Finally, my clinical findings, described as “remarkably at variance with current research and practice” are based on my research of the files of hundreds of youths in the correctional system. These youths’ attitudes, behavior, and lives completely changed when stimulants were replaced with mood stabilizers or antipsychotics. Many of them stayed on stimulant medications despite overly elevated mood, hallucinations, and aggressive behavior. Aggravated assault charges landed them behind bars.
With regard to Dr. Bekenstein’s comments, I can only say that if she thoughtfully rereads my article, she will realize that I did not say some of the things she perceived.
In the end, I have hundreds of former “treatment failures” to corroborate my statements. I am not alone either in my perspectives on these ADHD issues if all research and practice are considered, or in the conviction that science and patient treatment is advanced by divergent research that tests current views.
Editor’s note:
Thanks to Drs. Clark, Bekenstein, and Mota-Castillo.
The concept of publishing clinical “Pearls” is to allow experienced clinicians to share what they have learned in practice. The somewhat sad truth is that a lot of what we do in practice every day is not “evidence-based.” As Dr. Mota-Castillo points out, much of what was generally accepted not long ago has turned out not to be true.
For the purpose of determining whether a clinician has met “the standard of care” in a professional liability case, the standard is not that what they did would be agreed to by all clinicians, or even by a majority of clinicians. The standard is whether a “reasonable minority” of clinicians would agree. In the case of “Pearls,” we are willing to print recommendations that are endorsed by a reasonable minority, even if they do not represent the majority opinion.
In our regular articles, we are careful to differentiate majority from minority opinion. We have not done that so far in the “Pearls” section. In the future, we will make sure to include an editorial comment in cases like this where most practitioners probably would not endorse the author’s opinion.
To be honest, I am pretty sure that I have seen patients who had ADHD who also became cocaine abusers.
J. Randolph Hillard, MD
Editor-in-chief