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Every month, I see the boy to renew his prescription for Ritalin and to make sure that there are no serious side effects. At each visit, he greets me with a deep-rooted but quiet anger. His fidgeting and outbursts seem to have diminished, but there has been little improvement in his schoolwork. Last year, he barely passed the eighth grade and his mother admitted that 2 of his teachers simply elected to pass him to avoid a repeat year with him. Nevertheless, she is delighted with the results.
When the boy is on vacation from school, I have noticed a definite change in his demeanor. Typically, when school is out, pediatricians give children with ADD a “drug holiday.” When he does not take his medication, his fidgeting and inattention are back in full force but he beams with joy, at least when I see him, and tells me that without Ritalin he can again enjoy cutting up in front of his friends.
But in his mother’s defense, I don’t live with him and have no real idea how disruptive his ADD behaviors can be at home. In cases like these, I have to listen to the parent that does live with him. I remain terribly conflicted about pharmacologically altering this young man against his will. Using potent pills to treat a disorder we do not completely understand flies in the face of prudent medical practice, and yet we pediatricians do this all the time with our ADD patients. More than a century ago, the great physician Sir William Osler observed that “the desire to take medicine is one feature which distinguishes man, the animal, from the rest of his fellow creatures.” In the practice of pediatrics, we are often compelled to include the parent’s desire in that rubric.
But still, I wonder, am I doing the right thing?
Reprinted with permission from Medscape Pediatrics 6(2), 2004 www.medscape.com/viewarticle/488924?src=sr © 2004, Medscape.
About the Author:
Howard Markel, M.D., Ph.D., George E. Wantz Professor of the History of Medicine, Professor of Pediatrics and Communicable Diseases, Director of the Center for the History of Medicine at the University of Michigan, and author of When Germs Travel, from Pantheon Books.
Disclosure: Howard Markel, MD, PhD, has no significant financial interests or relationships to disclose.
 This article appeared in Pathways to Family Wellness magazine, Issue #04.
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