Here’s something to make you go hmmmm.

Following on the heels of articles and posts covering stimulant abuse by wealthy students and the seeming lack of ADD/ADHD diagnosis rigor in “Thinking About Stimulant Abuse” and “ADD/ADHD Medication: A Professional Conversation,” here’s a twist on the topic that, although it sounds wacko, makes sense in our crazy world.

If rich kids and parents can connive and cajole their MD’s into providing them with an attention deficit stimulant prescription- for meds that improve the concentration and achievement even of those who don’t have attention deficits- then why shouldn’t poor kids have equal access?

In so many words that’s the idea behind the rural Georgia practice of Dr. Michael Anderson. New York Times reporter Alan Schwarz chronicles Anderson’s work in “Attention Disorder or Not, Pills to Help in School.”

It’s a crazy situation that brings into play good medicine, societal mores and norms, poverty and wealth, our inability to measure school effectiveness, responsibilities of families, schools, and doctors.

From The New York Times:

“The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder ‘made up’ and ‘an excuse’ to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

‘I don’t have a whole lot of choice,’ said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. ‘We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.’

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

‘We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,’ said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. ‘We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.’

Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: ‘We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.’

Dr. Anderson’s instinct, he said, is that of a ‘social justice thinker’ who is ‘evening the scales a little bit.’

He said that the children he sees with academic problems are essentially ‘mismatched with their environment’ — square pegs chafing the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success…

…Dr. Anderson said that every child he treats with A.D.H.D. medication has met qualifications. But he also railed against those criteria, saying they were codified only to ‘make something completely subjective look objective.’ He added that teacher reports almost invariably come back as citing the behaviors that would warrant a diagnosis, a decision he called more economic than medical.

‘The school said if they had other ideas they would,’ Dr. Anderson said. ‘But the other ideas cost money and resources compared to meds.’(NYT)

That’s an equal access conversation.

It makes me think though.

With performance enhancing drugs (PFD’s) rampant in sports, the notion has been floated several places, that, maybe we should just acknowledge PFD’s and accept them, or, separate athletics into “juiced” by PFD’s and the natural or non-juiced.

Maybe we should have two categories of academics: ‘juiced’ vs. ‘non-juiced.’

Maybe we could develop categories for going through life too. This is crazy.