Tough Love

Another job for the dispatch writer is that of pharmaceutical cheerleader. Consider "Superaspirin," which appeared in the June 15, 1998, issue. The subject was Celebra, a promising drug being developed by Monsanto to treat inflammatory ailments such as arthritis. The author, Jerome Groopman, is a professor of immunology at Harvard Medical School, which may help to explain why he found a place in The New Yorker to puff Dr. Lee Simon, a Harvard colleague who helped design Monsanto's clinical trials for Celebra.

Simon appears late in the piece, injecting cortisone into Groopman's elbow (dispatch writers often make a cameo appearance). "Celebra is incredible," Simon tells his patient, pointing out that more than 10,000 people have received the drug— with no observed side effects. At the end of this narrative infomercial, Groopman works in a disclaimer. "It seems too good to be true," the patient-narrator tells the doctor, whereupon the doctor concedes that before it can be deemed safe, Celebra must be studied over several decades.

No such hesitation for Malcolm Gladwell, who displayed his knack for writing ad copy in "More Ritalin!," a story that received top billing on the February 15 cover flap. Ritalin is used to treat attention-deficit hyperactivity disorder, or A.D.H.D., in children; 30 years ago it replaced amphetamines as the preferred medication for A.D.H.D.

The piece appears to be a review of three recent books about Ritalin. But by the end of the first page, Gladwell makes mincemeat of the books, because their authors do not subscribe to that school which believes psychiatric disorders are rooted in biological causes and best treated by psychopharmacology alone.

The review quickly segues into an essay on the cutting edge of A.D.H.D. treatment. "My role in this," Gladwell said in an interview, "is I am interpreting the views of the leading experts of the day on this drug and this disorder."

To be sure, Gladwell is a brilliant writer. But in "More Ritalin!" his facility gets the best of him. He glibly endorses Ritalin, while glossing over long-standing concerns about prescribing psychoactive drugs to children. Specifically, Gladwell calls Ritalin "remarkably safe" and "not addictive," but does not mention its known potential to become addictive and to stunt a child's growth.

Gladwell brushes aside the risks. "When we say something is safe, we don't mean there are no side effects," he said. "When we say something is not addictive, we don't mean it's impossible to get addicted to it." Asked if he believes children experience withdrawal when they stop taking Ritalin, he said, "I know there would be changes in the child's behavior. Does that qualify as withdrawal?" (Once, a 14-year-old boy withdrawing from Ritalin killed a classmate with a baseball bat. Total fluke!)

Gladwell also left out this factoid: there have been no conclusive studies on the safety of long-term Ritalin use. This absence of evidence bothered some people at a recent "consensus conference" on A.D.H.D., sponsored by the National Institutes of Health, enough that the conference panel recommended studying "the benefits and risks of long-term use" of Ritalin. The panel also noted conflicting evidence as to whether Ritalin kids are likely to become teen drug abusers, contrary to Gladwell's story, which quoted a Harvard professor whose study showed a very low risk. Gladwell dismissed such nitpicky concerns, saying, "It is the consensus of many of those who attended that the NIH consensus panel was way too conservative."

Remember, this is the same man who warned against making science conform to a simplistic narrative. Could there be a double standard at work here? It's true that a layperson can be so willing to believe something that she treats inconclusive evidence as if it were proof of her cherished beliefs. But sometimes a dispatch writer gets so infatuated with an idea, he errs in the other direction, by treating inconclusive evidence as no evidence at all. Just because dosing kids with Ritalin has not been proved to be dangerous does not mean it is safe.

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