Attention Deficit

The Global Market For ADHD Medications

The University of California, Berkeley reports that ADHD has more than tripled worldwide since 1993. Researchers at UC, Berkeley found that the United States, Canada, and Australia “presented higher-than-expected rates of ADHD medication use between 1993 and 2003 - based on predictions from per-capita GDP indicators - a country-by-country analysis showed increases in ADHD drug consumption in countries ranging from France and Sweden, to Korea and Japan.” The US still leads the world in dollars spent on ADHD medication at $2.7 billion in 2006.

The University of California at Berkeley study was published in the journal, Health Affairs.  Researchers reviewed data on ADHD medication use among 5-19 year-olds in countries belonging to the Organization for Economic Cooperation and Development (OECD), whose members are largely economically fit North American, European and Northeast Asian nations.

The researchers stated that one in twenty-five children is taking medication for ADHD in the US. However, their research also suggests that the diagnosis of ADHD and subsequent use of medications to control it is now spreading worldwide.

Dr. Richard Scheffler, a UC Berkeley distinguished professor of health economics and public policy Overall thinks the study reflects global trends. “Given the global diffusion of ADHD medications, as well as the prevalence of this condition, ADHD could become the leading childhood disorder treated with medications across the globe,” Scheffler said. “We can expect that the already burgeoning global costs for medication treatment for ADHD will rise even more sharply over the next decade.”

The Berkeley researchers also cite that “Growth trends indicate that other countries are following in its tracks. For example, global spending on ADHD medications increased nine-fold among OECD countries during the time period studied. This increase is largely due to the advent and availability of more costly and long-acting medications such as Concerta™, Strattera™ and Adderral XR™”.

The use of medications outside of the US is still primarily short acting amphetamines. However, the pharmaceutical industry is well aware that they cannot reach the estimated $3.4bn by 2015, unless it is led by the launch of drugs with novel delivery mechanisms such as improved durations of action and anti-abuse profiles as media are raising the abuse flag significantly. These custom drugs will help differentiate these pipeline drugs from the current established ADHD therapies and increase market share.

It is important to note that although ADHD drugs have demonstrated efficacy in improving the three main symptoms of ADHD - inattention, hyperactivity and impulsivity - none have shown efficacy in treating the cognitive deficits of ADHD.

Drug makers are likely to increase the costs of these novelty release (e.g. long acting) drugs globally as they become more prevalent outside the U.S. in order to reach the estimated $3.4bn target in 2015.

Back to Berkeley, using the IMS Health MIDAS™, an international pharmaceutical database, researchers looked at data and found that between 1993 and 2003, “the number of countries using ADHD medications rose from 31 to 55, with the U.S. share of global market decreasing from 86.8 percent to 83.1 percent. Meanwhile, countries with traditionally low and moderate consumption of ADHD drugs were showing steady upswings.”

Stephen Hinshaw, who is frequently approached by the media to comment on ADHD, is chair of UC Berkeley’s Department of Psychology was a co-author of the study. Commenting on this study, Hinshaw states, “The results temper some key criticisms of ADHD. A common misconception is that ADHD only exists in the U.S. and that the pharmaceutical firms are getting bigger sales because of the ‘creation’ of the disorder in the U.S. Yet cross-cultural research has shown that ADHD exists in nearly any culture that has compulsory education. Clearly, ADHD–which has a substantial genetic liability–is not just a figment of American doctors’ imaginations.”

In a nutshell, here’s Hinshaw’s argument: The use of stimulant
medication in wealthy member nations of the OECD outside of the U.S. is
growing, therefore, “ADHD is not just a figment of American doctors’
imaginations.” I’m not arguing that ADHD is real or not real. I am
simply citing that pharmaceutical marketing dollars greatly contribute
to the rise in use of stimulant medications in these nations. For
example, when adult ADHD medication was marketed heavily in the U.S.,
sales of the drug skyrocketed. Did the number of diagnosed cases
increase? Yes. Did that mean more people had the disorder? No. If this
poor logic and poor research is the best Berkeley and Hinshaw can
produce, then the students that are graduated from Berkeley are doomed!
But, wait, that’s also a non causa pro causa!

Hinshaw has essentially committed a non causa pro causa (false cause). He’s co-authored a study of data from a pharmaceutical database and citing that the number of persons outside the U.S. in the Organization for Economic Cooperation and Development (OECD), whose members are largely economically fit North American, European and Northeast Asian nations. The pharmaceutical industry has spent many millions of dollars over the past few years to increase their profit in these nations in an effort to obtain their estimated goal of $3.4bn by 2015.

What can be clearly gleaned is that the Berkeley study is meaningless. It might have some teeth if the researchers actually correlated the marketing dollars spent by the pharmaceutical manufacturers to the numbers of persons using their medications in the OECD. It would be interesting to see the data on usage in third world countries who cannot afford it. I’d wager that they have far fewer cases of ADHD and use far less medication.