Latest / Radically Genuine / 206. EXPLOSIVE ADHD Debate You Need to Hear with Psychiatrist Dr. Ryan Sultan

Transcript

206. EXPLOSIVE ADHD Debate You Need to Hear with Psychiatrist Dr. Ryan Sultan · Radically Genuine

• 00:00:03:03 - 00:00:32:03 Speaker 1 Welcome to Radically Genuine Podcast. I am doctor Roger McFarlane back here in the Bethlem studio. Honored today to have Doctor Ryan Sultan. He is a child and adolescent psychiatrist. And here we go. We have another Columbia University professor. I am actually shocked that someone would come back down here from Columbia, given some of the challenges of the last one, but I do anticipate this one to be a much more interesting, conversation. 00:00:32:05 - 00:00:52:23 Speaker 1 And you're asking me some of the challenges with, Doctor Raggy, I guess I think ultimately, when you will get into some of these challenging discussion points, he would just say, trust me, I'm an expert. And, I wanted to get in depth a little bit more on some of the, critical aspects of our field, and I'm sure we'll be able to get involved in that today. 00:00:53:00 - 00:00:58:06 Speaker 1 Doctor? So why don't you tell my audience a little bit about who you are and the work that you're currently doing? 00:00:58:08 - 00:01:44:13 Speaker 2 I am, practicing adult and child psychiatrist. I have, practice integrative psych in New York, where we, we really specialize in, in, like, multimodal treatment modalities. I, have a, lab up at Columbia, and my interest is a lot in big data. So we call mental health informatics. So, like all the claims of every prescription that's written in the United States and being able to look at how old were they, how long did they take it for some of the population, things like that, as well as, insurance and, and data. 00:01:44:15 - 00:02:06:23 Speaker 1 Right. I think what really interests me about, the kind of work that you're doing right now is that you're embedded right in this ADHD epidemic that's existing in the United States. So I know my audience is very interested in understanding what is ADHD, what ADHD might not be, what is going on in our country when we're seeing these spikes in ADHD diagnosis? 00:02:06:23 - 00:02:10:00 Speaker 1 Are you aware the prevalence rate of ADHD? 00:02:10:02 - 00:02:37:05 Speaker 2 That's going to depend on what study you look at, right? Like it's going to be younger, individuals, the the published numbers, the highest I've ever seen is maybe 11%, on the lower end. I mean, in some countries, it's like three, and, in the adult population, I think the highest I've seen is probably like 4%. 00:02:37:11 - 00:03:05:12 Speaker 1 Okay. Yeah. I just got some CDC data. I think 2022 was the last point. I was able to obtain some data. And you're you're right on that. Like, there's right now over 7 million American children, under the age of 17 that have this diagnosis of ADHD. And what's interesting, it's almost 1 in 6 right now of boys in the United States is diagnosed ADHD. 00:03:05:12 - 00:03:31:07 Speaker 1 So more than 15%. And just looking at things epidemiologically, from a epidemiological perspective, the CDC tends to like under predict the degree of the condition, as we're seeing in our communities. What do you make sense of 1 in 6 boys being diagnosed ADHD? 00:03:31:09 - 00:04:12:17 Speaker 2 The first thing is if if, the most recent data that that I've been looking at, around stimulant prescribing, you know, demonstrates that the, the increase that occurred, was predominantly in more, more in females and males and that it actually started to even out. So, I would I would say that I suspect the where we are right now is whatever the prevalence of ADHD, it's actually probably a lot closer to being the same between males and females, which I think is an an important change because it's, it's it's getting at, I think what you're concerned. 00:04:12:17 - 00:04:15:01 Speaker 3 About and it's getting at it in like. 00:04:15:01 - 00:04:26:21 Speaker 2 Real time, ADHD was not diagnosed very frequently in females historically. 00:04:26:23 - 00:04:58:20 Speaker 2 And, you know, there was thoughts that it was a much more male oriented condition. And, you know, there's there's like neuro anatomical, developmental, work that was consistent with that around like, boys maturing neurologically like slower than girls. And, you know, that's ADHD in this sort of like classification of neurodevelopmental condition that maybe they're on a different trajectory. 00:04:58:22 - 00:05:08:04 Speaker 2 And, you know, that's supported by some of the statistics around like differences in their, in their, in their, in their brain maturation. 00:05:08:06 - 00:05:14:11 Speaker 3 What do I mean? 1 in 6. 00:05:14:13 - 00:05:23:18 Speaker 3 Does that seem high to me? It seems it seems high. 00:05:23:20 - 00:05:33:18 Speaker 2 When I compare it to my internal experience of what those age groups were like when I was in that age group, I would I would say, yes, it does feel high. 00:05:33:20 - 00:06:14:13 Speaker 1 Yeah. If we look back at 1990, there were 600,000 children on stimulants, 20, 24, over 6 million children on stimulants. That's a tenfold increase in a generation. Yeah. So it begs the question, first of all, is ADHD a legitimate medical condition? An are are we labeling and drugging various rates of normality? And it's it's become a real problem in the United States because we're going to have to make sense of the fact that the United States, which accounts for, let's say, $20 billion spent on ADHD drugs. 00:06:14:15 - 00:06:18:06 Speaker 2 We are we are way ahead of everyone else in in a we are we are the leader of this. 00:06:18:06 - 00:06:48:23 Speaker 1 So US has 4% of the world population and consumes 80% of ADHD stimulants. The UK has 1 to 2%, of children and adolescents diagnosed with ADHD. France is 1/20 of the US rate, which is point five. And there are regions in the United States where 20% of their kids in those regions are diagnosed with ADHD. So what the hell is going on? 00:06:49:00 - 00:06:56:08 Speaker 1 That can't be a legitimate medical condition. It's we're labeling various like variability of normal. 00:06:56:10 - 00:06:57:19 Speaker 3 I think the the way to. 00:06:57:19 - 00:07:03:07 Speaker 2 Think about ADHD is, 00:07:03:09 - 00:07:14:13 Speaker 3 There's sort of like buckets that have occurred. And with each progressive bucket there is a, a the the bucket has gotten. 00:07:14:13 - 00:07:23:08 Speaker 2 Bigger in terms of like what, what qualifies as ADHD. And for the most part, it's been expanded. 00:07:23:10 - 00:07:40:03 Speaker 2 Because it used to be like minimal brain dysfunction. Right. That was why is that even mean? I don't know that that diagnosis predates I remember reading that and thinking, I am so offended by that. There's an awful, awful, awful, name for diagnosis. 00:07:40:05 - 00:07:45:00 Speaker 3 And and it got expanded. Another question is the medications had been around. 00:07:45:02 - 00:08:09:00 Speaker 2 Okay. So it's not a new medication that came out. The medications that we use for ADHD. Well, there have been many there are so many permutations of them. There's so many. There's basically two different, compounds. One of them is Ritalin, which is like a metal of eight. And then the other one, it's like a mixed amphetamine salt, which is basically Adderall. 00:08:09:00 - 00:08:20:14 Speaker 2 I'm I'm oversimplifying this, like, greatly. Okay. And then we have all these different ways that we release them, you know, that occurred. You know, that's one thing that occurred. 00:08:20:14 - 00:08:23:20 Speaker 1 So you think that part of it is financial incentives? 00:08:23:22 - 00:08:24:22 Speaker 3 There's there's no question. 00:08:24:22 - 00:08:49:08 Speaker 2 That, like, there was a time in Psychiatry's past not so long ago. And I guess I can say this because I'm safe from this, right? Like, by the time I got on the scene of medical school, drug representatives were, I mean, they were policing, the medical students away from it. Everyone was like, very, very concerned about it. 00:08:49:08 - 00:08:51:15 Speaker 2 But before that, there had been. 00:08:51:17 - 00:08:52:24 Speaker 3 You know, there have been situations. 00:08:52:24 - 00:09:09:24 Speaker 2 Where, you know, the that that people were concerned that the if the person doing a study is also working with a drug company, does that distort how they want to interpret their findings? Right? I mean, and I don't think it's an unreasonable question to be asking. 00:09:10:01 - 00:09:12:02 Speaker 3 Right. And not that it's not even that the. 00:09:12:02 - 00:09:19:03 Speaker 2 Person in question went into it with that sort of devious intent. 00:09:19:05 - 00:09:21:01 Speaker 3 But at an unconscious level. 00:09:21:03 - 00:09:24:07 Speaker 2 Even. Right. Like, like I think that that there's there's. 00:09:24:07 - 00:09:25:02 Speaker 3 Definitely. 00:09:25:02 - 00:09:31:00 Speaker 2 Reason to be concerned about that and, and and and ask those questions. 00:09:31:02 - 00:09:46:09 Speaker 1 Yeah. I mean it's it's clear there's there's no way that we have 15% of all boys have a serious medical condition. So I think it begs the question on the reliability and the validity of the condition itself. 00:09:46:11 - 00:09:47:12 Speaker 2 I completely agree. 00:09:47:17 - 00:10:20:23 Speaker 1 So I try to be reasonable with this because I've worked in various settings. If you have somebody who deviates to such an extent from the normal right, like their level of hyperactivity and inattention is so problematic, including potentially life threatening, like darting out to traffic, climbing up, like bookshelves, you know, at age 4 or 5, this degree of hyperactivity that such functional impairment. 00:10:21:00 - 00:10:55:17 Speaker 1 And then we look at whatever options can exist to try to improve the quality of life of this particular kid is one thing. But what is that? Less than, I don't know, less than point 5% of the population, 0.05% of the population. It should deviate. So greatly from normal that, these diagnostic labels that are used in psychiatry or something called attention deficit hyperactivity disorder should be relatively rare, but it's not rare. 00:10:55:19 - 00:11:22:14 Speaker 1 In fact, it is so common that you'll walk down the street and you're going to be running into people who are on on stimulants, identifying with, brain condition in which we don't actually evaluate or test for biologically or medically. So here's my next question. Rely on validity and reliability. How does somebody get that diagnosis? 00:11:22:16 - 00:11:28:04 Speaker 2 I mean, this is the, 00:11:28:06 - 00:12:01:00 Speaker 2 This is the thing that that the field of mental health and psychiatry specifically have been struggling to overcome, which is like biomarkers. We do not have reliable biomarkers around these these labels. We have the, the you know, there's that we have a, a syndrome or model, a descriptive some journal model is what the DSM is by design, right? 00:12:01:02 - 00:12:31:03 Speaker 2 People complain that it lacks an overarching theoretical model that when they wrote that, they acknowledge that there was not that there that that was not a good idea because they didn't have that. And in fact, there was a lot of resistance around even simplifying it in this sort of way. So what they do is they, they end up, with these descriptive, these descriptive narrative lists of which is a symptom which. 00:12:31:03 - 00:12:36:22 Speaker 1 Is extremely problematic. You do you know why it's problematic? 00:12:36:24 - 00:12:39:21 Speaker 3 I don't question that. It's problematic. 00:12:39:23 - 00:12:48:22 Speaker 2 And of course, that's problematic. It's sort of for me gets into why. 00:12:48:24 - 00:13:04:00 Speaker 2 It's it's concerning when you take something that was in a specialty and you move it in primary care from a public health point of view to try to treat it, that you realize a lot of nuance starts to get lost, a lot of nuance can start to get lost. 00:13:04:02 - 00:13:28:01 Speaker 1 Yeah. So here's here's my point. I think ADHD is one of the biggest scams that has existed in health care. And I think just its existence has created mass harm. And here's my perspective on it is because, okay, I, I acknowledge that symptoms of hyperactivity or inattention exist. 00:13:28:03 - 00:14:00:09 Speaker 1 But the cause of that, the root causes that would influence that the use of an ADHD label almost immediately stops that investigation. I know in, in, in effective practice it shouldn't. But in the American health care system, these kids are getting diagnosed within 10 to 15 minutes. So, I mean, I could probably think of 20 conditions off the top of my head that would produce symptoms of. 00:14:00:09 - 00:14:01:02 Speaker 3 Yeah, absolutely. 00:14:01:02 - 00:14:01:19 Speaker 1 Attention. 00:14:01:20 - 00:14:02:10 Speaker 3 Absolutely. 00:14:02:14 - 00:14:05:12 Speaker 1 You know, that you would be able to measure on a checklist. Right. 00:14:05:14 - 00:14:06:09 Speaker 2 00:14:06:09 - 00:14:09:03 Speaker 3 The the again, getting back to. 00:14:09:03 - 00:14:29:17 Speaker 2 This, this sort of issue, you because you're you're exactly right. Like, like it's one of the reasons that I think that the mental health, you know, when we were having lunch, we were sort of thinking about different models of, of mental health and cognitive behavioral therapy is a more concrete one. There's more of a psychodynamic one. And, you know, mental health has been stuck in these sort of blurry models. 00:14:29:19 - 00:14:32:04 Speaker 2 Because we haven't been able to sort of figure out how to, how to. 00:14:32:06 - 00:14:32:24 Speaker 3 How to solve that. 00:14:32:24 - 00:14:34:20 Speaker 2 Issue. 00:14:34:22 - 00:14:40:03 Speaker 3 And, you know, it getting back to the idea. 00:14:40:05 - 00:14:43:24 Speaker 2 Around ADHD and people being overdiagnosed. 00:14:44:01 - 00:14:46:03 Speaker 3 That's a legitimate concern. And particularly it's a. 00:14:46:03 - 00:14:49:06 Speaker 2 Concern after the, 00:14:49:08 - 00:14:50:04 Speaker 3 The pandemic. 00:14:50:04 - 00:15:01:22 Speaker 2 When there was a telehealth waiver that allowed, controlled substances, which stimulants are controlled substances. This is the this is the thing that most people are most concerned about. 00:15:01:24 - 00:15:02:20 Speaker 3 That that they were. 00:15:02:20 - 00:15:18:12 Speaker 2 Able to, prescribe them from remote locations. You don't have to come in person. You know, that was supposed to be temporary because of the emergency. As I, understand, it is not, though there have there is some debate over that. 00:15:18:16 - 00:15:21:00 Speaker 3 And also we just have a general telehealth system. 00:15:21:00 - 00:15:39:03 Speaker 2 So it's not just an ADHD problem. I think this is a problem for all psychiatric diagnosis. You know, a lot of these systems you get asked a questionnaire, which isn't even a real questionnaire. It's not a it's not a validated research questionnaire. It's a questionnaire that they had someone just made up out of the the DSM criteria that probably isn't qualified to do something like that. 00:15:39:05 - 00:15:45:07 Speaker 2 And then the person answers it, and then you spend under ten minutes with this prescriber. 00:15:45:09 - 00:16:02:05 Speaker 1 It's because people want Adderall. You know, because Adderall is a performance enhancing drug. You know, if anyone took out or if I took an Adderall right now, it's going to have a, at least a short term, in all likelihood, almost positive effect. It can actually boost my mood. It could increase my focus and it psychotic. 00:16:02:07 - 00:16:09:22 Speaker 1 It could also have a range of negative consequences as well. So do you believe ADHD is a discrete and legitimate medical condition? 00:16:09:24 - 00:16:11:07 Speaker 3 Yeah, I think there's a narrower. 00:16:11:07 - 00:16:26:00 Speaker 2 Version of ADHD that that is a a psychiatric disorder. That is a condition that that that exists and that we see manifesting. And I think that there's, there's. 00:16:26:02 - 00:16:30:09 Speaker 1 So you believe like it's has biological origins. It's genetic. 00:16:30:11 - 00:16:32:18 Speaker 3 Yeah. But you can't sort of break these things down. 00:16:32:18 - 00:16:46:02 Speaker 2 Into is it biological, is it genetic? Every psychiatric disorder is biological and genetic and it's also cultural. And it's also related to like mismatch in evolutionary biology. And it's related to environmental factors. 00:16:46:04 - 00:16:48:00 Speaker 3 And my, you know, ADHD. 00:16:48:00 - 00:16:55:08 Speaker 2 Symptoms get better when I exercise because that increases dopamine and higher levels of dopamine or associated with improved attention and mood like. 00:16:55:10 - 00:16:59:02 Speaker 3 There's, you know, it is biological and it is well. 00:16:59:04 - 00:17:15:17 Speaker 1 The other thing, well then it wouldn't be a, discrete, identifiable medical condition if somebody is sedentary, doesn't get sun exposure or sits in their house all day on their phone, and then struggles to have, you know, focus enough to, to be effective in school or. 00:17:15:17 - 00:17:17:08 Speaker 3 Well, there's, there's, there's new data coming. 00:17:17:08 - 00:17:18:09 Speaker 2 Out, actually. 00:17:18:11 - 00:17:38:07 Speaker 1 But that wouldn't be they wouldn't what I mean by that is the solving of the problem shouldn't be stimulants. The solving of the problem should be get off your ass and start moving. Be outside, change your diet. I mean, you're if you're if you're living like a human is not supposed to live. It's not because you have ADHD. 00:17:38:09 - 00:17:43:07 Speaker 1 You're experiencing the normal and expected human response to a sedentary lifestyle, right? 00:17:43:07 - 00:17:50:13 Speaker 2 You're describing like like things that are major risk factors to create symptomology that overlaps with ADHD. So. 00:17:50:13 - 00:17:52:11 Speaker 1 You say so ADHD is separate than. 00:17:52:11 - 00:18:00:06 Speaker 3 That. Yeah. Yeah. I think that there's I think that there's the people when they talk about ADHD, at least when people talk. 00:18:00:06 - 00:18:12:20 Speaker 2 About it in like the general way, not among people that are sub specialized in the field. I don't even know what people are talking about. If a patient comes in and sees me and I, this depression is the same thing. They come in and they talk about the depression. 00:18:12:20 - 00:18:14:12 Speaker 3 That please stop, stop this and. 00:18:14:13 - 00:18:18:03 Speaker 2 Tell me what you're feeling like. I don't I don't need the word that you think. 00:18:18:03 - 00:18:18:24 Speaker 3 Is going on. 00:18:18:24 - 00:18:20:11 Speaker 1 Yeah, I have depression, I. 00:18:20:11 - 00:18:27:16 Speaker 3 Know I don't, I don't know. Stop. Please stop stop. I understand, but they, you know, they think they're being helpful. 00:18:27:18 - 00:18:29:01 Speaker 2 00:18:29:01 - 00:18:34:16 Speaker 3 They they they think they figured it out. Now it's ChatGPT. 00:18:34:19 - 00:18:36:00 Speaker 2 And I figured it out together. 00:18:36:03 - 00:18:41:08 Speaker 3 Okay. No, really, this is this is. And it's like the WebMD thing, except to, like, cubed. 00:18:41:10 - 00:18:43:13 Speaker 2 Yeah. Because the thing is interactive. 00:18:43:13 - 00:18:50:01 Speaker 3 And it has all this information and it's going to agree with you because it's it's sort of designed that's that's sort. 00:18:50:01 - 00:18:57:18 Speaker 2 Of the way it is. And, and so if you're anxiously telling you your symptoms, it's going to convince you that you, you probably have that or should be. 00:18:57:18 - 00:19:00:03 Speaker 3 Concerned about it. And then you show up at the doctor. 00:19:00:05 - 00:19:09:22 Speaker 2 And you are concerned about it and you're worried about it, and you've identified symptoms. Maybe, maybe there needs to be better gatekeeping on the doctor's part. But I actually think that there was a. 00:19:09:22 - 00:19:12:03 Speaker 3 Whole I disagree. I don't think it's that. 00:19:12:03 - 00:19:21:13 Speaker 2 People are like nefariously wanting Adderall as a performance testing drug. I think it's people really believe this is what is going on with them. 00:19:21:15 - 00:19:23:05 Speaker 3 Or at least that that that is, that is. 00:19:23:05 - 00:19:27:08 Speaker 2 One of the groups that has ended up here. Yeah. 00:19:27:10 - 00:19:48:11 Speaker 1 Well, I've interviewed way too many people. I mean, this is a college town. So we were talking about this beforehand, and, Lehigh University is a, pretty difficult engineering school. You know, it's one of the top rated engineering schools. And certainly, there is a high rate of abuse of Adderall, especially during, you know, periods of exams and so forth. 00:19:48:11 - 00:20:03:15 Speaker 1 So there are there is the seeking out, the Adderall. And the easier you can obtain that, then the higher the stimulant prescription rates are going to be. And of course, there's a financial incentive to sell more drugs. I mean, that's just that's clear. 00:20:03:15 - 00:20:05:05 Speaker 2 By who. 00:20:05:07 - 00:20:09:06 Speaker 1 Those who sell the drugs. So let's say you were talking about you mean. 00:20:09:06 - 00:20:12:08 Speaker 3 The like kid who's diverting it like. 00:20:12:12 - 00:20:13:24 Speaker 1 No, I mean, if let's say you do. I mean. 00:20:13:24 - 00:20:16:01 Speaker 2 The producer of the drug. 00:20:16:03 - 00:20:23:16 Speaker 1 The producer of the drug, and who gets to prescribe it, there's both the financial incentives there. So, like, let's say, you've seen like him, hims or hers. 00:20:23:16 - 00:20:43:05 Speaker 2 Oh, yeah. That's the this is very upsetting. Cerebral I think is the worst. They were ranking the clinicians, but the number of prescriptions that they wrote for stimulants to try to put them on a monthly stimulant subscription plan and like it gave me. 00:20:43:10 - 00:20:44:14 Speaker 1 The drug dealing. 00:20:44:16 - 00:20:56:18 Speaker 3 Drugs. I'm like, I'm like, this is like, I could not believe that. I could not believe that I was disturbed. It was like A34 part Wall Street Journal thing. And this it's really, really disturbing. 00:20:56:20 - 00:21:06:05 Speaker 2 I, I hope that the, the telehealth, mental health world has, has improved significantly from that. Yeah, I really hope it has. 00:21:06:05 - 00:21:35:14 Speaker 1 But I mean, we've created an environment for them to flourish. And we have to understand who's behind that, who's the one that's continuing to push the medicalization of the human experience on the American population, where 15% of all boys are diagnosed with ADHD. So you believe that there is a discrete and identifiable ADHD, diagnosis? I see it only as a constellation of, of symptoms that could have a range of various causes. 00:21:35:16 - 00:21:45:07 Speaker 1 And I think that if we improve the mental health system, we would be addressing those causes. So I think we identify traumatized kids with ADHD. I think we. 00:21:45:09 - 00:21:45:17 Speaker 2 Know we. 00:21:45:17 - 00:22:09:01 Speaker 1 Diagnosed worriers and anxious kids ADHD. We have kids who have don't even consume real food, and then have ADHD symptoms in school. Oh my God, the schools don't even sell real food. And we put kids under, fluorescent lighting, which light has an impact on your ability to focus attention? 00:22:09:02 - 00:22:10:09 Speaker 2 Just unpleasant. 00:22:10:14 - 00:22:23:19 Speaker 1 Very unpleasant. So we diagnose those kids with ADHD. We diagnose, other legitimate medical conditions with ADHD, like, thyroid conditions or imbalances. 00:22:23:24 - 00:22:27:22 Speaker 3 And anyone who has had an ADHD diagnosis. 00:22:27:24 - 00:22:45:15 Speaker 2 That is a mistake. Gnosis of a thyroid condition that is disturbing. I mean, that is because it is so easy to evaluate for a thyroid condition. That is that is really, really upsetting, if that is, if there are any significant number, I mean, actually that happening at all, I completely agree with you, is that's. 00:22:45:15 - 00:22:49:18 Speaker 1 What happens when you hand a checklist over a checklist and says, oh. 00:22:49:18 - 00:22:53:13 Speaker 3 You have so you you take issue. 00:22:53:14 - 00:23:25:16 Speaker 2 With the, because this is a, this is a public health decision, the teaching primary care, like adult primary care in pediatrics to evaluate for ADHD because it could because it increased but did increased diagnosis. And everyone expected that because it but the the the people who did that anticipated that there were that it was an inequality issue is how they framed it. 00:23:25:18 - 00:23:46:02 Speaker 2 It was an inequality issue around like who was getting the best treatment. And there was like an access issue, and you had to be able to go to a specialized person. Like that was sort of the logic behind it. You think it's just like a Band-Aid for like larger societal changes that need to happen. 00:23:46:04 - 00:24:10:12 Speaker 1 So first of all, I think a lot of things are born in marketing rooms. So even when you talk about the decreased stigma campaigns or when you try to talk about prescribing drugs in terms of like inequality based on, you know, socioeconomic status or race, it's just to increase the prevalence rate of those drugs. I don't think we should be drugging kids. 00:24:10:14 - 00:24:37:17 Speaker 1 I think the problems with stimulants, which we'll get into, I want to discuss the, the problems with stimulant medication, and it's, outcomes. But you and I differ because you believe there's this condition called ADHD. I don't believe there's this condition of ADHD. But if there is, let's say it was genetic. It's biological. Right. What do you think the prevalence rate would the legitimate prevalence rate then be of people who, in the United States and in. 00:24:37:19 - 00:24:40:17 Speaker 2 I mean, it's a it's useful to think about it from an age group point of view. 00:24:40:17 - 00:24:44:16 Speaker 1 That's. Yeah. Let's use children and adolescents under the age of 18. 00:24:44:18 - 00:24:57:08 Speaker 2 Under 18, like like narrow definition ADHD. Let's see. 00:24:57:10 - 00:25:08:11 Speaker 2 I'd say like 3 to 4 and a half is probably the, the highest. I would go, and these are the individuals that. 00:25:08:13 - 00:25:15:16 Speaker 2 Tend to be dysregulated at a fairly young age. 00:25:15:18 - 00:25:16:17 Speaker 3 Yeah, I would say that that's. 00:25:16:17 - 00:25:27:12 Speaker 2 Probably the there's, there's that. And the other group would be the high functioning ones that sort of, struggle around learning as they get older. Yeah. I think that's about what I would say. Okay. 00:25:27:18 - 00:26:00:23 Speaker 1 So we're diagnosing kids 3 to 4 times higher than what you believe would be the prevalence rate. So let's say there are 3% of the population have these genuine symptoms. They create pretty significant an impairment in functioning. Right. Are you saying that then the 3% those symptoms are not accounted for by any other possible reasons that we could intervene without a, you know, a powerful schedule one pharmaceutical? 00:26:01:00 - 00:26:19:15 Speaker 2 Unquestionably, especially in younger individuals. Right. Like, unquestionably, while stimulants are highly effective at reducing symptoms, and they are they're the most effective medication in psychiatry at reducing symptoms of the condition like it is. It is it is impressive. The. 00:26:19:17 - 00:26:57:20 Speaker 1 I worked in schools, I have seen, these drugs take kids who couldn't sit in their chairs and, take the life out of them. So when you say it's improving symptoms, which it technically it is. I also see it taking the life out of, like a, an eight year old boy who, you know, would rather be outside moving his body connected to nature, just sitting in that classroom in itself, under the fluorescent lights, not being able to move, having to follow a teacher is part of the problem. 00:26:57:22 - 00:27:20:23 Speaker 1 Now he's got the label of ADHD, and I don't debate the fact that he would meet that criteria. The question is the legitimacy of the condition. Wouldn't we look at like if we're a flourishing culture in society, wouldn't we suggest that possibly it's the public school itself, the manner in which we're educating what we're doing to to kids in the name of public education? 00:27:21:00 - 00:27:28:21 Speaker 1 That could be the problem, that we're actually slapping the label on kids who are supposed to be active, connected to nature, outside and so forth. 00:27:28:23 - 00:28:06:17 Speaker 2 I guess I think multiple things can be true. Those are those are all true things. And I think that there needs to be a serious conversation about how we think about, structuring, our education system. I think that that, that is, that is scientifically informed by the most recent data that we have. I do not I do not think that the fact that, kids have very little physical activity integrated into their their day, particularly in things like elementary school, I think that that's really, really problematic for a lot of reasons. 00:28:06:19 - 00:28:24:00 Speaker 2 And I, I think we need to introduce more of that. I completely agree with you. But I also think there's this problem that we have to figure out a solving. I guess I come around from a different point of view. Is the kid who's getting in trouble all the time that again, let's assume the system is stuck the way it is, right? 00:28:24:00 - 00:28:49:11 Speaker 2 Because I don't have a magic wand like the the the kid is getting in trouble every day. They're calling out, okay. They're they feel bad about themselves because they're getting in trouble all the time. They know that they're different, right? Like their self-esteem is starting to suffer, and they're like crying at home. Their parents like. Like, this is like a real situation that happens, like, all the time, no doubt. 00:28:49:11 - 00:29:13:15 Speaker 2 And it breaks my heart. It breaks my heart. Right? Like it totally breaks my heart. Like, what are we going to do it very easy. Obviously, everyone should have access to thorough diagnostic evaluation to exclude things. All psychiatric symptoms are, by definition, diagnosis of exclusive exclusivity. Like you have to have diagnostic physicals every now and otherwise explained by a medical condition or whatever. 00:29:13:15 - 00:29:17:00 Speaker 2 It says it over and over again. 00:29:17:02 - 00:29:18:17 Speaker 3 That should happen 100% and like. 00:29:18:17 - 00:29:21:20 Speaker 2 Treat those those things, you. 00:29:21:20 - 00:29:23:12 Speaker 3 Know, evaluate what. 00:29:23:15 - 00:29:25:03 Speaker 2 Especially in younger kids like. 00:29:25:05 - 00:29:27:10 Speaker 3 So what that we can do to educate parents. 00:29:27:10 - 00:29:44:00 Speaker 2 To help them adjust how they interact with the kid and work with the kid to be building skills, because that's what you're really worried about with these ADHD kids. Like, it's like, you know, you want them to develop mentally this these kids being labeled ADHD, you know, like, well, different sort of what the meaning of it is. But I think we're we maybe. 00:29:44:01 - 00:29:47:20 Speaker 2 No, we're talking about the same patients. You know, how are we going to sort of. 00:29:47:20 - 00:29:48:22 Speaker 3 Provide help for. 00:29:48:22 - 00:29:50:14 Speaker 2 Them in that way? 00:29:50:16 - 00:30:01:18 Speaker 3 I don't know, you know, how do you handle that? It when that shows up in your office and like, I can't move everyone to a specialized school like I, you know, I parents that have limitations. 00:30:01:24 - 00:30:07:06 Speaker 2 You know, school systems are. 00:30:07:08 - 00:30:08:02 Speaker 2 The way they are. 00:30:08:02 - 00:30:13:05 Speaker 3 I meant to say it right. I mean, what do you do about that? 00:30:13:07 - 00:30:39:07 Speaker 1 Yeah, I think it's a statement on, a mismatch between what we're designed to do and what modern, you know, society right now is, pushing upon us. I don't think we're designed to be sitting inside on technology in rows away from nature. Yeah. Now there's some there's going to be there's going to be a range of people who have a greater ability to regulate that and be able to do that. 00:30:39:09 - 00:30:59:24 Speaker 1 But those kids that do call out or the kids that are having trouble in those systems, I don't necessarily believe that the answer to that is to give them a schedule one drug stimulant. I've been looking into some research on this. It looks like these actual symptoms, according to a recent published study, I'll try to include it in the show notes. 00:31:00:01 - 00:31:38:23 Speaker 1 There's a 77% decrease in these ADHD symptoms. When you increase the kids time in nature. Right. So we're going to say like what? What's normal? Is it normal what we're doing right now, with technology, with our school system, or is it more normal from an evolutionary perspective that we should be connected in to nature? And then it asks the larger question, isn't there just going to be a a segment of because there's this variability in the population, thank God there's variability in a population, that evolutionary speaking, like they were the ones that had to hunt, maybe they were protecting their tribe. 00:31:39:00 - 00:32:06:05 Speaker 1 They were warriors and they needed to be able to have this, attention to stimuli that was outside of of the focus. Right on them. Right? Like they needed to be able to pick up on other stimuli around them, in order to attend to it and potentially save the life of themselves or others. And so now we take those same type of kids, we put it in modern society, and we label it a disorder, which is why I argue that it is not a discrete medical condition. 00:32:06:05 - 00:32:07:18 Speaker 1 It's cultural. Right? 00:32:07:21 - 00:32:09:04 Speaker 2 It's or it's trait. 00:32:09:04 - 00:32:10:02 Speaker 3 Right. Like a. 00:32:10:02 - 00:32:10:11 Speaker 2 Trait. 00:32:10:11 - 00:32:12:02 Speaker 3 It could be it could be a trait or two. 00:32:12:06 - 00:32:12:13 Speaker 2 So I. 00:32:12:13 - 00:32:13:19 Speaker 3 Actually think. 00:32:13:21 - 00:32:25:21 Speaker 2 One of the, to me, one of them, you know, we're just asking, like evolutionary biology, evolutionary psychiatry, like, like, I think one of the most. 00:32:25:23 - 00:32:35:23 Speaker 2 You know, sort of meaningful aspects of this when I try to think about like, is this true? Right. Because it's a really good explanation. It's a really good explanation. We have to figure out how to prove it better. 00:32:36:00 - 00:32:38:13 Speaker 3 Is that is that there's there's this. 00:32:38:13 - 00:32:45:04 Speaker 2 Prevalence of people that meet a criteria for something that's a trait. Right? 00:32:45:06 - 00:32:49:14 Speaker 3 And it's kind of no matter how you slice. 00:32:49:14 - 00:32:55:00 Speaker 2 It, it's it's a meaningful chunk. And from a natural selection point of view. 00:32:55:02 - 00:32:56:07 Speaker 3 That should should have been gone. 00:32:56:10 - 00:32:57:15 Speaker 2 Like that shouldn't if that. 00:32:57:15 - 00:33:00:02 Speaker 3 Was not adaptive, that should not. 00:33:00:02 - 00:33:24:22 Speaker 2 Have made it this far. Right. Yeah. And it it made it like all the way through like farming which was another rough one, you know. And, and it's still around post-industrial evolution like, you know, but in information age it's, it's in more trouble and I'll tell you why it's in more trouble. We don't know this yet for, you know, like, science is very cautious when it's trying to figure things out. 00:33:24:24 - 00:33:29:05 Speaker 2 But there there are multiple studies and I, you know, legitimate journals. 00:33:29:07 - 00:33:32:22 Speaker 3 That suggest that social media interaction, particularly. 00:33:32:22 - 00:33:34:01 Speaker 2 Ones that are like rapid. 00:33:34:01 - 00:33:39:07 Speaker 3 Changing flashing lights, like super stimulating stuff, stuff that like, it's really. 00:33:39:07 - 00:33:41:04 Speaker 2 I mean, you're like, you're just it's like. 00:33:41:04 - 00:33:42:18 Speaker 3 Boom, boom, boom. It's a little bit like a drug. 00:33:42:18 - 00:33:48:18 Speaker 2 Like, I mean, literally the response in your brain, if you look at it under a scan versus a drug, it looks actually kind of similar. It's a little upset. 00:33:48:18 - 00:33:49:16 Speaker 1 It's designed that way. 00:33:49:17 - 00:33:52:07 Speaker 2 I mean, like, you know. 00:33:52:09 - 00:33:56:05 Speaker 3 I, I have thought that before. 00:33:56:07 - 00:34:20:13 Speaker 2 I really want to believe that's not true. I really I really want to believe that's not true because it would upset me. So much. Yeah. But it's it's I mean, so much to think that that, that, that, that, that, that, that is that, that someone would or a group of people would continue to do that with known harm, that I mean it literally, I have an uncomfortable feeling in my torso just even imagining that that's that that's true. 00:34:20:13 - 00:34:21:04 Speaker 1 All right. But you're. 00:34:21:04 - 00:34:22:07 Speaker 3 Right. There's data to support that. 00:34:22:07 - 00:34:24:05 Speaker 1 Well, yeah. There's data. I mean, did. 00:34:24:05 - 00:34:25:02 Speaker 2 It that data this fourth. 00:34:25:07 - 00:34:37:02 Speaker 1 Did businesses do do harm. What is what is their job. Where in this information age where your attention is commodity. And so with a social media app, for example, they need to keep your eyes on their platform. 00:34:37:03 - 00:34:38:15 Speaker 3 Yeah, they want to make money, they want to make money. 00:34:38:15 - 00:34:59:22 Speaker 1 And that phone, that phone has these notifications and these sounds that direct your attention all the time. Right. So now when I'm doing my evaluations, one of the things I'm asking from my clients is for them to pull out their phone and tell me their screen time. And I've I've just seen it incrementally increase increase over the past decade. 00:35:00:03 - 00:35:07:03 Speaker 1 Do you know what's typical right now? When I asked that question, what would be the average? 00:35:07:04 - 00:35:21:12 Speaker 2 I don't know, but I'll give you something that you're going to find interesting. The, I've looked at data from the ABCd study, which like, looks at these kids that are growing up, and there's a point at number of hours of screen time where the likelihood of you reporting depression becomes 100%. 00:35:21:14 - 00:35:23:21 Speaker 1 What is that? 00:35:23:23 - 00:35:27:02 Speaker 3 I don't want to get done. I don't want to say the number because I don't, you know, like, I'm assigned. 00:35:27:02 - 00:35:27:24 Speaker 2 Somewhere I, you know, within. 00:35:27:24 - 00:35:28:21 Speaker 1 Six hours. 00:35:28:23 - 00:35:34:06 Speaker 2 No no no no, no, it's it's much higher than that. Okay. But but it's it's disturbing how. 00:35:34:08 - 00:35:36:20 Speaker 1 Over there's a dose response. 00:35:36:22 - 00:35:42:02 Speaker 3 Well, it does okay. At the beginning. It's okay. Right at the beginning. There isn't that much of a change. It sort of looks. 00:35:42:03 - 00:35:49:06 Speaker 2 Like it's asymptotic. And then it just starts, like shooting up like, and, and and. 00:35:49:08 - 00:35:51:11 Speaker 3 Frankly, I think this is like a, this is like a. 00:35:51:11 - 00:36:07:23 Speaker 2 Secret pandemic that like, we're all in on, don't realize is happening because we're all sucked into it, too. Yeah. It's really upsetting. And I think that the countries that are considering restricting phone use from an age point of view and social media are right. 00:36:08:02 - 00:36:14:03 Speaker 3 They are on the because because, you know, good. You know, people are like, oh, you're the parent needs some moderate. 00:36:14:03 - 00:36:46:06 Speaker 2 I work with a lot of parents, guys, I work with parents that even have a lot of resources, like way more resources than the average person. It is very, very, very hard to manage a young person's cell phone and what they're doing and the amount of use that they have is very, very, very hard. The only way we're going to solve this problem is if we have like, I don't know, more to two year right word, but like like a restricted start point so that no one can be the one that breaks it like, no, no what like the thing that new York. 00:36:46:06 - 00:36:56:13 Speaker 3 State did with schools during the day. I'm sorry. Anxious mom. Like I'm sorry anxious dad. Like, if you really need to talk to your child, like, call the school and they will go get your child, but your child is. 00:36:56:13 - 00:37:00:02 Speaker 2 Immersed in learning right now and you do not need to be interacting with them. 00:37:00:02 - 00:37:08:12 Speaker 1 Yeah. Jonathan Hyde is doing all this work on that. I think the recommendation is don't let your kids get a smartphone before the age of 15. I think that's wise. 00:37:08:14 - 00:37:13:00 Speaker 2 Yeah, I agree, it's a hard one. Yeah, it's a really, really hard one. 00:37:13:00 - 00:37:30:17 Speaker 1 But we're seeing parents pacify toddlers, you know, with, with, with, some form of technology, maybe not smartphones, but they're, you know, looking at iPads and a number of things. And so I want to refer to your point is I think the brain is adaptive. Right. And where it is going to it's going to tend to the most interesting stimuli. 00:37:30:19 - 00:37:51:21 Speaker 1 And this technology hijacks the brain. And I don't think this is a disorder or a problem. I think it is just the brain adapting to what is provided to it. It's meant to do that. And then we're we're taking kids who are being raised on this technology, and then we're putting them in these environments in which they're meant to sit still and focus like it's 1955. 00:37:52:01 - 00:38:16:03 Speaker 1 It's not going to work. You can't continue to educate in the way we're educating and not have these rates of ADHD. There's no way this is a discrete, identifiable medical condition when you diagnose it. 15% of boys in the United States, but like less than 1% in France, like, it's not like you go over to France and then, you know. 00:38:16:05 - 00:38:18:08 Speaker 3 100%. Yeah, actually, I'll tell you two stories. 00:38:18:08 - 00:38:41:24 Speaker 2 So I mean, I'm like, and if we went to the second phase on my first, like, it's like the third time I learned about evolution, but I always, you know, like when you're in school, you keep learning about things. So like I got really into it after like my post-doc in evolutionary psychiatry. And so when I was traveling around, I went when I was in different countries, I always tried to spend time with if there was a sort of more indigenous group of people that are have been living in a way for a longer period of time. 00:38:42:01 - 00:38:52:19 Speaker 2 You know, I'm not exactly a hunter gatherer, but like a like as close as we're going to get. I found some herders once, and I always ask them about ADHD. 00:38:52:21 - 00:38:54:18 Speaker 3 And the the general. 00:38:54:18 - 00:38:57:04 Speaker 2 Answer that I get is, what. 00:38:57:04 - 00:38:57:20 Speaker 1 The fuck is that? 00:38:58:01 - 00:39:05:20 Speaker 3 No no no no no, you described the thing and they know what you're talking about. Okay. Like, you can describe a group of people. 00:39:05:20 - 00:39:09:04 Speaker 2 In a way that they it's not in a dysfunctional way. You're describing it, right? 00:39:09:04 - 00:39:13:10 Speaker 3 Like you're describing someone that's maybe not that interested. 00:39:13:12 - 00:39:17:13 Speaker 2 You know, keeping to themselves doing whatever they want. They have different interests. 00:39:17:15 - 00:39:19:20 Speaker 3 But they can get really excited about things and they. 00:39:19:20 - 00:39:23:08 Speaker 2 Get really into, like you describe like a more positive version of you and they know what you're. 00:39:23:08 - 00:39:26:13 Speaker 3 Talking about, like, okay. And I, you know, they don't think of it in. 00:39:26:13 - 00:39:27:20 Speaker 2 A negative way. It's not. 00:39:27:20 - 00:39:28:13 Speaker 1 Pathology. 00:39:28:13 - 00:39:33:05 Speaker 3 It's not pathology. When the kids go. 00:39:33:07 - 00:39:34:07 Speaker 2 To like Western. 00:39:34:07 - 00:39:35:09 Speaker 1 Schools. 00:39:35:11 - 00:39:55:02 Speaker 3 Is when they start hearing about it in a different way, you know, it's the the story of ADHD as a mismatch. Again, it's a pretty good story. It's a pretty good story. We have not been able to test it empirically, but it's a pretty good story. And it it begs questions around like it is. Are there other. 00:39:55:02 - 00:40:07:23 Speaker 2 Interventions that could help individuals with ADHD at a, at a larger societal, systemic level? Because that's actually what would have to happen. That would, be able to reduce prevalence overall. 00:40:08:01 - 00:40:11:20 Speaker 3 And I think one of the important ones is like, actually media exposure to social media. 00:40:11:22 - 00:40:21:11 Speaker 2 Is making it worse, which is what the several papers showed, at least in ADHD individuals, you know, imagine like a TikTok, like all those flashing lights that seem to, at least in the short term, make their symptoms worse. 00:40:21:17 - 00:40:46:22 Speaker 1 Yeah. And you see this industry that's developed now and I know you're not as on social media to the extent that maybe I am with some of the things I'm doing with business. But you see all these influencers who've developed these businesses, like ADHD coaches or the pharmaceutical industry funds these movements, even psychiatrist, to develop videos to increase the prevalence rate of a of a certain condition, because that increases the sales of of the particular drugs. 00:40:46:22 - 00:41:04:14 Speaker 1 And so you take a normal behavior, which we all experience. Like when we were walking out of the restaurant, I left my bag there, right. And you pointed to remind me, or sometimes, like you're on multiple devices and you're you have something in your head like, oh, I need to do a search on this. And then you click over and you forget what your search was. 00:41:04:14 - 00:41:29:03 Speaker 1 All these normal things, you lose your keys, and now they become symptoms of, of a condition which people over identify with. And now you're developing this own story of who you are. We see this where people with ADHD in relationships are now blaming the end of relationships on their ADHD diagnosis. So it's the diagnostic issue of, of reliability. 00:41:29:03 - 00:41:50:21 Speaker 1 So I was looking into the field study work on reliability for ADHD. It has a .61 kappa, which basically means it's almost a coin flip between. If you put two doctors doing an evaluation of the same person, one is going to see with ADHD and one's not. And so there's a 40% disagreement between doctors on each DSM. 00:41:50:21 - 00:41:51:22 Speaker 3 Is that the label. 00:41:51:23 - 00:41:53:00 Speaker 1 The DSM five is from. 00:41:53:01 - 00:41:53:22 Speaker 2 Five? Okay. 00:41:53:24 - 00:42:28:07 Speaker 1 So there's a 40% disagreement between doctors, right? We have zero biological tests. The average evaluation is 15 to 20 minutes and there are 20 plus conditions that exist that can mimic ADHD. So we see a problem with the diag, the diagnosis the reliability of it. So my question is is when you provide a diagnosis as a psychiatrist specializing in, child, adolescent and adult psychiatry, and you are providing a diagnosis of ADHD and treatment of ADHD, how do you come about that diagnosis? 00:42:28:09 - 00:42:52:02 Speaker 2 Quite to the occasional dismay of a new patient? A very I took a long time. I and I get away with it because I, I, I, I really like to do education and so I spend a lot of time in an evaluation process helping someone think about it with me and, and, so I spend a lot of time, I spend multiple sessions. 00:42:52:02 - 00:43:16:20 Speaker 2 You need collateral information. You really want to put together, something that that that there's there's clear impairment. There's clear reason that the diagnosis is, is going to sort of move them in a direction of what you think is going to be a positive improvement. Right? You have a plan for them, like there's a whole thing you need to put together. 00:43:17:01 - 00:43:27:21 Speaker 2 Diagnosing for the sake of diagnosing is like silly, right? I mean, like there's no there's no point to it if you're not going to have something that's going to be able to be helpful for them. So I, I have. 00:43:27:21 - 00:43:29:08 Speaker 3 A pretty extensive evaluation that. 00:43:29:08 - 00:43:42:16 Speaker 2 That we do we use a number of different scales. We don't do neuroscience testing. But we, we do send them out to different domains. So we try to get a picture that's as global as possible around stuff. 00:43:42:18 - 00:43:45:07 Speaker 1 Mostly just an interview. 00:43:45:09 - 00:43:48:13 Speaker 3 And yeah. Yeah, it's the definition is a clinical. 00:43:48:13 - 00:43:55:08 Speaker 2 The definition is a, not a checklist. They're validated research skills checklist. 00:43:55:10 - 00:43:56:07 Speaker 3 No. 00:43:56:09 - 00:43:57:09 Speaker 1 Connors. 00:43:57:11 - 00:43:57:24 Speaker 3 Yeah. No, I. 00:43:57:24 - 00:43:59:16 Speaker 1 Was going to bring the Connor's in here. The class. 00:43:59:16 - 00:44:04:10 Speaker 2 Is okay. The worst one is the ADHD adult five. 00:44:04:10 - 00:44:04:19 Speaker 3 That one. 00:44:04:19 - 00:44:10:14 Speaker 2 Like, is really just not. It's just not sufficient. 00:44:10:16 - 00:44:16:05 Speaker 3 You. Because but my goal is, is I want to help people. I want to I want to mitigate. 00:44:16:05 - 00:44:22:08 Speaker 2 The risk of someone having. 00:44:22:10 - 00:44:31:14 Speaker 2 Distress unable to move forward in their academics. Right. Because, like, you know, four times more likely to drop out of college, right? I mean, I think that's like, that's not good. 00:44:31:14 - 00:44:36:03 Speaker 1 Like, yeah, that's kind of that's kind of made up, made up statistics. Right. 00:44:36:03 - 00:44:37:19 Speaker 2 So I don't think is made up. 00:44:37:21 - 00:45:09:20 Speaker 1 Well, if we're saying if we're saying, 15% of all boys in the United States have an ADHD diagnosis compared to less than 1% of those in other European countries, we're making up the diagnosis to begin with, right? So we can't say that that's valid and then use other data that follows an invalid diagnosis and then say, well, that's valid because, I mean, there's a lot of reasons why somebody might, you know, flunk out of college. 00:45:09:22 - 00:45:13:14 Speaker 1 That has nothing to do with a neurological condition. But we can apply it and. 00:45:13:14 - 00:45:20:18 Speaker 3 Say that just in this, in this study, the, the, the, the people, the ADHD identification. 00:45:20:20 - 00:45:31:03 Speaker 2 Is a completely, unrelated, concept to the like, what's the events that have occurred with them? They're not not they're not connected. It's like they showed up. 00:45:31:07 - 00:45:33:13 Speaker 1 Did you say to increase the likelihood that they were okay? 00:45:33:13 - 00:45:41:12 Speaker 2 But but but the people are followed before they even get the ADHD diagnosis like so. So it's like a it's a it's a longitudinal, assessment. 00:45:41:14 - 00:45:48:05 Speaker 1 Yeah. So that reminds me of, probably some of the better studies that we've had. The MTA study. 00:45:48:05 - 00:45:49:19 Speaker 3 Yeah, the MTA studies. Great. Yeah. 00:45:49:19 - 00:45:50:07 Speaker 1 So that was. 00:45:50:07 - 00:45:53:14 Speaker 2 Said they're going to talk about to continue with the Albany funding. 00:45:53:16 - 00:46:02:07 Speaker 1 So 600 children, filed for 16 years randomized controlled trials funded by our government. 00:46:02:07 - 00:46:03:11 Speaker 3 Yeah. And I hear the funding. 00:46:03:11 - 00:46:14:13 Speaker 1 Yeah. So, results after eight plus years. And I think this is with stimulant medication, zero benefit and 24 outcome measures. 00:46:14:13 - 00:46:39:01 Speaker 2 Yeah. So it's notwithstanding the medication, the only the original paper, they're on study on medication and after that, they are not on medication. I'm 100% sure of that. And in fact, they've they've actually evaluated the likelihood that they would nothing like the that they surveyed if any of them hadn't had taken medication at all. And the vast majority of them had not taken any medication, for extended periods of time. 00:46:39:03 - 00:47:00:24 Speaker 2 So the MTA study is, is a group of individuals. So they split them up into several groups. One of them was, meds. Only one of them was a like a skill building program. They did this whole, like, summer camp with them was really cool. And the other one was a combined treatment. And then they evaluated the sort of like, normal controls, and the individuals that met the ADHD criteria. 00:47:00:24 - 00:47:19:09 Speaker 2 And they've been following them for, I think the most recent paper is maybe 20 years out that they, they've had it. But they only got treatment for that initial I can't remember. It might have only been a summer. It might have been six months. I don't I don't recall how long they got it for, but it's definitely not later. 00:47:19:11 - 00:47:46:06 Speaker 1 Okay. But, what I just saw before coming in here and kind of reading over, I guess it was probably the the original study. No improvement in academics, no improvement in behavior, depression, anxiety, social functioning, the only finding that determines the non medicated kids versus the medicated kids was the kids who were medicated had two inches less in stunted growth. 00:47:46:08 - 00:47:50:22 Speaker 1 And there were other studies too. Which I thought so. 00:47:50:22 - 00:47:53:04 Speaker 2 So again, the the. 00:47:53:06 - 00:48:26:21 Speaker 1 Here here I have the the MTA started in 1994. Yeah. Initial results were in 1999. That was 14 month outcomes. There was a three year follow up in 2004, a six year follow up in 2007, an eight year follow up in 2009, and then the 16 year follow up published through 2016 to 2017. So study design, almost 600 kids, 579 kids across, ages seven to almost ten years old, six sites. 00:48:26:23 - 00:48:55:06 Speaker 1 And I am funded largest, most expensive ADHD study ever conducted. Cost was 4 million. We had a medication management alone group, a behavioral therapy alone group a combined group, and then treatment as usual, which is the community care. So at 14 months the medication groups shows, better symptom reduction. But the findings were heavily, and these findings were heavily publicized to push the use of the drug. 00:48:55:08 - 00:49:18:08 Speaker 1 But at at three years, the medication advantage had faded by half. Yeah. And then all groups started converging at 6 to 8 years, which is when they published this, between 2007 and 2009, they found no differences between any of the treatment groups. In fact, the medicated children were then 1.5in shorter. So that was like the major finding. 00:49:18:08 - 00:49:20:15 Speaker 1 It's stunted their growth. Those. 00:49:20:17 - 00:49:21:04 Speaker 3 Are you sure? 00:49:21:07 - 00:49:54:03 Speaker 1 Inches 1.5in. Yep. Okay. And, those who used, medication. Now we're starting to demonstrate worse outcomes at, at 16 years, of the study there, they came to the conclusion that there's no benefits for the from the medication height suppression of two plus inches. There was no improvement in school completion, arrests, psychiatric hospitalizations or employment. And here's a critical quote from the lead researcher, Doctor James Swanson. 00:49:54:03 - 00:50:09:06 Speaker 1 In 2009. The notion that medication normalizes behavior in academic performance is not supported by the meta data. And then we had in a Nadine land, Lamberts research. 00:50:09:06 - 00:50:24:19 Speaker 2 Can we can we stick with the MTA for sure? Yep. Okay. So, I, I the the the thing that is different for me and some of this is how you're seeing this and how I'm seeing it. So I'm going to try to sort of frame how I think we're each seeing it. 00:50:24:21 - 00:50:27:12 Speaker 1 Well I read it and then I popped it into I. 00:50:27:14 - 00:50:28:02 Speaker 2 Okay. 00:50:28:02 - 00:50:35:13 Speaker 1 And so I'm actually reading, what I brought back to you, which was consistent with which I read. 00:50:35:15 - 00:50:35:24 Speaker 3 Yeah. 00:50:36:00 - 00:50:47:07 Speaker 2 And, so the, the MTA study, you writes the four groups that we talked about, the the findings were that during the. 00:50:47:09 - 00:50:50:02 Speaker 3 The time of medication, end of behavioral treatment. 00:50:50:02 - 00:51:16:23 Speaker 2 Okay. So that's an initial study. You get improvements, in, in, in, in all groups. Unfortunately this was very disappointing. By the way, the the least improvement was in the non medication group. The community group did better than that. And then the meds and behavior I think did the best and then meds only. So you actually did better in the combined treatment. 00:51:16:23 - 00:51:18:10 Speaker 2 That's the original 14 months. 00:51:18:10 - 00:51:18:24 Speaker 1 14 months. 00:51:19:02 - 00:51:19:17 Speaker 2 And 14 months. 00:51:19:21 - 00:51:21:04 Speaker 3 And then they had this. 00:51:21:04 - 00:51:26:12 Speaker 2 Idea, they had this theoretical model that does not seem to be true. 00:51:26:18 - 00:51:53:15 Speaker 3 That they thought these ADHD kids, they just don't have these, like, learning skills. You know, what we're going to do is we're going to show you that meds alone doesn't work and that behavioral on doesn't work. And if we do them, the meds and the behavior, they get the best outcome, which they showed, but they thought it was going to be a permanent neurological or something like change that it was going to be like a, like an antibiotic. 00:51:53:17 - 00:52:06:07 Speaker 3 And it's not like that is that is the main disappointing finding is they thought they were going to cure ADHD and then they kept following these individuals. And there's even one more paper that came out. 00:52:06:09 - 00:52:19:09 Speaker 2 Maybe like in the last six months, that looks at, changes in like, symptomology over time and that, that symptomology actually fluctuates, over the lifetime. 00:52:19:12 - 00:52:22:16 Speaker 3 But when they say those bad outcomes. 00:52:22:18 - 00:52:53:07 Speaker 2 Which is the divorce, more likely to be on like, government assistance, accidental deaths, lower educational attainment, all of those outcomes are the the ones who had that label of ADHD. I'm doing air quotes. And as compared to the ones that did not meet the criteria, and that group was all one together. So the behavioral treatment like just the ADHD people and and that's who gets followed. 00:52:53:07 - 00:52:54:21 Speaker 2 And there are no medication. 00:52:55:00 - 00:52:56:24 Speaker 3 So the interpretation of it. 00:52:57:01 - 00:53:16:01 Speaker 2 And we can disagree with this, was that this is what happens when you don't keep treating them. That's the interpretation that the people who who have done that study, like I know them personally, like believe is what the meaning of it it's now you see it differently that can you help me understand what that is? 00:53:16:03 - 00:53:23:20 Speaker 1 Well, first, I don't believe that there is an identifiable discrete, medical condition called ADHD. So hold on a second. 00:53:23:22 - 00:53:30:13 Speaker 3 That's enough for there to be for people that we all meet. We all agree. But those certain criteria. 00:53:30:15 - 00:54:04:04 Speaker 1 What here's the problem is the treatment is not targeting what the problem is. It's a label that gives us absolutely nothing. So if you have five kids who have, nutritional deficiencies, five kids are getting beat at home, live in poverty stricken homes. You get five kids who, you know, aren't sleeping well at night. You get, five kids who would just be much better outside playing and in the environment, and you label them all the same thing, and then you just say, we're going to keep you in this environment. 00:54:04:04 - 00:54:23:08 Speaker 1 We're not going to actually target the real problems that exist, and then we're going to try to measure it. That's my problem with the field in general. The other thing is how we can create outcome measures and the way we look at drugs. You use the word medicine. To me it's not medicine. You're assuming it's medicinal. It's correcting something that's dysfunctional. 00:54:23:10 - 00:54:46:07 Speaker 1 I'm going to say if if I have social anxiety and I have three double vodka tonics. Right. And, and that's a chemical that's, that's, that's impacting my brain. And then you measure my social anxiety symptoms. They're going to decrease. We're not going to say alcohol is an evidence based medicine for social anxiety. 00:54:46:09 - 00:55:01:21 Speaker 2 We've already medicalized alcohol. It's called benzodiazepines. They act in the same mechanism. Which is why, guys, if you take benzodiazepines, please do not drink. Alcohol is not safe. Yeah. You will, you will suppress your respiratory drive and you can die. Yeah. It's like super serious. 00:55:02:01 - 00:55:25:20 Speaker 1 So yeah, it makes sense to me why you would provide a stimulant to all those kids, even the ones who are in trauma, homes. And those were having sleep difficulties and other things and certain symptoms improved because that's what a stimulant will do, right? That's how a stimulant acts on the brain. But it's not like, that's a medicine that's correcting something. 00:55:25:24 - 00:55:47:04 Speaker 1 You're drugging somebody and you're improving something in the short term until the brain adapts, right? The brain seeks out homeostasis. So it's going to in order to have the same response. Right. You're going to need more and more of, of a drug, of a substance in order for you to be able to respond the same way. And we that's why we don't really see that there. 00:55:47:10 - 00:55:51:10 Speaker 1 These are sustainable, positive outcomes in response to the stimulus. 00:55:51:10 - 00:55:52:05 Speaker 3 So we don't know that. 00:55:52:05 - 00:56:21:18 Speaker 1 Now, if a stimulant had no negative effects, right. There was no problems with long term stimulant use at all. Then I'd say, what's the big deal? It's rather benign, but there are and this is what we're also doing. And this is where psychology, me as a behaviorist comes up against like, psychiatry for example, when you start to teach somebody that their behavior, their emotions, their thoughts are something that is outside of their control, right? 00:56:21:18 - 00:56:44:02 Speaker 1 You have to externalize it to a substance, right? And you start creating that narrative and you start creating the relationship. You shouldn't be surprised as they get older that they turn to other substances to try to change the way that they feel alcohol, drugs, and they see the quality of their life to come from outside of them to something they can ingest. 00:56:44:04 - 00:57:13:09 Speaker 1 You are creating long term customers. Another reason why we're seeing the increase in the amount of people receiving multiple psychiatric diagnoses. In our culture, we are creating chronic and long term customers because the paradigm is off. The model is wrong. I'm going to bring up meeting Lamberts research because she was a clinical school psychologist at UC Berkeley. She conducted one of the most important longitudinal studies on ADHD medication effects. 00:57:13:11 - 00:57:36:16 Speaker 1 Her study design 500 children. We need these longitudinal studies. That's like the only way we're going to be able to follow these outcomes. 500 children from San Francisco Bay area filed for 20 years between the 70s and 90s, tracked both medicated and unmedicated children with ADHD symptoms. Children who took stimulants had significantly higher rates of cocaine dependance, tobacco dependance, stimulant addiction. 00:57:36:16 - 00:57:57:20 Speaker 1 In adulthood, risk was dose dependent. More medication equaled higher addiction risk. Those medicated for more than one year had the highest addiction rates. No long term benefit from academic and academic performance from stimulant use, and you're never going to find anything that shows that it does medicate children. 00:57:57:21 - 00:57:59:03 Speaker 3 That's not true. 00:57:59:05 - 00:58:07:12 Speaker 1 You're never going to find a good study, I guarantee you this. That shows that you improve academic outcomes. 00:58:07:14 - 00:58:11:05 Speaker 2 I long term stimulant. How do you how do you define outcomes? 00:58:11:07 - 00:58:21:23 Speaker 1 Graduating better grades. Going off to college. The same way you would identify any outcome academically. Test scores. 00:58:22:00 - 00:58:32:13 Speaker 2 Yeah. Test scores don't usually go up, but there are multiple studies that look at graduation rates. And final completion. And the. 00:58:32:13 - 00:58:33:17 Speaker 3 Most I think the, the. 00:58:33:17 - 00:58:35:23 Speaker 2 Most meaningful stuff is this. 00:58:36:00 - 00:58:39:22 Speaker 1 Medicated children did not have better high school completion rates. 00:58:39:24 - 00:58:44:13 Speaker 3 But this is this is there's research. There's a national. So so when we do. 00:58:44:13 - 00:59:08:20 Speaker 2 Studies, guys like, you know, one of the ideal ways to look at something is to have as much of a, the real actual data as if you can measure sort of everything. So, we have this really nice database that measures, insurance data, like, you know, because it sort of takes the US healthcare system that's sort of divided, and it combines all the data. 00:59:08:20 - 00:59:16:03 Speaker 2 So it allows you to sort of monitor, people over time and see what happened to them. So one of the things that's really interesting that they. 00:59:16:03 - 00:59:19:14 Speaker 3 Found, I think this is probably the most compelling. 00:59:19:16 - 00:59:27:14 Speaker 2 Data set around treatment, is that when you look at individuals that have. 00:59:27:16 - 00:59:38:04 Speaker 2 F 90 point, you know, whatever, like the, the ICD code for, for for ADHD, they've been given that label in an official setting. Right. It's been presented to their health care. 00:59:38:04 - 00:59:39:10 Speaker 1 Kind of must be accurate then. 00:59:39:13 - 00:59:41:16 Speaker 3 Well, but whether you. 00:59:41:16 - 00:59:45:20 Speaker 1 Understand like that's the least reliable, that is the least. 00:59:45:22 - 00:59:46:03 Speaker 3 Doc. 00:59:46:08 - 00:59:46:17 Speaker 1 On to. 00:59:46:18 - 00:59:48:01 Speaker 3 Put a group together. 00:59:48:03 - 01:00:05:14 Speaker 1 Doc, you got hold on a second. Right. You even admitted yourself if we have 15% of boys, 11 to 17% of the country has a obtaining a diagnosis of ADHD. Okay? There's no way that's valid. No way. So we're giving. 01:00:05:14 - 01:00:06:22 Speaker 3 And the the national. 01:00:07:00 - 01:00:12:14 Speaker 2 Studies on that, not the CDC data but the the national survey studies are are are lower than. 01:00:12:14 - 01:00:18:09 Speaker 1 That. Oh, I think it's much, much higher because you can do, you can do the epidemiological. 01:00:18:09 - 01:00:18:21 Speaker 3 Research. 01:00:18:22 - 01:00:26:07 Speaker 2 Experience of people thinking they have ADHD is is inaccurately high right. Inaccurate high. But but here's. 01:00:26:07 - 01:00:28:22 Speaker 3 A here's how people get it. I just don't. 01:00:29:01 - 01:00:33:13 Speaker 1 Know. This is really important because it's going to invalidate probably what you're about to say because, oh, I feel. 01:00:33:13 - 01:00:35:02 Speaker 2 Really invalidated for. 01:00:35:08 - 01:00:36:04 Speaker 3 Invalidating. 01:00:36:04 - 01:00:36:10 Speaker 2 Me. 01:00:36:12 - 01:00:39:18 Speaker 3 Like I have. But hold on a second. I would take my iPad. I would take it out right now. 01:00:39:22 - 01:00:56:09 Speaker 1 Listen, this the United States has 4 to 5 times higher rates of ADHD compared to other developed countries, right? So almost every one of those, like a large percentage of those, kids from that data base, it's it's not even going to be valuable. 01:00:56:10 - 01:00:58:10 Speaker 3 Let's just that. 01:00:58:12 - 01:00:59:20 Speaker 1 That's why you need to do control. 01:01:00:00 - 01:01:03:04 Speaker 3 Studies. This is a what they do is they do they do a controlled study. 01:01:03:04 - 01:01:25:02 Speaker 2 They have a they have a number of like fancy statistical models. They use that that replicate like an RCT. It's like these like stats. People are so smart. And what they do. So, so that baseline group that, that has been given that code, much higher incidence of having a emergency room visit, that is labeled as a motor vehicle accident. 01:01:25:02 - 01:01:26:18 Speaker 2 Okay, we get that. 01:01:26:20 - 01:01:28:17 Speaker 1 Well, first of all, those people are on drugs, too. 01:01:28:18 - 01:01:41:21 Speaker 3 No no no no no no no. So so so so so the the the that specific group and then we you when you when we finish review when you slice them up and you look at when they were you look at the time period they were on and when they were on medication and when they were, because we have their prescriptions. 01:01:41:21 - 01:02:04:15 Speaker 3 Okay. And and you look at that, being on medication during the time period almost normalized the difference between the people that had that label and everyone else. So in terms of risk of motor vehicle accident. So the people that have the label and had a prescription that was current during that time period were much less likely. Even when you controlled for all the demographics to do that. 01:02:04:17 - 01:02:25:00 Speaker 3 The because this condition or this thing that we're labeling makes it harder to drive a car like I mean it literally does like like you kids tailgate is a huge problem. There's a long day, documented history around motor vehicle accidents and speeding tickets, particularly among boys. That have. 01:02:25:02 - 01:02:27:13 Speaker 2 You know, this classification. 01:02:27:15 - 01:02:45:21 Speaker 3 And, and we have that's a, that's a that's upsetting to me. Like, I don't want these these kids getting into car accidents, right? I mean, like like, if I have data that shows that that reduces that, that that's something I need to tell a parent. I need to tell the parent that so that that they understand that and that they can make an educated decision. 01:02:45:21 - 01:02:55:00 Speaker 3 They don't have to medicate their child, but they have to make an educated decision based on things that we we do see. 01:02:55:02 - 01:03:20:07 Speaker 1 All right. So first of all, I mean, I try to be scientific, right? Scientifically minded person. So, when bullshit is provided, I feel like a have a professional responsibility to call out bullshit, right. So that's not how you create medical conditions. You don't say, oh, we have a group of kids who's more likely to get in a car accident. 01:03:20:09 - 01:03:44:19 Speaker 1 It's because they have ADHD. And all right, we're going to give them a stimulant drug. And I have no idea about the data, the whole thing. If things aren't randomized controlled, you can't just say, like in the world that I live in and work in, almost everyone who comes into my center says they have ADHD. So the validity of something like that, the reliability of a study like that is just nonsense. 01:03:44:19 - 01:03:55:00 Speaker 1 I would never I would never talk about it. Instead, I'd want to look at, okay, what are the legitimate long term findings of well controlled study? 01:03:55:02 - 01:04:00:18 Speaker 3 So, so and there's multiple studies. You say a substance use issue, but you mentioned substance use. 01:04:00:24 - 01:04:21:23 Speaker 2 There are four studies that have occurred more recently than that, that have been better controlled than that. Right. Because whenever you get a study published, it's it's hard to get it published unless you can prove that the study you did is advancing beyond that study in some ways. And all four of them either showed there is no difference when you are medicated and you have ADHD of your substance use risk or there is a decreased risk. 01:04:22:00 - 01:04:26:22 Speaker 2 There is this is that has been altered four times since that. 01:04:26:24 - 01:04:46:11 Speaker 1 Yeah. I mean, psychiatric research is one of the poorest qualities of research that is always pushed by thought leaders and industries. And when you get into it and you look at the real data, and the quality of the studies, they tend to be really poor. Like Joseph Biederman is a great example. When who was getting paid millions? 01:04:46:13 - 01:04:47:21 Speaker 2 Rest in peace. 01:04:47:23 - 01:05:03:23 Speaker 1 Man. That guy's evil. I mean, one of the most one of the most evil human beings. Someone who, you know, he he made up childhood bipolar disorder, for the benefit of, pushing mood stabilizers. And he was making millions doing it, but. 01:05:03:24 - 01:05:06:20 Speaker 3 Yeah. And and the data actually. 01:05:06:20 - 01:05:18:21 Speaker 2 Shows that the majority of the kids that had bipolar disorder also had ADHD. So my interpretation, which is can be different than yours, is that it was a mislabeling of of something else. 01:05:18:21 - 01:05:21:16 Speaker 1 Well, neither one of them are legitimate conditions. Right. 01:05:21:18 - 01:05:22:21 Speaker 3 But the problem with. 01:05:22:21 - 01:05:23:19 Speaker 1 This kind of stamped. 01:05:23:19 - 01:05:24:15 Speaker 3 Medicine, medicine. 01:05:24:15 - 01:05:26:03 Speaker 2 Always has to start. 01:05:26:03 - 01:05:27:09 Speaker 1 You mean drugs at that? 01:05:27:11 - 01:05:28:10 Speaker 3 01:05:28:12 - 01:05:50:11 Speaker 2 Medicine. A field as a field? As a as I'm representing psychiatry and the field today, medicine as a field has to start at a descriptive level. And so, like, like pneumonia used to just mean, like a much wider amount of things related to your, your, your lungs. 01:05:50:11 - 01:05:53:14 Speaker 3 And they have narrowed it down and identified. 01:05:53:16 - 01:05:56:22 Speaker 2 All these different types of pneumonias and all these different types of lung problems you can have. 01:05:57:02 - 01:06:06:13 Speaker 3 And they sub categorized things that normally were lumped together. And I have no doubt that the thing that's being called ADHD today is a wildly heterogeneous. 01:06:06:13 - 01:06:08:09 Speaker 2 Thing caused by many different. 01:06:08:09 - 01:06:13:14 Speaker 3 Things, and that individuals have variation in terms of how they're getting to that point. 01:06:13:17 - 01:06:14:14 Speaker 2 Of view. 01:06:14:16 - 01:06:29:05 Speaker 3 And I also think that there's a good chance that this is a trait that that is a mismatch, a mismatch in today's society. We are on the same page about that. We're in the 100%. And I even would like to reevaluate other options. 01:06:29:05 - 01:06:35:16 Speaker 2 Other other other other options and opportunities to help these people so they do not have dysfunction. 01:06:35:22 - 01:06:45:13 Speaker 3 The problem that I have is how do these is I, I see people having problems because of that mismatch. By definition, the mismatch causes problems. 01:06:45:15 - 01:06:47:04 Speaker 1 All right. So I have a question for you I want to be on. 01:06:47:04 - 01:07:07:00 Speaker 3 And I just don't know what like like like like what do I do when a kid has been in an emergency room and I've been called in. This is a real story multiple nights in a row, okay? And he's so dysregulated at home like the, you know, the the preschool has said he can't come back to school tomorrow. 01:07:07:02 - 01:07:09:10 Speaker 2 Like, and we've tried to preschools. 01:07:09:12 - 01:07:11:00 Speaker 3 Like that's, that's like a situation that. 01:07:11:00 - 01:07:13:16 Speaker 1 Obviously you sedate him and throw him in the corner, you. 01:07:13:18 - 01:07:14:09 Speaker 3 Know. 01:07:14:11 - 01:07:41:00 Speaker 1 So hold on a second I want to I'm not saying that legitimate problems like what you just described don't exist. God, obviously, I mean, there's abuse, there's poverty, there's parents who are neglectful. We have kids who, are malnutrition. And we can go on and on and on. Just remember, my point is, is that the label itself stops further exploration and does not solve the problems. 01:07:41:00 - 01:07:52:02 Speaker 1 We're drugging young kids. That's interesting. Now, my question here, though, is for you. I want you to be honest. How much does it cost for a, ADHD, a full ADHD evaluation with you? 01:07:52:04 - 01:08:21:11 Speaker 2 The range of pricing is in the, hundreds upwards, depending on depending on who they're seeing. And, we are out of network providers. So we try to help people out by figuring out how to get reimbursed from their insurance. And that is a huge problem in the mental health system that it is so difficult to find people, who are covered on insurance. 01:08:21:11 - 01:08:47:24 Speaker 2 There's a huge, huge problem, and there's an incredible disparity of people having resources. You're talking a lot about all these things that, could be addressed with these people that are are potential drivers for this thing that we're labeling as ADHD. And you're right, we need to figure out how to lower the barriers to those types of things as well. 01:08:48:00 - 01:08:49:09 Speaker 1 Yeah. I mean, I don't the. 01:08:49:12 - 01:08:50:12 Speaker 2 Other thing that we have to do, but. 01:08:50:15 - 01:08:50:22 Speaker 1 Yes. 01:08:50:22 - 01:08:56:12 Speaker 3 Yeah, I mean, if someone has ADHD, do you or someone if someone is having trouble, let's, let's, let's, let's not. 01:08:56:13 - 01:09:08:11 Speaker 2 Use a diagnosis. If someone is having trouble organizing themself and getting things done, is it reasonable to teach them how to make a list and prioritize a list? 01:09:08:13 - 01:09:09:19 Speaker 1 Of course. 01:09:09:21 - 01:09:16:12 Speaker 2 Yeah, it's it's hard to find someone that can do that kind of teaching. Yeah. And that's a very basic organizational skill. But I. 01:09:16:12 - 01:09:17:05 Speaker 1 Want my. 01:09:17:06 - 01:09:18:10 Speaker 2 People need to I. 01:09:18:10 - 01:09:19:24 Speaker 1 Want my center point to be. 01:09:19:24 - 01:09:21:16 Speaker 2 A learn to succeed. 01:09:21:18 - 01:09:22:13 Speaker 1 Here's my specialty in. 01:09:22:13 - 01:09:23:24 Speaker 2 Our like modern society. 01:09:23:24 - 01:10:00:07 Speaker 1 If we're going to medicalized something right, we're going to put it under the purview of our medical system, which is an allopathic model. Right. And we're going to say the reason that these conditions exist is because we have this identifiable medical condition, and we can treat it. Well, then if you better be able to produce, much better outcomes in comparison to alternative treatments, your conceptualization better be solid scientifically. 01:10:00:09 - 01:10:19:10 Speaker 1 Like if you're going to call it a brain condition, then we need to have biological tests that support it, and we have to have strong science to support it. If you're saying the most effective treatment is going to be a pharmaceutical, then informed consent is required. Then we have to understand what the long term outcomes are going to be, both negative and positive. 01:10:19:15 - 01:10:45:22 Speaker 1 And my goodness, we better be able to prove that they outperform a non medicated group because we are what we are doing is we are experimenting on brains in a way that has never been done in human history, in human history, we're talking a very short, discrete period of time. We've we've made up a condition called ADHD. 01:10:46:02 - 01:11:07:07 Speaker 1 And now we have a pharmaceutical to treat it. That's a huge industry. And and when you look at the numbers that we are 4% of the population, but 80% of the stimulant medication can't tell me there's no financial conflicts of interest. When you have a medical specialist whose entire role in the system is to write prescriptions, you can't tell me that there's financial conflicts of interest. 01:11:07:07 - 01:11:10:00 Speaker 3 Yeah, that these are these are real problems. 01:11:10:02 - 01:11:41:14 Speaker 2 These are real, real, real, real problems. You know, one of the things that I think really, and I guess psychiatry should have advocated better for itself, but like during changes in how insurance was structured in the, like, 90s, psychiatry went out of the business as, as a broad statement, right, of, of psychotherapy and, got all these ways that the insurance companies actually make it so that. 01:11:41:16 - 01:11:42:17 Speaker 3 It. 01:11:42:19 - 01:12:03:03 Speaker 2 Even if the psychiatrist wants to do psychotherapy, the, the they get paid better if they choose not to do that. And then in every and every system you work in, they don't want you like the people above, don't want you to be spending time with patients. You were discouraged from doing that. Because you're you're you have a specialized skill that other people. 01:12:03:05 - 01:12:05:00 Speaker 3 Don't have that is that is. 01:12:05:02 - 01:12:18:14 Speaker 2 Absolutely problematic. The, the, the getting an evaluation, should be something that allows you and one of the the, the, the the reasons that, that I have training in medicine is that I'm supposed. 01:12:18:14 - 01:12:25:05 Speaker 3 To be thinking about all of these things that you're talking about, like, like absolutely thinking about thyroid ism, just like I would think about that with depression. 01:12:25:05 - 01:12:25:18 Speaker 2 Like. 01:12:25:20 - 01:12:30:00 Speaker 3 Absolutely. I think that the why, despite their why, hasn't stored incentives. 01:12:30:02 - 01:12:37:24 Speaker 1 Yeah. Why hasn't psychiatry completely adapted to where we are right now. Like I actually one of. 01:12:37:24 - 01:12:45:15 Speaker 3 The what would that look like I in psychiatry is actually a very you know the because of like the psychotherapy thing, like it's a it's a fairly. 01:12:45:15 - 01:12:47:07 Speaker 2 Reflective field. So I'm. 01:12:47:07 - 01:12:50:22 Speaker 3 Actually like and unquestionably. 01:12:50:22 - 01:12:55:14 Speaker 2 It's like made a lot of mistakes. Like, 01:12:55:16 - 01:12:56:24 Speaker 3 What would that look like? 01:12:57:03 - 01:13:40:20 Speaker 1 Here's my viewpoint because I think we require, medical professionals who are working with people whose primary presentation is psychiatric and for them to act again, like doctors ordering lab tests, evaluating lab tests, getting to know patients and families again. Right. Like, yeah, absolutely. Spent spending time and thoroughly evaluating them and using your position in society, in a positive manner because, what we know through a lot of this interesting research on placebo and nocebo is that the, the white coat, approach, like the fact that you there's some of the best and the brightest go into medical school. 01:13:40:20 - 01:14:14:13 Speaker 1 You're obviously very, very smart and intelligent, have to get through the rigors of that type of training. So you have a level of expertise. So a medical professional actually influences outcomes by the way they describe it to their patients, by building or offering hope by saying there's a reason you could be feeling this way, and then you could actually map out a plan that would target that, even if you weren't doing the day to day behavioral work like say, say it like really, we don't need our physicians, you know, having people learn how to like, manage their homework, for example. 01:14:14:13 - 01:14:15:20 Speaker 1 Right. We. 01:14:15:20 - 01:14:16:17 Speaker 3 Don't need we don't need. 01:14:16:17 - 01:14:17:15 Speaker 1 Our physicians doing. 01:14:17:16 - 01:14:24:12 Speaker 2 This. And they maybe that's that's I mean, I like doing that with people. And I think it's useful. So please don't take that away from me. But. 01:14:24:14 - 01:14:25:20 Speaker 1 Well, you can do it if you want. 01:14:25:23 - 01:14:28:23 Speaker 2 Like, but I would rather have the, the I understand from an efficiency point of view. 01:14:28:23 - 01:14:30:04 Speaker 3 But that's exactly. 01:14:30:06 - 01:14:38:16 Speaker 2 One of the things that accidentally contributed to this. The, the, the psychiatric evaluation is really supposed to be like, you know. 01:14:38:20 - 01:14:43:18 Speaker 3 Like medicine has to be psychiatrists. Mental health has all of these different fields. 01:14:43:18 - 01:14:52:04 Speaker 2 That are in it. Right? Like you have a PhD in psychology, which comes from a research background, like like big picture. Then there's like. 01:14:52:04 - 01:14:57:04 Speaker 3 Sides, then there's social workers and there's counselors like we come together. 01:14:57:04 - 01:14:59:03 Speaker 2 And you know, the, the, the. 01:14:59:05 - 01:15:08:21 Speaker 3 Psychiatric evaluation should really feel like a top high level evaluation to think about what is the best trajectory for this. 01:15:08:21 - 01:15:09:08 Speaker 2 Person. 01:15:09:12 - 01:15:27:24 Speaker 3 Right. Like that's actually what should be happening, which is why, you know, 15 minute med visits are like honestly, they feel they they're before criminal like I don't I'm I've been thinking about ADHD for a long time, whether you believe it or not and or not. I've been thinking about it a long. 01:15:27:24 - 01:15:33:09 Speaker 2 Time, and I've read a lot about the thing we we, you and I are talking about a phenomenon like. 01:15:33:11 - 01:15:37:14 Speaker 3 I don't feel comfortable in 15 minutes being able to make accurate assessments. 01:15:37:14 - 01:15:38:07 Speaker 1 That standard. 01:15:38:13 - 01:15:40:18 Speaker 3 I don't feel comfortable in that. So that is that is. 01:15:40:23 - 01:16:01:24 Speaker 1 You know, what standard is now. And and so my resistance to all of this is because I have an outpatient center. And so my the clients that come in here are either going into their primary care settings or seeing a psychiatrist and they say, I have ADHD. I ask every single one, as does my staff. How did you obtain that diagnosis? 01:16:02:01 - 01:16:12:18 Speaker 1 Well, they just told me, how long did you see this individual? The first time, maybe 40 minutes. The second time, 15. 01:16:12:22 - 01:16:14:12 Speaker 3 I hear this all the time. 01:16:14:14 - 01:16:38:04 Speaker 1 And they walk out with 3 or 4 drugs and 3 or 4 diagnosis. I have, I have depression, I have an anxiety disorder, I have ADHD, I have bipolar two. This is how psychiatry has devolved into just being an arm of the pharmaceutical company or corporate medicine, where now they're just like really quickly sending out labels and drugs. 01:16:38:04 - 01:16:47:13 Speaker 1 And that's why we have the the mental health epidemic that exists in this country. We have more people on drugs, we have more people on diagnosis, and we're deteriorating. 01:16:47:13 - 01:16:49:17 Speaker 3 Yeah. I think that the mental health epidemic. 01:16:49:17 - 01:17:08:09 Speaker 2 Is, is is a prevalence problem that's being driven by a number of factors. And I think that the pharmacology that you're seeing is a trailing response to that. I don't see it as drive me. I mean, oh, wow. I mean, the arrow, I guess could go both ways. But like, you know, to me, it feels like the mismatch, is. 01:17:08:09 - 01:17:28:24 Speaker 1 You need to you need more. So you need a history lesson. But but but no, but, stock, listen to me for we're gonna stop right there. Doc, you have to go back and look into post 1987. You have to look at what the pharmaceutical companies did once they started pushing SSRI onto the general population. 01:17:28:24 - 01:17:39:06 Speaker 3 And then the commercials, remember? I remember you remember the egg commercial with this. Who remembers the sad egg with the umbrella left Brazil off a come on guys like. 01:17:39:06 - 01:18:17:06 Speaker 1 But it was all coordinated. And what they did is they targeted first your profession. They hired thought leaders, academic thought leaders. They published the textbooks. They created these horrible, trials to support the efficacy of their drugs, clear fraud in from placebo washout periods to actually pulling out suicidal clients, not including them in the, other data in the final data, adding, stimulant drugs to SSRI medication, all different kinds of games for it to outperform placebo. 01:18:17:06 - 01:18:41:19 Speaker 1 And it hasn't been able to do that in any meaningful way. And then they target the American population with direct to consumer advertising. So they have the bullshit studies. They have the air of legitimacy with the academic thought leaders. They train every single upcoming medical student and the same way there's these we have these identifiable biological conditions. We have these drugs to treat them now. 01:18:41:19 - 01:18:44:16 Speaker 1 It's like diet. It's like insulin for diabetes. 01:18:44:16 - 01:18:46:09 Speaker 3 No, that's not how it's. 01:18:46:09 - 01:19:10:22 Speaker 2 Taught in medical school or in residency. And and that's that is not an accurate representation. I agree that that is a representation. The, the oversimplification of psychiatric conditions, for instance, like depression is like a serotonin deficit or like, I mean, that's like still stuck to that. That's a marketing that's a marketing idea. That's 100% a marketing idea. 01:19:10:22 - 01:19:20:04 Speaker 2 That is absolutely not, a like complete thought on the but, you know, the neurobiology that is but there's not even, like a partial thought. Yes. 01:19:20:04 - 01:19:30:24 Speaker 1 But, you know, we're here because of that reductionist model, and we still have, primary care doctors and psychiatrists claiming the same thing. Trust me, I get on the phone with them. 01:19:31:01 - 01:19:34:06 Speaker 3 How do you feel about how do you feel about. 01:19:34:08 - 01:19:38:11 Speaker 2 What do they call physician extenders or advanced providers? How do you feel about that? 01:19:38:11 - 01:19:41:08 Speaker 1 They're all trained in a similar way. 01:19:41:10 - 01:20:01:22 Speaker 2 You know, so there's a study that we're, we're looking at now and we, we're looking at the increase in stimulants, like, which, you know, yes, guys, stimulants have increased. And I was curious about like when what population they've increased more. And, I'm curious about who's actually writing those prescriptions. Because we can see that. 01:20:01:22 - 01:20:22:11 Speaker 2 We can see is it psychiatrists that are writing more prescriptions than they used to? You know, is it like, I don't know, like the ObGyn or something, like, you know, and, and the early data suggests, that the less training you have in psychiatry, sort of those are the people that had the, the increase in it. 01:20:22:15 - 01:20:28:03 Speaker 3 Now, does that mean that the diagnosis is wrong? No. You know, it's certainly it's certainly. 01:20:28:03 - 01:20:52:06 Speaker 2 Concerning because you're right that the the complexity of the diagnosis is, is significant because it is so nuanced. Because it is, it is, it is also you're trying to target like, every problem solving. Right? Like giving a diagnosis to someone and not being able to help them in any way is sort of not very useful. Like, you know, you want to think about how are you going to sort of help those people? 01:20:52:08 - 01:21:02:12 Speaker 2 But the data seems to show that the increase in prescribing. To get back to my point, it was more likely, you know, in, in, for instance, like the, physician extenders. 01:21:02:14 - 01:21:13:23 Speaker 1 Yeah. And that profession's growing. So, we're just we have more and more psychiatric nurse practitioners prescribing drugs than at any other point, but it has more than half to. 01:21:13:23 - 01:21:15:01 Speaker 3 Spend in that field. 01:21:15:01 - 01:21:30:21 Speaker 2 Actually, when I talk to graduates in the field, they report that they feel they need more training than they they've gone they actually reported that. So so like, you know, I think that additional training is something that needs to be thought about. Right. And these are, scheduled. 01:21:30:21 - 01:21:35:01 Speaker 3 By the DEA. Are they as dangerous as opioids? I certainly don't think so. But, like. 01:21:35:01 - 01:21:37:08 Speaker 2 They are, they are controlled substances for a reason. 01:21:37:08 - 01:21:40:00 Speaker 3 You can become psychotic on these medications. 01:21:40:02 - 01:22:01:18 Speaker 2 At a very high doses. So no one's been able to demonstrate this. You theoretically could have an arrhythmia from it. Again, like not being able to be demonstrated, sleep disruptions. There's, you know, there's sort of issues around that. And people also misuse it in a true substance use way. There's certain ones that people will actually grind up and they will they will snort that which is completely unsafe. 01:22:01:20 - 01:22:05:08 Speaker 2 And very scary for me as a physician to think about. 01:22:05:10 - 01:22:30:02 Speaker 1 Yeah. Obviously, I think it's systemic when when you have the large scale hospital based programs buy up all primary care and you have corporate medicine, what they do, what they care about is the bottom line. Yeah. So it's getting people in. It's getting people out. You write the prescription, you move them along. The benefits to that are pretty vast. 01:22:30:02 - 01:22:57:07 Speaker 1 It's from, the pharmaceutical companies to the reps to the hospitals, to the insurance companies. It's a big giant racket. And it's a huge, huge problem. And it's the reason all these prescriptions are going up in the diagnosis are going up, is because anyone can achieve it. Like, if I wanted to walk out of this office today and get a, Adderall prescription, I could do it and I could do it because I could just my right. 01:22:57:09 - 01:23:24:01 Speaker 1 And to me, that's not science. That's not medicine. You shouldn't be able to obtain a schedule one narcotic by saying I have, I can't focus. There needs to be a greater, like, empirical scrutiny for these psychiatric conditions, or you just become, unfortunately, the useful idiots of of industry. And it's not just medicine, it's also the therapy industry. 01:23:24:03 - 01:23:50:13 Speaker 1 Every therapist now is pretty much fear conditioned to have to refer into the medical system. And that's from their licensing boards, from their ethics classes. You know, it's it's an entire industry that has pushed us into this chronic disease epidemic. And it's not until we stand ethical people stand up against and call out the bullshit and say, a, an entire country, 25% of a country on a psychiatric drug is not a flourishing society. 01:23:50:15 - 01:23:56:22 Speaker 1 Not at all. In fact, like when Rome was falling. What did they have? Circuses and bread. You know, we have what? Prozac and therapy. 01:23:56:22 - 01:23:57:15 Speaker 3 So so again. 01:23:57:15 - 01:24:04:12 Speaker 2 I, I, I'm with you. I just I struggle to figure out what. 01:24:04:14 - 01:24:05:03 Speaker 1 The alternative. 01:24:05:03 - 01:24:12:11 Speaker 3 Is. No no no no no. What concretely. What concretely. Because I think this this has to be done at a, at a at a large scale level. 01:24:12:11 - 01:24:14:24 Speaker 2 It can't be done. I mean, you guys. 01:24:15:01 - 01:24:17:13 Speaker 3 You know, I was talking about it as a way to get the information out. 01:24:17:13 - 01:24:32:24 Speaker 2 Like Twitter is a way to get to me. X is the way to get the the information up. But like what actual large large scale or or systemic level changes do you think that that we could make that would be effective around this? 01:24:33:01 - 01:24:56:08 Speaker 1 See, I don't think it's going to be large scale. I think it's going to be grassroots. I think when people are provided the information, when, when the culture wakes up and says, oh my goodness, 60% of our country has some chronic disease, 25% of us are on a psychiatric drug. We're getting sicker. And we have all these problems. 01:24:56:08 - 01:25:20:08 Speaker 1 In fact, it's a death spiral for us economically. You wake up and say, we're going to have to change the way we live, right? And that's going to have to come from within the individual. You have to be awake enough to know that, life isn't better lived by numbing out on drugs or turning to stimulants to be able to gain some energy or focus, we have to look at our entire lifestyles. 01:25:20:10 - 01:25:44:09 Speaker 1 We rely way too much on doctors in this country. In fact, health care is the largest industry. And, it's a it's a huge problem. And it starts with education. I think the Maha movement is an important one in this country, because it's going to be led by mothers. You know, it's going to be young mothers who are going to who are turning to natural food and natural health care, and they're going to say, fuck this. 01:25:44:09 - 01:26:06:00 Speaker 1 I'm going to be raising my kids healthy. I'm not going to, I'm not going to give them 26 vaccines before that, you know, before they're one years old. I'm going to actually start now taking health care into my own hands, because it's been completely corrupted by both government forces and industry forces. So it's not going to come from the same people who caused the problem in the first place. 01:26:06:03 - 01:26:27:16 Speaker 1 It's not going to be the from the ones who are going to benefit from financially, who are writing the textbooks or taking pharma dollars or the revolving door from the FDA back into the pharmaceutical companies. It's going to come from communities. It's going to come from grassroots efforts where people say, I'm pulling myself out of this nonsense. We're not metabolizing every single aspect of being human. 01:26:27:18 - 01:26:41:04 Speaker 1 Life is tough. You're going to go through hard times. You're going to go through episodes. You don't have major depressive disorder. It's just a label. You are struggling and there's a benefit to it. You might have a legitimate problem in school. Let's solve the problem. 01:26:41:04 - 01:26:43:12 Speaker 3 Yeah. You're trying to shift away. 01:26:43:14 - 01:27:08:09 Speaker 2 From the the worrying about the diagnosis name, right. Like to what is the actual issue and how can we help you. And that is the best way to help someone like Mike. I mean, it's, it's, for any thing, you know, like, like including, like a cardiac or a lung issue, like, you know, that's why education is so important. 01:27:08:11 - 01:27:20:04 Speaker 2 How do you, like, help someone help themselves as much as possible. And I can feel empowered by that. I, I think that we don't do enough of that. I, I completely agree with you. 01:27:20:05 - 01:27:45:03 Speaker 1 I think it's a real problem when the expert class, the professional class, has lost trust. And then that's one of the unfortunate consequences or fortunate consequences, depending on you. Look at it from the Covid epidemic, is that a lot of people were able to the pandemic, I'm sorry, were able to wake up and see, wow, these public health recommendations were not in our best interest. 01:27:45:05 - 01:28:05:11 Speaker 1 Right. But we don't have the same. We didn't have the efficacy that they told us you were going to get from having, another, an MRI and mRNA technology, which ends up being a gene therapy. Wow. Like, we now have to really take a look at who we used to just blindly trust. Now we have to take this into our own hands and to return to common sense. 01:28:05:13 - 01:28:07:16 Speaker 1 So, you know, if if. 01:28:07:18 - 01:28:12:03 Speaker 3 I think that's a great ideology. 01:28:12:05 - 01:28:22:15 Speaker 2 And I think it can generate some good things, I just feel like there's concrete problems that need to be solved, like, I just like. 01:28:22:17 - 01:28:59:13 Speaker 2 The the the the the bottom line is that, like, you know, people are having issues and and removing some of the classical medical system. While it is fair to be concerned that it is overextended itself, totally reasonable. Okay. Like, that removing things also creates sort of a gap around the real initial problem. That was the thing that started, maybe, maybe you can say that the, the, the current problem like is, is described as a larger magnitude than it is. 01:28:59:13 - 01:29:03:16 Speaker 2 But there was some initial thing that like, occurred. 01:29:03:18 - 01:29:05:15 Speaker 3 How do we how do we address that? Like, you. 01:29:05:15 - 01:29:07:18 Speaker 2 Know, I just I'm just not sure we know what's happening. 01:29:07:20 - 01:29:10:24 Speaker 3 But, like, you know, like, like, you know, immunologically. 01:29:10:24 - 01:29:24:04 Speaker 2 Like you put too many people together, like, it's really easy to transmit like an infection. Right? It's just like a reality. Like, I mean, we we have to be okay with the return of some of these things. 01:29:24:04 - 01:29:25:14 Speaker 3 I mean, that just seems like. 01:29:25:14 - 01:29:26:07 Speaker 1 What do you mean by that? 01:29:26:07 - 01:29:32:16 Speaker 3 Like, You know, like, no one has tuberculosis. 01:29:32:16 - 01:29:36:13 Speaker 2 Really, anymore. Like, we got rid of that, like, you. 01:29:36:13 - 01:29:38:05 Speaker 1 Know, why do you think that? 01:29:38:07 - 01:29:58:06 Speaker 2 I mean, this predates me, obviously. So, like. And I'm, by the way, not an expert in this area, but, my understanding is there's a number of initiatives that we did to or did we manage, the spread of this, you know, and entering the United States, it's incredibly, incredibly rare. 01:29:58:08 - 01:30:10:24 Speaker 1 Yeah. There's a there's a few public health, interventions across time that have, you know, decreased the prevalence of what used to be, chronic conditions, sanitation. 01:30:11:04 - 01:30:21:04 Speaker 2 Yeah, that's that's a great one. I mean, you've, you've you've seen the show frontiers back to the 1880s. They don't have a, they don't have a toilet. Seems very, very, very concerning to me. 01:30:21:06 - 01:30:22:12 Speaker 1 Problems with nutrition. 01:30:22:14 - 01:30:23:15 Speaker 2 So that's a big one. 01:30:23:15 - 01:30:31:13 Speaker 1 2 trillion. And and and poverty like those were the two major things. And then we also, you know, poisoned the population. So. 01:30:31:15 - 01:30:32:07 Speaker 2 What do you mean by that? 01:30:32:13 - 01:31:01:23 Speaker 1 Like arsenic in the, fertilizer that grows our food? You know, which then created symptoms that we labeled as polio. And so I, I'm not saying that we remove medical care. I think there needs to be a complete paradigm shift, and there needs to be parallel institutions. And I think all those things are happening. What's interesting in the vaccine movement is that, you know, you just you just don't have, placebo controlled trials. 01:31:01:23 - 01:31:08:02 Speaker 1 Amazingly, I didn't know we all grew up thinking that, that vaccines were. 01:31:08:02 - 01:31:11:07 Speaker 2 I know there's just the, the there's an ethical concern with that. 01:31:11:07 - 01:31:12:05 Speaker 1 There is not no. 01:31:12:05 - 01:31:13:06 Speaker 3 No, no, I'm sharing. 01:31:13:06 - 01:31:21:09 Speaker 2 I'm sharing the I'm sharing the internal point of view. I'm speaking as the sort of like a medical establishment to response. Right? Like, I've. 01:31:21:09 - 01:31:23:11 Speaker 1 I've heard it on my podcast episodes. 01:31:23:13 - 01:31:24:24 Speaker 3 Like, how do you. 01:31:25:01 - 01:31:33:10 Speaker 2 How do you address that? Like, and what do you do if someone dies in the in the non treatment group from the condition. Like what? 01:31:33:12 - 01:31:55:17 Speaker 1 What do you do if someone dies from the treatment? I mean that's why you do studies doc. You do that. You don't say that. I'm going to put this on the vaccine schedule, and we're not going to have a placebo controlled trial because, you know, we have to provide them this vaccine. Now we have like 60 some we have these meaningful positive outcomes from 1955 to now. 01:31:55:17 - 01:32:10:10 Speaker 1 We don't where we are. People don't understand. We're sicker. We might be living a little bit longer because of our advanced technology and keeping sick people alive, but we are sicker than we were 40 years ago. 01:32:10:12 - 01:32:12:06 Speaker 3 And we have ways. 01:32:12:08 - 01:32:19:20 Speaker 1 That, you know, that we have already built in control groups around vaccines. 01:32:19:22 - 01:32:39:17 Speaker 1 The Amish, certain, Jewish communities by the religious exemption, they do not, they do not get vaccines, any of them. Do you do you think, you know, we're asking ethical questions? Do you think that they're, they're sicker than the general US population? 01:32:39:21 - 01:32:44:10 Speaker 2 I mean, there are lots of differences in those communities from the general US population. 01:32:44:10 - 01:32:47:06 Speaker 1 Yes, but they live a healthier lifestyle. 01:32:47:08 - 01:33:00:05 Speaker 2 Well, well, for a number of reasons. Probably. So like the the technology thing is a big one outdoors. Right? Right. They're eating meal food. The the physical activity is built in, which is, which is 01:33:00:07 - 01:33:09:10 Speaker 1 But they don't get they don't but they don't get vaccines. If, if, if vaccines were lifesaving, wouldn't they be obtaining some of these conditions that we get vaccinated for. 01:33:09:16 - 01:33:12:03 Speaker 3 The the I again again, I'm not an expert in this. 01:33:12:03 - 01:33:36:22 Speaker 2 I the two times I've seen something that should have been vaccine prevented in the New York area, was a insular, Hasidic community. I think it was a sort of community. But again, that's not that's not a data set. I can only speak to that person I've never worked with. We probably should judge people. 01:33:36:23 - 01:34:04:09 Speaker 1 You should just. I never part of this is questioning, questioning what you've been told. And so the parallel institutions, there are parallel institutions that are coming like, I think, what happens in a free society if you have free market capitalism is that if you are overly relying on one business and that one business isn't performing right, like so our health care system, we're getting sicker. 01:34:04:11 - 01:34:33:22 Speaker 1 We're not doing a good job of preventing disease. There's pretty good evidence we may be creating in itself. You see this parallel systems that come up. So in psychiatry, which is interesting I've been following this closely. Metabolic psychiatry, nutritional psychiatry. You know, doctor Christopher Palmer was on this podcast. Right. And if bipolar or ADHD were these discrete identifiable genetic medical conditions and we start seeing people better get better from a keto diet, what is happening there? 01:34:33:24 - 01:34:55:19 Speaker 1 Well, obviously, we were labeling, psychiatric conditions in response to metabolic illness to other things. And that's that's the great. It's like we had a psychiatrist who were trained to be, you know, standard physicians and not just label and write a prescription. You could be providing these type of I recommend I. 01:34:55:19 - 01:34:56:10 Speaker 3 Actually think. 01:34:56:10 - 01:35:05:18 Speaker 2 That, if we wanted to do that, the barrier you would have would not be. 01:35:05:20 - 01:35:26:17 Speaker 2 I think it would be the psychiatric community. They want more time universally with their patients. And they would like to do more extensive things. I don't I don't think you'd get any. I mean, the diagnostic thing, like they're not going to agree upon with you. I'm not going to agree with you on that. But, more time with your patients for more thorough evaluation. 01:35:26:19 - 01:35:35:00 Speaker 2 Like, sign me up for that. Well, I mean, the the it's better for the patients outcomes going to be better because they're going to understand what's going on with them a lot better and they can. 01:35:35:00 - 01:35:38:07 Speaker 3 Understand it beyond a label. They're going to understand it in a. 01:35:38:07 - 01:35:58:12 Speaker 2 Symptom model that is helping them think about, like, what is the problem that they have, right? So if we're monitoring a problem in your attention or your mood or whatever, like, like we're thinking about in terms of like, how are we trying to help you with that? Because you are the kind of person that, you know, it's so difficult for you to start an email or of that at work. 01:35:58:13 - 01:36:12:17 Speaker 1 If most psychiatrists want the system to be better and they actually want to advance their field and help people beyond 15 minute evaluations and prescriptions, what's stopping them? 01:36:12:19 - 01:36:20:14 Speaker 2 What's what's stopping them? The the financial incentives and practicality of the current structure system 100%, hundred percent. 01:36:20:19 - 01:36:22:19 Speaker 3 The the look, the quality of the. 01:36:22:19 - 01:36:46:11 Speaker 2 Care in the VA can be criticized for many reasons, but one of the things that the VA does that I've never seen before, is there is basically an unlimited time and number of like, encounters for mental health and substance use related conditions. Which is fantastic because these are time intensive things. These people like, how do you help these people? 01:36:46:11 - 01:37:17:07 Speaker 2 One of the ways you help them is face to face time, working with them on something, encouraging them, coaching them. So, you know, that's the only system that has that everything else has significant restrictions on that. And, you know, that's a problem that needs to be addressed. And you mentioned it earlier. I think the the sort of like entry of, companies that have a fiduciary duty to like, shareholders or like venture capital is, is is something that's also very concerning for the health care system. 01:37:17:11 - 01:37:38:11 Speaker 2 It feels like it actually could make it this problem that, you know, we disagree upon the, the, the, the intensity of it or the gravity or the extent of it, but like we agree has it. There is a problem like that. It seems like it would get worse actually under this situation. And I worry about I worry about that future, I worry about that future. 01:37:38:13 - 01:37:57:19 Speaker 2 Because while there, you may have criticisms of community mental health treatment, which look, I mean, there are there are limitations to community mental health treatment, unquestionably. Reorganizing it or in this new way around, a centralized profit model, really worries me a lot. 01:37:57:21 - 01:38:26:13 Speaker 1 Yeah. I wanted to share with you my viewpoint on why I would eliminate the ADHD diagnosis completely and look towards a paradigm shift. Okay, so I want to first talk about what the costs of the diagnosis. Okay. One, it creates, what's called a fixed mindset. So I'm going to start with the psychological harms. The fixed mindset is that there is something genetically or biologically broken with you. 01:38:26:13 - 01:38:28:15 Speaker 1 It's only fixed with pills. 01:38:28:17 - 01:38:50:18 Speaker 2 And that and that is a problem. And that is absolutely not how a person should be experiencing their diagnosis. If that is how it is, that is not the point of the diagnosis I've seen on TikTok, people explaining away like they just can't do things and then they give. It's not just ADHD for lots of different diagnoses like, whoa, guys like that's actually not the point of the diagnosis. 01:38:50:18 - 01:39:01:14 Speaker 2 That was never that was never the point. The point was not to give you like a free pass, like it's to sort of describe an issue you're having. And then figure out how to help you with that issue. 01:39:01:18 - 01:39:24:22 Speaker 1 Yep. Reduced self efficacy is documented in research. So the moment that somebody starts identifying with the label, they decrease their belief in their ability to do things and surprise me. Identity formation, this idea of of having a psychiatric diagnosis and its definition. So goes into like part of like a very similar to reduce self efficacy. 01:39:24:22 - 01:39:40:08 Speaker 1 This is creation of this identity of what you can and who you cannot be not supported by any sound science, but rather the label of ADHD as a medical diagnosis that limits what you can achieve in the world. And learned helplessness ends up being a like a major factor. 01:39:40:08 - 01:39:56:23 Speaker 2 So all fails on the if that is the experience that someone has of a diagnosis, that is that is the health care system letting them down the because the the treatment and evaluation of these things should feel empowering to the individual. But not not not not at all what you are describing. 01:39:57:04 - 01:40:19:15 Speaker 1 Yeah ADHD is also and I'll talk about some of the problems with the, the label and turning to stimulants is that it becomes a gateway diagnosis into the mental health system. So you might start with a stimulant, but with all the other psychological problems I just described. And what are the, you know, some of the negative adverse consequences of taking stimulants, especially at a young age. 01:40:19:17 - 01:40:47:04 Speaker 1 You are now more likely to take a drug for depression, an SSRI, to take a mood stabilizer later in life. And of course, to, also experiment with other drugs. What often really does get it, unaddressed sleep deprivation. Right? The average kid now is getting 1 to 2 hours less sleep than needed. And that is often, again, multifactorial. 01:40:47:04 - 01:41:07:21 Speaker 1 So one of them, of course, is the use of technology and smartphones. But also just when we start school is a problem. 70% of kids in the mental health system have some sort of a reaction to some, you know, traumatic event might not lead to PTSD, but it's a valid like reaction to maybe real struggles. 01:41:07:21 - 01:41:42:14 Speaker 2 So that's something we've we've figured out and understood more. There's some really nice work that came out of I think, you know, the Sinai around trauma and epigenetics and the transmissibility of it. Right. So like it's sort of crazy, right? Like, you know, we didn't think that you could change your DNA in that way. It sort of goes against, a lot of the early ideas around evolutionary biology and, and you can it seems like it's sort of almost like a light switch or like a dimmer, and that these things are our generational origin and, and we are more but we have to continue to sort of identify these things. 01:41:42:14 - 01:41:44:14 Speaker 2 Absolutely identify these things. 01:41:44:16 - 01:41:49:04 Speaker 3 As contributing factors to people that are struggling with attention. 01:41:49:04 - 01:41:49:15 Speaker 2 Today. 01:41:49:15 - 01:41:52:09 Speaker 3 I completely agree with that. 01:41:52:11 - 01:42:09:01 Speaker 1 Yeah. I already mentioned nutritional deficiencies, educational mismatches. So yeah, even like really intelligence kids are more likely to be identified as ADHD because they're bored or their mind is creative and works in other ways. And then of course, kids who are struggling. 01:42:09:01 - 01:42:13:05 Speaker 2 With that, the ADHD community wants to be true. I've never found that to be true. 01:42:13:07 - 01:42:14:09 Speaker 1 Well, I think, I think they. 01:42:14:09 - 01:42:25:02 Speaker 2 Were they're like, look, I have sort of ADHD, like it's like, which might be true. I'm not saying it's not true. I'm not saying it's all true. Actually. I just don't know that there's actually a scientific study to support that. 01:42:25:02 - 01:42:48:04 Speaker 1 Yeah, I've obviously we can say that there's an educational mismatch and kids are put in that environment and I'm getting drugged and labeled, there's financial incentives that are maintaining a system. So I'm talking about trying to eliminate the entire ADHD paradigm more than 20 billion annually on ADHD drugs. The average psychiatrist visit is 300 to $500. School districts get additional funding for each ADHD diagnosis. 01:42:48:04 - 01:42:49:10 Speaker 1 That's true. 01:42:49:12 - 01:42:52:10 Speaker 3 In what state is that? I've never heard that before. 01:42:52:15 - 01:42:53:11 Speaker 1 01:42:53:13 - 01:42:57:16 Speaker 3 It's because they're giving accommodations to them. Because they're not. They're not. 01:42:57:18 - 01:43:03:24 Speaker 2 They're not providing meds. So, like, it's not like they're prescribing the meds, like, is it, is it is it thought to be like for an IEP. 01:43:03:24 - 01:43:04:24 Speaker 3 Or something like. 01:43:04:24 - 01:43:08:02 Speaker 1 Yeah, I believe it's around special education. So the number isn't. 01:43:08:02 - 01:43:11:16 Speaker 3 That a good thing that they get more because that's a way to help them. 01:43:11:18 - 01:43:31:14 Speaker 1 It's a perverse incentive. So you're more if you're going to get more like state dollars or federal dollars, then you are financially incentivized to identify more kids as being special education. Just I mean, just on that just so. 01:43:31:14 - 01:43:51:03 Speaker 2 Weird because generally, like as a child psychiatrist, when a kid needs like help at school, the school usually is doing everything they can to not let them get that diagnosis because it costs the school system more money than they have. Right. Like it's a they have a high threshold that's interesting to hear that they're ones that have gone in the opposite direction. 01:43:51:03 - 01:43:53:01 Speaker 1 I've been I've been in the public school system. 01:43:53:02 - 01:43:58:18 Speaker 2 And and it's like the, it's like number of kids with like an IEP or something like that. 01:43:58:20 - 01:44:29:11 Speaker 1 I believe. So special education students then eligible for, you know, state dollars or federal dollars. Parents also can get SSI payments. So, Social Security, disability payments, if their kid is is and if you've seen the numbers, you know, completely off the roof about the the money the federal government's paying for Social Security based on psychiatric disability since the really since the pharmaceutical model became so prevalent, the United States. 01:44:29:16 - 01:44:38:00 Speaker 2 Yeah. We made a good decision. Reevaluating that relationship. The the pharmaceutical model I feel historically. 01:44:38:00 - 01:44:39:15 Speaker 3 Has influenced this idea. 01:44:39:17 - 01:44:45:04 Speaker 2 And maybe there's a residual effect for it. But. 01:44:45:06 - 01:44:57:18 Speaker 2 Psychiatric drugs are the are largely the ones that are used are virtually generic at this point. So the there's not as much of a financial incentive as they used to be. But I agree with you that there's. 01:44:57:18 - 01:44:58:09 Speaker 1 Still somebody. 01:44:58:09 - 01:45:02:21 Speaker 2 In the 90s. In the 90s, there definitely was an incentive, right? Like, you know, when. 01:45:03:00 - 01:45:03:08 Speaker 1 They're still. 01:45:03:08 - 01:45:06:18 Speaker 2 Poor. That's why everyone made an SSRI like I, I don't even remember how many there are. 01:45:06:18 - 01:45:11:04 Speaker 1 There's still somebody that's producing the drug and selling the drug. There's still financial incentives. 01:45:11:08 - 01:45:14:14 Speaker 3 But but I went to a DEA meeting where they said the problem they had for that. 01:45:14:14 - 01:45:21:24 Speaker 2 Shortage was that the companies didn't want to produce them because they're they weren't making enough money on them. 01:45:22:01 - 01:45:25:23 Speaker 3 That that's why that's I'm just question. I agree with some of your points, but I question that. 01:45:26:00 - 01:45:26:08 Speaker 2 I. 01:45:26:10 - 01:45:29:01 Speaker 1 Thought it was production post Covid. 01:45:29:03 - 01:45:30:00 Speaker 3 That was also a problem. 01:45:30:00 - 01:45:39:05 Speaker 2 But the other one is they've had trouble getting them to increase it because it's not the, the you know, I mean, they're capitalists right there. The markup is not as good as it is on other things. 01:45:39:07 - 01:45:47:19 Speaker 1 Well, it's just from a financial incentive perspective. Then we would be seeing a decrease in the drugs if there wasn't financial benefit. 01:45:47:21 - 01:45:50:18 Speaker 3 I think TikTok, 01:45:50:20 - 01:45:53:13 Speaker 2 And telehealth are, are big factors. 01:45:53:16 - 01:45:55:17 Speaker 1 Agreed. But that's also financial incentives. 01:45:55:18 - 01:45:56:10 Speaker 2 Yeah. Oh yeah. 01:45:56:15 - 01:45:58:02 Speaker 3 No no no no no no 100%. Yeah. 01:45:58:02 - 01:46:30:04 Speaker 1 So want to go on more. Fine. The the farm investments are, are pretty substantial because pharma invests, you know, billions annually in marketing to doctors to get them to make these diagnoses. They've hired key opinion leaders like Russell Berkeley, for example, and Joseph Biederman. And so we have to look at, all right, what's going on in, what studies, not only in the United States but in other countries would say, all right, this is a model for us that we should be following. 01:46:30:04 - 01:46:35:06 Speaker 1 So there's the Finland model. Later school starts more research. Oh, I like this. 01:46:35:06 - 01:46:38:12 Speaker 2 This is good. Let's think about how we're going to solve this. I'm a problem solver. 01:46:38:13 - 01:46:42:07 Speaker 1 Later school start time would decrease. The number. So I there's a. 01:46:42:07 - 01:46:48:07 Speaker 2 Lot of data to support that, not just for ADHD. That's just a globally good idea. 01:46:48:09 - 01:46:49:14 Speaker 1 More resource. 01:46:49:16 - 01:46:51:08 Speaker 2 Yes. Yes. 01:46:51:10 - 01:46:53:05 Speaker 1 And bring it on and less homework. 01:46:53:07 - 01:46:55:15 Speaker 3 Yeah I, I mean I didn't. 01:46:55:15 - 01:47:05:13 Speaker 2 Like doing homework but less homework so that they have a free mind at home and can sort of like do other things like what's, what's your, what's your, your budget. 01:47:05:13 - 01:47:20:11 Speaker 1 So we're going to spend seven hours or more at school. Tell me why you have to then repeat that and not allow kids to be kids. It's such a limited and restricted way to think about how we learn. 01:47:20:13 - 01:47:21:07 Speaker 3 It also over. 01:47:21:07 - 01:47:24:12 Speaker 2 Values, certain type of learning. 01:47:24:12 - 01:47:24:23 Speaker 1 It does. 01:47:24:23 - 01:47:25:17 Speaker 3 Right. Like it's, it's. 01:47:25:17 - 01:47:48:20 Speaker 2 It's it's, like, you know, during the, the, the, During sort of like, like, like lockdown, like one of the things that I think is an unintended consequence, right, is, is that the social emotional growth that you get from in persons of. And then I think there's I think people have changed their mind in this, but then there's a whole generation of young people that don't understand this. 01:47:48:22 - 01:48:12:09 Speaker 2 The social emotional group of an in-person interaction is, is a meaningful, add like it's, you know, it's up there with like, math and like, writing and reading like it is a really maybe more important than those things actually. Right. And like and like, so what are the other I think it's like, what are the other things that they need to be unlearning and growing unstructured play. 01:48:12:11 - 01:48:13:14 Speaker 2 Yeah. Oh yeah. 01:48:13:16 - 01:48:15:11 Speaker 3 That's that's a oof. 01:48:15:13 - 01:48:16:10 Speaker 2 01:48:16:12 - 01:48:27:03 Speaker 3 Then that's a hard one because I think something that this is something that, you know, I think we are not solving thinking enough about, you know, there's this for whatever reason, I think expectations around. 01:48:27:03 - 01:48:46:02 Speaker 2 Parents have gotten really high. And, a lot of parents are worried about sort of not, doing enough. And, also, parents are very busy, right? Like, it's it's life is I don't know, I mean, I'm, I, I'm not even that old. And I feel like the world is faster than. 01:48:46:02 - 01:48:50:05 Speaker 3 It used to be. And so you end up with these situations where, like. 01:48:50:07 - 01:48:55:20 Speaker 2 Parents do not have good plans, like for how to manage their. 01:48:55:20 - 01:49:02:19 Speaker 3 Kid during time periods and, and, and devices end up being introduced for the educational. 01:49:02:19 - 01:49:18:06 Speaker 2 Ones that are education oriented are probably, not as much of an issue in any device at all is not an issue there certain things that are worse, but like unquestionably like there's a, there's just like shift towards a significant amount of attention on, on electronic devices and there's data. 01:49:18:06 - 01:49:19:16 Speaker 3 To show that at least in those. 01:49:19:16 - 01:49:22:03 Speaker 2 With this. 01:49:22:05 - 01:49:33:07 Speaker 2 Concept of ADHD, we'll call it, that their, their, you know, evaluation of the severity of their condition is worse when exposed to these types of things. You know, I think. 01:49:33:07 - 01:49:35:23 Speaker 3 That's something that we have to think about. 01:49:36:00 - 01:49:38:20 Speaker 2 How to help parents. 01:49:38:22 - 01:49:46:18 Speaker 1 Yeah. And some of this is economic, to, to parents that need to work full time in order to. 01:49:46:23 - 01:49:49:12 Speaker 3 Watching your children, like, I mean, like, oh. 01:49:49:14 - 01:50:14:06 Speaker 1 Yeah. No, I mean, I'm the first one to say is we're starting to see, a decline in the Western world. And I think we're on the end. End stage here of what was once a world power. The United States as a culture were deteriorating. And a lot of these conditions that we're identifying and discussing today are related to the real problems we have in a culture that's not flourishing. 01:50:14:08 - 01:50:27:24 Speaker 1 And part of that is, is that, the US dollar doesn't go as far as it used to. And then we have good evidence of that. Right? So you need to work that much more just to meet, a standard of living that, 40, 50 years ago. 01:50:27:24 - 01:50:28:24 Speaker 3 How do we help them? 01:50:28:24 - 01:50:36:22 Speaker 2 Like now? Like how do we help them now? That's that's what I struggle with. I'm not, I'm not. I couldn't even answer. I'm just saying that like. 01:50:36:24 - 01:50:37:13 Speaker 1 Well, yeah. 01:50:37:14 - 01:50:39:15 Speaker 2 Yeah, I think it's like it's like, how do we do that? 01:50:39:15 - 01:50:51:18 Speaker 1 Yeah. We so we have like look at like the Texas link study. So these kids obviously are going to be in school for 15 minute recesses daily, 40% decrease in those symptoms that we label as ADHD test scores are up to. 01:50:51:20 - 01:51:10:24 Speaker 2 And that's supported by again like I know it's on a biomarker, but it's like a low key biomarker like that's supported by the the fact that, you see on imaging. Right, the activity of dopamine changes like and goes up and normalized in a number of different scenarios. And one of them is physical activity, like, like it's a great. 01:51:11:04 - 01:51:28:03 Speaker 2 Well, I want to be clear, I don't think it solves everyone's situation. You know, you and I disagree on that, but I am 100% in the boat with you that this needs to be introduced for many reasons beyond just, concerns about ADHD diagnosis. 01:51:28:05 - 01:51:50:03 Speaker 1 Yeah. I mean, at the very least, if you said to me that there was an extremely small, population that had these rather extreme dysfunctional, you know, behavioral problems, I would be with you on a different conversation and try to solve that problem. But we're sitting here, you know, where, you know, 15% of boys are getting diagnosed ADHD. 01:51:50:03 - 01:51:51:16 Speaker 1 So it's a completely different exercise. 01:51:51:16 - 01:51:52:21 Speaker 3 And autism is. 01:51:52:21 - 01:52:23:01 Speaker 2 Another one, right? Like the I actually think the autism differentiation is more of a problem. Needs one. Because I think that there's there's the idea of an autism spectrum has given people license to think that any time they do anything that remotely resembles a autistic behavior, that they are autistic, and that the term actually is sort of like has like a general meaning and our, our, our, our, our culture as well. 01:52:23:01 - 01:52:24:18 Speaker 2 Now, at this point. 01:52:24:20 - 01:52:54:19 Speaker 1 Definitely diagnostic expansion is a real problem. It's a problem with ADHD, it's a problem with autism. But from what I understand, we have, an increase in the most severe conditions of autism. So that's that's a problem. We haven't really that's a whole nother podcast, I think. But I think when, like, my point is, is that ADHD is in a discrete medical condition, you don't have attention and hyperactivity issues because you have ADHD. 01:52:54:21 - 01:53:11:21 Speaker 1 You have them because of everything we talked about today, nutrient, deficiencies, 20 plus other maybe conditions that do exist. Addiction to technology, sleep deprivation, lack of, exercise movement. 01:53:11:23 - 01:53:13:22 Speaker 3 So, so then your objection actually. 01:53:13:22 - 01:53:15:09 Speaker 2 Is is an interesting thing. 01:53:15:09 - 01:53:17:17 Speaker 3 It's your objection. 01:53:17:19 - 01:53:24:24 Speaker 2 Becomes much more, legitimate in a post DSM world. Right. So like because to because. 01:53:24:24 - 01:53:26:13 Speaker 3 If you want to study that. 01:53:26:15 - 01:53:43:23 Speaker 2 Group of people that are having this issue and try to figure out what's going on with them, you need to classify them together based on some subset of criteria. And so that you and I can both like, evaluate them and agree on the same thing. Right. When we're talking about the same thing. That's the whole point of the DSM originally was not for people to be diagnosed. 01:53:43:23 - 01:54:03:20 Speaker 2 It was literally so that if he's a researcher and I'm a researcher and we both want to like, evaluate whatever thing we want to evaluate, you know, you want to evaluate exercise and I want to validate organizational skills that then when we talk to each other like we the people that we are working with, like largely resemble each other, that was the whole point of it. 01:54:03:22 - 01:54:07:07 Speaker 2 That still needs to be true, the sort of label, but. 01:54:07:07 - 01:54:13:05 Speaker 3 At but before the DSM, psychiatry was very uninterested. 01:54:13:08 - 01:54:18:23 Speaker 2 In, specific diagnostic standardized labeling. That's a change that occurred. 01:54:19:00 - 01:54:22:10 Speaker 3 Again, you know, I don't know. I mean, I wasn't around, I. 01:54:22:11 - 01:54:40:20 Speaker 2 Don't I don't think I was even born. I was even born. But but but, you know, that's that's what you're sort of getting at. It's like, it's like, can we can we spend more time helping people with the thing that's going on with them? Subsub categorizing. What is the thing going on with them? Because it's a heterogeneous problem. 01:54:41:01 - 01:54:45:16 Speaker 2 And, and working with them. I think that's really what we're saying. 01:54:45:18 - 01:55:02:24 Speaker 1 Yeah, I mean, it. I guess it's kind of like if somebody came into a primary care center and they had like a really bad headache and it was going on for potential, like, I don't know, a couple weeks, we wouldn't send them out. You know what you have. Hey, in the. 01:55:03:01 - 01:55:11:17 Speaker 2 Room actually, what's the story for sending this person to the emergency room? Anyone who has a very bad headache lasting many days should go to an emergency room. 01:55:11:19 - 01:55:33:00 Speaker 1 We wouldn't say they have headache disorder and say you just, you know, you need to take Tylenol every day. Instead, you say that's a symptom with many potential causes, including. Yeah, I mean, it could be an aneurysm. It could be cardiac, it could be a brain tumor. Yep. Right. So what I'm saying is once you add into the cultural lexicon, I have ADHD, it's a discrete medical condition. 01:55:33:02 - 01:55:33:20 Speaker 3 So. So do you. 01:55:33:20 - 01:55:35:03 Speaker 1 Stop the investigation? 01:55:35:03 - 01:55:36:13 Speaker 3 Do you want psychiatrists. 01:55:36:13 - 01:55:38:19 Speaker 2 To be more vocal about pushing. 01:55:38:19 - 01:55:43:06 Speaker 3 Back against this? Because again, I think that the the gap in the field and. 01:55:43:06 - 01:55:52:10 Speaker 2 Again, like, you know, this is the world that that I'm in at least sort of like academic, psychiatry like it doesn't disagree with these things. 01:55:52:11 - 01:55:55:23 Speaker 1 Oh, they do, I don't know, like, I mean, the. 01:55:55:23 - 01:55:57:12 Speaker 3 Standard it's a heterogeneous. 01:55:57:12 - 01:56:00:24 Speaker 2 Condition caused by many different things, you know, like, you know. 01:56:01:00 - 01:56:02:06 Speaker 3 I would call it. 01:56:02:06 - 01:56:08:02 Speaker 2 Like a, a syndrome. But that's where you start, right? Like like it's it's. 01:56:08:04 - 01:56:33:22 Speaker 1 Well, I mean, I've gotten I've gotten into the arguments on, like, social media, you know, a, a standard trained psychiatrist coming out of an elite institution like Johns Hopkins, for example, would say ADHD is a brain condition. We have solid brain science, and we we treat that with, a stimulant medication. And we've got all these great outcomes, and they believe that. 01:56:33:22 - 01:56:52:09 Speaker 1 And it doesn't go any further than that. And if they'll actually say that this prevalence rate here in the United States is because of, like, greater access to care and better health care, they just like continue to say the lines that have been handed over to them, like like a ventriloquist dummy, they repeat the same things over and over again because that's what they were told. 01:56:52:09 - 01:57:11:10 Speaker 1 And they believe in that. They don't understand all the financial conflicts of interest that got them to say that in the first place. They're not thinking independently. No, we don't have an ADHD epidemic in the United States. We have a labeling problem, a mislabeling problem. We have a chronic disease epidemic in the United States. And we're not we're not targeting that. 01:57:11:12 - 01:57:32:24 Speaker 1 And luckily, I think there are parallel institutions and there's going to be changes. And I think it's slowly starting to occur. But when the establishment is so aligned with with industry and there are so many financial conflicts of interest, it's going to be a slow, slow return back to, sanity. 01:57:33:01 - 01:57:42:16 Speaker 3 I still think like there's a problem now and and it's that we can't flip a switch. 01:57:42:18 - 01:57:48:12 Speaker 2 And introduce this stuff like that. And it's it's what you get. 01:57:48:13 - 01:57:57:16 Speaker 1 When like, the problem is we don't have enough Adderall. The problem is kids aren't outside the game. But the problem is we're giving kids these technologies. 01:57:57:18 - 01:57:59:15 Speaker 3 That sleep that they do. You want to introduce. 01:57:59:15 - 01:58:34:06 Speaker 2 Is is is is not complicated. I suspect what would happen if you increased you know, this is a great study and we want to like, you know, like, get this funded. Come tell me, like, if you took two groups of individuals, those that are, like, have this classification or we're calling it phenomenon, like, and those that don't, and, you know, you looked at school systems and you, you, you broke down the ones that have it and you add it in, say, like, you know, this exercise activity, I suspect you would see a decrease in symptomology we do. 01:58:34:07 - 01:58:35:19 Speaker 3 I don't think you would. 01:58:35:19 - 01:58:44:22 Speaker 2 See an elimination of it. I don't think you would see nomination of it, but you would see a decrease in some, and there would be some people that no longer met criteria. I completely agree with you on that. 01:58:44:24 - 01:58:48:14 Speaker 3 Yeah. I think I think that's a very, reasonable hypothesis and it's a testable problem. 01:58:48:14 - 01:59:12:12 Speaker 1 Yeah. I think that's been actually been done. And then there's just, you know, there's some kids where like that school environment's not for them. They're supposed to be doing something else. I mean, and they end up growing up to do other things. You know, I remember when I was working in schools and we'll try to kind of wrap this up a bit is that you would see these kids in key developmental periods, like challenging ones, like moving into adolescence, going through puberty, how long? 01:59:12:12 - 01:59:35:01 Speaker 1 It was absolutely painful for them to be in school. They would get this label. But two things were happening outside. They might have been extremely, like, effective in sports for one. Or they end up going to like a vo tech school. And there are the kids that are just need to use their hands and they have to move, and they can hyperfocus successfully when it fits who they are. 01:59:35:03 - 01:59:36:11 Speaker 3 So, so you think they should. 01:59:36:12 - 02:00:05:23 Speaker 2 So people that are struggling because we agree that there's there's like this group of people that are having problems. So I think we agree upon that. Of course. You know, I think we've agreed upon this like lumping of them, at least from a conversational point of view. Your feeling is that the another intervention would be to those individuals are struggling to try to, give them opportunities. 02:00:05:23 - 02:00:22:02 Speaker 2 I think they would have to want to do this right, to, to opt into a different type of schooling that, is less likely to, maybe manifest, these problems. But I think that's a very reasonable. 02:00:22:02 - 02:00:42:12 Speaker 1 Well, and this is happening now. I know you're in. You're from a city, a major global city of obviously like the situations where a lot of parents who are in rural America and, you know, there's a large homeschool movement. And so a lot of parents are pulling them out because of the problems with their school system. They know that kids need to be outside. 02:00:42:12 - 02:01:01:22 Speaker 1 They need to be moving around. They need to be learning in different ways. They need to be disconnected from those devices. And so you just see kids do better in different environments. We're labeling them ADHD because of, yeah, of what our public school system has devolved into. 02:01:01:24 - 02:01:21:13 Speaker 1 And I understand your point. Someone comes into your office, they're only going to go to public school. They're giving the teacher a hard time. They have behavioral problems. Parents work multiple jobs. Like, I'm. I'm not saying you don't have a difficult job. I think you have a difficult job. And you have that prescription which can have some degrees of effects. 02:01:21:13 - 02:01:40:07 Speaker 1 I'm not denying all those things. And I can still say at the same time that I don't think that's a viable solution for a flourishing, country, that cares about its youth. And, I think it's a huge cultural problem. 02:01:40:09 - 02:01:48:01 Speaker 1 Certainly not the certainly not the actions of a healthy country. You know, more pharmaceutical drugs at younger ages is not a healthier country. 02:01:48:03 - 02:01:49:02 Speaker 3 And I think that just gets. 02:01:49:02 - 02:02:10:05 Speaker 2 Into the discussion around, like, is there are there ways that our modern, Western world has turned into that are driving increases in psychiatric diagnosis? I think it's a very reasonable question. It's a very, very, very, very reasonable question to look at. 02:02:10:06 - 02:02:13:01 Speaker 3 It's a hard question to look at. But there's there's certainly there's certainly. 02:02:13:07 - 02:02:18:16 Speaker 2 Lines of evidence that would support that. And, and you know, I think those are those are things that we. 02:02:18:16 - 02:02:21:17 Speaker 3 Should look at. And maybe that's, you know, so every time the, the. 02:02:21:17 - 02:02:24:09 Speaker 2 The, the heads of these NIH, things. 02:02:24:09 - 02:02:32:08 Speaker 3 Change. You know, they often have new ideas. You know, that's a reasonable thing that that's a, that's a big that's a big thing that you could do to sort of look at and. 02:02:32:08 - 02:02:36:12 Speaker 2 Evaluate and come up with ideas, around how to do that. 02:02:36:14 - 02:03:09:15 Speaker 1 Yeah. And unfortunately, we'll have to close it out on that is, what you're going to have to acknowledge is the financial conflicts of interest. And, those who are fighting to keep it the way it is. So right now, you know, there are people make a lot of money off this model, a lot of money, and they have lobbyists in Washington, and they control media, and they are trying to maintain this structure despite the evidence that we are deteriorating our health, our mental health, they're doing everything they can because the sicker we are, the richer they are. 02:03:09:17 - 02:03:41:09 Speaker 1 The sicker we are, the more dependent we are. Right? So there is not that financial incentive to do the things we talked about today. It has to be grassroots. It has to be through conversations. It has to be through all parallel systems. And, you know, the functional nutrition movement, the functional psychiatry and metabolic psychiatry, you know, looking at the, making sure that there are rigorous studies around vaccines, comparing it to control groups like we have to have science has to return to public health. 02:03:41:11 - 02:03:51:12 Speaker 1 And you have to admit that, you know, it was completely corrupted throughout our lifetime. And that's the unfortunate reality that we're facing. Final word before we close it out. 02:03:51:14 - 02:04:13:05 Speaker 2 Well, it was fun. We definitely have different points of views, but I think it was it was helpful for me to sort of get a sense of where, you know, you are in your thinking and, and, and the people maybe that you're, you're interacting with around, what problem they see. Right. Because I think that there's a bunch of common ground around it. 02:04:13:05 - 02:04:18:07 Speaker 2 It's it's around thinking about what's the best way to to solve this. Yeah. 02:04:18:09 - 02:04:26:03 Speaker 1 Well, I'm very grateful for your willingness to drive down here and have this conversation today. So, Doctor Ryan cylinder, I want to thank you for a radically genuine conversation.