2011-12-13

When Thinking About Health, Sometimes Logic Trumps "Science"

According to The Wall Street Journal, a series of studies downplay the risk anti-ADHD drugs pose to patients' developing cardiovascular disease.

Considering optimal therapy regimens, this is probably true. On the other hand, applying some logic is absolutely necessary for situations like these.

Logic and ADHD Treatments
Stated simply, ADHD drugs tend to be variants of amphetamines and other such stimulants. Setting aside their therapeutic benefits, we all know the impact that amphetamines have on human health. Even in an acute state, they increase heart rate and cause constriction of blood vessels. They temporarily increase blood pressure and trigger some neurochemical stimulants that are typically associated with physical activity, stress, excitement, and so forth.

Considering all of that, it stands to reason that ADHD drugs are a bit harder on the cardiovascular system than the absence of ADHD drugs. We don't need a study to tell us this; we know it aprioristically. It is true because it must be true. It is true because many of these physiological responses are precisely the therapeutic benefit of the drugs in question.

Therapeutic Benefits and Trade-Offs
As I try to emphasize throughout Stationary Waves, the most important aspect of big decisions is not the particular course of action to take (in this case, should a person with ADHD take anti-ADHD medication?), but the trade-offs associated with each option.

Issues are not simple or binary. Few things in life boil down to a simple yes/no response. We must learn to stop thinking about things in terms of yes or no.

Instead, weigh the benefits according to your own needs and values. Considering not just the risk of anti-ADHD medication, but the physiologically necessary response to ingesting them, is taking the medication worth it?

The answer is: It depends entirely on your own, unique situation. I certainly don't have the answer. Neither does your doctor. You have it! You shouldn't make this decision based on a WSJ headline claiming that "there is nothing to fear." There isn't anything to fear, but that's not the issue.

The issue is how much cardiovascular health are you prepared to sacrifice for the sake of the therapeutic benefits. If you have a severe case of ADHD, medication even in large doses is certainly worth the trade-off. If you have an extremely mild case, you can probably self-treat using other methods. (May I suggest exercise?) If your case falls somewhere in between, you have to balance both aspects of your health, make an informed decision, and then monitor your choice carefully.

You may also have to "pick up the slack" by exercising more. Not because "you read so in a study," but because you know certain medications put you at greater risk for cardiovascular malaise and you simply wish to avoid avoidable consequences.

It's the same with diabetes. There is no "right answer," you have to make informed choices and consider your lifestyle and your own behavior. Furthermore, you have to be objective about who you are and how you actually behave.

I can trust myself to exercise once or twice a day, with very few exceptions, therefore I can get by with less insulin than other type 1 diabetics. Is this approach sensible for everyone? Absolutely not. Most people don't work out as much as I do. Many people who genuinely want to work out as much as I do can't spare the time or energy to do so. Such diabetics should consider using more insulin than I do, and managing their diet more carefully than I.

But in every case, we are talking about trade-offs associated with choices; we are not simply talking about a prescription of X minutes of exercise combined with Y units of insulin and food choices from a single, static menu.

It's Not the Industry, It's the Absence of Reflection
When people suggest that the pharmaceutical industry is "evil" because they "get us hooked on drugs we don't need," I think they are often perceiving therapeutic choices as simple yes/no scenarios. People are inclined to want a simple, definitive answer. It's natural; but it is also very naive.

The industry isn't hell-bent on getting you hooked. Instead, they are in the business of providing options based on what you're willing to trade. That doesn't mean all drugs are perfectly safe, that simply means that some people may wish to take dangerous drugs if the therapeutic benefits are great enough for that particular individual.

So when you make decisions about your health, don't just think about whether a drug is "safe," or "effective," or even "safe and effective." Consider what the product offers you and what you're willing to give up in order to gain that benefit.

Everything in life is a variable that we can control for our own benefit, so long as we understand the trade-offs.