The 'Can we?' and the 'Should we?' of science

Also, the brain imaging studies are notable for their low sample sizes, plus serious differences in age and sex between the test groups and the control groups. And it’s rare for two of them to agree on which regions of the brain are different in ADHD patients, to the point that, according to one prominent meta-analysis, “only 25–50% of published reports had reproducible results.” (Like the bat researchers in China, these people have a tremendous incentive to publish scientific papers – but only a small incentive to publish good papers.)

Amid all this confusing literature on the physical effects of ADHD drugs, a few facts still manage to stick out. One is that stimulant drugs suppress children’s growth. While some studies bury this conclusion by using a test group comprised mainly of children who only took the medication briefly or irregularly, the best studies (which focus on children who were on heavy dosages for three years or more) show strong evidence of a permanent height reduction.

Another fact is that, while ADHD is often blamed on a chemical imbalance in the dopamine transporter protein in the brain, ADHD patients who have never been medicated have normal amounts of dopamine transporters. But, as shown here and here , patients who have been on drugs for a long time suffer a steady increase in transporter concentrations (meaning less free dopamine). Nor is this the only chemical anomaly at issue; this Dutch study from 2017 showed that exposure to Ritalin in childhood leads to lasting deficiencies in the neurotransmitter GABA+, a chemical associated with impulse control, which the drug is boosting in the short term.

Then add to this all the psychological harms of long-term drug dependency – the insomnia, the social isolation, the low motivation, the erratic moods, the narcissism and lack of self awareness. Anyone with a drug-addled relative or close friend will have some idea of what it’s like, and while most of us don’t like to use the word “addict” to describe a ten or twelve-year-old who meekly takes the speed pills that his doctor gave him, the biological processes behind drug dependency are the same whether the drug came from a licensed or an unlicensed pharmacist.

So why do we keep doing it? Why do Americans and European and Australians keep getting their children started on lifelong drug dependencies in order to treat elementary-school behavior issues which, two generations ago, were not considered medical problems at all?

The answer? Because it works. Perhaps not in the long run, since most of the studies show that the academic benefits of putting a schoolchild on ADHD drugs are strong for the first year or two, drop off after that, and might become negative in the end. But the evidence that starting a child on medication leads to an instant drop in disruptive behavior, an improved ability to sit still, and a better focus on homework is so strong that hardly anyone bothers to argue with it. And millions of parents and teachers can tell you that their lives got much easier the moment their troublesome child was medicated.

But in the big picture, we’re looking at the same sort of ethics failure that gave us the Covid pandemic. In both cases, science has given people an effective way to satisfy their immediate wants. In China, it was up-and-coming virologists who wanted to pad their résumés, and possibly get tenure, by cataloguing the hundreds upon hundreds of bat viruses that are just a few mutations away from infecting humans.

And in the United States and Europe, it is parents and schoolteachers who want their children to write more neatly, and to sit still for eight hours a day without squirming too much or talking out of turn. (You can tell that this is mostly about policing classroom behavior by looking at the fact that children born in December, who are constantly being compared with classmates a little older than themselves, are 47 percent more likely to be medicated for ADHD than children born in January.)

Back in the Victorian era, it was common for parents of fussy toddlers to give them morphine for their teething pains. In the United States, the commonest brand was “Mrs. Winslow’s Soothing Syrup,” which at its peak sold more than 1.5 million bottles per year. As one might imagine, this remedy created more problems than it solved, and the “Soothing Syrup” finally disappeared at around the same time that cocaine and lithium were disappearing from our sodas.

One might be tempted to read this odd piece of history as a tale of science triumphing over ignorance and superstition. But the truth isn’t that simple, because the key fact here is that Mrs. Winslow’s Soothing Syrup actually worked! The core scientific claim of the people who sold this drug was that giving a one or two-year-old morphine will ease the pain of a new tooth coming in – and nobody disagrees with this! Our ancestors just decided that the syrup’s benefits weren’t as important as its harms.

The question, for our own time, is whether we will be as wise as our forebears, who knew that science and ethics are not quite the same thing, and who knew that the question of “Can we do it?” and the question of “Should we do it?” will often have two different answers.

An earlier generation’s scientists were wise enough to see that while they could use opiates to relieve the pain and suffering of infants, they probably shouldn’t. One can only hope that, sooner or later, the present generation will realize that much the same logic applies to using meth analogues to relieve hyperactive grade schoolers, or to manufacturing deadly viruses in a not-quite-sealed-off lab in order to add to mankind’s stock of publishable (but not exactly useful) scientific knowledge.