if that is where the evidence leads, but the research presented didn't hold up to scrutiny. So while I definitely disagree with you, I do so from a place of appreciation for pushing me to do more digging into this things and whether *I* should hold the beliefs that I do.

> I do appreciate this conversation

Me too :)

I like discussions like these because its always an opportunity to absorb more information.

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