Parentdish.com interviewed me a few weeks ago, about ADHD.  I do not treat ADHD myself, which allows me to have a kind of broad, unbiased perspective on it — and, like most diseases considered “new”, history tells us it is old but “newly named”.  The very popular article, widely reblogged, is here:

http://www.parentdish.com/2009/05/11/would-you-drug-your-child-to-enhance-academic-performance/

and here are my original answers in the interview :

> Please provide me with your definition of ADHD and ADD. Is this a truly physiological disease? I am skeptical, I admit. It seems like when I was a kid, students with ADD or ADHD were just called “hyper” or “active.”

Look, forget about clinical definitions; let’s talk about people.  ADD/ADHD is the disease that caused Alexander to be The Great.  It also caused him to drink himself to death.

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http://thefamilygroove.com/apr09_EveryBreathYouTake.htm

EVERY BREATH YOU TAKE
DR. ANATOLY BELILOVSKY, MD, ANSWERS YOUR ASTHMA FAQS AND TALKS
OUTDOOR POLLUTION, ALTERNATIVE TREATMENT AND STRESS

Q: What is asthma, really?
A: Asthma is the reversible narrowing of bronchi,
the pipes through which air reaches your lungs.
Look at it this way: Imagine breathing through
your eyes. Have you heard of bronchospasm?
That’d be like your eye was closed. Bronchial
inflammation? That’d be like your eye was swollen
shut and filled with gunk. Reversible obstruction? That’d be like your eye was shut one minute (a trigger response) and wide open the next.

Q: Why is there so much asthma lately?
A: The theory that makes the most sense, and is best backed up by evidence, is the hygiene hypothesis. In several studies, it was found that in developing countries, people who were infested by intestinal parasites had less allergy and asthma than those who were not, and in a German study, less asthma was found in children who survived a life-threatening infection. The immune system is constantly on the lookout for infections and parasites and, lacking real targets for the immune cells to attack, sometimes attacks healthy tissues or overreacts to minor infections. There are a number of infectious agents such as respiratory syncytial virus or mycoplasma that have been identified as commonly associated with asthma, and, of course, pollutants can trigger attacks. Blaming all asthma on outdoor pollution is probably incorrect, as the air is cleaner now than it has been for hundreds of years because of stricter environmental controls.

Q: How is asthma treated?
A: There are medications like albuterol, which relaxes the muscles holding the airway closed; steroids, which decrease the swelling; and antibiotics, which treat the infections that may either trigger or complicate asthma episodes. A common mistake is to assume that, if shortness of breath is absent, all is well. This error is best avoided with the use of a little toy called a peak flow meter. It measures how fast you can breathe out, compared with both your personal best and the ideal calculated for your age and height. Peak flow numbers will drop long before actual shortness of breath appears, allowing you to adjust your treatment or seek help early. Another dangerous mistake is to treat with beta-agonists (like albuterol) alone. They work quickly, but in the worst attacks, they fail without warning; dependence on beta-agonists has caused many deaths in asthmatics. Think of them as fire extinguishers; if you use one daily, there is something wrong in your kitchen, and they are useless against a big fire. There are a number of preventive medications that keep attacks from happening, and a number of rescue medications that stop breakthrough attacks, but the old “can’t breathe, take a puff” routine is not only useless, but potentially deadly.

Q: What are alternative treatments for asthma?
A: First of all, emotional distress is a well-known asthma trigger. The lungs and the brain are connected by the vagus nerve, and vagus activity is known to produce asthma attacks, so whatever makes you feel less anxiety will probably have an effect against asthma. Secondly, a number of plants produce toxins that, in small quantities, have an asthma-blocking activity. Unfortunately, as these toxins are needed by the plants to keep them from being eaten by animals, they tend to have serious side effects. Ephedrine in ma huang, theophylline in tea, and scopolamine in deadly nightshade are examples of such poisons. Many currently used medications are “declawed,” less toxic derivatives of natural plant poisons. Thirdly, human and animal adrenal glands produce steroid hormones, some of which fight the inflammation that is part of an asthmatic event. Both natural versions of these hormones and synthetic derivatives are used sparingly, as they produce their effect by suppression of immunity. “Declawed” versions of these hormones are easily destroyed in the bloodstream; they are given as inhalations directly into the airways and do not produce measurable effects anywhere else in the body.

Physical activity appears to help more often than not; exercise-induced asthma appears to be less common than asthma that gets better with consistent exercise. In any case, asthma should never serve as an excuse for reduced activity. Finally, anything that controls heartburn will probably reduce asthma severity as well—and since caffeine, fat, overeating, spicy foods, alcohol, smoking and tight clothing can all induce heartburn, avoiding them might be worth a try.

Dr. Anatoly Belilovsky is a New York pediatrician whose 365-day practice, Belilovsky Pediatrics, won an AmeriChoice award for Center of Excellence in asthma care. He is a graduate of Princeton University and served as a clinical instructor in pediatrics at Cornell’s Weill Medical College. For more information, visit his website and blog www.babydr.us.

The first time I was right in my predictions and wished I wasn’t, it was on a subject I already beat to death: immunizations. In the very early 1990′s, as the Soviet Union fell apart, one of the results of its decomposition was a drastic drop-off in immunizations. And, seeing, to my distress, dozens of recent immigrants with few to no immunizations, I spared no effort getting them caught up to US standards. In at least one case I was too late: a little girl died of measles encephalitis while in my care. This family’s tragedy was a pale shadow of the massive disaster that befell what was left of the Soviet Union: thousands of deaths of preventable disease, mainly whooping cough, measles and diphtheria, and hundreds of thousands experiencing pain or disability.

But his is not about pushing for more mandatory immunizations. Quite the contrary.

It is a historical fact that public health works best in efficient tyrannies. Godwin’s Law states that sooner or later, Nazis will be invoked in any online discussion, so I might as well get this out of the way early: Nazi Germany and Stalin’s USSR had the most effective public health systems in the world at the time. They weren’t necessarily good, as the former was used to kill the less-than-perfect children, the latter developed psychaitric techniques for mind control, and both experimented on the unwilling, but as far as delivering their concept of health care to the masses, no one could touch them. In both cases, the motive was the same — a healthy, procreating herd of workers to be used for war or industrial development as needed; the means — an enslaved workforce including medical personnel to be used at government’s discretion; and the opportunity — the ability to deliver health care to homes and schools and workplaces bypassing the annoying complication of informed consent. As anyone who knows history can appreciate, when tyrannies fall, power plants crumble before prisons; and as public health enforcement withered away, the public rebelled against immunizations as they did against marching in goosestep. The latter was free of consequences; the former was not.

It bothers me that, as we get increasingly safer and more effective immunizations in our arsenal, and more and more information demonstrating their safety, we get more and more families asking to opt out. I think this is happening because of increasing government mandates — both for the families to accede to every single immunization in the pharmacopeia, and for us to escalate pressure on the families to do so. Tyrannies do not encourage thought; they result in either bovine acquiescence or pigheaded rebellion, and neither is a considered choice. I bothers me equally to have my patients line up to obey the Authorities, or distrust me as the agent of the Authorities. I do my own thinking and I prefer you do the same. And I’d much rather call someone an idiot than turn them in as a neglectful parent. So if you think I insulted your intelligence in our recent discussion about immunizations, well, yes, that was my intent. But, all in all, I’d rather live in a country that has freedom of stupidity. I shudder to think of how a government might outlaw stupidity successfully.