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House Government Reform Committee Hearing

Copyright 2002 eMediaMillWorks, Inc.
(f/k/a Federal Document Clearing House, Inc.)  
FDCH Political Transcript

 

September 26, 2002 Thursday


TYPE: COMMITTEE HEARING

LENGTH: 32279 words

COMMITTEE: HOUSE GOVERNMENT REFORM COMMITTEE

HEADLINE: U.S. REPRESENTATIVE DAN BURTON (R-IN) HOLDS HEARING ON THE OVERMEDICATION OF HYPERACTIVE CHILDREN

SPEAKER:
U.S. REPRESENTATIVE DAN BURTON (R-IN), CHAIRMAN

LOCATION: WASHINGTON, D.C.

WITNESSES:

NEIL BUSH, FOUNDER, CHAIRMAN AND CEO, IGNITE! INC.
LISA-MARIE PRESLEY, SPOKESPERSON, CITIZEN'S COMMISSION FOR HUMAN RIGHTS
BRUCE WISEMAN, PRESIDENT, CITIZEN'S COMMISSION ON HUMAN RIGHTS, CO-CHAIRMAN, NATIONAL FOUNDATION FOR WOMEN LEGISLATORS, EDUCATION TASK FORCE
MARY ANN BLOCK, AUTHOR "NO MORE ADHD"
PATRICIA WEATHERS, PRESIDENT, PARENTS FOR A LABEL AND DRUG FREE EDUCATION
DR. RICHARD NAKAMURA, ACTING DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH, NATIONAL INSISTUTES OF HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES
E. CLARKE ROSS, CEO, CHILDREN AND ADULTS WITH ATTENTION-DEFICIT/, HYPERACTIVITY DISORDER
DR. DAVID FASSLER, AMERICAN PSYCHIATRIC ASSOCIATION

BODY:

(CORRECTED COPY)
 
HOUSE COMMITTEE ON GOVERNMENT REFORM HOLDS A HEARING ON THE
OVERMEDICATION OF HYPERACTIVE CHILDREN
 
SEPTEMBER 26, 2002

SPEAKERS:
U.S. REPRESENTATIVE DAN BURTON (R-IN)
CHAIRMAN
U.S. REPRESENTATIVE BENJAMIN A. GILMAN (R-NY)
U.S. REPRESENTATIVE CONSTANCE MORELLA (R-MD)
U.S. REPRESENTATIVE CHRISTOPHER SHAYS (R-CT)
U.S. REPRESENTATIVE ILEANA ROS-LEHTINEN (R-FL)
U.S. REPRESENTATIVE JOHN MCHUGH (R-NY)
U.S. REPRESENTATIVE STEVE HORN (R-CA)
U.S. REPRESENTATIVE JOHN L. MICA (R-FL)
U.S. REPRESENTATIVE THOMAS M. DAVIS III (R-VA)
U.S. REPRESENTATIVE MARK E. SOUDER (R-IN)
U.S. REPRESENTATIVE JOE SCARBOROUGH (R-FL)
U.S. REPRESENTATIVE STEVEN C. LATOURETTE (R-OH)
U.S. REPRESENTATIVE BOB BARR (R-GA)
U.S. REPRESENTATIVE DAN MILLER (R-FL)
U.S. REPRESENTATIVE DOUG OSE (R-CA)
U.S. REPRESENTATIVE RON LEWIS (R-KY)
U.S. REPRESENTATIVE JO ANN DAVIS (R-VA)
U.S. REPRESENTATIVE TODD PLATTS (R-PA)
U.S. REPRESENTATIVE DAVE WELDON (R-FL)
U.S. REPRESENTATIVE CHRIS CANNON (R-UT)
U.S. REPRESENTATIVE ADAM PUTNAM (R-FL)
U.S. REPRESENTATIVE C.I. "BUTCH" OTTER (R-ID)
U.S. REPRESENTATIVE EDWARD L. SCHROCK (R-VA)
U.S. REPRESENTATIVE JOHN J. DUNCAN, JR. (R-TN)
 
U.S. REPRESENTATIVE HENRY WAXMAN (D-CA)
RANKING MEMBER
U.S. REPRESENTATIVE TOM LANTOS (D-CA)
U.S. REPRESENTATIVE MAJOR R. OWENS (D-NY)
U.S. REPRESENTATIVE EDOLPHUS TOWNS (D-NY)
U.S. REPRESENTATIVE PAUL E. KANJORSKI (D-PA)
U.S. REPRESENTATIVE PATSY MINK (D-HI)
U.S. REPRESENTATIVE CAROLYN B. MALONEY (D-NY)
U.S. DELEGATE ELEANOR HOLMES NORTON (D-DC)
U.S. REPRESENTATIVE ELIJAH E. CUMMINGS (D-MD)
U.S. REPRESENTATIVE DENNIS J. KUCINICH (D-OH)
U.S. REPRESENTATIVE ROD R. BLAGOJEVICH (D-IL)
U.S. REPRESENTATIVE DANNY K. DAVIS (D-IL)
U.S. REPRESENTATIVE JOHN F. TIERNEY (R-MA)
U.S. REPRESENTATIVE JIM TURNER (D-TX)
U.S. REPRESENTATIVE THOMAS H. ALLEN (D-ME)
U.S. REPRESENTATIVE JANICE D. SCHAKOWSKY (D-IL)
U.S. REPRESENTATIVE WILLIAM LACY CLAY (D-MO)
U.S. REPRESENTATIVE DIANE E. WATSON (D-CA)
U.S. REPRESENTATIVE STEPHEN LYNCH (D-MA)
 


*


BURTON: Good morning. A quorum being present, the Committee on Government Reform will come to order. And I ask unanimous consent that all members' and witnesses' written and opening statements be included in the record. And without objection, so ordered.

I ask unanimous consent that all articles, exhibits and extraneous or tabular materials being referred be included in the record. Without objection, so ordered.

Today, we're going to be discussing a very important issue that affects many, many children in the United States. As all of us know, our children are our future. I doubt there is a single member of Congress that doesn't feel strongly that we need to do our dead level best to protect and ensure the health and wellbeing of the children of this nation.

Today, we're going to talk about a group of symptoms known as Attention Disorder. In the last two decades, we've heard more and more attention about Attention Deficit Disorder, ADD and Attention Deficit Hyperactive Disorder, ADHD.

The most common treatment for this disorder is a drug called Ritalin. This drug is being given to more and more children in this country. It has become very controversial.

There has been over a 500 percent increase in the use of Ritalin in the United States since 1990. It's estimated that 4 to 6 million children in the United States take Ritalin every single day.

On one side of this issue, we're going to hear from the associations of psychiatrists and a parent's organization known as Children and Adults with Attention Deficit Hyperactivity Disorder or CHADD. They believe that 13 percent of the U.S. population, adults and children, suffer from an attention disorder and that it should be treated with medication.

At the other end of the discussion is the Citizens Commission for Human Rights. They challenge the legitimacy of calling ADHD a neurobiological disorder. They raise serious questions about giving strong medication to young children.

Also in the discussion are concerned parents. Imagine being a parent of a young child and receiving a note from your school instructing you to take your child to their pediatrician for evaluation. In this note from the school, there's a checklist for you to take to the doctor. The school officials have diagnosed your child as possibly having ADHD.

They make this diagnosis because your child makes careless mistakes on homework, does not follow through on instruction, fails to finish schoolwork, has difficulty organizing tasks, loses things and is forgetful in daily activities.

That sounds like me when I was in grade school. I did not take Ritalin. I became a congressman.

(LAUGHTER)

When you take your child to a doctor, instead of blood tests and a thorough medical evaluation, you have a conversation with a doctor about the school's checklist. And you leave a few minutes later with a prescription for your young child for a psychotropic drug.

Did the doctor test your child for a thyroid disorder? Did your doctor test your child for a heavy metal toxicity? Did you doctor talk to you about your child's allergies?

Did your doctor even mention nutrition or possible food sensitivity? Did your doctor ask if your child's IQ had been tested and if he was gifted? Probably not.

We all know that prescription drugs continue to command a greater percentage of the overall healthcare dollar. According to the Department of Health and Human Services, prescription drugs accounted for nine percent of all U.S. healthcare expenditures in fiscal year 2001. This is a 14.7 percent increase in one year.

Ritalin, as you know, is classified as a Schedule II stimulant under the Federal Controlled Substances Act. In order for a drug to be classified as a Schedule II, it must meet three criteria: one, it has to have a high potential for abuse; two, it has to have a currently accepted medical use in treatment in the United States; and three, it has to show that abuse may lead to severe psychological or physical dependence.

This is a Schedule II drug. And this is the definition.

Some of the things we've heard about Ritalin cause me to have some concerns. And I'd like to hear from all of our witnesses today about those issues.

The -- quote -- "experts" tell us that Ritalin is a -- quote -- "mild stimulant." However, research published in 2001 in the "Journal of the American Medical Association" showed that Ritalin was a more potent transport inhibitor than cocaine.

This isn't me saying this. This was in the "Journal of the American Medical Association." It said that Ritalin was a more potent transport inhibitor than cocaine.

The big difference appears to be the time it takes for the drug to reach the brain. Inhaled or injected cocaine hits the brain in seconds, while pills of Ritalin normally consumed take about an hour to reach the brain. Like cocaine, chronic use of Ritalin produces psychomotor stimulant toxicity, including aggression, agitation, disruption of food intake, weight loss, stereotypic movements and death.

There have been only two large epidemiological studies on the long-term dopamine effects of taking Ritalin for years. One study found more drug addiction in children with ADHD who took Ritalin, compared with children with ADHD who took no drug, while the other study shows the opposite result. So they are inconclusive at this moment.

The question that remains to be answered, according to the authors of this study, is whether the chronic use of Ritalin will make someone more vulnerable to decreased dopamine brain activity, as cocaine does, thus putting them at risk for drug addiction.

Even more disturbing than the prescribing of Ritalin to school age children is a trend to prescribe this medication to preschoolers. A study published in the "Journal of the American Medical Association" in 2000 offered some key insights into this dangerous new trend. Fifty-seven percent of 223 Michigan Medicaid enrollees younger than four years of age with a diagnosis of ADHD received at least one psychotropic medication to treat the condition during a 15-month period in 1995 to 1996.

Ritalin and clonadine were prescribed most often. Additionally, the authors found that in the Midwestern states' Medicaid population, there was a threefold increase in total prescribing of stimulants between 1991 and 1995, a 300 percent increase.

There was a threefold increase in prescribing Ritalin, a 28-fold increase in prescribing clonadine and a 2.2-fold increase in prescribing of antidepressants. This is children between the ages of two and four years old.

These are trends that I think we ought to be concerned about. Is it safe to give these drugs to very young children? What will the long-term effects be? Are children being diagnosed correctly?

I hope we can shed some light on all of these issues today.

In concluding, let me just say, over the last four years, this committee has looked at numerous health issues. We've looked at the role of dietary supplements, nutrition and physical activity in improving health. We've looked at the role of complementary and alternative medicine in our healthcare system.

We've looked at pharmaceutical influence on advisory committees at the Department of Health and Human Services. And we've looked at the possible relationship between childhood vaccines and the autism epidemic.

It's obvious to me that we can no longer ignore that our healthcare system is in need of major overhaul and attitude change. We have a generation of doctors who have not been trained in nutrition. We have statistics that show that 85 percent of the illnesses Americans face are related to lifestyle. We have camps of conventional doctors who are trained to suppress symptoms through drugs and camps of complementary and alternative medical professionals, including doctors, who are trained to look at the whole person and their environment.

It's time that we put the labels of conventional and alternative aside and think about an integral approach, a complete approach, to care. We owe it to all of us, but especially our children.

I am pleased that we have such a stellar list of witnesses today. Mr. Neil Bush, the brother of the president, was going to be here with us. But unfortunately, he could not be. So what we have done is we have a tape of an interview that was conducted with Mr. Bush that we show at the outset of our hearing, before we hear from our witnesses.

As everybody knows, he is not only the brother of the president, but he is the CEO of Ignite! Learning and the son and brother of two presidents and was supposed to be here, but unfortunately, he couldn't. He did have a family experience with a misdiagnosis of ADHD.

Ms. Lisa Marie Presley, I'm sure everybody knows who Ms. Presley is. She is not only a very talented young lady and a very attractive young lady, she is the daughter of Elvis Presley and his lovely wife. And she is here today to testify. And we are looking forward to her testimony.

She is a concerned mother and the international spokesperson for the Citizens Commission on Human Rights.

Ms. Patti (ph) Weathers, who is here with us and we're glad to have you. She will share her family's story about a school trying to force medication as a condition of school participation.

Dr. Mary Ann Block, the author of "No More ADHD" is here. And we appreciate your being here as well.

And of course, we have Mr. Wiseman, who has been active in this issue for a long time. And we appreciate your attendance as well, Mr. Wiseman.

WISEMAN: Thank you.

BURTON: I want to thank all of our witnesses for being here today. And I look forward to your testimony. And the hearing record will remain open until October the 10th.

Mr. Waxman is not here at the present time, so I'll now yield to the distinguished gentleman from New York, my colleague, Mr. Gilman.

GILMAN: Thank you, Mr. Chairman. And I want to thank Chairman Burton for holding this important hearing to examine the issue of medicating school children in the treatment of Attention Deficit Hyperactive Disorder.

As a congressional member who has long been interested in the ongoing war on illicit drugs, I'm surprised by the extensiveness of the use of use of controlled substances such as Ritalin with a high potential for abuse and the propensity for its dependence to treat psychiatric disorders in children. This issue is surrounded by substantial controversy, a debate that we fully expect to be highlighted by today's witnesses.

And while we recognize the merits of the positions argued by each side, my concerns lie in another area. I don't doubt that there are many children with genuine illnesses or disorders that could benefit from a treatment regime involving Ritalin and similar drugs.

I am concerned, however, with a number of other issues. The first of these is a trend toward treating younger and younger children with these dependent drugs. Ritalin is generally not recommended for children under age six. Yet there was a threefold increase in its prescription for children aged two to four between 1991 and 1995.

Also of concern is that parents are being pressured into having their children take these drugs when a diagnosis is made by a teacher or other school official and not by any medical professional. As a result, the potential for abuse is enormous.

Educators want conformity in the classroom. But the desire for order needs to be balanced against the health of the children.

The heavy advertising that the extensive lobbying of school districts by drugs companies for these products is very distressing. The decisions involving treatment need to be made by medical personnel who know the individual patient and not by someone with some financial stake in the system.

Moreover, we've not seen any evidence that suggests the medical profession has any significant knowledge about the long-term effects of these drugs. Given that this is a relatively recent phenomenon, it's possible that long-term studies have not been undertaken. And if that's the case, we could be setting ourselves up for a potential disaster down the road.

Once again, Mr. Chairman, thank you for holding this important hearing this morning. And I look forward to the testimony of our witnesses.

BURTON: Thank you, Mr. Gilman.

Ms. Watson, do you have an opening statement?

WATSON: Yes, I do.

BURTON: Ms. Watson, you are recognized.

WATSON: I want to thank you, Mr. Chairman. And I have a few observations I'd like to share based on an experience while I was teaching and as a school psychologist.

Although fidgeting and not paying attention are normal and common childhood behaviors, a diagnosis of ADHD may be required for children in whom frequent behavior produces persistent dysfunction. The challenge is to evaluate, inform the parents and consider the alternatives before choosing an invasive and artificial drug treatment.

An adequate diagnostic evaluation requires histories to be taken from multiple sources -- from the parents, from children, from teachers and from others that associated with the child -- a medical evaluation of general and neurological health, a full cognitive assessment, including school history, use of parent and teacher rating scales and all necessary adjunct evaluation, such as an assessment of speech and language patterns, et cetera. These evaluations take time and require multiple clinical skills.

Regrettably, there is a lack of appropriate trained professionals and monetary resources in the current school system. As a school psychologist in Los Angeles, for every 10 students that I worked with, there were approximately four or maybe even five on Ritalin.

It was very frustrating to see many of the medicated children completely numb to stimuli. In many cases, they were almost like robots.

Drugs should not be overly prescribed or seen as the only solution to these problems. The American Academy of Pediatrics published a policy statement in 1996 on the use of medication for children with attention disorders, concluding that the use of medication should not be considered the complete treatment program for a child with ADHD and should be prescribed only after a careful evaluation.

Because stimulants are also drugs of abuse and because children with ADHD are at an increased risk of substance abuse disorder, I have concerns about the potential for the abuse of stimulants by children taking the medication or diversions of drugs to others. Just yesterday, I read in the "Washington Post" sports section that the Hall of Fame Pittsburgh Steeler Mike Webster pleaded "no contest" in September 1999 to forging prescriptions to obtain Ritalin.

And I finally say that this point has to be made. And it goes to the fact that this great athlete is probably someone who, early on, showed hyperactivity. And probably because he was bored in class or whatever the circumstances might have been, but he now has an addiction that I think in some ways could be equated with the use of cocaine, which is so prevalent in my district and in the school district that I represent.

So I am very, very concerned that we are bringing our children up in a drug culture. And you can't turn on the television or the radio or read a newspaper that we're not pushing something to wake you up, put you sleep. You know, "Want your z's? Take this."

And so children are surrounded by this culture. We need not have this particular effect in our schools.

So Mr. Chairman, thank you very much for holding this hearing. And I look forward to hearing the presenters.

BURTON: Thank you very much, doctor. I appreciate that.

Mr. Horn?

HORN: Mr. Chairman, I thank you for this further series of where there has been misuse of pharmaceuticals. And I agree completely with what my colleague, Mr. Gilman -- we've been all over Europe and everywhere else to see that drugs -- and when it's used for small children and they have no say about it and when it's wrong, we should make sure that doctors are properly put together, have what type of either adolescents or the others.

So I would commend you and would hope that we can get soon to the witnesses, since they're outstanding.

BURTON: Thank you, Mr. Horn.

Mr. Cummings?

CUMMINGS: Thank you very much, Mr. Chairman. I want to thank you for holding this hearing. I bring a very interesting perspective to this hearing, in that as a young African-American boy in South Baltimore, I know that what happened to a lot of us is we were actually pushed into special education. We were given all kinds of drugs. And they said that we were hyperactive and told that, you know, that our hyperactivity could not be controlled.

But what they failed to understand -- and in this poor neighborhood in South Baltimore -- was that we didn't have the playgrounds. We didn't have them. We played on glass. G-L-A-S-S.

We didn't have the leagues, the baseball leagues, that stuff that little boys would normally do to get that energy out of them. And so what happened, as is happening today in my district, are little children are being drugged to keep them stable, so they say, so that they can learn.

And I think I agree with Congresswoman Watson that we've got a situation where we have to bring this whole situation under control. And Mr. Chairman, I applaud you for bringing attention to it because it's a very serious thing.

Just today, I was listening to one of our national stations. And they were talking about how there are over 1 million African-American men in prison -- 1 million. There are more African-American men in prison than there are in college.

And you have to wonder how many of them may have started off with folks saying that, "There's something wrong with you." And we have to understand, when you tell a child that there is something wrong with them, it goes with them until they die.

And it's not -- I've often said -- it's not the deed, it's the memory that haunts folks. And so I think that perhaps -- I don't know whether our witnesses will touch on this -- I think that perhaps we categorize children at an early age. And we misdiagnose them. And then we put them on a train, on a track, that leads to nowhere.

And so that's why, Mr. Chairman, I'm glad we're exploring this. I think that it took a lot of foresight on your part to even open up this door so that we could peek in. Because I can tell you that I know of a lot of children right now who are sitting in classrooms and they've been drugged. And they don't know -- they're not sure what's going on with them. All they know is that they have been labeled.

And last but not least, Mr. Chairman, let me say this. In our society today, too often, what we do is we look at a child's behavior and say to our selves that that behavior is a deficit as opposed to an asset.

And I can recall, as a young boy, one of the reasons why they put me in special education and put me to the side is because they said I talked too much.

(LAUGHTER)

They said, "You talk too much." And I'm so glad that there were some people that saw it as an asset.

(LAUGHTER)

Did not drug me to quiet me and said to use this asset that God has given you so that you can help to bring benefit to the rest of society. And so, for those reasons, I take it very personal what we're doing here today because there are so many people that don't get off of that train leading to nowhere.

And so with that, Mr. Chairman, I yield back.

BURTON: Thank you, Mr. Cummings. And I'd just like to say that your testimony parallels some of the things I heard about me when I was in school. And I guess I still talk too much sometimes.

Let's see, Ms. Davis?

DAVIS: Thank you, Mr. Chairman. I appreciate you holding this hearing. And I want to bring an entirely different perspective to what has been said. I'm the mom of an ADHD son who is now 21. I would have given anything, back when he was six or seven, if someone from the school would have sent a note home and said, "Have your son tested or checked out."

Instead, we went for several years thinking we were bad parents; something was wrong; we could not control our child; we didn't know what was wrong with him. And it was at the end of his second grade, when his teacher said he was below grade level and she passed him because she just didn't want to deal with him anymore.

And it was a struggle at home. It was a strain on our marriage. This is our younger son. We couldn't handle him. We couldn't control him.

And during that summer, I happened to be talking to a lady who asked me had I ever had my son tested for Attention Deficit Hyperactivity Disorder, which I had never heard of. I took him to a psychologist -- I took him to my pediatrician, who sent me to a psychologist.

We wrestled with putting our son on Ritalin. I did not want to medicate my child. My husband didn't want to medicate him. We wrestled with that a great deal.

The first day of school in third grade, he was sent to the principal's office for acting up. That went on for a week. And it wasn't acting up like bad behavior. It was he just couldn't control himself.

And long story short, the second week, we put him on Ritalin. We did not tell the school. Back then, the teachers in our area were not trained on Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder. They didn't know much about it.

At the end of the first nine weeks, when the report card came out -- keep in mind, this is the young man they wanted to hold back in second grade or said he was below grade level. We received a call to come to the school.

I went to the school, met the principal, the reading specialist and the third grade teacher, who said our son was a brilliant, gifted child and wanted to put him in the gifted learning class. He made straight A's.

We then told them we did not want him in the gifted class. We explained the Ritalin. And I will tell you that Ritalin was a savior to us for our son.

We tried everything. We tried the diet. We tried the behavior changes. We tried everything before we succumbed to the Ritalin.

We didn't keep him on it during the holidays. We didn't keep him on it during the summer. He did great. The psychologist said it was all right not to have him on it during the summer and during the holidays.

He did great. When he was in high school, he opted to go off the Ritalin. We've had no trouble with our son. He has not had a problem with drugs.

In fact, just the opposite. We explained to him that, with the Ritalin, if he were to ever try drugs, it could totally harm him. And I believe that, in this country, we have a tendency to swing from one end to the other. I do believe we've swung to the other.

We've gone from when people didn't know about Ritalin and Attention Deficit Disorder to now any time you have a child who is active at all, we put him on Ritalin. I would not want to see the children going on Ritalin at age two, three, four, five.

It was a hard decision for us at eight to put our son on Ritalin. I do believe that, in some cases, Ritalin is what helps. It doesn't -- and one thing we explained -- and I don't mean to take up too much time.

But one thing we explained to our son is that the Ritalin didn't make him smart. It didn't make him get the A's. It just helped him to concentrate, to be able to use the abilities that he already had.

I do think there are children and parents who will need to put their children on Ritalin. But I don't think it's anywhere near the number of kids that I see on Ritalin today.

And I appreciate you holding this hearing. And I hope and pray that before parents put their children on Ritalin, they will have them tested in every respect. They will talk it out with everyone before they do it and that they know it would just be the last resort.

For us, it was a lifesaver. He's 21. He's doing great. He's not on Ritalin, hasn't been on it since 10th grade. But it was a lifesaver, Mr. Chairman.

So I would hope we wouldn't outlaw it altogether, but that we would take a serious check on our conscience before we put our kids on the Ritalin. And I thank you, Mr. Chairman.

BURTON: Thank you very much, Ms. Davis.

Dr. Weldon?

Excuse me, Mr. Duncan, I think you're next, then we'll go to Dr. Weldon.

You want to go to Dr. Weldon? OK, Dr. Weldon?

WELDON: Mr. Chairman, I want to commend you for holding this hearing and just mention that you are taking us into a very complicated but very, very important arena. And I am very, very appreciative of the lady from Virginia's testimony.

My perception is that Ritalin is, to a certain degree, a victim of its own success. It has helped a lot of children. But there are many children who are being placed on it unnecessarily.

I think there is a broader issue that I would like to see the committee address, though I expect we will not be able to in the confines of the amount of time remaining on the calendar, and that is: is there some other underlying process going on to account for the larger and larger number of kids that are being labeled with these behavioral and learning disorders? And I'm specifically talking about something in the environment, something in the food that could be playing a role. Vaccines is another thing worth considering.

And again, thank you very much for convening this hearing. I'm looking forward to hearing the testimony of our witnesses. And I yield back.

BURTON: If we don't get to those other issues you referred to, Dr. Weldon, we'll try to hopefully do that in the coming year.

Judge Duncan?

DUNCAN: Mr. Chairman, first of all, I want to thank you and the staff for calling this hearing. I don't believe there is any committee in the Congress that has held hearings on a wider variety of really important topics than this committee has under your chairmanship.

I listened very closely and intently, as all of us did, to Ms. Davis' statement. I can tell you that I remember having lunch one day in the House dining room with a family that told me almost the exact same story. And I have no doubt that there are some children in this country -- many children, perhaps, in this country -- that have benefited from Ritalin.

But I also have spoken -- I've spoken on the floor of the House twice about this subject because I believe that this drug -- I have to believe that this drug is way overprescribed in this country. And I believe it's all really about money.

I mentioned in one of my floor statements that I had read an article in 1998 by the former second ranking official of the Drug Enforcement Administration who had retired to Knoxville. And he wrote an article in the "Knoxville News Sentinel" and said that Ritalin was being prescribed in the United States six times more than in any other industrialized nation in the world. And he said in this article that Ritalin had the same properties basically as some of the most addictive drugs there are.

I read in 1999, in "Time" magazine that production of Ritalin had increased sevenfold -- seven times -- in the past eight years and that 90 percent of it was being consumed in the United States. And "Time" magazine said in that article -- quote -- "The growing availability of the drug raises the fear of the abuse. More teenagers try Ritalin by grinding it up and snorting it for $5 a pill than get it by prescription."

Then I read in "Insight" magazine, which has had several articles about this, that almost every one of the teenager shooters that we've read about in recent years have been boys who were at the time or who had recently been taking Ritalin or other similar mind-altering drugs.

And late last year, the same magazine, "Insight" magazine had an article, which said 30 years ago, the World Health Organization concluded that Ritalin was pharmacologically similar to cocaine in the pattern of abuse it fostered and cited it as a Schedule II drug, the most addictive in medical use.

The Department of Justice also cited Ritalin as a Schedule II drug under the Controlled Substances Act. And the Drug Enforcement Administration warned that -- quote -- "Ritalin substitutes for cocaine and the amphetamine in a number of behavioral paradigms."

I also read one study that said that almost all Ritalin was being prescribed to young boys who came from -- who were the children of very successful parents, both of whom were working full time outside of the house. Now I say again, I know that there are people for whom Ritalin has been a lifesaving drug.

But I also know that I think -- and I have a family that has many teachers in it -- but I know sometimes that, you know, there are some poor teachers who I think have recommended Ritalin just because they personally couldn't properly handle a young boy that was being, what we used to say, "He's all boy." He's very, very active.

And I've known personally two or three of these young boys that have been put on Ritalin. And they have appeared to me to be in zombie-like states.

And so I think we need to look very closely at this. I don't believe we need to outlaw Ritalin. But I believe it needs to be greatly, greatly reduced in its usage.

And I'll say it again, I believe it's being overprescribed in this country just because of the profit factor, the money that's out there that the drug companies want to make.

Thank you very much.

BURTON: Thank you, judge.

What I'd like to do is take the committee to the five-minute mark. We have almost 12 minutes left on the clock. And then we will have to recess for three votes. And I would urge all members to come back so we can hear our witnesses, if it's at all possible.

And with that, I'd like have our witnesses stand and be sworn in. Would you please rise? Raise your right hand.

Do you swear to tell the whole truth and nothing but the truth, so help you God?

Be seated. I'd like to start off by showing a tape of Neil Bush, who could not be with us today, because he had some things he wanted to say. And we'd like to show that real quickly.

So would we put our attention on the monitors?

(BEGIN VIDEOTAPE)

(UNKNOWN): If you'd like to be in our studio audience when you're in New York, send an e-mail to ABC News.com.

Diane?

(UNKNOWN): All right, Tony. Well, he calls himself the lowest profile member of the Bush family. But President Bush's brother Neil can't entirely hide from the spotlight. And this morning, he joins us to put the spotlight on something else, schools overprescribing drugs like Ritalin to treat students with Attention Deficit Disorder or problems.

And he should know. He says it almost happened to his son, Pierce. And I ran up the stairs this morning, too. I'm not in as good of shape as I thought.

Neil, it's great to see you this morning.

BUSH: Thank you very much for having me.

(UNKNOWN): What happened with Pierce?

BUSH: Pierce is, like millions of kids, very bright, very engaging. He kind of cruised through elementary school on the pure power of his personality.

He got into middle school, where the rubber meets the road, where kind of the strict, kind of hard work of learning kicks in, where the textbook, test, memorize and forget model of education is there. And he started doing more poorly.

And the knee-jerk reaction of schools -- not just private, but public schools; not just poor, but good schools -- is to label kids like that with ADD and to literally prescribe drugs to them.

(UNKNOWN): And he was prescribed Ritalin, but he didn't take it?

BUSH: And he refused to take Ritalin. He wouldn't take, you know, an aspirin for a headache. So he refused. And it's changed my life.

I've put a lot of time into thinking about this. And I think we do overprescribe Ritalin. And we way overdiagnose ADD. It's a very subjective diagnosis.

It's not like somebody can take a blood sample or a CAT scan and analyze. And it's just sad to me. It's sad that we drug over 6 million kids in this country with mind-altering drugs to have them be more compliant in a school system.

(UNKNOWN): Well, I want to talk about some of the alternatives. But as we do it, I know one of the things you felt with Pierce, that he just wasn't being challenged enough. And that, as soon as he got challenged, it all changed.

I want to show everybody a clip of him. He was on "Larry King," not so long ago, talking about Uncle President George.

(UNKNOWN): Now what you have been saying is that it's very important to examine the kind of teaching that is taking place for a child before automatically prescribing a drug. You've even said that textbooks are kind of an ultimate villain in this for not engaging kids?

BUSH: Well, textbooks are used for 75 to 80 percent of the communication of the curriculum. And textbooks clearly fail to engage kids the way kids learn best. We have a 19th century system of education, teaching kids that are 21st century thinkers, who are engaged outside of school in so many intriguing ways.

And so it's just really, really sad to me that we haven't changed the way we instruct and engage kids. If you engage a child in school, the symptoms of ADD go away.

(UNKNOWN): And in fact, you were dyslexic as a kid.

BUSH: I was. Right.

(UNKNOWN): And you say that your mother really applied a full court press.

BUSH: Yeah, well, my mother, the best thing she ever did was never lose hope in me, never lose faith in me as a human being and as a learner. A lot of dyslexics, by the way, because they have trouble reading, have a hard time staying engaged in school and therefore, are labeled ADD.

When you lack attention and when you appear to be disorganized, when you're not on task, any symptom that exists whenever you're bored to death, then you're labeled and drugged. And it's really sad to me.

I was dyslexic. I read stuff with a passion, though, that I care about. And I care deeply about how kids learn and how we can reform the system so that kids are truly engaged.

(UNKNOWN): And you're, in fact, working on a -- you have a company?

BUSH: I do. I have a company, Ignitelearning.com. We are building courseware that is built first around how we know kids think and learn. And then secondly, it's integral to what a teacher is teaching in school. So when they're teaching history, kids are using music and animation.

It's really exciting to see that light turn on in kids. Every kid has a gift for learning. Not one kid should be left behind. And we need to arm teachers with 21st century tools, you know, to help them be more successful.

(UNKNOWN): I have to turn to one other Neil Bush child.

(END VIDEOTAPE)

BURTON: I want to thank ABC for providing that tape to us. And we are now at a point where we have to recess. Please forgive me -- you on the panel and everybody in the audience. We'll get back here just as quickly as possible.

We have three votes. The first one will be through in about 10 minutes and then we have two five-minute votes. So we'll be back here in about 25 minutes.

So get a cup of coffee or a glass of water and forgive us for having to recess. We'll be right back.

Stand in recess to the call of the gavel.

(RECESS)

BURTON: The committee will once come to order. There will be other members coming back besides me and Ms. Davis, but we just had votes on the floor and we rushed back. So they will be wandering in. Those things happen.

Before we start with the panel, who are on their way out, as I understand it, I want to thank Sam Brunelli for helping me arrange this. For those of you who don't know who Sam Brunelli is, he was an all-pro football player for some team out west called the Denver Broncos. Is that what it was, Sam?

Yeah, well. Sam did a great job for them. He was all-pro. But I think this year, they're going to be whipped by the Indianapolis Colts in that division.

And Sam's thinking over there, "Not in your lifetime."

(LAUGHTER)

In any event, you've all been sworn. And I want to thank you for being patient with us while we were gone.

What's the order?

I think what we'll do is we'll start right down the list there. Ms. Weathers, why don't you start with your testimony? And if you can, keep your testimony to five minutes. But we won't kill you if you go just a few seconds over.

WEATHERS: OK. My name is Patricia Weathers. I am a mother from New York State. I have considerable concern regarding the outcome of this hearing because my son, Michael, was one of the children profiled for ADHD by our school district.

When Michael was in kindergarten, I began getting reports that he was having behavioral problems. What was meant by this is that Michael was talking out of turn, climbing around in class and apparently not sitting still.

The following year, while Michael was in first grade, his teacher told me that his learning development was not normal and that he would not be able to learn unless he was put on medication. Near the end of first grade, the school principal took me into her office and said that unless I agreed to put Michael on medication, she would find a way to transfer him to a special education center.

I felt intimidated, scared and unsure of what to do as a result of the school's coercive tactics. At no time was I offered any alternatives to my son's needs, such as tutoring or standard medical testing. The school's one and only solution was to have my child drugged.

At this point, his teacher filled out an actor's profile for boys, which is an ADHD checklist, and sent it to his pediatrician. This checklist, along with a 15-minute evaluation by the pediatrician, led to my son being diagnosed with ADHD and put on Ritalin.

After a while, my son started to exhibit serious side effects from the drug. He was not socializing, became withdrawn and began chewing on various objects. His eating and his sleeping were sporadic and of great concern to me.

Instead of recognizing the side effects of the drugs, the school psychologist claimed Michael now had either bipolar disorder or social anxiety disorder and needed to see a psychiatrist. She produced a name and a number of the psychiatrist I was to call. The psychiatrist talked to my son and I for a short period. And again, with the aid of school reports, diagnosed him with social anxiety disorder.

She handed me a prescription for an antidepressant, telling me it was a wonder drug for kids. Those were her exact words.

There was no information about the serious side effects associated with this drug. The drug cocktail that was to follow caused even more horrendous side effects, making his behavior more and more out of character. I could no longer recognize my own son.

Fearing what these drugs had done to him, I stopped them. Through this whole ordeal, the school psychologist's favorite saying was that it was trial and error. If one drug didn't work, try another.

Realizing that I was no longer willing to fall in line and give my child drugs, the school threw him out. For a final blow, they proceeded to call Child Protective Services on my husband and I, charging us with medical neglect for refusing to drug our child. This charge was later ruled unfounded.

On August 7 of this year, the "New York Post" featured my son's story and the fact that I had decided to file a lawsuit against the school system on behalf of my son, Michael's ordeal. On Friday, September 20, this lawsuit was officially filed in federal court.

Within just a few days of the "New York Post" article being published, over 65 parents came forward to describe their own personal stories of coercion and intimidation used by school districts to strong arm them into drugging their children. Since then, many more have come forward.

Through my family's experience, I feel the issue of informed consent is crucial. As a parent, I was simply not provided with accurate and critical information regarding the issue of ADHD. I was never made aware of the controversy surrounding this disorder, whereby many medical professionals do not validate it as a true medical condition.

I was never provided with the information that there is no independent, valid test for ADHD. I was never given any warnings about the documented side effects that could occur with the drugs used to treat it. I was never informed that there are studies showing the correlations between stimulant use and later drug use.

As a final point, I was at no time made aware that this drug use could bar my child from future military service. As a mother, I should have been given all of this information to make an informed decision on behalf of my child.

After all, it is we who are ultimately responsible for the nurture, care and protection of our children. We are unable to fulfill this obligation and make sound educated decisions without getting all the facts.

Accountability is what I am seeking. I would never have subjected my son to being labeled with a mental disorder if I had known that it was a subjective diagnosis. I would not have allowed my son to be administered drugs if I had been given full information about the documented side effects and the risks.

It is for this reason that I am asking this committee to fully investigate these matters as they relate to the issue of informed consent and to enact legal safeguards so that parents can fulfill their obligations to shield their children from any potential harm.

Thank you.

BURTON: Thank you very much, Ms. Weathers. I think that was a very, very important statement. And we really appreciate your coming here today.

And I'd like to -- Dr. Block?

BLOCK: I am Dr. Mary Ann Block, an osteopathic physician from Texas. For those of you who are unfamiliar with the osteopathic profession, let me tell you a little bit about us.

We are fully licensed physicians, with the ability to write prescriptions, perform surgery and be residency trained in all the same specialties as MDs. The difference between MDs and DOs is twofold. One, as a DO I have 150 more hours in medical school than MDs. Osteopathic physicians tend to be more holistic in their approach because of the philosophy that teaches us that the body and mind should be viewed as a unit.

Because of my medical training, my goal as a physician is to look for and treat the underlying cause of a patient's problem, rather than just covering the symptoms with drugs. I have seen and treated thousands of children from all over the United States who had previously been labeled ADHD and treated with amphetamine drugs.

By taking a thorough history and giving these children a complete physical exam, as well as doing lab tests and allergy testing, I have consistently found that these children do not have ADHD, but instead have allergies, dietary problems, nutritional deficiencies, thyroid problems and learning difficulties that are causing their symptoms.

All of these medical and educational problems can be treated, allowing the child to be successful in school and in life without being drugged. The American Osteopathic Association has published my program as the osteopathic approach to treating the symptoms called ADHD.

This approach is supported in the medical literature as well. The "Annals of Allergy" reported in 1993 that children with allergies perform less successfully in school across the board than children who do not have allergies. Yet doctors prescribe amphetamines without ever checking the child for allergies.

A study in the "Journal of Pediatrics" in 1995 reported that children who ate sugar had an increase in adrenaline levels that caused difficulty concentrating, irritability and anxiety. A double blind crossover study published in "Biological Psychiatry" found that Vitamin B-6 was actually more effective than Ritalin in a group of hyperactive children.

Another study found that children with magnesium deficiencies were characterized by excess fidgeting and learning difficulties. There are many more studies in the medical literature that indicate an association between nutritional deficiencies and attention and behavioral problems. Yet, doctors prescribe amphetamines without checking a child's diet.

There is no valid test for ADHD. The diagnosis called ADHD is completely subjective.

While some like to compare ADHD to diabetes, there really is no comparison. Diabetes is an insulin deficiency that can be objectively measured. Insulin is a hormone manufactured by the body and needed for life. ADHD cannot be objectively measured. And amphetamines are not made by the body, nor are they needed for life.

The prescription drugs that are used to treat symptoms of attention and behavior come with a host of potential side effects. According to the manufacturers of the drugs, the following side effects can and do occur: insomnia, anorexia, nervousness, seizures, headaches, heart palpitations, cardiac arrhythmias, psychosis, angina, abdominal pain, hepatic coma, anemia, depressed mood, hair loss, weight loss, tachycardia, increased blood pressure, cardiomyopathy, dizziness and tremor, to just name a few.

These drugs are classified as Schedule II controlled substances with high abuse potential. According to reports in the "Journal of the American Medical Association," the drug Ritalin has been found to be very similar to and more potent than cocaine.

Ritalin and cocaine are so similar that they are used interchangeably in scientific research. There are no long-term studies on the safety and effectiveness of these amphetamine drugs, though millions of children are treated with them for years at a time.

When I was in school and when my children were in school, there was no need to drug millions of children. While there are children who have attention and behavioral problems and these problems may have increased due to poor diets, an increase in sodas and candy in our schools, an increase in allergies due to changes in our environment and an increase in learning problems, it does not mean these children have a psychiatric disorder called ADHD.

It means they have medical and educational problems that can be fixed. Most of the children I have seen who have been prescribed these drugs have never had a physical exam. No doctor listened to their heart, even though many of the side effects of the drugs are heart related.

Since there is no valid test for ADHD, most doctors get the information for the diagnosis from the child's teacher in the form of a checklist. If the teacher wants the child to be taking these drugs, all she or he has to do is fill out the checklist indicating that the child has many problems in the classroom.

One child was diagnosed as ADHD and prescribed Ritalin. But I got to treat him instead. Once his allergies and learning problems were corrected, he went on to become a National Merit finalist and accepted to an Ivy League university.

Every child deserves that opportunity. Many of the parents of these children have told me that the teachers and principals have pressured them to put their children on these drugs, threatening to report them to Child Protective Services if they do not comply.

CPS actually removed a child from his home after the school reported the mother for not giving the child his drug. The ironic thing was she had been giving him the drug. The drug made him worse, not better.

I cannot imagine any reason to give a child an amphetamine to cover up symptoms when the problem can be fixed and no drug is required. Let's give our children the medical and educational evaluations they need to diagnose the real problems.

Let's treat these real problems and give our children the future they deserve without drugs. I will show a brief video, which shows a child's disruptive behavior, caused from allergies. And I'm also submitting, as part of my written evidence, my latest book, "No More ADHD: 10 Steps to Help your Child's Attention and Behavior Without Drugs."

Thank you.

(BEGIN VIDEOTAPE)

BLOCK: This is a video of a 9-year-old boy, undergoing allergy testing. He uses the noise to distract himself. We ask the children to sit still and concentrate for 10 minutes.

The reaction to this first allergy shot makes him feel bad. It causes him to be uncooperative, belligerent, unable to sit still or concentrate.

After 10 minutes, he is given another dose of the same allergen. But this time, it is a dose that makes his symptoms go away. After receiving the correct dose, he can sit still, he can focus and concentrate and he is no longer angry or belligerent.

(END VIDEOTAPE)

BURTON: Does that conclude your testimony? Thank you very much.

Ms. Presley?

PRESLEY: Thank you very much, Congressman Burton and committee members for the opportunity to address this hearing. I'm here as a mother mostly because I have to put my children in school and I have also had direct contact with these children who are medicated. And I can tell by their behavior that they are.

They're usually manic, very destructive, very interested in destruction. You know, we've already said it a hundred times, but between 6 and 8 million American children are being given Schedule II narcotics and/or mind-altering antidepressants.

It's not just ADHD. Some of them cause -- the other ones -- cause tics, cause this which goes into a spiral of OCD, Tourette's, this, that and the other thing. And all these normal behaviors for children are now -- everything is a disorder. I mean, I basically will have everything under the sun at this point.

Yeah, I'll stand up and testify to that too.

But anyway, I'm just saying, I have personally seen the side effects of these drugs. Ritalin, for example, can cause nervousness, loss of appetite, weight loss and manic behavior. Even the manufacturer warns that it can cause psychotic episodes. Suicide is a risk during withdrawal.

Some of these drugs are advertised as non-addictive. But I have known numerous people who have been to rehab centers to get off of them.

Teenagers on powerful psychiatric drugs committed more than half of the recent teenage shooting sprees. That's very alarming, resulting in 19 deaths and 51 wounded. I don't think there has been a correlation made in the media with that one, but it seems awfully coincidental, not coincidental.

Parents need to be informed of drug-free alternatives to the problems of attention, behavior and learning. A child could be fidgety in class or simply bored with what they are learning and then diagnosed with a learning disorder and put on drugs.

Some of these disorders, from what I understand, are also -- you know, they raise their hand and decide something is a disorder, that it's not factually, scientifically proven to be such. There is no blood test. There has been no autopsies to confirm brain -- what is it called? -- chemical imbalance.

A child could have allergies, lead poisoning, eyesight or hearing problems and be simply in need of tutoring or something even more basic than that, which could be phonics. I have not seen one happy and well-adjusted child as a result of these drugs. That's just my personal experience.

What is basically happening is that we are relying on a chemical to change the mood of a child. At least one of these drugs is more potent than cocaine. And we are turning them into drug addicts at a very young age.

My hope is that the committee will recommend legislation that prevents school personnel from coercing parents into placing their children on to mind-altering drugs. They become dependent on them and then, you know, it leads to further drug addiction, which then leads to crime, which leads to all the other terrible things that we always have to deal with in life.

And ultimately, that we don't allow that into the schools -- period. Our schools should only be there to educate our children and not to diagnose any -- have the ability or the right to diagnose children with mental health problems.

It's way overprescribed, way overdone. And I think that, at least, even the people, from what I've seen here today that have a disagreement -- you know, want to go on the other side of the fence still see that it's a situation and it's a problem.

And that's all I have to say. It's a concern.

BURTON: And you have been the head of this organization or one of the leading spokesmen for some time now?

PRESLEY: Yeah. Actually, no, I'm just becoming. I mean, I have done a lot of things with them before on this front. But I have now taken the title as the spokesperson for this committee.

BURTON: Very good, very good.

Mr. Wiseman?

WISEMAN: Thank you, Chairman Burton and members of the committee for the opportunity to speak today. For over 30 years, CCHR's observations and conclusions have been drawn from speaking to hundreds of thousands of parents, doctors, teachers and others.

For example, at seven, Matthew Smith (ph) was diagnosed through his school as having ADHD. His parents were told he needed a stimulant to help him focus and that non-compliance could bring criminal charges for neglecting their son's educational and emotional needs.

On March 21, 2000, while skateboarding, Matthew (ph) tragically died from a heart attack. The coroner determined that he had died from the long-term use of the prescribed stimulant.

We all know that there are children who are troubled, who do need care. But what that care is or should be is the point of contention.

In 1999, in the wake of the Colombine school shootings, CCHR worked with Colorado State Board of Education member Mrs. Patty Johnson (ph), who had a precedent-setting resolution passed that recommended academic, rather than drug solutions for behavioral and learning problems in the classroom.

Mrs. Johnson (ph) stated -- and I quote -- "The diagnosing of children with mental disorders is not the role of school personnel. Nor is recommending the use of psychiatric drugs." The resolution told educators that their role was to teach and pursue academic and disciplinary solutions for problems of attention and learning.

In 2000, Jennifer L. Wood (ph), chief legal counsel for the Rhode Island Department of Education, issued a letter to all schools that under the Individuals with Disabilities Education Act -- quote -- "It is not lawful for school personnel to require that a child continue or initiate a course of taking medication as a condition of attending school."

School personnel cannot require, suggest or imply that a student take medication as a condition of attending school. Yet this is violated across the nation.

Millions of children are being drugged with powerful stimulants and antidepressants, placing our nation's children at risk. In 2001, the "Journal of the AMA" reported that Ritalin can act much like and is chemically similar to cocaine. It admits that while psychiatrists have used this drug to treat ADHD for 40 years, they have never known how or why it worked.

As a result of overmedicating our children and the fact that so many parents were being forced to place their child on such drugs, currently more than half of our states have introduced and/or passed some type of legislation or regulation to restrict the use of psychiatric drugs for children. I am submitting a selection of these for the committee's review, one of which cites the 1998 NIH Conference on ADHD, which said in part, "We don't," -- and I'm quoting -- "we don't have an independent, valid test for ADHD."

"There are no data to indicate that ADHD is due to a brain malfunction. And finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remain speculative."

This is perhaps the crux of the problem. We are relying on a diagnosis that is subjective and open to abuse.

Evidence reviewed by the National Academy of Sciences this year indicates that toxic chemicals contribute to learning or behavioral problems, including lead, mercury, industrial chemicals and certain pesticides. Furthermore, thousands of children put on psychiatric drugs are simply smart.

The late Dr. Sydney Walker (ph), psychiatrist and author, said -- and I quote -- "These students are bored to tears. And people who are bored fidget, wiggle, scratch, stretch and start looking for ways to get into trouble."

All of this information should be made available to parents when making an informed choice about the medical or educational needs of their child. This is in keeping with U.S. Public Law 96-88, which states -- quote -- "Parents have the primary responsibility for the education of their children. And states, localities and private institutions have the primary responsibility for supporting that parental role."

As senior government officials, you represent the lives of all citizens. Families are grieving for the loss of children because they are not provided with all the facts about mental health treatments, especially psychotropic drugs, and were denied access to alternative and workable solutions.

We respectfully request that the Government Reform Committee recommend federal legislation that: a) makes it illegal for parents or guardians to be coerced into placing their child on psychotropic drugs as a requisite for his or her remaining in school; b) protects parents or guardians against their child being removed from their custody if they refuse to administer a psychotropic drug to their child; c) provides parents the right of informed consent, which includes all information about alternatives to behavioral programs and psychotropic drugs, including tutoring, vision testing, phonics, nutritional guidance, medical examinations, allergy testing, standard disciplinary procedures and other remedies known to be effective and harmless; and finally, that such informed consent procedure must include informing parents about the diverse medical opinion about the scientific validity of ADHD and other learning disorders.

Thank you.

BURTON: Thank you very much.

Let me just start with you, Mr. Wiseman. You indicated that -- are there some states that don't allow the dismissal of a child because of the parents' refusal to use these mind-altering substances?

WISEMAN: That don't allow the dismissal of a child?

BURTON: Are there some states that have some kind of a last right of refusal for parents to keep the child in school if they refuse to take these mind-altering substances?

WISEMAN: Well, there are states -- if I'm understanding the question correctly -- states have started, in 1999, to actually pass legislation and regulations prohibiting schools from doing that. But it has been a problem, so much of a problem that there are now 27 states that have passed or have legislation or resolutions in progress that address this issue.

So it was enough of a problem that, as I say, more than half the states in the country have actually had to address the problem with legislation because it was being abused. Parents were being coerced.

BURTON: Well, the reason I ask that question is many school districts in many states around the country, they require children to get inoculations for as many as 26 different childhood diseases. My grandson received nine shots in one day. And I think, in total, the number of shots that he would receive prior to going to first grade would be around 26.

WISEMAN: My word.

BURTON: He received 47 times the amount of mercury that is tolerable in an adult in one day. And two days later, he became autistic. And of course, he's -- well, we're hoping he's going to recover. He may be permanently damaged.

And I guess the point I'm trying to make is these requirements are at the school board level or at the county level or at the state level. They're not requirements that the federal government imposes.

And so I'm wondering, you're asking for legislation at the federal level that would give parents the right to refuse these mind- altering substances. And one of the problems that we will have with some of our colleagues is that that will be looked upon as an infringement of the local school boards' or states' rights.

And I just wondered if you had given that any thought?

WISEMAN: Well...

BURTON: It's not that I'm opposed, you understand, to trying to do what we can here at the federal level to deal with the problem after we hear all the testimony. But each individual state has, up to this point, been dealing with childhood problems like this.

WISEMAN: Yes. Unfortunately -- and not to be repetitious, but unfortunately, we hear in our organization mothers calling in that are being coerced. And the abuses is tragic.

Parents are being threatened with either criminal charges, as I mentioned in my testimony, or in some cases the loss of their children because they're not put on mind-altering drugs. I mean, we're at the dawn here of the 21st century. And there are some children who aren't permitted to go into school unless they're on a mind-altering drug.

The federal legislation that bears on this is the Individuals with Disabilities Education Act. The problem is that the definitions in that law and the definitions that filter down to the school districts under that law are so subjective that, you know, the disorder is in the eye of the beholder. There are no objective tests for this, as has been testified here this morning and from folks on the panel.

There is no scientifically-based studies that enable somebody to make such a diagnosis. So because they are so subjective, it's open to abuse.

BURTON: Well, what I would like to have from you, Mr. Wiseman, is some proposed language that we can take a look at that might be appropriate at the federal level. We approach stepping into states' rights with great trepidation, at least on this side of the aisle. So this is something we would have to take a hard look at.

But I will look at it and see if we can fashion something that will maybe encourage the states to be more concerned about parental rights and how the children are handled and whether or not they're completely, properly tested before they start putting these drugs into them.

WISEMAN: As a former teacher of American history, I share one, your love of the Constitution and your concern for states' rights very, very much. But with somewhere on the order of 6 million children in this country being placed on these Schedule II narcotics, I do think it's something the federal government should look for. And we'll be happy to provide you with some suggested wording.

BURTON: Very good.

Ms. Weathers -- and I'll get to you, Ms. Davis, in just a minute, as soon as we finish this first tranche of questions, OK? Be with you in just a second.

Ms. Weathers, you stated that your son's school pressured you to medicate your son and that, at the time, you trusted them because they were -- quote, unquote -- "the experts." At any time, did the school or your son's doctor talk to you about the potential side effects of those drugs?

WEATHERS: Absolutely not. The most the pediatrician had told me was that there was possible appetite suppression and possible insomnia. She never at any time advised me that there are deaths related to this. There is cardiac problems, heart problems related to these drugs, that his growth would be seriously impaired.

When I took Michael off these drugs, within three weeks, he grew three sizes. So nobody can tell me that those drugs didn't have a great, a tremendous, a horrendous effect on him.

BURTON: OK.

Did your doctor also recommend any behavioral modification training or counseling for your son?

WEATHERS: Absolutely not. She did not. Basically, I had to go in, I believe, every three to four months for a prescription refill.

BURTON: So they just didn't check any of that out? They just said, "These are the things that you have to do," and prescribed the drugs.

WEATHERS: All she did was ask me how he was doing.

BURTON: Did the doctor ever do any blood tests or objective medical evaluation to look at any possible biological basis for his behavior?

WEATHERS: I don't believe there was. I think early on there was a blood test taken. But once again, you don't have a blood test to determine ADHD. You can only have a blood test to rule out underlying causes.

And I believe the only thing they did rule out was lead toxicity.

BURTON: Dr. Block, what have you found that the schools do specifically to encourage the use of medications for attention and behavior?

BLOCK: The parents that come to me report consistently that the teachers and the principals and even the school nurses pressure them to go to a physician and get their child labeled and drugged. In addition, even though the state of Texas Board of Education has passed one of these state resolutions concerning being concerned about the drugging of children, it appears to me that the teachers are not yet aware of it because nothing seems to have changed since that resolution has passed.

Some schools are giving lectures to parents, inviting parents to come hear talks about diagnosing and drugging their children for ADHD. Another thing that has recently occurred, it's not unusual for me to make recommendations for certain nutrients or other things that the child may need to naturally help their body and mind work better. And I will write a prescription for that child to receive that nutrient at school.

What is happening now, though, is that the schools are denying my medical prescription and saying that they will not give a child anything at school except a drug. That, to me, is practicing medicine without a license.

And unfortunately, physicians themselves, according to the FDA, less than one percent of doctors actually know the side effects of the drugs that they are prescribing. Pharmaceutical reps that come to my office have told me more than once that I'm the only doctor they've called on that asked what the side effects of the drug was that they were repping to me.

BURTON: Let me -- I see I'm running out of time here and I want to get to Ms. Davis.

Do you have any idea how physicians are influenced by the pharmaceutical companies to prescribe these medications for kids?

BLOCK: Yes, as a physician, I see this influence all the time. For one thing, I don't think any of us can turn on the television, radio, open up a newspaper or magazine without seeing multiple advertisements for prescription drugs. They go so far as to say, "Ask your doctor if this drug is right for you," encouraging the public to go to the doctor to get a drug.

But in addition, I don't believe the public is aware of the strong influence the pharmaceutical industry has on physicians. From the time we start medical school until the day we stop our practice, we are strongly influenced or attempted to be strongly influenced by the pharmaceutical industry. Our medical journals, which are purported to be unbiased, usually have about 60 percent of their pages as full-page ads from the pharmaceutical industry.

If I go to a continuing medical education meeting, which is required by law that I attend so many hours each year, the doctors who are talking to us are being paid by the pharmaceutical industry to give those lectures. Many doctors are being paid in their offices to do research for the pharmaceutical industries as well.

They also give money to different groups who go out and promote the use of these drugs for our children. So the pharmaceutical companies have a tremendous influence on our society and especially on physicians.

And it is concerning when doctors don't even know the side effects. There is no way that they can tell a patient if they don't know them themselves.

BURTON: I will yield to Ms. Davis. But let me just say, my son- in-law is a doctor. And I've gone to a number of these lectures that are put on by pharmaceutical companies. And I can tell you, as one who goes -- and they're very nice dinners they put on and very expensive in many cases, have great wines and all those sorts of things -- they do have doctors that come in and talk about the attributes and the positives about these drugs. So they are very effective in selling their products to the doctors and the doctors writing those prescriptions.

Ms. Davis?

Incidentally, we'll have a second round of questions because I have some more questions for the panel.

Ms. Davis?

DAVIS: Thank you, Mr. Chairman. I don't have too many.

I tried to state at the beginning that we just have this tendency in our country to go from one end to the other and we never seem to find the right balance. And I think that's where we are right now with the ADHD and the Ritalin. Like I said, when my son was put on it, the teachers didn't even know about ADHD. And I understand now they're even training the teachers in school or something.

And my concern is -- in fact, my son's pediatrician wasn't even that familiar with it. He sent me to a psychologist. And we did a lot of testing.

It was explained to me -- and Dr. Block, this is for you -- it was explained to me that with the ADHD, the child has the blood in the frontal lobe of his brain, I guess, just goes so slow that that's why he can't concentrate. He's seeing like three different pictures or what have you.

And that's why they can sit in front of a TV for hours because so much is going on. And that the Ritalin would speed up the blood flow and then cause them to be able to concentrate.

Have you ever heard that?

BLOCK: I certainly have heard that. And it is an interesting theory. But it has never been proven.

And in fact, drugs like Ritalin and other amphetamine-type substances, one of the basic things they do is make you focus. They can make you overfocus.

But it's been found that anyone who takes this type of drug will have a similar effect because that's what it is. It doesn't prove that someone needs the drug because they have that effect.

But there are many theories going and there is many people who are looking at all kinds of brain scans and everything else. But when you look at the child in my video who was reacting to an allergy, I assure you if you did a brain scan of him at the time when he's reacting, you would see reactions.

And so my focus is really on information, informed consent, that parents be told what all their options are, that they be told all the possible side effects to any treatment. And you know, I think parents always care so much for their children, they're going to do what's right for their child if they're given all the information.

DAVIS: I agree with you. And we were told the side effects of Ritalin when we gave it to our son. That's why it took us so long to give it to him because we didn't want to do it. And it was actually a last resort for us to do that. And it did work for him.

Ms. Weathers, I had a question for you. And if you'll give me a second, it will come back to me.

You said that the teachers all said your son had a problem. Did you every find out what the problem is or was? Is this just recent?

WEATHERS: No, this isn't recent. You know, in my opinion, Michael is extremely bright. He was not reading at grade level. There was a lot of factors that were playing a role in his behavior that were not even addressed by the teachers.

When he was going into fifth grade, he was reading at a second grade, eighth month level, OK? That isn't normal. They were putting him in a special ed room and not teaching him phonics. And I think that's horrendous, I really do.

DAVIS: Did you have problems with him at home?

WEATHERS: No, I would never, ever -- and I'm going to make this perfectly clear for everybody in this room -- I would never have contemplated drugging my child, ever.

He never had behavior problems at home. The minute he entered school, that's when the trouble started.

That is when I was coerced. I felt under pressure. I felt like everyone was telling me that this was the best thing.

I was a single mom. I was scared. I was unsure. And I felt these are the experts. They know children. And I know and I get hundreds of phone calls throughout the country, hundreds from other parents in the same -- having the same experience that I have endured and my family and my son has endured.

And as far as Hawaii, I have a woman in the state of Hawaii who had to leave the state of Washington because she was so pressured. She wanted to pick the state with the lowest consumption of Ritalin use. And she flew her entire family to Hawaii.

Her name is Susan Perry (ph). And I'm in contact with her now. And we are fighters. And I'm going to fight this issue until the very end because parents are not informed nowadays.

We're not told the side effects. We are just not. And it's just tragic because our children are suffering. And our children are what counts.

DAVIS: Thank you, Ms. Weathers. I totally agree with you. And as a mom, there is nothing more important to me than our kids. And I know how you feel.

Thank you, Mr. Chairman.

BURTON: We'll have a second round of questions.

Let me just tell you something that's of interest that you might find interesting, Ms. Weathers. Mercury is in a lot of our vaccines. Mercury is a toxic substance. And I've talked to a number of doctors, including doctors here on the Hill that treat congressmen. And I told them, I said, "Do you know that in our flu shots that we get, there is mercury?"

And some of the doctors said, "No, no, there's no mercury in there." And I took the insert out and I showed it to them. And it says, "Thimerosal." And they said, "See, there's no mercury in there."

I said, "Thimerosal contains mercury." Has never been properly tested since 1929. It was tested on 27 people who all were dying from meningitis. All of them died. And so they say that the mercury didn't cause it.

But they've never tested it ever since. And it's been given to our children. My grandson got nine shots, many containing mercury, in one day. And two days later, he was autistic and may be maimed for life. He is not responding as we would like.

And so you are absolutely correct. Parents need to be informed about the substances in the vaccines and in the pills and all the other treatments they're getting. And if they don't get that, then shame on us.

And doctors need to be given the proper information from the Food and Drug Administration. And the Food and Drug Administration has been derelict in their responsibilities of doing it.

And I'm very sorry we don't have the FDA here today because the FDA's responsibility is not only to test these things, to do double blind studies and everything else before we start administering these things to the population and our children, but they're also supposed to inform people. And they haven't been doing that as well.

And that's one of the reasons why we've had so many problems with them over the years. But we will be contacting the FDA about that.

What? What is it?

Let me ask you, Dr. Block, one more question. As you know, we -- and I will have other questions I would like to submit to you for the record that you can answer later.

As you know, we've learned that a government-funded study found a correlation between the use of thimerosal, mercury-containing vaccines and a diagnosis of ADD. Do you think that every child that is referred to a child for ADD evaluation should be tested for heavy metals?

BLOCK: Yes. I do think every child should be. In addition to seeing a lot of children with attention and behavioral problems in my practice, I see a lot of children who have been diagnosed as autistic. And through testing these children for heavy metals and often finding mercury and lead and other heavy metals, begin testing the children who have attention and behavior problems and often find the same thing with them as well.

I think that these problems are on a continuum where one child has severe symptoms and gets the autistic label, while another child gets an ADHD label. But I'm finding the same underlying problems in all of these children.

BURTON: Heavy metals being one of them?

BLOCK: Heavy metals being a major one, yes.

BURTON: So it would be your opinion that these preservatives they're putting in that contain aluminum and mercury, in particular, should be taken off the market? They should take those things off the market.

BLOCK: They should be taken off the market. They were supposed to be taken off the market, was my understanding. But they have not been taken off the market.

Many pediatricians actually believe they have been taken off the market. So they have not looked to see if the thimerosal is in the vaccine.

But they are still in the vaccines. Children are still getting as many as eight or nine different diseases immunized against in a single visit to the doctor's office. And many of those vaccines do contain the mercury and aluminum, which work together to make the problem even worse.

Let me just say that we suspect -- and in fact, I'm pretty sure -- that while they're starting to get mercury out of children's vaccines here in the United States, we send vaccines all over the world to Third World countries. And we send them with multiple vaccines in one vial. And they are still using the mercury, the thimerosal in those almost entirely around the world.

And so while we're starting to get them out of our vaccines, we're continuing to inject mercury into children all over the world in Third World countries, which I think is almost criminal.

Let me ask Mr. Wiseman a couple -- oh, Ms. Presley a question here. Why did you choose to get involved in this discussion of ADHD? Have you had a family that was misdiagnosed?

PRESLEY: Yes, I have. I have also had experience with mercury. I had nine fillings at one point.

And I went two years almost going crazy, getting every asthma, this that, hypoglycemia, candida, all these troubles. I've baffled every doctor from one coast to the next. And then when I finally got the diagnosis that I had -- you're supposed to have between zero and three normal in a human body. And I had 1,000-plus.

And the doctor called me. And the term "mad as a hatter" is from people who used to work in felt factories where they would be exposed to mercury and they'd go crazy.

Now I had experience with that. And the moment I started taking things either naturally or a chelation agent to get it out, all the symptoms stopped. So I've had personal experience with that. And I do know that they are not only in the vaccines, they are in fillings that children -- they still use it in the mouth.

BURTON: Amalgams.

PRESLEY: Yes, amalgams.

BURTON: And most people don't know that 50 percent of the silver fillings in your mouth, 50 percent of those are mercury.

PRESLEY: Yes. Yes, sir.

BURTON: And a lot of people don't know that.

PRESLEY: Other than that, the reason I got involved was because I've had personal experience around children who are medicated. And I see their behavior. And I see that it's usually something very obvious. They do have allergies.

I've seen them on it. I've seen them manic, crazy. And then they come off it and there's a whole another story. If you actually find the reason, there's always a simple explanation for it.

And I just don't want to see our future generation being drugged. And I also don't like to see it being promoted as something non- addictive when it absolutely is.

BURTON: One last question to Mr. Wiseman and I may ask a few more after we get through with my colleagues here. Are teachers qualified to diagnose medical conditions?

WISEMAN: Absolutely not, congressman. We have talked to people at the Department of Education who say that that's DOE policy. And virtually every state has that as a policy. Yet it's happening across the country.

BURTON: We actually have teachers in schools using a checklist that go to a doctor. And they are making a direct or indirect recommendation to the doctor that this child be put on Ritalin?

WISEMAN: Yes, they have checklists that come out of the Diagnostic Statistical Manual for ADHD. I have seen them.

BURTON: And the doctors, many times, follow the recommendations of the teachers?

WISEMAN: Of course.

BURTON: Ms. Morella, do you have questions?

MORELLA: I do, sir.

BURTON: Ms. Morella?

MORELLA: Thank you. Thank you, Mr. Chairman. And thank you for calling this hearing. And I wanted to thank the witnesses also for calling this hearing. And I wanted to thank the witnesses also for coming together to offer their comments on it.

What I particularly like is that you brought in witnesses that have various perspectives from all sides of the debate. And I think it's important that we listen to arguments from those who believe Attention Deficit Disorder is not a brain disorder and those who believe it is and warrants medication along the lines of Ritalin.

And considering that there has been a 500 percent increase in the use of Ritalin in the United States since 1990 and roughly 4 to 6 million children may be using it daily, I think it's important that we ascertain the root causes of ADHD and how to best alleviate its effects.

I want to ask a couple of questions, if I may. One -- you know, I might ask it of Ms. Presley. It's a pleasure to see you in person.

PRESLEY: Thank you.

MORELLA: Thank you for being here. And also to Mr. Wiseman, because I have before me a statement that has been made by the International Citizens Commission on Human Rights President Jan Eastgate (ph). This is a quote.

"Society has been under a concerted attack for decades, designed and implemented by psychiatrists. This attack claims countless lives each day. Like some malignant disease running rampant, it threatens the future of society and ultimately mankind."

Now what I'm wondering is: do you believe in this expression that I have just read to you? If both of you would comment on that, I would appreciate it.

WISEMAN: I can comment, congressman. We are a psychiatric watchdog group. We investigate and expose psychiatric abuse. And what we see going on in psychiatric hospitals, not only in the United States, but around the world, would make you weep.

I have personally investigated the abuses that go on in these hospitals, the physical abuse, the sexual abuse, the drugging people into stupors, the electroshock treatment. What psychiatry has done to our educational system, psychiatric testimony in the courtroom where murderers and rapists are let go because they're not guilty because they had an irresistible impulse, based on psychiatric testimony.

So I would certainly agree with Ms. Eastgate's (ph) comments.

PRESLEY: I personally have not seen it do any good for anyone I've ever known personally. That's just my own experience, whether it be drugging, electric shock therapy, which does still exist, which is very barbaric.

I don't think it goes -- I have my own personal issue with the subject. But that's not why I'm here right this moment. This is more related to the drugs again, which is psychiatry-based, of course.

MORELLA: So you put them all into that one category?

PRESLEY: I think they're all correlated.

MORELLA: If I could ask one other question? Several medical organizations like the AMA, the Centers for Disease Control and Prevention and the National Institutes of Health believe that Attention Deficit Hyperactive Disorder is a brain disorder that may require psychiatry or psychiatric drugs for treatment.

And I wonder: how could you explain the considerably different viewpoint that they hold, as opposed to the viewpoint of CCHR?

WISEMAN: I don't know if you're asking me or Ms. Presley, but I'll address it and she can as well.

PRESLEY: I'll address it as well.

MORELLA: Thank you.

WISEMAN: I think the operative word in your question, congresswoman, is "believe." And it's a matter of belief.

Our concern is that there is no biologic, organic, scientific basis for ADHD. These are subjective symptoms. These are behavioral symptoms. The child fidgets, he looks out the window, he butts into line.

The psychiatrist wraps these attributes up and throws a label on it. And the children are subsequently drugged. That various medical organizations believe that it's a brain disease is just that. It's a belief -- without true scientific validity.

Our point here really is parents should have an opportunity to get the other side. They need to have informed consent. They need to know, at the very least, that the diagnosis is controversial.

Ms. Presley, do you have anything to add?

PRESLEY: Yes, I haven't seen any evidence. I'm not scientific. I can't back it up scientifically. But I just have not seen -- whether it be a blood test to diagnose or any other thing to diagnose. It is not confirmed. There is no way to do it.

And there are too many people -- I would like to do a documentary on it actually one day, just to show how long it takes, when you take a child to a psychiatrist, before they whip the thing out and start writing a prescription. It's usually 10 minutes, 15 maybe? And it's usually just basically, you know, based on...

MORELLA: I could go on. And I am not a scientist. But I have always had a great belief in CDC and NIH and AMA. And you just said, "Forget it."

PRESLEY: I would like to just also point out that there is an intermingling of those three, of course. You know, the drug companies, pharmaceutical companies go along very much with the APA.

They all make money. It's a big industry, you know? To push drugs, diagnose disorders and give drugs for it. It's an industry. They're making money -- a lot of money, a lot of money.

MORELLA: Dr. Block, do you want to comment?

BLOCK: ... has stated that there is no valid test for it and that it is not a brain disorder. And also, the medical profession is based on coding. And it's coding based on getting paid by the insurance company.

So a diagnosis that can be objectively defined, such as diabetes, hypertension, things like that, there are codes for those things. The psychiatric community has made codes for their psychiatric disorders. But just because there is a code for it and doctors can diagnose it and get paid for it doesn't mean that there is an objective brain disorder going on.

MORELLA: Mr. Chairman, then I will yield back. But I would guess, Dr. Block, you would probably gain a little bit too if people were scared away from psychiatric drugs, right?

BLOCK: Do I gain?

MORELLA: You probably would gain financially.

BLOCK: I have a medical practice, working with these children. But for me, if I get them well and out of my office, they don't have to keep coming back; whereas, if they're being drugged, they do keep coming back.

MORELLA: Fine. Thank you very much, Mr. Chairman.

BURTON: Ms. Davis?

DAVIS: I have one more question for Ms. Weathers. When you took your son back to the pediatrician to get the prescription refilled, did you say he did not do a physical, he or she?

WEATHERS: No, she didn't. She did not do a physical exam to refill the prescription for Ritalin. He would have once a year physical before he started school. That was the only physical he had during the course of the year.

DAVIS: Thank you, Mr. Chairman.

BURTON: Judge Duncan?

DUNCAN: Mr. Chairman, I apologize. I had another meeting I had to go to, so I'm not going to ask any questions at this time. I'll ask them of the next witnesses.

BURTON: Let me just ask a few more questions. In particular, since Ms. Morella is still here, I would like for her to hear just a couple of things that were said in her absence.

According to the AMA, the properties of Ritalin very closely parallel cocaine, is that correct?

WISEMAN: Yes.

BURTON: And according to the AMA -- or not the AMA in this particular case -- according to some testimony that was given today, if you grind up Ritalin and make it into a powder, the effect of the Ritalin is very, very similar to the effect of cocaine. And it is habit-forming.

BLOCK: Not just the same. It is the same, not just similar.

BURTON: So cocaine and Ritalin, when put into powder form, are the same?

BLOCK: They go to the same receptor site in the brain and they provide the same high when taken in the same manner and are used interchangeably in scientific research.

BURTON: They're used interchangeably in scientific research.

BLOCK: Correct.

BURTON: OK, so when you put a child on Ritalin for a long period of time, there is a fairly good chance that that child will be addicted, just like a person who uses cocaine?

WISEMAN: Congressman, I know you asked that of Dr. Block, but if I might point out, there is a study by a Dr. Nadine Lambert at the University of California at Berkeley that followed 492 children for 26 years and found that those who were labeled with ADHD and given stimulants were 200 to 300 times more likely to abuse tobacco and cocaine in adulthood.

BURTON: They were 300 times...

WISEMAN: Two to three times more.

BURTON: Two to three times more likely to use...

WISEMAN: Tobacco and cocaine in adulthood.

BURTON: OK. Now let me ask you a question that I think we'll ask of the doctors that are going to come up here, so they will have a preview of some of the questions we're going to ask.

Has there been any autopsies on children who allegedly have ADHD to see if there was any difference between their brain and the brain of a child that had ADHD and were given these substances like Ritalin?

BLOCK: I don't know of any autopsies. I know that there are studies that have shown changes in the brain of children. But these children were taking drugs like Ritalin. And there have been studies that showed children who took cocaine had brain changes that looked like holes in their brain, just spots on the X-rays. And so the Ritalin may be making -- doing the damage that shows up in these children's brains.

BURTON: Is there any evidence, through autopsies, of brains that would show that children who have ADHD have any abnormality?

BLOCK: I know of no such studies.

WISEMAN: I know of no such, sir.

BURTON: Any other questions from -- let's see what we have here.

DAVIS: Mr. Chairman?

BURTON: Mr. Wiseman, let me just ask you a couple more questions. I'll get right back to you. Unless you want me to yield to you right now?

DAVIS: No.

BURTON: OK.

We've seen reports that Ritalin and antidepressants are being described for 2-year-olds in the Medicaid population. Are you aware of aware of any clinical trials that have evaluated the safety of these drugs in children aged 2 years old?

WISEMAN: No, sir.

BURTON: OK.

WISEMAN: In a word. And if I can say, I think it's a travesty that children, in some cases, that are still in diapers are labeled with ADHD and put on, in some cases, several mind-altering drugs. I think it's barbaric.

BURTON: So there have been no clinical trials to your knowledge?

WISEMAN: Not that I'm aware of, sir.

BURTON: Are you aware that the NIH conducted a consensus conference on ADHD several years ago? Did they look at the entire scope of treatment options? Or did they just focus on Ritalin?

WISEMAN: No, they primarily focused on Ritalin. I testified at those hearings in November of 1998. And they had three days of slides and presentations and so forth. And I read the final conclusion.

We do not have a valid, independent test for ADHD. There are no data to indicate that ADHD is due to a brain malfunction.

And finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remain speculative. That was after three days of presentations.

BURTON: But did they look at the entire scope of treatment options?

WISEMAN: No, sir.

BURTON: It was just Ritalin only.

OK. And finally, what biologic conditions can lead to an inability to concentrate in class? In the schoolroom?

WISEMAN: Well, as I mentioned in my testimony and as Dr. Block has said, there's a number of underlying physical problems, such as mercury poisoning, lead toxicity, and those kinds of things that actually can affect the nervous system and can make children act hyperactively.

BURTON: And just being kids.

WISEMAN: Yes.

BURTON: I will tell you, if they had had Ritalin when I was a boy, I have no question in my mind, as many times as I was sent to the principal's office for being out of control, that I would have been on Ritalin. I really believe that because I was a real pain in the foot.

(LAUGHTER)

Do you have any questions?

DAVIS: Yeah, if you will indulge me for a minute. You're saying that there is no proof that it's not a biological disorder. But there's no proof that it isn't. There is no proof that it's not a biological disorder as well, right?

WISEMAN: It's kind of trying to prove a negative, but that's correct.

DAVIS: What do you say to a parent who has had their child tested? There is no physical disorder, there is no mercury because there have been no fillings. There is no allergies, there's no nothing.

And you have more than -- Mr. Chairman, I believe the children who are ADHD, it's a lot more than just out of control. There's many more symptoms other than out of control.

They're not just a hyper child. What do you say to that parent who has had the child tested for everything and there is no other explanation? And then they take the Ritalin and it totally changes things?

BLOCK: I think that every parent has the right to choose what's best for their child. And the problem is they're not being made aware of the options and the possible side effects, that they are being pressured to put the child on the drug, even when they choose not to. And we are learning new things all the time because mercury doesn't just come from fillings. Mercury comes from vaccines and all children -- amongst all children that have had vaccines.

So there are many different reasons why children have these problems. And learning problems are a big one that schools often overlook. And nowadays, I'm finding out that even some of the places that used to test children for learning disabilities are now saying, "Well, they'll get them, see if they have attention deficit first. And then we'll look at that."

But it's the, you know, tail wagging the dog. It's the learning problems causing the attention and behavior problems. We need to fix those first.

DAVIS: I don't disagree with you. And just to set the record straight, Mr. Chairman, I fully believe in my heart that children are being overmedicated and everybody is being diagnosed if they're just being children.

Thank you.

BURTON: Thank you, Ms. Davis.

Yes, Ms. Morella, of course.

MORELLA: Thank you, Mr. Chairman.

BURTON: My great friend from Maryland.

MORELLA: Thank you. And it's simply that I was looking over the credentials. And I noted that the Citizens Commission on Human Rights was established by the Church of Scientology. Therefore, I wondered, how is the organization now related to Scientology? And what is the church's stance on psychiatry and psychiatric drugs?

WISEMAN: Well, Congresswoman, we're proud to have been founded by the Church of Scientology some 32 years ago. We are, however, an independent, IRS-recognized, public benefit corporation. And our role is a social reform activity to clean up the field of mental health.

So we investigate and expose psychiatric abuse and psychiatric violation of human rights.

MORELLA: Does the church have a stance on it?

PRESLEY: Can I just say no on that one? No. I mean, I personally am not here for that reason at all.

I'm here because I'm a mother and I care about children and that's it. And I knew that that was going to come up as a question in here. And I knew that it was going to be speculated that it's because you're a Scientologist, blah blah blah.

The bottom line is that I just think it's inhuman and it's not right. And it abusive and an epidemic and it needs to be looked into. It has nothing to do with religious beliefs or anything else, as far as I'm concerned.

MORELLA: No, I believe that you are motivated obviously because you care deeply about it. But I just wondered, does the church have a stand on it?

WEATHERS: Can I say something as a parent and just as a parent?

MORELLA: OK.

WEATHERS: I feel that this issue transcends all social and political and religious backgrounds. I think this is our children.

And we need to really address the issue that this is our children and this is our future generation here. This doesn't have to deal with anything other than our children.

MORELLA: I believe your motivation. I truly do. I'm a mother myself. But I am curious still about whether or not Scientology...

WISEMAN: Sure. I'm delighted to answer your question.

I've been a Scientologist for 32 years. Every Scientologist I know is very concerned about human rights abuse. But that's not really the issue from our point of view and why we're here.

Our concern is that parents aren't being given all the information and the choices. They're not given informed consent on the issue. That's really the concern, congresswoman.

BURTON: Before I yield to Mr. Gilman, let me just say, because we're going to have some votes on the floor, we had one in 10,000 children, according to CDC, that were autistic a decade or so ago. We now have one in 250 children or more that are autistic today.

We've had a fortyfold increase, 40 times increase in the number of children that are autistic in America. And there are a great many scientists and doctors that believe that some of the contents, including mercury, in vaccines are a major contributing factor.

We have an epidemic. The young lady, Ms. Weathers, talks about our kids and our future and what it's going to do to our society. Put a pencil to the amount of money it's going to take to take care of children today who are going to be adults in 15 years who are autistic, who can't get a job, who can't function properly in society.

You're talking about billions, maybe trillions of dollars. And we need to find the answers and get it straightened it out. And if mercury, as I suspect, is a major cause, then we damn well better get it out of our vaccines.

Mr. Gilman?

GILMAN: Thank you, Mr. Chairman. I'm curious, Dr. Block -- and I regret I had to go to another meeting and couldn't be here for your testimony, has there been any long-term study of the long-term effects of utilizing Ritalin?

BLOCK: No, there has not. The drug manufacturers themselves say there are no long-term studies. And the National Institutes of Health, when they had their conference, stated that most drug trials were very short, up to three months. Yet children are placed on these drugs for years and years without the knowledge that we need to know if they're safe.

GILMAN: Sounds like we have to undertake that study.

Background material provided to our committee cites American Academy of Pediatrics data that estimates four to 12 percent of children in the U.S. have some form of ADHD. Is this estimate applicable to other countries like Japan? Or this uniquely an American problem?

BLOCK: This is uniquely an American problem. Ninety percent of all Ritalin in the world is sold in the United States.

I have seen families from all over the world at my medical clinic. And those who have come from other countries always have an American connection. They were in an American school and told their child needed to be drugged.

If they moved them to the British school, they were told their child was fine. And I've seen this story occur over and over again.

GILMAN: When educators observe potential ADHD cases, how much weight is given to non-ADHD factors, such as the level of physical activity, diet, environment and other possible disorders?

BLOCK: Usually, there is not anything given to that. What is usually done is the teacher fills out a checklist describing behaviors that the child has at school. And parents may be asked to fill out this checklist.

The parents that bring their children to my office have told me that their doctor, in most cases, never did a physical exam, never listened to their child's heart, even though many of the side effects of the drugs can affect the heart.

They're not looking for other problems, not looking for allergies, learning problems, thyroid problems, anything physical or educational that might be wrong with the children, before labeling and drugging them.

GILMAN: In previous unrelated hearings covering the war on drugs, the drug enforcement Administration, DEA, has testified that many adolescent takers of Ritalin often hoard more supply and sell it to customers through an illegal secondary market. Is this a significant problem? And I address it to any of our panelists.

BLOCK: This is a significant problem. And there have been reports that indicate that Ritalin is the most abused drug in high school and colleges.

And there are other drugs, like Adderall. I don't want to just focus on Ritalin. There are many other amphetamine or amphetamine- type drugs that are abused on the street in the same way.

GILMAN: And in general, the percentage of the student body taking Ritalin or similar drugs is smaller in parochial schools than the same percentage in public schools. Why do you think that's the case?

BLOCK: Well, I can't think to exactly why. But from what I've heard, there is a great deal of discipline in many parochial schools. But I'm also seeing a change there, where the drugging of children is increasing in private and religious schools to a great extent as well.

GILMAN: Do any of our panelists want to add any comments to the questions I've just asked?

WISEMAN: Only, congressman, that last year or perhaps the year before, there was legislation proposed and I believe it passed by Congressman Holt's -- Henry Hyde's committee, excuse me -- that dealt with this issue of the abuse of Ritalin in schools. The DEA was very concerned about it.

And I don't recall the number of that legislation or its name. But I think that was in the year 2000. Legislation was actually proposed and passed, I believe, in this body that dealt with that issue.

GILMAN: Ms. Presley, did you want to comment?

PRESLEY: I don't know the statistics and the formalities of what exactly -- this is more for you two, I think.

GILMAN: Ms. Weathers, did you want to comment?

WEATHERS: No, not at this time. I don't know the statistics.

GILMAN: And Dr. Block, do you have any final statement you'd like to make?

BLOCK: Well, I think that all of us have consistently stated that we're very concerned about the abuse of these drugs and our children and the fact that parents are not given informed consent and not given all the options to look at all the possible problems that their children might have to correct those problems and not drug them. And I think that's what we'd like to see changed.

GILMAN: I want to thank our panelists for being here today and giving us your testimony. Thank you, Mr. Chairman.

BURTON: We have eight minutes and 33 seconds on the clock. I have a couple more questions for this panel and then we'll dismiss them, unless the other panelists have some questions.

We have one vote on the floor and then if you could come back, we would appreciate it. Let me just say that I really appreciate you being here.

One thing I would like to clear up is although there are people here who are members of the Church of Scientology, there are a lot of other people that you work with that are not members that share the same views. Am I correct on that?

WISEMAN: We work with allied groups across the country.

BURTON: Dr. Block, you're not a Scientologist, are you?

BLOCK: No, sir. I'm not.

BURTON: Ms. Weathers, you're not a Scientologist, are you?

WEATHERS: No, absolutely not.

BURTON: I just hope that there is no stigma attached to the people at this hearing because of their religious beliefs. We're here today to find out if -- and find evidence to find out if -- there is an abuse of Ritalin and other drugs of that type and whether or not they are habit forming and whether or not they are absolutely necessary and whether or not parents are getting adequate information so they can make an informed decision.

Those are the major issues that we're looking at here today. And I appreciate it very much.

I will have additional questions for this panel that I would like for you to submit in writing. And any legislative proposals that you think needs to be made, we'd like to have that in writing.

We can't guarantee that all of them are going to be enacted. You know the legislative process is like watching sausage being made. You don't want to watch it.

(LAUGHTER)

But we will take a look at all that.

Anything else from the committee before we recess? OK, we stand in recess to the fall of the gavel and we'll go to the next panel when we come back.

PRESLEY: Thank you very much.

(RECESS)

BURTON: The committee will reconvene. We'll now hear testimony from the second witness panel, Dr. Richard K. Nakamura. He is the acting director of the National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services.

Unfortunately, the Department of Education's witness was unable to be here today. Why is that?

OK, so doctor, would you please approach the table? Where is he? In the bathroom. OK, well, we will wait. I certainly wouldn't want to interfere with that.

Does anybody know any good jokes?

Dr. Nakamura, welcome. No, that's all right. I understand exactly. Would you please stand so you can be sworn, sir?

Do you swear to tell the whole truth and nothing but the truth, so help you God? Thank you.

I presume, after hearing the testimony of the other witnesses and the questions, you have an opening statement. OK, would you proceed? Can you turn your microphone on, sir?

NAKAMURA: Thank you, Mr. Chairman and members of the Committee on Government Reform for the opportunity to discuss an important medical condition here today. I am Richard Nakamura, the acting director of the National Institute of Mental Health. Professionally, I am a brain scientist, also called a neuroscientist.

The National Institute of Mental Health is one of the National Institutes of Health. We are the federal health institute responsible for research to reduce the burden of mental illness and other behavioral disorders. We take that responsibility seriously.

Ultimately, this hearing is about our children and helping them live full, productive lives. I come here before you both as a scientist and as a parent of children, some of whom have received services themselves.

Permit me to provide some background information from the neurosciences. We used to think that the brain simply unfolded according to strict genetic instructions. And those instructions, like body growth, ended in late adolescence and the brain was done.

From there, it was thought that it was all downhill and one could only lose neurons. But now we know that the brain is actively constructed from birth -- and even before birth -- by an interaction of genes with behavior and the environment. On the way, the brain goes through periods of massive growth and significant pruning or cell loss.

This is normal. We know that that pruning occurs to neurons that do not get incorporated into behavioral programs of the brain. Thus, we lose neurons that are not used.

Genes provide the scaffold for this growth, but the actual survival of neurons and their connections are determined by our environment and our behavior. This has important implications for disorders such as ADHD.

Parenthetically, we also know that there are some new neurons that develop in the brain every day of life, true to at least the age of 72, to help us older dogs learn new tricks.

What is ADHD or Attention Deficit Hyperactivity Disorder? There are two major components. First, there is an inattention or distractibility component. And this is the primary feature in ADD.

And then there is a hyperactivity or impulsivity component. For a diagnosis of ADHD, the diagnosis must be of long duration. It must be developmentally inappropriate. It must cause significant impairment. And it must be present in two or more settings of a child's life -- for instance, at least school and home.

When diagnosing ADHD, a clinician must be very careful to distinguish between that disorder and several other conditions that may look similar, such as sensory or learning disorders, anxiety or bipolar disorders and many others that have already been mentioned here. An adequate workup cannot be done in 15 minutes.

In this regard, I have the statement from the American Academy of Pediatrics, which has a very good guideline for how to do an adequate workup of ADHD. And I would like to submit this and some other documents for the record.

BURTON: Sure, without objection.

NAKAMURA: Three to five percent of children are diagnosed with ADHD, with boys being much more affected than girls. While some have questioned the reality of ADHD because we do not have a biological marker for the condition, the reality of individuals that cannot focus on a task for developmentally appropriate periods of time and show significant learning and job performance deficits as a result have convinced most physicians and scientists, just as most are convinced that other behavioral disorders without clear biomarkers, such as autism and schizophrenia and pain are real.

In these cases, it is the clarity and consistency of the behavioral syndrome or the effectiveness of interventions that is convincing. Many large professional and scientific bodies have looked into the topic of ADHD and have concluded that it is real.

Some of these groups, for the record, are: U.S. surgeon general, the American Medical Association, the American Psychiatry Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association and the American Academy of Pediatrics.

Also in 2002, an international consensus statement on ADHD was published by a large group of scientists who indicated their belief that the evidence for ADHD was very well justified and scientific.

What about the outcomes of untreated ADHD? There is an initiation of a trajectory because children who cannot attend or hyperactive have great trouble learning. Since learning is progressive and since our brain structures are determined by our behavior and learning, we need an active intervention to keep healthy outcomes on track.

Untreated, ADHD leads to increased medical utilization, school failure, poor social relationships, anti-social activities, use of harmful substances, brushes with the law and serious accidents.

So how is ADHD treated? Because ADHD is a chronic problem and treatments need to work for long periods, we recommend early detection and beginning with behavioral approaches, including parent and child training.

Now remember, this is after a diagnosis has been reached and all other possibilities have been eliminated through the appropriate differential diagnosis. Obviously, if behavioral approaches work, they should be employed with occasional booster training sessions.

However, in many cases, this will not result in improvement. So then we recommend a trial of a stimulant medication. In our experience, stimulant medications are highly safe and effective for properly diagnosed children and adults.

Now no choice of a stimulant medication should be made without careful consultation between parents, the children and clinicians. We do not believe that teachers, other than potentially making a suggestion that the child has a problem and it might be ADHD, beyond that teachers should not be diagnosing, nor recommending treatment for the condition.

When stimulant medications are used, there should be a long-term follow-up to ensure the continuing efficacy of treatment, proper dosing and proper adherence. What this means for children is that a trajectory that can lead to school failure -- I'm sorry, there is one other important point to make.

We have estimated and our data suggests that behavioral and/or medication treatment therapies will help 90 percent of children with ADHD. What this means for children is that a trajectory that can lead to school failure and social difficulties can be interrupted and replaced by a trajectory that can lead to more normal behavior and, therefore, more normal brain and behavioral development.

BURTON: Excuse me, Dr. Nakamura. Would it be possible for you to summarize the rest of your statement so we can get to the questions?

NAKAMURA: Sure.

BURTON: I want to get all of the substance of everything you have to say. And we will be -- all the members will be reading your statement.

NAKAMURA: I have one more paragraph.

By intervening to keep a child's development on track, many ADHD children can be helped to normal, productive lives. That is the point of our efforts.

I would like to say a final word about science. Science is a procedure that helps us learn the truth about interventions and outcomes by systematically testing ideas about the world and about human beings. This is the best way we know to learn whose ideas are right and how to keep us from continuing therapies that do not work or actually cause harm.

Ultimately, we need to move away from anecdotes to scientific tests of ideas if we are to have the best and most helpful lives.

Thank you.

BURTON: Thank you, doctor.

There are about 6 million children in America that are using Ritalin or substances very similar to that. Do you think they all need that?

NAKAMURA: We have heard different numbers. We don't know exactly how many children are being prescribed. But we have heard the number in the range of 3 million, as opposed to 6; 6 might include all the adults.

BURTON: Well, Pat...

NAKAMURA: But I won't dispute it.

BURTON: Pat Weathers, who testified, she said that her child was fine at home, but at school didn't pay much attention and was looking out the window and that sort of thing, like I did when I was a child, because I wanted to play baseball or, as I got older, chase the girl down the street. And she said that the teacher had a checklist and went through the checklist and called her in with the principal and said, "Your child has attention deficit problems. And we think that he ought to be treated," or she ought to be treated -- was it he or she?

"He ought to be treated." They went to the doctor. And she said the doctor looked at that, spent less than 15 minutes with them and prescribed Ritalin.

Now according to your testimony, that's not the way it should be done. Is that correct?

NAKAMURA: Given the description and because I don't know the particulars of this case, but given the description, no. That is not the way it should be done.

BURTON: Well, I mean, I listened to your testimony very closely. And you said that you ought to look at school. You ought to look at home. There ought to be consultation. There ought to be a whole lot of things that take place before you start using Ritalin.

Isn't that what you said?

NAKAMURA: Yes.

BURTON: Yeah. We have heard a lot of stories about teachers saying, "This child has an attention deficit problem." And they do this checklist and they send them to doctors. And the Ritalin is just a fait accompli. They're going to give it to him when they go there.

You don't think that's right, do you?

NAKAMURA: The guidelines of the American Academy of Pediatrics and the Institute's position are that you cannot make the diagnosis and you should not be writing a prescription with that little information.

BURTON: Have our health agencies informed our educational system around the country or state superintendents of public instruction or local school boards that there are certain things that should be followed? To give them a diagram on what they should do before they start giving children Ritalin and sending them to the doctor?

NAKAMURA: The information is certainly available on web sites. We have not, as an institute, sent information directly to all the schools in the country.

BURTON: Well, let me just tell you a story. One of the doctors, one of the most important doctors here on Capitol Hill, I said, "Do you know there is mercury in the vaccines you're giving us for flu?" And he said, "No, there's not."

And so I took the insert out. And I gave it to him and he looked at it and said, "Well?" And I said, "Well, thimerosal has mercury in it." Well, he didn't know that. The doctor didn't know that.

Now if we're spending all this money on our health agencies and you have a criteria that's supposed to be used for children before they go on these mind-altering drugs, then why in the heck doesn't the schools know about it? Because they don't. Many of the doctors don't even know that.

Now I want to talk to you about neurons. And I would submit to you that our health agencies, for a very low cost, could put it on their e-mail site and they could send a notification out to all state boards of education and local school boards and say, "On our e-mail site, we have the criteria that should be followed before a child starts taking Ritalin or other drugs of this type."

I don't know why you don't do it. It makes sense to me. And it would save the legislative branch a lot of time and trouble.

Now I want to talk to you a little bit about the neurons you were talking about. You talked about the neurons growing and being replaced and replicated on a very regular basis. Do you think mercury has an adverse effect on neurons?

NAKAMURA: I honestly don't know. I believe that mercury is clearly a substance you don't want in the body.

BURTON: Let me ask you this. Thimerosal, most of the vaccines we're sending overseas to all these kids in Third World countries still has it in there. And they're getting it out gradually here in the United States, but not as quickly as they ought to because we have had this absolute epidemic of children that are autistic from one in 10,000 now to one in 250.

And a lot of people say, "Well, that figure, one in 10,000, might be way off." But we do, everybody acknowledges we've got a big, big problem, even if that figure is incorrect. I don't think it is.

But we had some scientists from Canada send us a video, which I want you to give a copy to the doctor. Have you seen that video?

NAKAMURA: I don't believe so.

BURTON: It shows the neurons, which there is a sleeve on the neurons, is there not? Isn't there a sleeve?

NAKAMURA: Right.

BURTON: It shows what happens to the sleeve on the neurons when a very minute amount of mercury is introduced into the close proximity to it. And it just destroys it. It just destroys it.

And ultimately, it destroys or damages severely the neurons. Would you say that would have an impact on the brain of that child?

NAKAMURA: Yes. It certainly depends on the form of the mercury. But...

BURTON: The form? You say the form of the mercury.

NAKAMURA: There are some forms of mercury...

BURTON: Oh, I know there are two different kinds that we're talking about. Has there been testing done to show that one of them has an impact, but the other one doesn't? On neurons?

NAKAMURA: I could not tell you about that result. I do know that one form is much more destructive than the other form and that thimerosal contains the less destructive form.

However, I would agree that I would not like to see mercury...

BURTON: Well, the hearings we have had -- and I've had scientists and doctors of your caliber from all over the world. And the thimerosal and the mercury in these vaccines is very damaging. And they believe it contributes to neurological problems in these kids.

And you said it yourself. No mercury should be introduced into the human body.

And yet, they're doing it every day. And they did it to me. And they did it to every member of Congress that wanted to get a shot for flu. Why is that?

NAKAMURA: I can't offer you any explanation for that.

BURTON: You're with the Department of Health.

NAKAMURA: I am with the Department of Health. The Center for Disease Control and the FDA are the controlling organizations.

BURTON: Are they part of the Department of Health?

NAKAMURA: Yes.

BURTON: Do you ever talk?

NAKAMURA: They don't ask my advice on the issue of vaccines.

BURTON: So how do we get the message down to them besides going down there with a ball bat and hitting them in the head?

NAKAMURA: I would be happy to pass this information on through the department, to the appropriate organization.

BURTON: Well, I think they already know this.

NAKAMURA: I believe they do, too.

BURTON: Yeah, they've been to my committee before and they're going to be back here again. And they think they're going to get rid of me...

NAKAMURA: You are very, very clear.

BURTON: ... when I'm not chairman any more, but I'm going to be here. And I'm going to probably be a subcommittee chairman. And I can guarantee you, if I am, I'm going to be on the Health Subcommittee. So I'm going to have you guys back again and again.

Now let's talk about the cocaine. Is there any relationship between -- and I'm going to go to my colleagues as soon as this question is over. I've run way over, so excuse me.

Is there any connection or is there any relationship between cocaine and Ritalin? Do they have any of the same properties?

NAKAMURA: The stimulant properties of both derive from similar chemical properties.

BURTON: If a person who wanted to snort cocaine, if they ground up Ritalin and made it into a powder form, would it have a similar effect on their brain?

NAKAMURA: It would probably not do as much for them. However, yes, they would get a high from ground up methylphenidate.

BURTON: So they are similar?

NAKAMURA: They are similar in that sense, yes.

BURTON: Could you become addicted to Ritalin ground up and snorted like cocaine?

NAKAMURA: That would increase the addiction potential of the methylphenidate, yes.

BURTON: OK, so why is it that children taking Ritalin might not become addicted and become a more likely prospect for long-term addiction to more stronger drugs?

NAKAMURA: There are a couple of things going on. One is that our experience has been that this is not happening, that most children are using this appropriately, that pharmacies and physicians are being fairly careful about their prescribing practices, so they don't allow automatic renewals of prescriptions and that the number of pills are counted to make sure that the number of pills being taken by the child...

BURTON: I understand, but a lot of children get this in the early years and they spread it out maybe all the way through high school. Is there a possibility of addiction?

NAKAMURA: So far, when we have looked, there is either no increase in addiction or slightly reduced level of addiction for kids who are on medications compared to kids who are not on medications.

BURTON: You have done long-term studies on this?

NAKAMURA: We have done studies that have varied in the amount of time from 14 months to 20-something years.

BURTON: Is that right? And yet you say the properties are very similar to cocaine?

NAKAMURA: Yes.

BURTON: I don't understand that disparity there. Maybe you can explain that in the second round.

Let me yield to my colleagues.

Mr. Gilman?

GILMAN: Thank you, Mr. Chairman.

Dr. Nakamura, welcome to our panel.

NAKAMURA: Thank you.

GILMAN: In your testimony, you stated that "good treatment begins with accurate diagnosis, which can best be achieved through implementation of state-of-the-art diagnostic approaches in practice settings. We know through research that a clinically valid diagnosis of ADHD can be reached through a comprehensive and thorough evaluation done by specially trained professionals using well-tested diagnostic interview methods." That's your testimony, is it not?

NAKAMURA: Yes.

GILMAN: Basically, your testimony implies that doctors don't need to do any evaluation of possible biological issues, such as thyroid or heavy metal toxicities, things for which there are objective clinical tests, rather than a subjective interview method. Doesn't it worry you that by not doing good medicine -- in other words, biomedical evaluation -- children with biological issues are simply having the symptoms suppressed, rather than resolved?

Does that concern you at all?

NAKAMURA: By stating that a proper workup be done, we meant that proper differential diagnoses also be done. And we recommend the American Academy of Pediatrics clinical practice guidelines, which make it very clear that you need to do an adequate differential diagnosis, so you eliminate other possibilities.

Now there are, I think, reasonable questions about whether or not some areas will produce these kinds of symptoms. So I believe between ourselves and the earlier panel, there may be disagreements about how much allergies can participate in this, et cetera. But we do recommend that those be checked before making a recommendation and a diagnosis of ADHD.

GILMAN: So there should be a good biomedical evaluation. Is that what you're saying?

NAKAMURA: Yes.

GILMAN: You state that ADHD is one of the most researched conditions in children's mental health. Just how much is being spent on that kind of research at NIMH and NIH?

NAKAMURA: Well, more than NIMH just spending money, I can tell you that last year, we spent $53 million studying ADHD.

GILMAN: Is any of this research evaluating biological issues, such as mercury or lead toxicity, that our chairman has indicated?

NAKAMURA: None of this at the moment is looking at lead toxicity and mercury.

GILMAN: Is there any reason why you're not looking at it?

NAKAMURA: We have, as our process, a peer-reviewed competition for grants. We would be quite interested in getting an application which tried to look at the contributions of both lead and mercury to ADHD.

GILMAN: Do you need an application to undertake that kind of a study?

NAKAMURA: Well, we found that, in order to get studies done well, getting them in through a peer review process is very important. If any of you have investigators who have indicated that they are interested in pursuing this study...

GILMAN: Well, we're interested in this committee. Do you need an application to dig into that kind of an approach?

NAKAMURA: We need an application to make sure that the research that's proposed will answer the question.

GILMAN: Don't you initiate any studies on your own? Do you have to wait for applications if there is some problem out there?

NAKAMURA: We can initiate studies on our own.

GILMAN: Well, I suggest that maybe you ought to take a look at the mercury or lead toxicity on your own, rather than waiting for an application. Is any of the research evaluating alternative therapies, such as acupuncture, neurofeedback, massage, craniosacral therapy and special dietary approaches? Is there any research now looking at any of those?

NAKAMURA: I understand that the National Center for Complementary and Alternative Medicine is pursuing all of those.

GILMAN: They are undertaking that?

NAKAMURA: Yes.

GILMAN: I just have one or two other questions, doctor.

In a 1995 background paper from the Drug Administration, DEA, the following statement was made -- and I quote -- "It has recently come to the attention of the DEA that Ciba-Geigy, the manufacturer of Ritalin, marketing under the brand name Ritalin, contributed $748,000 to CHADD from 1991 to '94. The DEA has concerns that the depth of the financial relationship with the manufacturer was not well known to the public, including CHADD members, that have relied upon CHADD for guidance as it pertains to the diagnosis and treatment of their children."

"In a recent communication from the United Nations International Narcotics Board, INCB expressed concern about non-governmental organizations and parental associations in the U.S. that are actively lobbying for the medical use of Ritalin for children with ADHD. The UN organization further stated that financial transfer from a pharmaceutical company with the purpose to promote sales of an internationally controlled substance would be identified as hidden advertisement and in contradiction with the provisions of the 1971 convention."

"In fact, a spokesman for Ciba-Geigy stated that 'CHADD is essentially a conduit for providing information to the patient population.'" That's a direct quote from them. "The relationship between Ciba-Geigy, which is now Novartis, and CHADD raises serious questions about CHADD's motive in proselytizing the use of Ritalin."

This is what DEA had to say. And this same DEA paper states that CHADD, in conjunction with the American Academy of Neurology, submitted a petition to reschedule Ritalin from Schedule II to Schedule III under the Controlled Substances Act because controls are unduly burdensome for the manufacturer and for physicians who prescribe it and patients who need it. CHADD denied that the financial contributions received from Ciba-Geigy have any relationship to their actions.

And the DEA went on to note that of particular concern to them was that most of ADHD material prepared for public consumption by CHADD and other groups and made available to parents does not address the above potential or actual abuse or Ritalin. Instead, it is portrayed as a benign, mild substance that's not associated with abuse or any serious side effects.

The DEA went on to note in their report -- and I quote -- "In reality, however, there is an abundance of scientific literature which indicates that Ritalin shares the same abuse potential as other Schedule II stimulants. Case reports document that Ritalin abuse, like any other Schedule II stimulant, can lead to tolerance and severe, psychological dependence."

"In a review of the literature, the examination of current abuse and trafficking indicators reveals a significant number of cases where children are abusing Ritalin."

So what is your comment with regard to DEA's report?

NAKAMURA: The key thing that I would comment is it's very important to realize that when ADHD is properly diagnosed, there seems to be very little problem with substance abuse and even diversion. The GAO recently put out a report on attention disorder drugs, reported that there were few incidents of diversion or abuse identified by schools.

And that it's the experience that we have, so far, which indicates that there is not an increase in abuse by those with ADHD who are taking Ritalin. Rather, there is either a normal amount or a reduced amount of abuse by those kids. We do know that untreated ADHD kids go on to abuse drugs at high proportions.

BURTON: The gentleman's time has expired.

GILMAN: Please, can you yield? I just have one more.

BURTON: Sure, OK. Go ahead.

Yield to me just for one second, though.

GILMAN: Sure.

BURTON: Was that the only study that was done on that, that said that there was no increased abuse?

NAKAMURA: No, there were three studies.

BURTON: OK, tell me about the other two studies real quick. Weren't there other studies that showed that there was increased use?

NAKAMURA: There was one study...

BURTON: There was one study. You didn't mention that. It's interesting that you mention the one that says what you want, but you don't mention the one that says what you don't want.

And this Congress up here doesn't want you to come up here and shade things the way that the health agencies want. We want you to tell the truth for the American people. It really bothers me that you guys do this all the time. You do it all the time.

Tell the whole truth, not just the part that you want told.

What was the other thing, real quickly?

And the pharmaceutical companies, Congressman Gilman just made a strong point here. The pharmaceutical companies found an awful lot of this stuff, these studies and other things that you're talking about. You said the GAO said that there was no problem with this.

You didn't quote the DEA. The DEA is the agency that we charge to go after the drug dealers and the drug abusers and the drug problems in this country. Why is it you didn't quote the DEA instead of just a GAO study that you asked for?

NAKAMURA: I had just been given the information about DEA.

BURTON: You mean to tell me you guys don't have access to that over there?

NAKAMURA: No, I just pointed out that there was other information as well.

GILMAN: Thank you. And I'll yield in just a moment. But doctor, are you concerned about the relationship between CHADD and the pharmaceutical company? Is there any concern by NIH with regard to that?

NAKAMURA: That is not an area -- I don't believe that the NIMH has a right to interfere with that transaction. What we try and do, make very careful about NIMH, is that there is no interaction with drug companies that could influence our decisions.

GILMAN: But here we have a drug company that is influencing a parental group. And that drug company has some financial motivation. Isn't there any oversight by NIH of that kind of a relationship?

NAKAMURA: No, there is no oversight that I am aware of at NIH. NIH's job is to do good research. And that's what we try and do.

GILMAN: Well, I hope that NIH would do more than just do research and make certain that the information given to the public is factual and not motivated by any financial interest.

I'll be pleased, Mr. Chairman, to yield the balance of my time.

BURTON: Mr. Horn?

HORN: Dr. Nakamura, a study conducted at Georgetown found that children with ADHD are seven times more likely to have food allergies than other children? Isn't it true that children in an allergic state would be adversely affected in their ability to focus and concentrate?

What has NIMH and NIH done to evaluate the correlation between food allergies and attention disorders?

NAKAMURA: My understanding is that we have had some earlier studies in which we looked for allergies as related to ADHD and other kinds of externalizing or disruptive behavior disorders and found that a small proportion -- about five percent -- could be accounted for by those allergies. And certainly, we believe that where they exist, you take care of those before you develop a diagnosis.

HORN: Are you concerned that children may be misdiagnosed with ADHD?

NAKAMURA: Absolutely.

HORN: Well, that's good to know.

NAKAMURA: We would very much like to see children properly diagnosed. In our current system, physicians are compensated inadequately for working -- for doing a full workup. It is hard for physicians, as we understand it, to get more than a certain amount of money.

This might have a tendency to cause them to move a little too fast and maybe not have enough time to come up with alternative conclusions about a disease process.

HORN: Dr. Nakamura, in the Novartis PDR in Ritalin, there is a warning that Ritalin should not be used in children under the age of six years because the safety and efficacy had not been established. I am troubled that the National Institutes of Health would offer to pay parents of 3-year-olds over $600 to test Ritalin on their children.

And there is apparently -- let's see here, it was the APA meeting quote. And is the federal government testing psychotropic drugs in children under the age of 6?

NAKAMURA: Let me tell you how this study is being conducted.

HORN: Go ahead.

NAKAMURA: Because of the reports that so many children are being provided with Ritalin at younger ages, the National Institute of Mental Health decided that it needed to do a study on the safety of such drugs at those lower ages. Our IRB looked at this issue very carefully.

And we did the following: we have run the most vigorous study possible, to exclude children from this study, in the sense that we do a very vigorous examination of whether or not alternative possibilities for explaining the behavior of the children. We require that the children go through a full behavioral therapy session, that is a set of sessions, before they are begun. And only then is there a final getting the parents' permission to go ahead with the trial of Ritalin.

HORN: How many children are under six years of age?

NAKAMURA: I believe that the design is to get 100 children.

HORN: In your testimony, you talk about the studies that have been conducted on individuals with ADHD have -- quote -- "less brain electrical activity and show less reactivity to stimulation in one or more of these regions." Are you still standing by that?

Can you please tell us if any of these tests were conducted on individuals diagnosed with ADHD who had never been treated with psychotropic drugs?

NAKAMURA: In those studies, no. We are about to see a study come out in which that specific comparison has been made.

HORN: Please explain how the drugs can affect these same activities in the brain.

NAKAMURA: Pardon me, I don't understand.

HORN: Please explain how the drugs can affect these same activities in the brain.

NAKAMURA: I'm sorry, it's -- which same activities in the brain?

HORN: We'll submit it to you and put it at this point in the hearing record.

NAKAMURA: I apologize for not understanding.

BURTON: He is talking about the brain activity, less brain electrical activity.

NAKAMURA: And the drug is stimulating it.

BURTON: Yes, he is talking about how would it affect it? Go ahead.

NAKAMURA: So let me explain what we believe is going on with stimulant medications; that is, that certain portions of the brain show reduced activity compared to normal children. And this is in the area of executive function, particularly in the frontal lobes.

Unlike an earlier statement, it isn't because blood is going slower. Blood is going at the normal rate. It's the activity and the oxygen pickup of those neurons which is different, which means that the frontal lobes aren't using as much energy as those in normal.

And by a small amount of Ritalin, it increases and selectively increases the amount of energy and the activity of neurons in the frontal lobes, which provides the executive function these kids need in order to control their behavior better.

HORN: I yield back my time to the chairman.

BURTON: Thank you, Mr. Horn. We are not through questioning Dr. Nakamura, so you will have another chance.

Ms. Davis?

DAVIS: Thank you, Mr. Chairman. If I just heard you correctly, you said the Ritalin speeds up the activity in the frontal lobe. So did you hear me give the explanation earlier to the first panel about the blood flow in the frontal lobe of the brain? Can you comment on that?

NAKAMURA: Yeah. When you do certain studies, in order to look at the activity of the brain, what it actually does is looks at the flow of oxygen through the brain. It's sometimes called blood flow.

What you're really concerned about is the activity of the neurons in the brain. And so it isn't so much a problem of slow blood. It's a problem of neuroactivity, which the blood is a surrogate measure for.

What we've been finding is that frontal lobe activity in those with ADHD is reduced and that the Ritalin helps increase it. Because frontal lobes are responsible for executive function, that makes it easier for self control and for self-directed activity to go on.

DAVIS: Based on that and to go back to -- I forget who asked the question -- about the possible addiction of Ritalin because it has the similar characteristics of cocaine. It was my understanding that if you put a child -- and I'd like you to comment on it -- put a child on Ritalin who is not ADHD, it has a different effect on that child than the child who has ADHD.

For instance, our son, when we put him on Ritalin, because a normal -- had normal behavior, not slowed down, dead, lethargic or a zombie or what have you, but actually became what you would call normal. But if you put a child who was not ADHD on Ritalin, it was like giving them speed. And they actually become the opposite and become hyper.

Can you comment on that?

NAKAMURA: In general, if children, normal children, use Ritalin at normal doses and through normal pathways -- that is, ingestion -- they might have side effects of losing sleep and losing weight. But at those levels, it shouldn't become addictive. And cocaine has much less addictive properties when ingested in a slow way when you ingest it.

If you change the way it's delivered to the body, so that you figure out a way of injecting it, a way of snorting it or sniffing, that speed increases the addictive properties. I understand that one of the things that drug companies are trying to do are create a form of methylphenidate, which is less able to be ground up and used in any form other than the appropriate ingested form.

So I believe the drug companies are trying to solve the problem of the potential addictive properties if you misuse these chemicals.

DAVIS: Is there any validity to giving Ritalin to a child who is not ADHD and giving it to one who is, that there is a difference in the behavior?

NAKAMURA: I'd like to liken it to a bell-shaped curve in the sense that if performance is optimal, at the peak of a curve, for a normal child who is at the peak of the curve, you're going to push them past optimal performance. There may be some gains, in terms of being able to stay up late or do a short-term sports event. But there are more penalties to be had for those children.

For those with ADHD, it appears that they are onto the left of the curve and can be pushed up to normal performance by these drugs.

DAVIS: Thank you, Mr. Chairman. Thank you, doctor.

BURTON: Judge Duncan?

DUNCAN: Thank you, Mr. Chairman.

Dr. Nakamura, you may have heard me this morning when I stated that -- or quoted one article in which the just-retired deputy director of the Drug Enforcement Administration said that Ritalin is prescribed six times as much in the United States as in any other industrialized nation, six times as much as in Canada, Great Britain, other countries like that. Does that concern you?

Do you know of any reason why that would make any sense at all? And also, that "Time" magazine said that production of Ritalin has increased sevenfold in the past eight years and that 90 percent of it is consumed in the United States, 90 percent?

NAKAMURA: Yes, this is of concern. However, the United States is often at the leading edge of a number of things. And so it's not completely surprising that it should be happening more in the United States.

I do know that the use of Ritalin is up strongly in Europe and that it is perceived as being safe and effective. And the experience in the United States is being taken into consideration here.

DUNCAN: I have an article here that says, an article last year in the "Journal of the American Medical Association" said that psychotropic medications have tripled in preschoolers, ages two to four, during the previous five years, the past five years. More disturbing is that during the last 15 years, the use of Ritalin increased by 311 percent for those ages 15 to 19 and 170 percent for those ages five to 14. And that's from the "Journal of the American Medical Association."

And this "Insight" magazine that I quoted earlier this morning says that of approximately 46 million children in kindergarten through grade 12, 20 percent have been placed on Ritalin at some point. And your figures are much, much lower than that.

NAKAMURA: Yes. All the figures that we have on national prevalence of the use would make us very surprised if the figure surpassed five percent.

DUNCAN: But you don't question these figures from the "Journal of the American Medical Association" that say that psychotropic medications have tripled in preschoolers during the previous five years?

NAKAMURA: We accept that. And we are very concerned about what that means and how practice is being changed. Our previous director, Steve Hyman (ph), was not convinced that we knew enough about diagnosis of some of our disorders at those ages to be prescribing medications.

One of the...

DUNCAN: It says in this article here, it says, "This can be good news only for investors in the Swiss-based pharmaceutical company Novartis, which makes Ritalin." For instance if the number of children taking the drug increased fivefold, so did the drug company's resultant profits and stock value -- presumably stock value.

In a June 28, 1999 article, "Doping Kids," it was estimated that Novartis generated an increase in stock market value of $1,236 per child prescribed Ritalin. Based on these evaluations, the drug company would have enjoyed an increased stock market value of approximately $10 billion or more since '91.

NAKAMURA: I can assure you that I haven't shared in any of that.

DUNCAN: I know you meant that to be humorous. But I think this is very sad that we may be drugging or doping children and that it's all about helping a big drug giant make whopping profits.

And let me ask you this, getting more directly into your field, and I'm just curious about this. I know nothing about it.

Is there a real difference or are there significant differences between the brains of small boys and small girls?

NAKAMURA: Yes.

DUNCAN: That might cause this? Because everybody has said that there are many more small boys that are being prescribed this medication than small girls. Is there anything in your research on the brain that would help explain that?

NAKAMURA: There is no question that the hormone differences between boys and girls, which increases at early adolescence, creates differences in behavior.

DUNCAN: Early adolescence, most of these kids are being prescribed this before early adolescence.

NAKAMURA: Yes. There are hormone differences that start from birth. And one important point is that there are some who feel that attention deficit is much more prevalent in girls than we have measured and that girls have simply not been identified because they are not seen as a problem. They simply sit in the classroom and fail quietly, whereas boys tend to act out at the same time. So they come to the attention of teachers and the girls are ignored.

DUNCAN: My time is up. But let me just ask one more quick question.

I spent 7.5 years before coming to Congress as a state trial judge, trying the felony criminal cases, the most serious criminal cases. And the first day I was judge, they told me that 98 percent of the defendants in felony cases came from broken homes.

And I went through, because 96 or 97 percent of the people plead guilty and apply for probation, I went through about 10,000 cases. And I can't tell you how many thousands of times I read, "Defendant's father left home when defendant was two and never returned. Defendant's father left home to get a pack of cigarettes and never came back."

And I can tell you this: crime goes back, it's caused by drugs and alcohol and running with the wrong crowd and all that. But you can trace all the felony crimes, with very few exceptions, back to this broken home situation.

And I remember reading one article that said that, I think, 90 percent of these children that were being prescribed Ritalin were in homes from very successful, two-parent families where both parents were working. And I'm wondering -- and I don't have any doubt that some children really benefit from Ritalin and really need it.

But I'm also wondering, is somebody studying where there may be some sort of a social cause of this? That maybe this is, in some way, boys crying out for attention that they're not getting?

NAKAMURA: There is...

DUNCAN: Because there sure is a cause of the serious crime in this country, I can tell you that.

NAKAMURA: There are a lot of social changes that are going on in our country.

DUNCAN: And wouldn't that also help explain why possibly that some of these other industrialized nations are not seeing it nearly as much of this as we are because they don't have many of these -- as much of this, as much of the breakdown of the family as we do?

NAKAMURA: We don't know the answer to that. There are social changes that are going on with great rapidity in our country. And we are trying to figure out ways with which we might measure what effect these might have on subsequent behaviors.

There is a proposal for a large-scale study of a birth cohort by the National Child Health Institute, in which they would propose to look at 100,000 births, following these children, understanding everything that they are consuming, their vaccinations, how the family is structured, et cetera, to see how those might relate ultimately to disease and other behavioral problems, as well as medical problems.

So there are proposals to do that. This would be extremely expensive.

BURTON: Let me just follow up. You said that you thought 3 million children or thereabouts was on Ritalin or similar products. We've been told it's 6 million. Why is it you don't have some idea?

Can't you find out from the drug company how many prescriptions are being written for that?

NAKAMURA: Yes, we do. We are aware of how many prescriptions. Relating that to the number of individuals is a little trickier. I'm sure I could get you the information that we have for the record on what is the number that we are able to document.

BURTON: OK. Now Novartis gave $748,000 plus $100,000 last year to this organization called CHADD. You don't see anything wrong with that?

NAKAMURA: Organizations which -- many organizations receive money from companies. And I guess my feeling is that with many of it, as long as that's revealed...

BURTON: It's OK.

NAKAMURA: Right.

BURTON: Even though they're touting their own product? What about the $750,000 that the FDA gave to them for the same reason?

You know, I hope, if one thing comes out of this, that you will get information to all of the school boards in the country and the state school superintendents saying that there is a prescribed policy that should be followed before you put children on these drugs, not just some checklist that a teacher comes up with. That's very important. You think that needs to be done. But most people out there in the hinterlands don't know that.

Now my grandson -- and we all talk about our personal experiences -- he got nine shots in one day and got 47 times the amount of mercury that was tolerable in an adult. And two days later, he became autistic.

And like I told you earlier, we've gone from one in 10,000 to one in 250 kids, according to our health agencies, your health agencies, that have autism. They are autistic. So it's an absolute epidemic.

I wanted to show you, since you weren't familiar with this, a tape we got from Canada on what happens when mercury is introduced into the neurons of the brain. Can you roll that tape real quick? It will just take a minute.

(BEGIN VIDEOTAPE)

(UNKNOWN): How mercury causes brain neuron degeneration. Mercury has long been known to be a potent neurotoxic substance, whether it is inhaled or consumed in the diet as a food contaminant. Over the past 15 years, medical research laboratories have established that dental amalgam tooth fillings are a major contributor to mercury body burden.

In 1997, a team of research scientists demonstrated that mercury vapor inhalation by animals produced a molecular lesion in brain protein metabolism, which was similar to a lesion seen in 80 percent of Alzheimer-diseased brains. Recently completed experiments by scientists at the University of Calgary's faculty of medicine now reveal, with direct visual evidence from brain neuron tissue cultures, how mercury ions actually alter the cell membrane structure of developing neurons.

To better understand mercury's effect on the brain, let us first demonstrate what brain neurons look like and how they grow. In this animation, we see three brain neurons growing in a tissue culture, each with a central cell body and numerous neurite processes.

At the end of each neurite is a growth column where structural proteins are assembled to form the cell membrane. Two principal proteins involved in growth cone function are actin, which his responsible for the pulsating motion seen here, and tubulin, a major structural component of a neurite membrane.

During normal cell growth, tubulin molecules link together, end to end, to form microtubules, which surround neurofibriles (ph), another structural protein component of the neuronal axon. Shown here is the neurite of a live neuron, isolated from snail brain tissue, displaying linear growth due to growth cone activity.

It is important to note that growth cones in all animal species, ranging from snails to humans, have identical structural and behavioral characteristics and use proteins of virtually identical composition. In this experiment, neurons also isolated from snail brain tissue were grown in culture for several days, after which very low concentrations of mercury were added to the culture medium for 20 minutes.

Over the next 30 minutes, the neurite membrane underwent rapid degeneration, leaving behind the denuded neurofibriles (ph) seen here. In contrast, other heavy metals added to this same concentration, such as aluminum, lead, cadmium and manganese, did not produce this effect.

To understand how mercury causes this degeneration, let us return to our illustration. As mentioned before, tubulin proteins linked together during normal cell growth to form the microtubules which support the neurite structure. When mercury ions are introduced into the culture medium, they infiltrate the cell and bind themselves to newly synthesized tubulin molecules. More specifically, the mercury ions attach themselves to the binding site reserved toward guanosine triphosphate or GTP on the beta subunit of the affected tubulin molecules.

Since bound GTP normally provides the energy which allows tubulin molecules to attach to one another, mercury ions bound to these sites prevent tubulin proteins from linking together. Consequently, the neurite's microtubules begin to disassemble into free tubulin molecules within the neurite's supporting structure.

Ultimately, both the developing neurite and its growth cone collapse and some denuded neurofibriles (ph) form aggregates or tangles, as depicted here. Shown here is a neurite growth cone stained specifically for tubulin and actin before and after mercury exposure. Note that the mercury has caused disintegration of tubulin microtubule structure.

These new findings reveal important visual evidence as to how mercury causes neurodegeneration. More importantly, this study provides the first direct evidence that low-level mercury exposure is indeed a precipitating factor that can initiate...

(END VIDEOTAPE)

BURTON: OK, here's the point. And you're talking to a layman, not a scientist. But I can see. And we've looked at these things before. And I've had the finest minds around the world before this committee.

Mercury causes a degeneration in the brain tissues. It's a contributing factor, according to many, many scientists in Alzheimer's and autism and other neurological problems in children. Now it doesn't take a rocket scientist to be able to see that we need to get that substance out of anything going into the body.

You in the health agencies took it out of mercurochrome. You took it out of topical dressings. The reason you did that was because you said it leeches into the skin and can cause neurological problems.

And yet, you're still sticking it into our kids. And we have an epidemic that's gone from one in 10,000 to one in 250 kids in this country. And we're going to have to take care of those people. It's going to be a huge -- it's going to be a nuclear bomb on our economy at some point in the future.

Now you're talking about today Ritalin and how we need Ritalin and how all these kids in schools and these young kids are having to get it because of the way they act. A lot of that may be caused by the introduction of mercury and other toxic substances into the body.

So it seems to me logically that the first step you take in the health agencies is get mercury and these toxic substances out of our vaccines. We have not done that here in the United States.

And really, much to my chagrin, in most of the vaccines we're exporting to Third World countries, we're keeping it in there. We're not even trying to take it out, which means we're going to be causing these problems all around the world.

Now all I'd like to end up saying to you, from my perspective, is let's get mercury out of all of these vaccines. Let's look at whether or not the amalgams, as was indicated -- we all have fillings in our teeth. And these amalgams, and I've already had my mouth tested. I had five of these amalgams taken out.

But I had a very high rate of mercury vapor when I chewed and everything that was getting out in my mouth. And that would leech into the brain. Maybe that's part of my problem, I don't know.

But the point is, why don't we start, as our health agencies, to look at getting mercury out of any substance that goes into the human body or is in close proximity to it? And then, after we do that, we may not need to be giving these kids these mind-altering drugs because many of them may not be adversely affected.

Now if you do that, and you start informing our educational institutions of the criteria that should be used before you start giving these kids Ritalin, I think you'll solve a lot of these problems. And I also think our health agencies ought to take a hard look at whether or not pharmaceutical companies should have influence on the dispersion of these things and the usage of these things by using their money to create a wider body of users, which is what they're doing.

And I know that a lot of -- there's a revolving door at the health agencies where people go to the pharmaceutical companies, come over to the health agencies and go back. And we've looked at their financial disclosure forms and we've seen some things that were very curious there, people on advisory committees that have a vested interest in getting products passed into the mainstream of use here in this country.

And I'm not going to talk any more about this. But I hope that those of you from our health agencies who have heard what we had to say today -- what I had to say -- will take that message back because it's going to be a broken record. It ain't going to go away as long as I'm in the Congress and as long as we have committees like this.

And I've talked enough. Do any of my colleagues have any more questions for this gentleman?

DAVIS: Just one quick question, Mr. Chairman. In your research, have you found any difference or any discrepancies in boys versus girls with ADHD?

NAKAMURA: There are differences in behavior, but they both respond to Ritalin.

DAVIS: I guess discrepancy is not the word I wanted. Do there seem to be more boys or more girls?

NAKAMURA: Definitely more boys.

DAVIS: By a wide majority?

NAKAMURA: Four to one.

DAVIS: Thank you.

BURTON: Mr. Gilman?

GILMAN: Just one question, Mr. Chairman. Doctor, would your NIH consider a long-term study, a study of the long-term effects of Ritalin? I don't think any study has been undertaken from the testimony we have heard.

NAKAMURA: Right. We have an ongoing study of Ritalin, which is anticipated to be long term; that is, we will follow children for many years on it.

GILMAN: That's encouraging. Thank you very much.

Thank you, Mr. Chairman.

BURTON: Mr. Horn, anything else?

HORN: No, just on the last point made by Mr. Gilman, have you got the National Academy of Science and Medicine? Are they doing it? Or is it simply done within the NIH?

NAKAMURA: It's being funded by the NIH. The National Academy of Science doesn't actually conduct studies. They review studies.

HORN: Well, it might be worthwhile to get some people that are not completely involved with NIH and take a look. That's exactly what they are there for. We use them all the time here.

NAKAMURA: OK.

BURTON: Thank you, Dr. Nakamura. We have some questions we'd like to submit for the record. But if you would consent to answer those and send them back to us, we'd appreciate it.

NAKAMURA: Absolutely, sir.

BURTON: OK, thank you very much.

We have one more panel. And this last panel consists of Dr. E. Clarke Ross. He is the CEO of Children and Adults with Attention Deficit Hyperactivity Disorder. David Fassler, a doctor who is a representative of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

And who else do we have? That's it. OK, very good.

Do you gentleman have an opening statement? Oh, I'm sorry, let me swear you in. I almost forgot.

Please stand. Do you swear to tell the whole truth and nothing but the truth, so help you God?

Do you want to start, Mr. Ross?

GILMAN: Mr. Chairman, if I might interrupt, I have to go to another meeting. Could I ask just one question of Mr. Ross before I have to leave?

BURTON: Sure.

GILMAN: Mr. Ross, isn't it true that CHADD received a grant award of $750,000 from the CDC to establish and operate the National Resource Center on ADHD?

ROSS: Yes, we were awarded a $750,000 grant from the Centers for Disease Control and Prevention to operate a national resource center on ADHD.

GILMAN: And have your membership been made aware that those funds came from a pharmaceutical company?

ROSS: The money did not come from pharmaceuticals. The CDC funds came from appropriation of Congress, administered by the Centers for Disease Control and Prevention.

BURTON: If the gentleman would yield?

GILMAN: Be pleased to yield.

BURTON: If the gentleman would yield? You did get $748,000 from Novartis?

ROSS: Eighteen percent of our budget currently...

BURTON: You got that money?

ROSS: Over a three-year period in the mid-'90s, before I was there...

BURTON: Did you get $100,000 last year?

ROSS: We got $700,000 from the pharmaceutical industry in its entirety in the last year, which is 18 percent of our budget. And I didn't bring a breakout of each company. But it's on our web site. It's in our IRS returns. And I'm happy to provide it to the committee.

But 18 percent of our budget is derived, like most every other voluntary health agency in America, whether it's the Epilepsy Foundation, diabetes, cancer, heart, the National Health Council, which is the umbrella group. We try to diversify our funding. And we try to receive corporate funding, as well as membership donations and federal funds.

BURTON: Go ahead, Mr. Gilman.

GILMAN: One last comment. The DEA stated that $748,000 to CHADD from 1991 to 1994 came from the manufacturer of Ritalin. Is that correct?

ROSS: The then-owner, which has subsequently become Novartis, gave CHADD roughly that amount of money in that three-year period. Yes.

GILMAN: Was that made known to your membership?

ROSS: Yes. It is on our web site. Go right on the web site, you'll see who all our corporate donors are, how much they give and the totality of our budget.

GILMAN: Thank you.

Thank you, Mr. Chairman.

BURTON: Proceed, Mr. Ross.

ROSS: I'm here today to talk not only about the CEO of CHADD, but I'm the father of an 11-year old son, 11-year old son with inattentive type ADHD, anxiety disorder and a variety of other challenges and learning disorders. Andrew has a history of challenges. He had seizures, unprovoked seizures when he was 21 months old. At Johns Hopkins University at Kennedy Krieger, we've had a complete blood, metabolic workup when he was two and three years old to try to determine things like mercury, lead and other contributions.

Andrew has a series of developmental problems. Inattentive ADHD was not recognized until he was four in his first group learning situation. And teachers noticed that he was inattentive. He did not pay any attention to what was going on around him.

So I'm here to speak as a parent of an 11-year old son that we deal with daily with major challenges and that experience, as well as the CEO of CHADD.

Now what CHADD does -- and I do have a written statement that I'd like to have in the record. What CHADD does is disseminate the science-based information. And that's why the Centers for Disease Control and Prevention have given us a grant to do that.

And we rely on things like the United States Surgeon General Report on Mental Health and the ADHD and Dr. Nakamura and NIMH and the National Institutes of Health and the professional societies like the American Psychiatric, American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics. That's what 20,000 family members of CHADD rely on is the science, the federal agencies and the professional community.

The highest importance at the moment are guidelines that have been mentioned before. The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have issued best practice treatment guidelines on how to asses and treat ADHD.

And the recommendation of the surgeon general, the recommendation of NIMH and the recommendation of the two professional academies is what's called a multimodal treatment. It is not medication as a first entry. It is a multimodal treatment, which are: behavioral interventions, counseling interventions, special education interventions and, if needed, medication use.

We've done all of that in our family with our son, Andrew. We have also tried a variety of other complementary or so-called alternative interventions. None of them have had harm, but none of them have had any impact. And medication actually did have impact on Andrew, our son.

Andrew's life is filled with dedicated clinicians, from a pediatrician to a child psychiatrist to a child psychologist to a neurologist, to a speech pathologist and to a team of educators. Without their collective support, I cannot imagine where Andrew would be today.

Andrew is making steady progress. He is dealing with his anxiety. He is dealing with his inattentiveness. He is dealing with his learning challenges.

But he has major challenges. And for those who want to dismiss the professional community, the 20,000 family members in CHADD rely on the psychiatrist and the pediatrician and the psychologist for their professional advice.

And my wife and I rely on our clinical team. And we appreciate our clinical team. And they have made a huge difference in Andrew's quality of life and his future.

So we didn't fabricate disorders in Andrew. At age 11 months, he broke his ankle, put in a cast. When the cast came off, we all -- I've had a couple of broken ankles in my life -- when the cast comes off, we all have pain and stiffness as we try to push that ankle down.

Andrew's ankle never went down. Andrew's ankle stayed in the position of the cast. And so we went to Johns Hopkins.

Andrew has some developmental challenges. And he happens to have inattentive type of ADHD.

So the multimodal treatment study of NIMH showed that 69 percent of children with ADHD have concurring disorders. So this complicates the entire picture.

Is it ADHD? Is it bipolar disorder? Is it anxiety disorder? Is it learning disabilities? Is it a reaction to allergies and mercury?

These are very complex assessments to be made in a child. And the reason we at CHADD and the 20,000 members of CHADD advocate the pediatrician and child and adolescent psychiatry guidelines, which Dr. Fassler will talk about, is they are a comprehensive assessment. It's not a 10 minute and then medication.

At age four, when teachers told us that Andrew was not paying attention in the class and was very distractible, we went to a psychiatrist. The psychiatrist recommended Ritalin. We were not prepared to do that at age four. And we said, "No, we're going to try other interventions." And we tried a whole host of other interventions.

By age seven, with all these other interventions tried, Andrew was still inattentive. He was still easily distractible. And so we tried Ritalin. Actually, it didn't even work.

And we tried Dexedrine. It didn't even work. Then we tried Adderall. And Adderall had an immediate impact on Andrew's ability to attend to his day, to use a checklist so he can organize his immediate day, whether it's getting ready for school, going to bed at night, in school.

And so parents don't rush -- some may -- but parents, the 20,000 members of CHADD don't rush in and say, "Give us medication. We just want medication."

They have functional challenges in their child in their daily life. And they want help. And they rely on the professional community. And they rely on the science.

And in our case, we took three years of reluctance to medicate. But when we medicated, we had this immediate impact that was positive.

And so the question is: should we have medicated at age four? Or should we have waited until age seven? And that's every family's decision in consultation with their doctor.

We made it and that was our decision. And Andrew had a lot of problems from age four to seven. But that's hindsight. Every family has to figure that out.

The statistics show that stimulant medication works in 25 to 90 percent of children. So if you reverse that, it doesn't work in 10 to 25 percent of children and there are going to be side effects. And you have to seriously think about that and know that.

And Ms. Weathers' point about informed consent is basic to a family. We need to know what the positive attributes of an intervention are, including medication. And we need to know the possible side effects and communicate not every four months with your doctor, communicate a couple of times a month with the doctor on dose level, side effects.

And we have that relationship in our family with our clinical team.

BURTON: Mr. Ross, would it be possible for you to sum up so we can get on with the questions and so forth?

ROSS: Yes.

BURTON: I know you have a lot that you want to tell us about. And we'll be glad to get to that.

ROSS: I've made all the major points I want to make: the importance of the science, the importance of a clinical team, the importance of comprehensiveness, the importance of the pediatricians and child and adolescent psychiatry guidelines and how complex this is because many of these children have co-occurring disorders. So I'll rest.

BURTON: Thank you, Mr. Ross.

Dr. Fassler?

FASSLER: Thank you. My name is David Fassler. I'm a board certified child and adolescent psychiatrist practicing in Burlington, Vermont. I'm a clinical associate professor in the Department of Psychiatry at the University of Vermont College of Medicine.

I currently serve as the president of the Vermont Association of Child and Adolescent Psychiatry. I'm also a trustee of the American Psychiatric Association and a member of the governing council of the American Academy of Child and Adolescent Psychiatry.

First of all, let me thank Representative Burton and the committee for the opportunity to appear here today. My testimony is on behalf of the APA and the Academy. And I'd appreciate if my written remarks are entered into the record.

The American Psychiatric Association is a medical specialty society representing over 38,000 psychiatric physicians. The American Academy of Child and Adolescent Psychiatry is a national professional association representing over 6,500 child and adolescent psychiatrists who are physicians with at least five years of specialized training after medical school, emphasizing the diagnosis and treatment of mental illness in children and adolescents.

I'm happy to be able to talk to you about the diagnosis and treatment of Attention Deficit Hyperactivity Disorder, or ADHD, and to underscore some of the comments that you have already heard.

As a psychiatrist, when I think of ADHD, I think first of the faces of children and families who I have seen over the years. I think in particular of a seven-year old boy who is about to be left back in second grade, due to his disruptive behavior.

The teachers have labeled him "difficult to control." The other kids just call him weird. He has few friends and is already convinced that he is bad and different.

And I think of a 12-year-old girl with an IQ of 130. She is not disruptive, but she is failing seventh grade. And I think of 28-year- old administrative assistant who was relieved and appreciative when he received an accurate diagnosis and appropriate treatment for his longstanding condition. But I also remember his anger and frustration because, in his words, he missed out on 20 years of his life.

As you have already heard, according to NIMH, the National Institute of Mental Health, Attention Deficit Hyperactivity Disorder, or ADHD, is the most commonly diagnosed psychiatric disorder of childhood. It's estimated to affect approximately five percent of school-age children, although published studies have identified a prevalence rate as high as 12 percent in some populations.

As you have heard, it occurs between three and four times more often in boys than in girls.

We also know that ADHD does run in families. And contrary to previous beliefs, it doesn't always go away as you grow up. In fact, the latest research indicates that as many as half of all kids with ADHD continue to have problems into adulthood.

This is actually one of the reasons we see an increase in the overall use of medication. We are now recognizing and treating more adults with ADHD.

I have brought for the committee the Diagnostic and Statistic Manual of Mental Disorders, the DSM-4, which you have heard discussed today and which is central to our understanding of the formal diagnosis of ADHD. The key features, as has been explained, include inattention, hyperactivity and impulsivity.

I want to underscore one of the other elements that Dr. Nakamura spoke about, and that's that the symptoms must be interfering in the child's life at home, at school or at work -- at work for an adult -- or with their friends, with their peers. In two of those settings, so it's not just that you're agitated or that you're active, but that it's really interfering with your life, with your ability to function in those settings.

The diagnostic criteria are quite specific and they are well established within the field. They are the product of extensive and numerous research studies conducted at academic centers and clinical facilities throughout the country. And I have brought a number of the studies, which have already been mentioned, from the AMA, the Academy of Pediatrics and the Surgeon General's Report.

In addition, we now have a substantial body of research literature about both the genetic markers and the neuroanatomical abnormalities associated with this disorder. And you started to hear about some of it, some of the MRI, the CAT scan, the PET scan studies. And I think within the next year or two, we will even be able to use some of these in a more diagnostic way.

Let me be very clear. ADHD is not an easy diagnosis to make. And it's not a diagnosis that can be made in a five- or a 10- or a 15- minute office visit.

Many other problems, including hearing and vision problems, anxiety disorders, depression, learning disabilities, toxicity with heavy metals can all present with signs and symptoms which look similar to ADHD. There is also a high degree of comorbidity, meaning that over half of the kids who have ADHD also have a second psychiatric problem.

And as we heard this morning, the diagnosis of ADHD really requires a comprehensive assessment by a trained clinician. I don't think any of us you have heard today would disagree with that.

In addition to direct observation, the evaluation includes a review of the child's developmental, social, academic history, medical history, including evaluating the child for other medical conditions, including things like hyperthyroidism, the toxicities. We really need to rule those things out.

It also should include input from the child's parents and teachers and a review of the child's records. Schools play a critical role in identifying kids who are having problems. But as you have heard already today, schools should not be making diagnoses and they should not be dictating treatment.

ADHD is also a condition which should not be taken lightly. Without proper treatment, a child with ADHD may fall behind in schoolwork, may have problems at home and with friends.

It can have long-term effects on the child's self-esteem. It can lead to other problems in adolescence, including an increased risk of substance abuse that you've heard about, increased risk of adolescent pregnancy, increased risk of accidents, including car accidents in adolescents, school failure and increased risk of trouble with the law.

The treatment of ADHD should be comprehensive and individualized to the needs of the child in the family. Medication, including methylphenidate or Ritalin, can be extremely helpful for many children.

But consistent with the opening comments from Ms. Davis, medication alone is rarely the appropriate treatment for complex child psychiatric disorders, such as ADHD. Medication should only be used as part of a comprehensive treatment plan, which will usually include individual therapy, family support and counseling and work with the schools.

In terms of methylphenidate, we have literally hundreds of studies over 30 years clearly demonstrating the effectiveness of this medication on many of the target symptoms of ADHD. As you have also heard, it is generally well tolerated by children with minimal side effects.

Nonetheless, I share the concern that some children may be placed on medication without a comprehensive evaluation and accurate and specific diagnosis or an individualized treatment plan. Let me also be very clear that I am similarly concerned about the many children with ADHD and other psychiatric disorders who would benefit from treatment -- including treatment with medication, if appropriate -- but who go unrecognized and undiagnosed and who are not receiving the help that they need.

Let me turn specifically to the question of overdiagnosis and overtreatment. Just last week, a review article written by Peter Jensen was published which addressed this issue in detail. And I have included Dr. Jensen's article in the background materials.

Dr. Jensen is currently at Columbia University. He was formerly the associate director for child and adolescent research at the National Institute of Mental Health. He reviews all of the available scientific studies on this issue.

He notes that most studies and media reports have not been based on actual diagnostic data, where people actually sat and interviewed children and reviewed records, but they have relied instead on information from an HMO or a Medicaid medication database.

Dr. Jensen and his colleagues actually performed comparative evaluations on 1,285 children in four communities -- Atlanta, New Haven, Westchester and San Juan, Puerto Rico -- to determine the prevalence of ADHD, as well as the forms of treatment utilized. The results were that 5.1 percent of children and adolescents between the ages of nine and 17 met the diagnostic criteria for ADHD. Yet, only 12.1 percent of these children, or approximately one in eight, were being treated with medication.

So the majority of children with ADHD in this carefully controlled study were not being treated with medication, suggesting that at least in these communities, medication is currently underprescribed. These authors also found eight children out of these 1,285 who were receiving medication who did not meet the full diagnostic criteria for ADHD, although they did have high levels of ADHD symptoms.

Dr. Jensen concludes -- and I would concur -- that on the basis of these results, there is no evidence of widespread overtreatment with medication. On the contrary, it appears that, at least in these communities, the majority of children with ADHD are not receiving what we would consider to be appropriate and effective treatment.

There is a second study from the Mayo Clinic in Rochester, Minnesota, which is in the background materials. In the interest of time, I will skip the details, other than to mention that in that study, of all children on medication for ADHD, only .2 percent, which is two children in 1,000, had no evidence of the disorder whatsoever.

So again, the second study, carefully conducted study, simply doesn't support the argument that ADHD is generally overdiagnosed or overtreated. This is not to say that overdiagnosis or overtreatment doesn't happen in any areas of any communities, which is why we all need to continue our collective efforts to improve public awareness and to ensure access to comprehensive assessment services and individualized treatment, using the kinds of evidence-based guidelines which you have been hearing about and which have now been developed.

BURTON: Dr. Fassler, can you summarize? We have some votes on the floor.

FASSLER: I am summarizing with my recommendations. The APA and the Academy would offer the following specific recommendations for your consideration.

First, we fully support and would underscore the importance of accurate diagnosis and treatment, which requires access to clinicians with appropriate training and expertise and sufficient time to permit a comprehensive assessment. Next, we fully support the increased emphasis of the FDA and the NIMH on research on the appropriate use of medication in the psychiatric treatment of children and adolescents. And we welcome the expanded clinical trials and the longitudinal studies, which you have been hearing about.

We also fully support the passage of comprehensive parity legislation at both the state and the federal level. We fully support and welcome all efforts to sustain and expand training programs for all child mental health professionals, including programs for child and adolescent psychiatrists.

And finally, we fully support and appreciate the efforts of the current administration, through the new Freedom Commission on Mental Health, to focus increased attention on the diagnosis and treatment of all psychiatric conditions, including those which affect children and adolescents.

In summary, let me emphasize that child psychiatric disorders, including ADHD, are very real and diagnosable illnesses, which affect lots of kids. The good news is that they are also highly treatable.

We can't cure all the kids we see. But with comprehensive, individualized intervention, we can significantly reduce the extent to which their conditions interfere with their lives. The key for parents and teachers is to identify kids with problems as early as possible and to make sure that they get the help that they need.

Thank you.

BURTON: Thank you, doctor.

Do you have a few questions you'd like to ask, real quickly? Let me -- I'd like to ask you a whole bunch of questions, but unfortunately, we've got two votes on the floor. And you've been here all day and I don't want to keep you all any longer than we have to.

We have 6 million children that are using these drugs right now. I don't know how we got through all this when I was younger, but we did. And the society did fairly well.

Did you find any mercury in your son's blood work?

ROSS: No. We were hoping to find some toxic element so that we could have a simple explanation for the fact that he was having seizures and that he had a hypotonia and a lot of problems. No, we did not find...

BURTON: Found no mercury?

ROSS: No.

BURTON: Had he had all of this childhood vaccines?

ROSS: Yes. We contracted with our pediatrician two months before we delivered Andrew. And he has had the same pediatrician and...

BURTON: So he had all of his childhood vaccinations.

ROSS: He had all his childhood vaccinations. Now he was tested when he was two and three. And he has subsequent vaccinations.

BURTON: But the thing is, I wonder if you could contact your pediatrician and find out the lot numbers of those vaccinations. I would just be curious, I would like to see those, because mercury has been in these childhood vaccinations for 30, 40 years. And if he got a number of these vaccinations, as my grandson did, it's hard for me to believe that he didn't get some mercury injected into him.

ROSS: Well, what the doctor would have told me is not there wasn't some, is if it was abnormal. We were told there was not abnormal levels of mercury, lead and a whole bunch of things.

I don't know. I didn't see the result and I'm not a physician.

BURTON: I think most parents who have had these shots given to their children and who have autistic children would really argue with what is an acceptable level of mercury in the body. That's a subjective thing and it may vary from person to person.

So that's something that I'm sure would be debated.

You agree, Dr. Fassler, that there ought to be a thorough analysis of a child before they go on medication?

FASSLER: Yes. My bottom line would be that kids need a comprehensive evaluation before there is any treatment plan in place and that parents need to be advocates for kids to try and make sure that...

BURTON: I don't think anybody disagrees with that.

FASSLER: Right.

BURTON: And your organization also agrees with that?

ROSS: Yes. Every child should have a complete, comprehensive examination.

BURTON: Why is it then that around the country, we have school corporations that have this checklist where a teacher checks off the problems with a child, the child is taken to a doctor and it's a perfunctory thing for the doctor to say, "Well, it appears as though he needs Ritalin." And they write out a prescription for that.

That's not a thorough examination.

(UNKNOWN): And that's not what either of us or any of us who you have heard would support. There are checklists where teachers report what they're seeing in the classroom. But there shouldn't be a diagnosis made just on the basis of reviewing that checklist.

BURTON: My grandson never had a complete psychological analysis. He became autistic, as I said, right after getting all these shots. And yet, the school recommended, because he was difficult -- he was in a special ed class -- that he should be put on Ritalin. And they had a doctor also subscribe to that.

Of course, he wasn't put on Ritalin. We didn't allow that. And he seems to be doing all right on other ways that we're dealing with him.

But the fact of the matter is, in my own personal experience, that was the case: recommendation by the teacher and the doctor went along with that. How do we educate our educators around the country to understand that this has to be something that's done in a very thorough manner before you start putting these kids on these drugs?

(UNKNOWN): I think it's an excellent point. And I think collectively we need to work on getting that message to the schools. And part of it is our job, going into the schools, teaching teachers about the kinds of things to look for and when kids should be referred.

I think we need to do a better job at recognizing the signs and symptoms earlier and, you know, getting help for kids before they have major problems. Because often, you know, we all wait too late. And we may see things in adolescence that we may have been able to help with earlier in life.

BURTON: Let me just say that I hope you and CHADD and our health agencies will figure out some way -- I know how much time is left -- our health agencies will figure out a way to make sure that every school corporation, every superintendent of public instruction in all 50 states understand that there should be a thorough analysis before they put these kids on these drugs. If you would do that, I think you would eliminate a lot of the problems.

The other thing is I hope you'll agree that we shouldn't be introducing mercury or other toxic substances into people's bodies, whether they're kids or adults. And if we could get that point across, we might solve a lot of these problems.

I have a lot of questions I would like to submit to you for the record, Dr. Fassler and Mr. Ross.

I would also like to end by saying, Mr. Ross, we had what was called the "Keating Five" here in Washington. We had five senators that met with Mr. Keating on the savings and loan crisis.

And I don't believe any of those senators really intentionally did anything wrong. But the appearance of impropriety was very great and they got a heck of a lot of bad publicity when the savings and loan debacle took place.

And for you to get hundreds of thousands of dollars from Novartis, which manufactures Ritalin and your organization does advocate that children should use that, it gives the appearance of...

ROSS: We do not advocate any one drug. We advocate a multimodal treatment, which may include medication and...

BURTON: I understand.

ROSS: And the products are never discussed.

BURTON: Regardless, I understand. But the appearance is that they're feeding you to deal with this problem in that way. And I would just suggest, if there is a better way to fund your organization, even if it's only 18 percent, it would be helpful. Because if you was in the United States Senate or the House and that happened, you would have a heck of a problem.

With that, let me just say to you I really appreciate your being here. We will submit questions for the record. And we appreciate your response.

Thank you very much.

We are adjourned.

END

NOTES:
[????] - Indicates Speaker Unknown
   [--] - Indicates could not make out what was being said.[off mike] - Indicates could not make out what was being said.

PERSON:  DAN L BURTON (94%); BENJAMIN A GILMAN (57%); CHRISTOPHER SHAYS (57%); CONSTANCE MORELLA (57%); ILEANA ROS-LEHTINEN (56%); JOHN MICHAEL MCHUGH (56%); CHRIS JOHN (55%); THOMAS M DAVIS (55%); JOE SCARBOROUGH (54%); MARK E SOUDER (54%); STEVEN C LATOURETTE (54%); DAN MILLER (53%); JO ANN DAVIS (52%); TODD PLATTS (51%); ADAM PUTNAM (50%); 

LOAD-DATE: October 5, 2002

 

Copyright 2002 eMediaMillWorks, Inc.
(f/k/a Federal Document Clearing House, Inc.)  
FDCH Political Transcripts

 

September 26, 2002 Thursday


TYPE: COMMITTEE HEARING

LENGTH: 32279 words

COMMITTEE: HOUSE GOVERNMENT REFORM COMMITTEE

HEADLINE: U.S. REPRESENTATIVE DAN BURTON (R-IN) HOLDS HEARING ON THE OVERMEDICATION OF HYPERACTIVE CHILDREN

SPEAKER:
U.S. REPRESENTATIVE DAN BURTON (R-IN), CHAIRMAN

LOCATION: WASHINGTON, D.C.

WITNESSES:

NEIL BUSH, FOUNDER, CHAIRMAN AND CEO, IGNITE! INC.
LISA-MARIE PRESLEY, SPOKESPERSON, CITIZEN'S COMMISSION FOR HUMAN RIGHTS
BRUCE WISEMAN, PRESIDENT, CITIZEN'S COMMISSION ON HUMAN RIGHTS, CO-CHAIRMAN, NATIONAL FOUNDATION FOR WOMEN LEGISLATORS, EDUCATION TASK FORCE
MARY ANN BLOCK, AUTHOR "NO MORE ADHD"
PATRICIA WEATHERS, PRESIDENT, PARENTS FOR A LABEL AND DRUG FREE EDUCATION
DR. RICHARD NAKAMURA, ACTING DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH, NATIONAL INSISTUTES OF HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES
E. CLARKE ROSS, CEO, CHILDREN AND ADULTS WITH ATTENTION-DEFICIT/, HYPERACTIVITY DISORDER
DR. DAVID FASSLER, AMERICAN PSYCHIATRIC ASSOCIATION

BODY:

(CORRECTED COPY)
 
HOUSE COMMITTEE ON GOVERNMENT REFORM HOLDS A HEARING ON THE
OVERMEDICATION OF HYPERACTIVE CHILDREN
 
SEPTEMBER 26, 2002

SPEAKERS:
U.S. REPRESENTATIVE DAN BURTON (R-IN)
CHAIRMAN
U.S. REPRESENTATIVE BENJAMIN A. GILMAN (R-NY)
U.S. REPRESENTATIVE CONSTANCE MORELLA (R-MD)
U.S. REPRESENTATIVE CHRISTOPHER SHAYS (R-CT)
U.S. REPRESENTATIVE ILEANA ROS-LEHTINEN (R-FL)
U.S. REPRESENTATIVE JOHN MCHUGH (R-NY)
U.S. REPRESENTATIVE STEVE HORN (R-CA)
U.S. REPRESENTATIVE JOHN L. MICA (R-FL)
U.S. REPRESENTATIVE THOMAS M. DAVIS III (R-VA)
U.S. REPRESENTATIVE MARK E. SOUDER (R-IN)
U.S. REPRESENTATIVE JOE SCARBOROUGH (R-FL)
U.S. REPRESENTATIVE STEVEN C. LATOURETTE (R-OH)
U.S. REPRESENTATIVE BOB BARR (R-GA)
U.S. REPRESENTATIVE DAN MILLER (R-FL)
U.S. REPRESENTATIVE DOUG OSE (R-CA)
U.S. REPRESENTATIVE RON LEWIS (R-KY)
U.S. REPRESENTATIVE JO ANN DAVIS (R-VA)
U.S. REPRESENTATIVE TODD PLATTS (R-PA)
U.S. REPRESENTATIVE DAVE WELDON (R-FL)
U.S. REPRESENTATIVE CHRIS CANNON (R-UT)
U.S. REPRESENTATIVE ADAM PUTNAM (R-FL)
U.S. REPRESENTATIVE C.I. "BUTCH" OTTER (R-ID)
U.S. REPRESENTATIVE EDWARD L. SCHROCK (R-VA)
U.S. REPRESENTATIVE JOHN J. DUNCAN, JR. (R-TN)
 
U.S. REPRESENTATIVE HENRY WAXMAN (D-CA)
RANKING MEMBER
U.S. REPRESENTATIVE TOM LANTOS (D-CA)
U.S. REPRESENTATIVE MAJOR R. OWENS (D-NY)
U.S. REPRESENTATIVE EDOLPHUS TOWNS (D-NY)
U.S. REPRESENTATIVE PAUL E. KANJORSKI (D-PA)
U.S. REPRESENTATIVE PATSY MINK (D-HI)
U.S. REPRESENTATIVE CAROLYN B. MALONEY (D-NY)
U.S. DELEGATE ELEANOR HOLMES NORTON (D-DC)
U.S. REPRESENTATIVE ELIJAH E. CUMMINGS (D-MD)
U.S. REPRESENTATIVE DENNIS J. KUCINICH (D-OH)
U.S. REPRESENTATIVE ROD R. BLAGOJEVICH (D-IL)
U.S. REPRESENTATIVE DANNY K. DAVIS (D-IL)
U.S. REPRESENTATIVE JOHN F. TIERNEY (R-MA)
U.S. REPRESENTATIVE JIM TURNER (D-TX)
U.S. REPRESENTATIVE THOMAS H. ALLEN (D-ME)
U.S. REPRESENTATIVE JANICE D. SCHAKOWSKY (D-IL)
U.S. REPRESENTATIVE WILLIAM LACY CLAY (D-MO)
U.S. REPRESENTATIVE DIANE E. WATSON (D-CA)
U.S. REPRESENTATIVE STEPHEN LYNCH (D-MA)
 


*


BURTON: Good morning. A quorum being present, the Committee on Government Reform will come to order. And I ask unanimous consent that all members' and witnesses' written and opening statements be included in the record. And without objection, so ordered.

I ask unanimous consent that all articles, exhibits and extraneous or tabular materials being referred be included in the record. Without objection, so ordered.

Today, we're going to be discussing a very important issue that affects many, many children in the United States. As all of us know, our children are our future. I doubt there is a single member of Congress that doesn't feel strongly that we need to do our dead level best to protect and ensure the health and wellbeing of the children of this nation.

Today, we're going to talk about a group of symptoms known as Attention Disorder. In the last two decades, we've heard more and more attention about Attention Deficit Disorder, ADD and Attention Deficit Hyperactive Disorder, ADHD.

The most common treatment for this disorder is a drug called Ritalin. This drug is being given to more and more children in this country. It has become very controversial.

There has been over a 500 percent increase in the use of Ritalin in the United States since 1990. It's estimated that 4 to 6 million children in the United States take Ritalin every single day.

On one side of this issue, we're going to hear from the associations of psychiatrists and a parent's organization known as Children and Adults with Attention Deficit Hyperactivity Disorder or CHADD. They believe that 13 percent of the U.S. population, adults and children, suffer from an attention disorder and that it should be treated with medication.

At the other end of the discussion is the Citizens Commission for Human Rights. They challenge the legitimacy of calling ADHD a neurobiological disorder. They raise serious questions about giving strong medication to young children.

Also in the discussion are concerned parents. Imagine being a parent of a young child and receiving a note from your school instructing you to take your child to their pediatrician for evaluation. In this note from the school, there's a checklist for you to take to the doctor. The school officials have diagnosed your child as possibly having ADHD.

They make this diagnosis because your child makes careless mistakes on homework, does not follow through on instruction, fails to finish schoolwork, has difficulty organizing tasks, loses things and is forgetful in daily activities.

That sounds like me when I was in grade school. I did not take Ritalin. I became a congressman.

(LAUGHTER)

When you take your child to a doctor, instead of blood tests and a thorough medical evaluation, you have a conversation with a doctor about the school's checklist. And you leave a few minutes later with a prescription for your young child for a psychotropic drug.

Did the doctor test your child for a thyroid disorder? Did your doctor test your child for a heavy metal toxicity? Did you doctor talk to you about your child's allergies?

Did your doctor even mention nutrition or possible food sensitivity? Did your doctor ask if your child's IQ had been tested and if he was gifted? Probably not.

We all know that prescription drugs continue to command a greater percentage of the overall healthcare dollar. According to the Department of Health and Human Services, prescription drugs accounted for nine percent of all U.S. healthcare expenditures in fiscal year 2001. This is a 14.7 percent increase in one year.

Ritalin, as you know, is classified as a Schedule II stimulant under the Federal Controlled Substances Act. In order for a drug to be classified as a Schedule II, it must meet three criteria: one, it has to have a high potential for abuse; two, it has to have a currently accepted medical use in treatment in the United States; and three, it has to show that abuse may lead to severe psychological or physical dependence.

This is a Schedule II drug. And this is the definition.

Some of the things we've heard about Ritalin cause me to have some concerns. And I'd like to hear from all of our witnesses today about those issues.

The -- quote -- "experts" tell us that Ritalin is a -- quote -- "mild stimulant." However, research published in 2001 in the "Journal of the American Medical Association" showed that Ritalin was a more potent transport inhibitor than cocaine.

This isn't me saying this. This was in the "Journal of the American Medical Association." It said that Ritalin was a more potent transport inhibitor than cocaine.

The big difference appears to be the time it takes for the drug to reach the brain. Inhaled or injected cocaine hits the brain in seconds, while pills of Ritalin normally consumed take about an hour to reach the brain. Like cocaine, chronic use of Ritalin produces psychomotor stimulant toxicity, including aggression, agitation, disruption of food intake, weight loss, stereotypic movements and death.

There have been only two large epidemiological studies on the long-term dopamine effects of taking Ritalin for years. One study found more drug addiction in children with ADHD who took Ritalin, compared with children with ADHD who took no drug, while the other study shows the opposite result. So they are inconclusive at this moment.

The question that remains to be answered, according to the authors of this study, is whether the chronic use of Ritalin will make someone more vulnerable to decreased dopamine brain activity, as cocaine does, thus putting them at risk for drug addiction.

Even more disturbing than the prescribing of Ritalin to school age children is a trend to prescribe this medication to preschoolers. A study published in the "Journal of the American Medical Association" in 2000 offered some key insights into this dangerous new trend. Fifty-seven percent of 223 Michigan Medicaid enrollees younger than four years of age with a diagnosis of ADHD received at least one psychotropic medication to treat the condition during a 15-month period in 1995 to 1996.

Ritalin and clonadine were prescribed most often. Additionally, the authors found that in the Midwestern states' Medicaid population, there was a threefold increase in total prescribing of stimulants between 1991 and 1995, a 300 percent increase.

There was a threefold increase in prescribing Ritalin, a 28-fold increase in prescribing clonadine and a 2.2-fold increase in prescribing of antidepressants. This is children between the ages of two and four years old.

These are trends that I think we ought to be concerned about. Is it safe to give these drugs to very young children? What will the long-term effects be? Are children being diagnosed correctly?

I hope we can shed some light on all of these issues today.

In concluding, let me just say, over the last four years, this committee has looked at numerous health issues. We've looked at the role of dietary supplements, nutrition and physical activity in improving health. We've looked at the role of complementary and alternative medicine in our healthcare system.

We've looked at pharmaceutical influence on advisory committees at the Department of Health and Human Services. And we've looked at the possible relationship between childhood vaccines and the autism epidemic.

It's obvious to me that we can no longer ignore that our healthcare system is in need of major overhaul and attitude change. We have a generation of doctors who have not been trained in nutrition. We have statistics that show that 85 percent of the illnesses Americans face are related to lifestyle. We have camps of conventional doctors who are trained to suppress symptoms through drugs and camps of complementary and alternative medical professionals, including doctors, who are trained to look at the whole person and their environment.

It's time that we put the labels of conventional and alternative aside and think about an integral approach, a complete approach, to care. We owe it to all of us, but especially our children.

I am pleased that we have such a stellar list of witnesses today. Mr. Neil Bush, the brother of the president, was going to be here with us. But unfortunately, he could not be. So what we have done is we have a tape of an interview that was conducted with Mr. Bush that we show at the outset of our hearing, before we hear from our witnesses.

As everybody knows, he is not only the brother of the president, but he is the CEO of Ignite! Learning and the son and brother of two presidents and was supposed to be here, but unfortunately, he couldn't. He did have a family experience with a misdiagnosis of ADHD.

Ms. Lisa Marie Presley, I'm sure everybody knows who Ms. Presley is. She is not only a very talented young lady and a very attractive young lady, she is the daughter of Elvis Presley and his lovely wife. And she is here today to testify. And we are looking forward to her testimony.

She is a concerned mother and the international spokesperson for the Citizens Commission on Human Rights.

Ms. Patti (ph) Weathers, who is here with us and we're glad to have you. She will share her family's story about a school trying to force medication as a condition of school participation.

Dr. Mary Ann Block, the author of "No More ADHD" is here. And we appreciate your being here as well.

And of course, we have Mr. Wiseman, who has been active in this issue for a long time. And we appreciate your attendance as well, Mr. Wiseman.

WISEMAN: Thank you.

BURTON: I want to thank all of our witnesses for being here today. And I look forward to your testimony. And the hearing record will remain open until October the 10th.

Mr. Waxman is not here at the present time, so I'll now yield to the distinguished gentleman from New York, my colleague, Mr. Gilman.

GILMAN: Thank you, Mr. Chairman. And I want to thank Chairman Burton for holding this important hearing to examine the issue of medicating school children in the treatment of Attention Deficit Hyperactive Disorder.

As a congressional member who has long been interested in the ongoing war on illicit drugs, I'm surprised by the extensiveness of the use of use of controlled substances such as Ritalin with a high potential for abuse and the propensity for its dependence to treat psychiatric disorders in children. This issue is surrounded by substantial controversy, a debate that we fully expect to be highlighted by today's witnesses.

And while we recognize the merits of the positions argued by each side, my concerns lie in another area. I don't doubt that there are many children with genuine illnesses or disorders that could benefit from a treatment regime involving Ritalin and similar drugs.

I am concerned, however, with a number of other issues. The first of these is a trend toward treating younger and younger children with these dependent drugs. Ritalin is generally not recommended for children under age six. Yet there was a threefold increase in its prescription for children aged two to four between 1991 and 1995.

Also of concern is that parents are being pressured into having their children take these drugs when a diagnosis is made by a teacher or other school official and not by any medical professional. As a result, the potential for abuse is enormous.

Educators want conformity in the classroom. But the desire for order needs to be balanced against the health of the children.

The heavy advertising that the extensive lobbying of school districts by drugs companies for these products is very distressing. The decisions involving treatment need to be made by medical personnel who know the individual patient and not by someone with some financial stake in the system.

Moreover, we've not seen any evidence that suggests the medical profession has any significant knowledge about the long-term effects of these drugs. Given that this is a relatively recent phenomenon, it's possible that long-term studies have not been undertaken. And if that's the case, we could be setting ourselves up for a potential disaster down the road.

Once again, Mr. Chairman, thank you for holding this important hearing this morning. And I look forward to the testimony of our witnesses.

BURTON: Thank you, Mr. Gilman.

Ms. Watson, do you have an opening statement?

WATSON: Yes, I do.

BURTON: Ms. Watson, you are recognized.

WATSON: I want to thank you, Mr. Chairman. And I have a few observations I'd like to share based on an experience while I was teaching and as a school psychologist.

Although fidgeting and not paying attention are normal and common childhood behaviors, a diagnosis of ADHD may be required for children in whom frequent behavior produces persistent dysfunction. The challenge is to evaluate, inform the parents and consider the alternatives before choosing an invasive and artificial drug treatment.

An adequate diagnostic evaluation requires histories to be taken from multiple sources -- from the parents, from children, from teachers and from others that associated with the child -- a medical evaluation of general and neurological health, a full cognitive assessment, including school history, use of parent and teacher rating scales and all necessary adjunct evaluation, such as an assessment of speech and language patterns, et cetera. These evaluations take time and require multiple clinical skills.

Regrettably, there is a lack of appropriate trained professionals and monetary resources in the current school system. As a school psychologist in Los Angeles, for every 10 students that I worked with, there were approximately four or maybe even five on Ritalin.

It was very frustrating to see many of the medicated children completely numb to stimuli. In many cases, they were almost like robots.

Drugs should not be overly prescribed or seen as the only solution to these problems. The American Academy of Pediatrics published a policy statement in 1996 on the use of medication for children with attention disorders, concluding that the use of medication should not be considered the complete treatment program for a child with ADHD and should be prescribed only after a careful evaluation.

Because stimulants are also drugs of abuse and because children with ADHD are at an increased risk of substance abuse disorder, I have concerns about the potential for the abuse of stimulants by children taking the medication or diversions of drugs to others. Just yesterday, I read in the "Washington Post" sports section that the Hall of Fame Pittsburgh Steeler Mike Webster pleaded "no contest" in September 1999 to forging prescriptions to obtain Ritalin.

And I finally say that this point has to be made. And it goes to the fact that this great athlete is probably someone who, early on, showed hyperactivity. And probably because he was bored in class or whatever the circumstances might have been, but he now has an addiction that I think in some ways could be equated with the use of cocaine, which is so prevalent in my district and in the school district that I represent.

So I am very, very concerned that we are bringing our children up in a drug culture. And you can't turn on the television or the radio or read a newspaper that we're not pushing something to wake you up, put you sleep. You know, "Want your z's? Take this."

And so children are surrounded by this culture. We need not have this particular effect in our schools.

So Mr. Chairman, thank you very much for holding this hearing. And I look forward to hearing the presenters.

BURTON: Thank you very much, doctor. I appreciate that.

Mr. Horn?

HORN: Mr. Chairman, I thank you for this further series of where there has been misuse of pharmaceuticals. And I agree completely with what my colleague, Mr. Gilman -- we've been all over Europe and everywhere else to see that drugs -- and when it's used for small children and they have no say about it and when it's wrong, we should make sure that doctors are properly put together, have what type of either adolescents or the others.

So I would commend you and would hope that we can get soon to the witnesses, since they're outstanding.

BURTON: Thank you, Mr. Horn.

Mr. Cummings?

CUMMINGS: Thank you very much, Mr. Chairman. I want to thank you for holding this hearing. I bring a very interesting perspective to this hearing, in that as a young African-American boy in South Baltimore, I know that what happened to a lot of us is we were actually pushed into special education. We were given all kinds of drugs. And they said that we were hyperactive and told that, you know, that our hyperactivity could not be controlled.

But what they failed to understand -- and in this poor neighborhood in South Baltimore -- was that we didn't have the playgrounds. We didn't have them. We played on glass. G-L-A-S-S.

We didn't have the leagues, the baseball leagues, that stuff that little boys would normally do to get that energy out of them. And so what happened, as is happening today in my district, are little children are being drugged to keep them stable, so they say, so that they can learn.

And I think I agree with Congresswoman Watson that we've got a situation where we have to bring this whole situation under control. And Mr. Chairman, I applaud you for bringing attention to it because it's a very serious thing.

Just today, I was listening to one of our national stations. And they were talking about how there are over 1 million African-American men in prison -- 1 million. There are more African-American men in prison than there are in college.

And you have to wonder how many of them may have started off with folks saying that, "There's something wrong with you." And we have to understand, when you tell a child that there is something wrong with them, it goes with them until they die.

And it's not -- I've often said -- it's not the deed, it's the memory that haunts folks. And so I think that perhaps -- I don't know whether our witnesses will touch on this -- I think that perhaps we categorize children at an early age. And we misdiagnose them. And then we put them on a train, on a track, that leads to nowhere.

And so that's why, Mr. Chairman, I'm glad we're exploring this. I think that it took a lot of foresight on your part to even open up this door so that we could peek in. Because I can tell you that I know of a lot of children right now who are sitting in classrooms and they've been drugged. And they don't know -- they're not sure what's going on with them. All they know is that they have been labeled.

And last but not least, Mr. Chairman, let me say this. In our society today, too often, what we do is we look at a child's behavior and say to our selves that that behavior is a deficit as opposed to an asset.

And I can recall, as a young boy, one of the reasons why they put me in special education and put me to the side is because they said I talked too much.

(LAUGHTER)

They said, "You talk too much." And I'm so glad that there were some people that saw it as an asset.

(LAUGHTER)

Did not drug me to quiet me and said to use this asset that God has given you so that you can help to bring benefit to the rest of society. And so, for those reasons, I take it very personal what we're doing here today because there are so many people that don't get off of that train leading to nowhere.

And so with that, Mr. Chairman, I yield back.

BURTON: Thank you, Mr. Cummings. And I'd just like to say that your testimony parallels some of the things I heard about me when I was in school. And I guess I still talk too much sometimes.

Let's see, Ms. Davis?

DAVIS: Thank you, Mr. Chairman. I appreciate you holding this hearing. And I want to bring an entirely different perspective to what has been said. I'm the mom of an ADHD son who is now 21. I would have given anything, back when he was six or seven, if someone from the school would have sent a note home and said, "Have your son tested or checked out."

Instead, we went for several years thinking we were bad parents; something was wrong; we could not control our child; we didn't know what was wrong with him. And it was at the end of his second grade, when his teacher said he was below grade level and she passed him because she just didn't want to deal with him anymore.

And it was a struggle at home. It was a strain on our marriage. This is our younger son. We couldn't handle him. We couldn't control him.

And during that summer, I happened to be talking to a lady who asked me had I ever had my son tested for Attention Deficit Hyperactivity Disorder, which I had never heard of. I took him to a psychologist -- I took him to my pediatrician, who sent me to a psychologist.

We wrestled with putting our son on Ritalin. I did not want to medicate my child. My husband didn't want to medicate him. We wrestled with that a great deal.

The first day of school in third grade, he was sent to the principal's office for acting up. That went on for a week. And it wasn't acting up like bad behavior. It was he just couldn't control himself.

And long story short, the second week, we put him on Ritalin. We did not tell the school. Back then, the teachers in our area were not trained on Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder. They didn't know much about it.

At the end of the first nine weeks, when the report card came out -- keep in mind, this is the young man they wanted to hold back in second grade or said he was below grade level. We received a call to come to the school.

I went to the school, met the principal, the reading specialist and the third grade teacher, who said our son was a brilliant, gifted child and wanted to put him in the gifted learning class. He made straight A's.

We then told them we did not want him in the gifted class. We explained the Ritalin. And I will tell you that Ritalin was a savior to us for our son.

We tried everything. We tried the diet. We tried the behavior changes. We tried everything before we succumbed to the Ritalin.

We didn't keep him on it during the holidays. We didn't keep him on it during the summer. He did great. The psychologist said it was all right not to have him on it during the summer and during the holidays.

He did great. When he was in high school, he opted to go off the Ritalin. We've had no trouble with our son. He has not had a problem with drugs.

In fact, just the opposite. We explained to him that, with the Ritalin, if he were to ever try drugs, it could totally harm him. And I believe that, in this country, we have a tendency to swing from one end to the other. I do believe we've swung to the other.

We've gone from when people didn't know about Ritalin and Attention Deficit Disorder to now any time you have a child who is active at all, we put him on Ritalin. I would not want to see the children going on Ritalin at age two, three, four, five.

It was a hard decision for us at eight to put our son on Ritalin. I do believe that, in some cases, Ritalin is what helps. It doesn't -- and one thing we explained -- and I don't mean to take up too much time.

But one thing we explained to our son is that the Ritalin didn't make him smart. It didn't make him get the A's. It just helped him to concentrate, to be able to use the abilities that he already had.

I do think there are children and parents who will need to put their children on Ritalin. But I don't think it's anywhere near the number of kids that I see on Ritalin today.

And I appreciate you holding this hearing. And I hope and pray that before parents put their children on Ritalin, they will have them tested in every respect. They will talk it out with everyone before they do it and that they know it would just be the last resort.

For us, it was a lifesaver. He's 21. He's doing great. He's not on Ritalin, hasn't been on it since 10th grade. But it was a lifesaver, Mr. Chairman.

So I would hope we wouldn't outlaw it altogether, but that we would take a serious check on our conscience before we put our kids on the Ritalin. And I thank you, Mr. Chairman.

BURTON: Thank you very much, Ms. Davis.

Dr. Weldon?

Excuse me, Mr. Duncan, I think you're next, then we'll go to Dr. Weldon.

You want to go to Dr. Weldon? OK, Dr. Weldon?

WELDON: Mr. Chairman, I want to commend you for holding this hearing and just mention that you are taking us into a very complicated but very, very important arena. And I am very, very appreciative of the lady from Virginia's testimony.

My perception is that Ritalin is, to a certain degree, a victim of its own success. It has helped a lot of children. But there are many children who are being placed on it unnecessarily.

I think there is a broader issue that I would like to see the committee address, though I expect we will not be able to in the confines of the amount of time remaining on the calendar, and that is: is there some other underlying process going on to account for the larger and larger number of kids that are being labeled with these behavioral and learning disorders? And I'm specifically talking about something in the environment, something in the food that could be playing a role. Vaccines is another thing worth considering.

And again, thank you very much for convening this hearing. I'm looking forward to hearing the testimony of our witnesses. And I yield back.

BURTON: If we don't get to those other issues you referred to, Dr. Weldon, we'll try to hopefully do that in the coming year.

Judge Duncan?

DUNCAN: Mr. Chairman, first of all, I want to thank you and the staff for calling this hearing. I don't believe there is any committee in the Congress that has held hearings on a wider variety of really important topics than this committee has under your chairmanship.

I listened very closely and intently, as all of us did, to Ms. Davis' statement. I can tell you that I remember having lunch one day in the House dining room with a family that told me almost the exact same story. And I have no doubt that there are some children in this country -- many children, perhaps, in this country -- that have benefited from Ritalin.

But I also have spoken -- I've spoken on the floor of the House twice about this subject because I believe that this drug -- I have to believe that this drug is way overprescribed in this country. And I believe it's all really about money.

I mentioned in one of my floor statements that I had read an article in 1998 by the former second ranking official of the Drug Enforcement Administration who had retired to Knoxville. And he wrote an article in the "Knoxville News Sentinel" and said that Ritalin was being prescribed in the United States six times more than in any other industrialized nation in the world. And he said in this article that Ritalin had the same properties basically as some of the most addictive drugs there are.

I read in 1999, in "Time" magazine that production of Ritalin had increased sevenfold -- seven times -- in the past eight years and that 90 percent of it was being consumed in the United States. And "Time" magazine said in that article -- quote -- "The growing availability of the drug raises the fear of the abuse. More teenagers try Ritalin by grinding it up and snorting it for $5 a pill than get it by prescription."

Then I read in "Insight" magazine, which has had several articles about this, that almost every one of the teenager shooters that we've read about in recent years have been boys who were at the time or who had recently been taking Ritalin or other similar mind-altering drugs.

And late last year, the same magazine, "Insight" magazine had an article, which said 30 years ago, the World Health Organization concluded that Ritalin was pharmacologically similar to cocaine in the pattern of abuse it fostered and cited it as a Schedule II drug, the most addictive in medical use.

The Department of Justice also cited Ritalin as a Schedule II drug under the Controlled Substances Act. And the Drug Enforcement Administration warned that -- quote -- "Ritalin substitutes for cocaine and the amphetamine in a number of behavioral paradigms."

I also read one study that said that almost all Ritalin was being prescribed to young boys who came from -- who were the children of very successful parents, both of whom were working full time outside of the house. Now I say again, I know that there are people for whom Ritalin has been a lifesaving drug.

But I also know that I think -- and I have a family that has many teachers in it -- but I know sometimes that, you know, there are some poor teachers who I think have recommended Ritalin just because they personally couldn't properly handle a young boy that was being, what we used to say, "He's all boy." He's very, very active.

And I've known personally two or three of these young boys that have been put on Ritalin. And they have appeared to me to be in zombie-like states.

And so I think we need to look very closely at this. I don't believe we need to outlaw Ritalin. But I believe it needs to be greatly, greatly reduced in its usage.

And I'll say it again, I believe it's being overprescribed in this country just because of the profit factor, the money that's out there that the drug companies want to make.

Thank you very much.

BURTON: Thank you, judge.

What I'd like to do is take the committee to the five-minute mark. We have almost 12 minutes left on the clock. And then we will have to recess for three votes. And I would urge all members to come back so we can hear our witnesses, if it's at all possible.

And with that, I'd like have our witnesses stand and be sworn in. Would you please rise? Raise your right hand.

Do you swear to tell the whole truth and nothing but the truth, so help you God?

Be seated. I'd like to start off by showing a tape of Neil Bush, who could not be with us today, because he had some things he wanted to say. And we'd like to show that real quickly.

So would we put our attention on the monitors?

(BEGIN VIDEOTAPE)

(UNKNOWN): If you'd like to be in our studio audience when you're in New York, send an e-mail to ABC News.com.

Diane?

(UNKNOWN): All right, Tony. Well, he calls himself the lowest profile member of the Bush family. But President Bush's brother Neil can't entirely hide from the spotlight. And this morning, he joins us to put the spotlight on something else, schools overprescribing drugs like Ritalin to treat students with Attention Deficit Disorder or problems.

And he should know. He says it almost happened to his son, Pierce. And I ran up the stairs this morning, too. I'm not in as good of shape as I thought.

Neil, it's great to see you this morning.

BUSH: Thank you very much for having me.

(UNKNOWN): What happened with Pierce?

BUSH: Pierce is, like millions of kids, very bright, very engaging. He kind of cruised through elementary school on the pure power of his personality.

He got into middle school, where the rubber meets the road, where kind of the strict, kind of hard work of learning kicks in, where the textbook, test, memorize and forget model of education is there. And he started doing more poorly.

And the knee-jerk reaction of schools -- not just private, but public schools; not just poor, but good schools -- is to label kids like that with ADD and to literally prescribe drugs to them.

(UNKNOWN): And he was prescribed Ritalin, but he didn't take it?

BUSH: And he refused to take Ritalin. He wouldn't take, you know, an aspirin for a headache. So he refused. And it's changed my life.

I've put a lot of time into thinking about this. And I think we do overprescribe Ritalin. And we way overdiagnose ADD. It's a very subjective diagnosis.

It's not like somebody can take a blood sample or a CAT scan and analyze. And it's just sad to me. It's sad that we drug over 6 million kids in this country with mind-altering drugs to have them be more compliant in a school system.

(UNKNOWN): Well, I want to talk about some of the alternatives. But as we do it, I know one of the things you felt with Pierce, that he just wasn't being challenged enough. And that, as soon as he got challenged, it all changed.

I want to show everybody a clip of him. He was on "Larry King," not so long ago, talking about Uncle President George.

(UNKNOWN): Now what you have been saying is that it's very important to examine the kind of teaching that is taking place for a child before automatically prescribing a drug. You've even said that textbooks are kind of an ultimate villain in this for not engaging kids?

BUSH: Well, textbooks are used for 75 to 80 percent of the communication of the curriculum. And textbooks clearly fail to engage kids the way kids learn best. We have a 19th century system of education, teaching kids that are 21st century thinkers, who are engaged outside of school in so many intriguing ways.

And so it's just really, really sad to me that we haven't changed the way we instruct and engage kids. If you engage a child in school, the symptoms of ADD go away.

(UNKNOWN): And in fact, you were dyslexic as a kid.

BUSH: I was. Right.

(UNKNOWN): And you say that your mother really applied a full court press.

BUSH: Yeah, well, my mother, the best thing she ever did was never lose hope in me, never lose faith in me as a human being and as a learner. A lot of dyslexics, by the way, because they have trouble reading, have a hard time staying engaged in school and therefore, are labeled ADD.

When you lack attention and when you appear to be disorganized, when you're not on task, any symptom that exists whenever you're bored to death, then you're labeled and drugged. And it's really sad to me.

I was dyslexic. I read stuff with a passion, though, that I care about. And I care deeply about how kids learn and how we can reform the system so that kids are truly engaged.

(UNKNOWN): And you're, in fact, working on a -- you have a company?

BUSH: I do. I have a company, Ignitelearning.com. We are building courseware that is built first around how we know kids think and learn. And then secondly, it's integral to what a teacher is teaching in school. So when they're teaching history, kids are using music and animation.

It's really exciting to see that light turn on in kids. Every kid has a gift for learning. Not one kid should be left behind. And we need to arm teachers with 21st century tools, you know, to help them be more successful.

(UNKNOWN): I have to turn to one other Neil Bush child.

(END VIDEOTAPE)

BURTON: I want to thank ABC for providing that tape to us. And we are now at a point where we have to recess. Please forgive me -- you on the panel and everybody in the audience. We'll get back here just as quickly as possible.

We have three votes. The first one will be through in about 10 minutes and then we have two five-minute votes. So we'll be back here in about 25 minutes.

So get a cup of coffee or a glass of water and forgive us for having to recess. We'll be right back.

Stand in recess to the call of the gavel.

(RECESS)

BURTON: The committee will once come to order. There will be other members coming back besides me and Ms. Davis, but we just had votes on the floor and we rushed back. So they will be wandering in. Those things happen.

Before we start with the panel, who are on their way out, as I understand it, I want to thank Sam Brunelli for helping me arrange this. For those of you who don't know who Sam Brunelli is, he was an all-pro football player for some team out west called the Denver Broncos. Is that what it was, Sam?

Yeah, well. Sam did a great job for them. He was all-pro. But I think this year, they're going to be whipped by the Indianapolis Colts in that division.

And Sam's thinking over there, "Not in your lifetime."

(LAUGHTER)

In any event, you've all been sworn. And I want to thank you for being patient with us while we were gone.

What's the order?

I think what we'll do is we'll start right down the list there. Ms. Weathers, why don't you start with your testimony? And if you can, keep your testimony to five minutes. But we won't kill you if you go just a few seconds over.

WEATHERS: OK. My name is Patricia Weathers. I am a mother from New York State. I have considerable concern regarding the outcome of this hearing because my son, Michael, was one of the children profiled for ADHD by our school district.

When Michael was in kindergarten, I began getting reports that he was having behavioral problems. What was meant by this is that Michael was talking out of turn, climbing around in class and apparently not sitting still.

The following year, while Michael was in first grade, his teacher told me that his learning development was not normal and that he would not be able to learn unless he was put on medication. Near the end of first grade, the school principal took me into her office and said that unless I agreed to put Michael on medication, she would find a way to transfer him to a special education center.

I felt intimidated, scared and unsure of what to do as a result of the school's coercive tactics. At no time was I offered any alternatives to my son's needs, such as tutoring or standard medical testing. The school's one and only solution was to have my child drugged.

At this point, his teacher filled out an actor's profile for boys, which is an ADHD checklist, and sent it to his pediatrician. This checklist, along with a 15-minute evaluation by the pediatrician, led to my son being diagnosed with ADHD and put on Ritalin.

After a while, my son started to exhibit serious side effects from the drug. He was not socializing, became withdrawn and began chewing on various objects. His eating and his sleeping were sporadic and of great concern to me.

Instead of recognizing the side effects of the drugs, the school psychologist claimed Michael now had either bipolar disorder or social anxiety disorder and needed to see a psychiatrist. She produced a name and a number of the psychiatrist I was to call. The psychiatrist talked to my son and I for a short period. And again, with the aid of school reports, diagnosed him with social anxiety disorder.

She handed me a prescription for an antidepressant, telling me it was a wonder drug for kids. Those were her exact words.

There was no information about the serious side effects associated with this drug. The drug cocktail that was to follow caused even more horrendous side effects, making his behavior more and more out of character. I could no longer recognize my own son.

Fearing what these drugs had done to him, I stopped them. Through this whole ordeal, the school psychologist's favorite saying was that it was trial and error. If one drug didn't work, try another.

Realizing that I was no longer willing to fall in line and give my child drugs, the school threw him out. For a final blow, they proceeded to call Child Protective Services on my husband and I, charging us with medical neglect for refusing to drug our child. This charge was later ruled unfounded.

On August 7 of this year, the "New York Post" featured my son's story and the fact that I had decided to file a lawsuit against the school system on behalf of my son, Michael's ordeal. On Friday, September 20, this lawsuit was officially filed in federal court.

Within just a few days of the "New York Post" article being published, over 65 parents came forward to describe their own personal stories of coercion and intimidation used by school districts to strong arm them into drugging their children. Since then, many more have come forward.

Through my family's experience, I feel the issue of informed consent is crucial. As a parent, I was simply not provided with accurate and critical information regarding the issue of ADHD. I was never made aware of the controversy surrounding this disorder, whereby many medical professionals do not validate it as a true medical condition.

I was never provided with the information that there is no independent, valid test for ADHD. I was never given any warnings about the documented side effects that could occur with the drugs used to treat it. I was never informed that there are studies showing the correlations between stimulant use and later drug use.

As a final point, I was at no time made aware that this drug use could bar my child from future military service. As a mother, I should have been given all of this information to make an informed decision on behalf of my child.

After all, it is we who are ultimately responsible for the nurture, care and protection of our children. We are unable to fulfill this obligation and make sound educated decisions without getting all the facts.

Accountability is what I am seeking. I would never have subjected my son to being labeled with a mental disorder if I had known that it was a subjective diagnosis. I would not have allowed my son to be administered drugs if I had been given full information about the documented side effects and the risks.

It is for this reason that I am asking this committee to fully investigate these matters as they relate to the issue of informed consent and to enact legal safeguards so that parents can fulfill their obligations to shield their children from any potential harm.

Thank you.

BURTON: Thank you very much, Ms. Weathers. I think that was a very, very important statement. And we really appreciate your coming here today.

And I'd like to -- Dr. Block?

BLOCK: I am Dr. Mary Ann Block, an osteopathic physician from Texas. For those of you who are unfamiliar with the osteopathic profession, let me tell you a little bit about us.

We are fully licensed physicians, with the ability to write prescriptions, perform surgery and be residency trained in all the same specialties as MDs. The difference between MDs and DOs is twofold. One, as a DO I have 150 more hours in medical school than MDs. Osteopathic physicians tend to be more holistic in their approach because of the philosophy that teaches us that the body and mind should be viewed as a unit.

Because of my medical training, my goal as a physician is to look for and treat the underlying cause of a patient's problem, rather than just covering the symptoms with drugs. I have seen and treated thousands of children from all over the United States who had previously been labeled ADHD and treated with amphetamine drugs.

By taking a thorough history and giving these children a complete physical exam, as well as doing lab tests and allergy testing, I have consistently found that these children do not have ADHD, but instead have allergies, dietary problems, nutritional deficiencies, thyroid problems and learning difficulties that are causing their symptoms.

All of these medical and educational problems can be treated, allowing the child to be successful in school and in life without being drugged. The American Osteopathic Association has published my program as the osteopathic approach to treating the symptoms called ADHD.

This approach is supported in the medical literature as well. The "Annals of Allergy" reported in 1993 that children with allergies perform less successfully in school across the board than children who do not have allergies. Yet doctors prescribe amphetamines without ever checking the child for allergies.

A study in the "Journal of Pediatrics" in 1995 reported that children who ate sugar had an increase in adrenaline levels that caused difficulty concentrating, irritability and anxiety. A double blind crossover study published in "Biological Psychiatry" found that Vitamin B-6 was actually more effective than Ritalin in a group of hyperactive children.

Another study found that children with magnesium deficiencies were characterized by excess fidgeting and learning difficulties. There are many more studies in the medical literature that indicate an association between nutritional deficiencies and attention and behavioral problems. Yet, doctors prescribe amphetamines without checking a child's diet.

There is no valid test for ADHD. The diagnosis called ADHD is completely subjective.

While some like to compare ADHD to diabetes, there really is no comparison. Diabetes is an insulin deficiency that can be objectively measured. Insulin is a hormone manufactured by the body and needed for life. ADHD cannot be objectively measured. And amphetamines are not made by the body, nor are they needed for life.

The prescription drugs that are used to treat symptoms of attention and behavior come with a host of potential side effects. According to the manufacturers of the drugs, the following side effects can and do occur: insomnia, anorexia, nervousness, seizures, headaches, heart palpitations, cardiac arrhythmias, psychosis, angina, abdominal pain, hepatic coma, anemia, depressed mood, hair loss, weight loss, tachycardia, increased blood pressure, cardiomyopathy, dizziness and tremor, to just name a few.

These drugs are classified as Schedule II controlled substances with high abuse potential. According to reports in the "Journal of the American Medical Association," the drug Ritalin has been found to be very similar to and more potent than cocaine.

Ritalin and cocaine are so similar that they are used interchangeably in scientific research. There are no long-term studies on the safety and effectiveness of these amphetamine drugs, though millions of children are treated with them for years at a time.

When I was in school and when my children were in school, there was no need to drug millions of children. While there are children who have attention and behavioral problems and these problems may have increased due to poor diets, an increase in sodas and candy in our schools, an increase in allergies due to changes in our environment and an increase in learning problems, it does not mean these children have a psychiatric disorder called ADHD.

It means they have medical and educational problems that can be fixed. Most of the children I have seen who have been prescribed these drugs have never had a physical exam. No doctor listened to their heart, even though many of the side effects of the drugs are heart related.

Since there is no valid test for ADHD, most doctors get the information for the diagnosis from the child's teacher in the form of a checklist. If the teacher wants the child to be taking these drugs, all she or he has to do is fill out the checklist indicating that the child has many problems in the classroom.

One child was diagnosed as ADHD and prescribed Ritalin. But I got to treat him instead. Once his allergies and learning problems were corrected, he went on to become a National Merit finalist and accepted to an Ivy League university.

Every child deserves that opportunity. Many of the parents of these children have told me that the teachers and principals have pressured them to put their children on these drugs, threatening to report them to Child Protective Services if they do not comply.

CPS actually removed a child from his home after the school reported the mother for not giving the child his drug. The ironic thing was she had been giving him the drug. The drug made him worse, not better.

I cannot imagine any reason to give a child an amphetamine to cover up symptoms when the problem can be fixed and no drug is required. Let's give our children the medical and educational evaluations they need to diagnose the real problems.

Let's treat these real problems and give our children the future they deserve without drugs. I will show a brief video, which shows a child's disruptive behavior, caused from allergies. And I'm also submitting, as part of my written evidence, my latest book, "No More ADHD: 10 Steps to Help your Child's Attention and Behavior Without Drugs."

Thank you.

(BEGIN VIDEOTAPE)

BLOCK: This is a video of a 9-year-old boy, undergoing allergy testing. He uses the noise to distract himself. We ask the children to sit still and concentrate for 10 minutes.

The reaction to this first allergy shot makes him feel bad. It causes him to be uncooperative, belligerent, unable to sit still or concentrate.

After 10 minutes, he is given another dose of the same allergen. But this time, it is a dose that makes his symptoms go away. After receiving the correct dose, he can sit still, he can focus and concentrate and he is no longer angry or belligerent.

(END VIDEOTAPE)

BURTON: Does that conclude your testimony? Thank you very much.

Ms. Presley?

PRESLEY: Thank you very much, Congressman Burton and committee members for the opportunity to address this hearing. I'm here as a mother mostly because I have to put my children in school and I have also had direct contact with these children who are medicated. And I can tell by their behavior that they are.

They're usually manic, very destructive, very interested in destruction. You know, we've already said it a hundred times, but between 6 and 8 million American children are being given Schedule II narcotics and/or mind-altering antidepressants.

It's not just ADHD. Some of them cause -- the other ones -- cause tics, cause this which goes into a spiral of OCD, Tourette's, this, that and the other thing. And all these normal behaviors for children are now -- everything is a disorder. I mean, I basically will have everything under the sun at this point.

Yeah, I'll stand up and testify to that too.

But anyway, I'm just saying, I have personally seen the side effects of these drugs. Ritalin, for example, can cause nervousness, loss of appetite, weight loss and manic behavior. Even the manufacturer warns that it can cause psychotic episodes. Suicide is a risk during withdrawal.

Some of these drugs are advertised as non-addictive. But I have known numerous people who have been to rehab centers to get off of them.

Teenagers on powerful psychiatric drugs committed more than half of the recent teenage shooting sprees. That's very alarming, resulting in 19 deaths and 51 wounded. I don't think there has been a correlation made in the media with that one, but it seems awfully coincidental, not coincidental.

Parents need to be informed of drug-free alternatives to the problems of attention, behavior and learning. A child could be fidgety in class or simply bored with what they are learning and then diagnosed with a learning disorder and put on drugs.

Some of these disorders, from what I understand, are also -- you know, they raise their hand and decide something is a disorder, that it's not factually, scientifically proven to be such. There is no blood test. There has been no autopsies to confirm brain -- what is it called? -- chemical imbalance.

A child could have allergies, lead poisoning, eyesight or hearing problems and be simply in need of tutoring or something even more basic than that, which could be phonics. I have not seen one happy and well-adjusted child as a result of these drugs. That's just my personal experience.

What is basically happening is that we are relying on a chemical to change the mood of a child. At least one of these drugs is more potent than cocaine. And we are turning them into drug addicts at a very young age.

My hope is that the committee will recommend legislation that prevents school personnel from coercing parents into placing their children on to mind-altering drugs. They become dependent on them and then, you know, it leads to further drug addiction, which then leads to crime, which leads to all the other terrible things that we always have to deal with in life.

And ultimately, that we don't allow that into the schools -- period. Our schools should only be there to educate our children and not to diagnose any -- have the ability or the right to diagnose children with mental health problems.

It's way overprescribed, way overdone. And I think that, at least, even the people, from what I've seen here today that have a disagreement -- you know, want to go on the other side of the fence still see that it's a situation and it's a problem.

And that's all I have to say. It's a concern.

BURTON: And you have been the head of this organization or one of the leading spokesmen for some time now?

PRESLEY: Yeah. Actually, no, I'm just becoming. I mean, I have done a lot of things with them before on this front. But I have now taken the title as the spokesperson for this committee.

BURTON: Very good, very good.

Mr. Wiseman?

WISEMAN: Thank you, Chairman Burton and members of the committee for the opportunity to speak today. For over 30 years, CCHR's observations and conclusions have been drawn from speaking to hundreds of thousands of parents, doctors, teachers and others.

For example, at seven, Matthew Smith (ph) was diagnosed through his school as having ADHD. His parents were told he needed a stimulant to help him focus and that non-compliance could bring criminal charges for neglecting their son's educational and emotional needs.

On March 21, 2000, while skateboarding, Matthew (ph) tragically died from a heart attack. The coroner determined that he had died from the long-term use of the prescribed stimulant.

We all know that there are children who are troubled, who do need care. But what that care is or should be is the point of contention.

In 1999, in the wake of the Colombine school shootings, CCHR worked with Colorado State Board of Education member Mrs. Patty Johnson (ph), who had a precedent-setting resolution passed that recommended academic, rather than drug solutions for behavioral and learning problems in the classroom.

Mrs. Johnson (ph) stated -- and I quote -- "The diagnosing of children with mental disorders is not the role of school personnel. Nor is recommending the use of psychiatric drugs." The resolution told educators that their role was to teach and pursue academic and disciplinary solutions for problems of attention and learning.

In 2000, Jennifer L. Wood (ph), chief legal counsel for the Rhode Island Department of Education, issued a letter to all schools that under the Individuals with Disabilities Education Act -- quote -- "It is not lawful for school personnel to require that a child continue or initiate a course of taking medication as a condition of attending school."

School personnel cannot require, suggest or imply that a student take medication as a condition of attending school. Yet this is violated across the nation.

Millions of children are being drugged with powerful stimulants and antidepressants, placing our nation's children at risk. In 2001, the "Journal of the AMA" reported that Ritalin can act much like and is chemically similar to cocaine. It admits that while psychiatrists have used this drug to treat ADHD for 40 years, they have never known how or why it worked.

As a result of overmedicating our children and the fact that so many parents were being forced to place their child on such drugs, currently more than half of our states have introduced and/or passed some type of legislation or regulation to restrict the use of psychiatric drugs for children. I am submitting a selection of these for the committee's review, one of which cites the 1998 NIH Conference on ADHD, which said in part, "We don't," -- and I'm quoting -- "we don't have an independent, valid test for ADHD."

"There are no data to indicate that ADHD is due to a brain malfunction. And finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remain speculative."

This is perhaps the crux of the problem. We are relying on a diagnosis that is subjective and open to abuse.

Evidence reviewed by the National Academy of Sciences this year indicates that toxic chemicals contribute to learning or behavioral problems, including lead, mercury, industrial chemicals and certain pesticides. Furthermore, thousands of children put on psychiatric drugs are simply smart.

The late Dr. Sydney Walker (ph), psychiatrist and author, said -- and I quote -- "These students are bored to tears. And people who are bored fidget, wiggle, scratch, stretch and start looking for ways to get into trouble."

All of this information should be made available to parents when making an informed choice about the medical or educational needs of their child. This is in keeping with U.S. Public Law 96-88, which states -- quote -- "Parents have the primary responsibility for the education of their children. And states, localities and private institutions have the primary responsibility for supporting that parental role."

As senior government officials, you represent the lives of all citizens. Families are grieving for the loss of children because they are not provided with all the facts about mental health treatments, especially psychotropic drugs, and were denied access to alternative and workable solutions.

We respectfully request that the Government Reform Committee recommend federal legislation that: a) makes it illegal for parents or guardians to be coerced into placing their child on psychotropic drugs as a requisite for his or her remaining in school; b) protects parents or guardians against their child being removed from their custody if they refuse to administer a psychotropic drug to their child; c) provides parents the right of informed consent, which includes all information about alternatives to behavioral programs and psychotropic drugs, including tutoring, vision testing, phonics, nutritional guidance, medical examinations, allergy testing, standard disciplinary procedures and other remedies known to be effective and harmless; and finally, that such informed consent procedure must include informing parents about the diverse medical opinion about the scientific validity of ADHD and other learning disorders.

Thank you.

BURTON: Thank you very much.

Let me just start with you, Mr. Wiseman. You indicated that -- are there some states that don't allow the dismissal of a child because of the parents' refusal to use these mind-altering substances?

WISEMAN: That don't allow the dismissal of a child?

BURTON: Are there some states that have some kind of a last right of refusal for parents to keep the child in school if they refuse to take these mind-altering substances?

WISEMAN: Well, there are states -- if I'm understanding the question correctly -- states have started, in 1999, to actually pass legislation and regulations prohibiting schools from doing that. But it has been a problem, so much of a problem that there are now 27 states that have passed or have legislation or resolutions in progress that address this issue.

So it was enough of a problem that, as I say, more than half the states in the country have actually had to address the problem with legislation because it was being abused. Parents were being coerced.

BURTON: Well, the reason I ask that question is many school districts in many states around the country, they require children to get inoculations for as many as 26 different childhood diseases. My grandson received nine shots in one day. And I think, in total, the number of shots that he would receive prior to going to first grade would be around 26.

WISEMAN: My word.

BURTON: He received 47 times the amount of mercury that is tolerable in an adult in one day. And two days later, he became autistic. And of course, he's -- well, we're hoping he's going to recover. He may be permanently damaged.

And I guess the point I'm trying to make is these requirements are at the school board level or at the county level or at the state level. They're not requirements that the federal government imposes.

And so I'm wondering, you're asking for legislation at the federal level that would give parents the right to refuse these mind- altering substances. And one of the problems that we will have with some of our colleagues is that that will be looked upon as an infringement of the local school boards' or states' rights.

And I just wondered if you had given that any thought?

WISEMAN: Well...

BURTON: It's not that I'm opposed, you understand, to trying to do what we can here at the federal level to deal with the problem after we hear all the testimony. But each individual state has, up to this point, been dealing with childhood problems like this.

WISEMAN: Yes. Unfortunately -- and not to be repetitious, but unfortunately, we hear in our organization mothers calling in that are being coerced. And the abuses is tragic.

Parents are being threatened with either criminal charges, as I mentioned in my testimony, or in some cases the loss of their children because they're not put on mind-altering drugs. I mean, we're at the dawn here of the 21st century. And there are some children who aren't permitted to go into school unless they're on a mind-altering drug.

The federal legislation that bears on this is the Individuals with Disabilities Education Act. The problem is that the definitions in that law and the definitions that filter down to the school districts under that law are so subjective that, you know, the disorder is in the eye of the beholder. There are no objective tests for this, as has been testified here this morning and from folks on the panel.

There is no scientifically-based studies that enable somebody to make such a diagnosis. So because they are so subjective, it's open to abuse.

BURTON: Well, what I would like to have from you, Mr. Wiseman, is some proposed language that we can take a look at that might be appropriate at the federal level. We approach stepping into states' rights with great trepidation, at least on this side of the aisle. So this is something we would have to take a hard look at.

But I will look at it and see if we can fashion something that will maybe encourage the states to be more concerned about parental rights and how the children are handled and whether or not they're completely, properly tested before they start putting these drugs into them.

WISEMAN: As a former teacher of American history, I share one, your love of the Constitution and your concern for states' rights very, very much. But with somewhere on the order of 6 million children in this country being placed on these Schedule II narcotics, I do think it's something the federal government should look for. And we'll be happy to provide you with some suggested wording.

BURTON: Very good.

Ms. Weathers -- and I'll get to you, Ms. Davis, in just a minute, as soon as we finish this first tranche of questions, OK? Be with you in just a second.

Ms. Weathers, you stated that your son's school pressured you to medicate your son and that, at the time, you trusted them because they were -- quote, unquote -- "the experts." At any time, did the school or your son's doctor talk to you about the potential side effects of those drugs?

WEATHERS: Absolutely not. The most the pediatrician had told me was that there was possible appetite suppression and possible insomnia. She never at any time advised me that there are deaths related to this. There is cardiac problems, heart problems related to these drugs, that his growth would be seriously impaired.

When I took Michael off these drugs, within three weeks, he grew three sizes. So nobody can tell me that those drugs didn't have a great, a tremendous, a horrendous effect on him.

BURTON: OK.

Did your doctor also recommend any behavioral modification training or counseling for your son?

WEATHERS: Absolutely not. She did not. Basically, I had to go in, I believe, every three to four months for a prescription refill.

BURTON: So they just didn't check any of that out? They just said, "These are the things that you have to do," and prescribed the drugs.

WEATHERS: All she did was ask me how he was doing.

BURTON: Did the doctor ever do any blood tests or objective medical evaluation to look at any possible biological basis for his behavior?

WEATHERS: I don't believe there was. I think early on there was a blood test taken. But once again, you don't have a blood test to determine ADHD. You can only have a blood test to rule out underlying causes.

And I believe the only thing they did rule out was lead toxicity.

BURTON: Dr. Block, what have you found that the schools do specifically to encourage the use of medications for attention and behavior?

BLOCK: The parents that come to me report consistently that the teachers and the principals and even the school nurses pressure them to go to a physician and get their child labeled and drugged. In addition, even though the state of Texas Board of Education has passed one of these state resolutions concerning being concerned about the drugging of children, it appears to me that the teachers are not yet aware of it because nothing seems to have changed since that resolution has passed.

Some schools are giving lectures to parents, inviting parents to come hear talks about diagnosing and drugging their children for ADHD. Another thing that has recently occurred, it's not unusual for me to make recommendations for certain nutrients or other things that the child may need to naturally help their body and mind work better. And I will write a prescription for that child to receive that nutrient at school.

What is happening now, though, is that the schools are denying my medical prescription and saying that they will not give a child anything at school except a drug. That, to me, is practicing medicine without a license.

And unfortunately, physicians themselves, according to the FDA, less than one percent of doctors actually know the side effects of the drugs that they are prescribing. Pharmaceutical reps that come to my office have told me more than once that I'm the only doctor they've called on that asked what the side effects of the drug was that they were repping to me.

BURTON: Let me -- I see I'm running out of time here and I want to get to Ms. Davis.

Do you have any idea how physicians are influenced by the pharmaceutical companies to prescribe these medications for kids?

BLOCK: Yes, as a physician, I see this influence all the time. For one thing, I don't think any of us can turn on the television, radio, open up a newspaper or magazine without seeing multiple advertisements for prescription drugs. They go so far as to say, "Ask your doctor if this drug is right for you," encouraging the public to go to the doctor to get a drug.

But in addition, I don't believe the public is aware of the strong influence the pharmaceutical industry has on physicians. From the time we start medical school until the day we stop our practice, we are strongly influenced or attempted to be strongly influenced by the pharmaceutical industry. Our medical journals, which are purported to be unbiased, usually have about 60 percent of their pages as full-page ads from the pharmaceutical industry.

If I go to a continuing medical education meeting, which is required by law that I attend so many hours each year, the doctors who are talking to us are being paid by the pharmaceutical industry to give those lectures. Many doctors are being paid in their offices to do research for the pharmaceutical industries as well.

They also give money to different groups who go out and promote the use of these drugs for our children. So the pharmaceutical companies have a tremendous influence on our society and especially on physicians.

And it is concerning when doctors don't even know the side effects. There is no way that they can tell a patient if they don't know them themselves.

BURTON: I will yield to Ms. Davis. But let me just say, my son- in-law is a doctor. And I've gone to a number of these lectures that are put on by pharmaceutical companies. And I can tell you, as one who goes -- and they're very nice dinners they put on and very expensive in many cases, have great wines and all those sorts of things -- they do have doctors that come in and talk about the attributes and the positives about these drugs. So they are very effective in selling their products to the doctors and the doctors writing those prescriptions.

Ms. Davis?

Incidentally, we'll have a second round of questions because I have some more questions for the panel.

Ms. Davis?

DAVIS: Thank you, Mr. Chairman. I don't have too many.

I tried to state at the beginning that we just have this tendency in our country to go from one end to the other and we never seem to find the right balance. And I think that's where we are right now with the ADHD and the Ritalin. Like I said, when my son was put on it, the teachers didn't even know about ADHD. And I understand now they're even training the teachers in school or something.

And my concern is -- in fact, my son's pediatrician wasn't even that familiar with it. He sent me to a psychologist. And we did a lot of testing.

It was explained to me -- and Dr. Block, this is for you -- it was explained to me that with the ADHD, the child has the blood in the frontal lobe of his brain, I guess, just goes so slow that that's why he can't concentrate. He's seeing like three different pictures or what have you.

And that's why they can sit in front of a TV for hours because so much is going on. And that the Ritalin would speed up the blood flow and then cause them to be able to concentrate.

Have you ever heard that?

BLOCK: I certainly have heard that. And it is an interesting theory. But it has never been proven.

And in fact, drugs like Ritalin and other amphetamine-type substances, one of the basic things they do is make you focus. They can make you overfocus.

But it's been found that anyone who takes this type of drug will have a similar effect because that's what it is. It doesn't prove that someone needs the drug because they have that effect.

But there are many theories going and there is many people who are looking at all kinds of brain scans and everything else. But when you look at the child in my video who was reacting to an allergy, I assure you if you did a brain scan of him at the time when he's reacting, you would see reactions.

And so my focus is really on information, informed consent, that parents be told what all their options are, that they be told all the possible side effects to any treatment. And you know, I think parents always care so much for their children, they're going to do what's right for their child if they're given all the information.

DAVIS: I agree with you. And we were told the side effects of Ritalin when we gave it to our son. That's why it took us so long to give it to him because we didn't want to do it. And it was actually a last resort for us to do that. And it did work for him.

Ms. Weathers, I had a question for you. And if you'll give me a second, it will come back to me.

You said that the teachers all said your son had a problem. Did you every find out what the problem is or was? Is this just recent?

WEATHERS: No, this isn't recent. You know, in my opinion, Michael is extremely bright. He was not reading at grade level. There was a lot of factors that were playing a role in his behavior that were not even addressed by the teachers.

When he was going into fifth grade, he was reading at a second grade, eighth month level, OK? That isn't normal. They were putting him in a special ed room and not teaching him phonics. And I think that's horrendous, I really do.

DAVIS: Did you have problems with him at home?

WEATHERS: No, I would never, ever -- and I'm going to make this perfectly clear for everybody in this room -- I would never have contemplated drugging my child, ever.

He never had behavior problems at home. The minute he entered school, that's when the trouble started.

That is when I was coerced. I felt under pressure. I felt like everyone was telling me that this was the best thing.

I was a single mom. I was scared. I was unsure. And I felt these are the experts. They know children. And I know and I get hundreds of phone calls throughout the country, hundreds from other parents in the same -- having the same experience that I have endured and my family and my son has endured.

And as far as Hawaii, I have a woman in the state of Hawaii who had to leave the state of Washington because she was so pressured. She wanted to pick the state with the lowest consumption of Ritalin use. And she flew her entire family to Hawaii.

Her name is Susan Perry (ph). And I'm in contact with her now. And we are fighters. And I'm going to fight this issue until the very end because parents are not informed nowadays.

We're not told the side effects. We are just not. And it's just tragic because our children are suffering. And our children are what counts.

DAVIS: Thank you, Ms. Weathers. I totally agree with you. And as a mom, there is nothing more important to me than our kids. And I know how you feel.

Thank you, Mr. Chairman.

BURTON: We'll have a second round of questions.

Let me just tell you something that's of interest that you might find interesting, Ms. Weathers. Mercury is in a lot of our vaccines. Mercury is a toxic substance. And I've talked to a number of doctors, including doctors here on the Hill that treat congressmen. And I told them, I said, "Do you know that in our flu shots that we get, there is mercury?"

And some of the doctors said, "No, no, there's no mercury in there." And I took the insert out and I showed it to them. And it says, "Thimerosal." And they said, "See, there's no mercury in there."

I said, "Thimerosal contains mercury." Has never been properly tested since 1929. It was tested on 27 people who all were dying from meningitis. All of them died. And so they say that the mercury didn't cause it.

But they've never tested it ever since. And it's been given to our children. My grandson got nine shots, many containing mercury, in one day. And two days later, he was autistic and may be maimed for life. He is not responding as we would like.

And so you are absolutely correct. Parents need to be informed about the substances in the vaccines and in the pills and all the other treatments they're getting. And if they don't get that, then shame on us.

And doctors need to be given the proper information from the Food and Drug Administration. And the Food and Drug Administration has been derelict in their responsibilities of doing it.

And I'm very sorry we don't have the FDA here today because the FDA's responsibility is not only to test these things, to do double blind studies and everything else before we start administering these things to the population and our children, but they're also supposed to inform people. And they haven't been doing that as well.

And that's one of the reasons why we've had so many problems with them over the years. But we will be contacting the FDA about that.

What? What is it?

Let me ask you, Dr. Block, one more question. As you know, we -- and I will have other questions I would like to submit to you for the record that you can answer later.

As you know, we've learned that a government-funded study found a correlation between the use of thimerosal, mercury-containing vaccines and a diagnosis of ADD. Do you think that every child that is referred to a child for ADD evaluation should be tested for heavy metals?

BLOCK: Yes. I do think every child should be. In addition to seeing a lot of children with attention and behavioral problems in my practice, I see a lot of children who have been diagnosed as autistic. And through testing these children for heavy metals and often finding mercury and lead and other heavy metals, begin testing the children who have attention and behavior problems and often find the same thing with them as well.

I think that these problems are on a continuum where one child has severe symptoms and gets the autistic label, while another child gets an ADHD label. But I'm finding the same underlying problems in all of these children.

BURTON: Heavy metals being one of them?

BLOCK: Heavy metals being a major one, yes.

BURTON: So it would be your opinion that these preservatives they're putting in that contain aluminum and mercury, in particular, should be taken off the market? They should take those things off the market.

BLOCK: They should be taken off the market. They were supposed to be taken off the market, was my understanding. But they have not been taken off the market.

Many pediatricians actually believe they have been taken off the market. So they have not looked to see if the thimerosal is in the vaccine.

But they are still in the vaccines. Children are still getting as many as eight or nine different diseases immunized against in a single visit to the doctor's office. And many of those vaccines do contain the mercury and aluminum, which work together to make the problem even worse.

Let me just say that we suspect -- and in fact, I'm pretty sure -- that while they're starting to get mercury out of children's vaccines here in the United States, we send vaccines all over the world to Third World countries. And we send them with multiple vaccines in one vial. And they are still using the mercury, the thimerosal in those almost entirely around the world.

And so while we're starting to get them out of our vaccines, we're continuing to inject mercury into children all over the world in Third World countries, which I think is almost criminal.

Let me ask Mr. Wiseman a couple -- oh, Ms. Presley a question here. Why did you choose to get involved in this discussion of ADHD? Have you had a family that was misdiagnosed?

PRESLEY: Yes, I have. I have also had experience with mercury. I had nine fillings at one point.

And I went two years almost going crazy, getting every asthma, this that, hypoglycemia, candida, all these troubles. I've baffled every doctor from one coast to the next. And then when I finally got the diagnosis that I had -- you're supposed to have between zero and three normal in a human body. And I had 1,000-plus.

And the doctor called me. And the term "mad as a hatter" is from people who used to work in felt factories where they would be exposed to mercury and they'd go crazy.

Now I had experience with that. And the moment I started taking things either naturally or a chelation agent to get it out, all the symptoms stopped. So I've had personal experience with that. And I do know that they are not only in the vaccines, they are in fillings that children -- they still use it in the mouth.

BURTON: Amalgams.

PRESLEY: Yes, amalgams.

BURTON: And most people don't know that 50 percent of the silver fillings in your mouth, 50 percent of those are mercury.

PRESLEY: Yes. Yes, sir.

BURTON: And a lot of people don't know that.

PRESLEY: Other than that, the reason I got involved was because I've had personal experience around children who are medicated. And I see their behavior. And I see that it's usually something very obvious. They do have allergies.

I've seen them on it. I've seen them manic, crazy. And then they come off it and there's a whole another story. If you actually find the reason, there's always a simple explanation for it.

And I just don't want to see our future generation being drugged. And I also don't like to see it being promoted as something non- addictive when it absolutely is.

BURTON: One last question to Mr. Wiseman and I may ask a few more after we get through with my colleagues here. Are teachers qualified to diagnose medical conditions?

WISEMAN: Absolutely not, congressman. We have talked to people at the Department of Education who say that that's DOE policy. And virtually every state has that as a policy. Yet it's happening across the country.

BURTON: We actually have teachers in schools using a checklist that go to a doctor. And they are making a direct or indirect recommendation to the doctor that this child be put on Ritalin?

WISEMAN: Yes, they have checklists that come out of the Diagnostic Statistical Manual for ADHD. I have seen them.

BURTON: And the doctors, many times, follow the recommendations of the teachers?

WISEMAN: Of course.

BURTON: Ms. Morella, do you have questions?

MORELLA: I do, sir.

BURTON: Ms. Morella?

MORELLA: Thank you. Thank you, Mr. Chairman. And thank you for calling this hearing. And I wanted to thank the witnesses also for calling this hearing. And I wanted to thank the witnesses also for coming together to offer their comments on it.

What I particularly like is that you brought in witnesses that have various perspectives from all sides of the debate. And I think it's important that we listen to arguments from those who believe Attention Deficit Disorder is not a brain disorder and those who believe it is and warrants medication along the lines of Ritalin.

And considering that there has been a 500 percent increase in the use of Ritalin in the United States since 1990 and roughly 4 to 6 million children may be using it daily, I think it's important that we ascertain the root causes of ADHD and how to best alleviate its effects.

I want to ask a couple of questions, if I may. One -- you know, I might ask it of Ms. Presley. It's a pleasure to see you in person.

PRESLEY: Thank you.

MORELLA: Thank you for being here. And also to Mr. Wiseman, because I have before me a statement that has been made by the International Citizens Commission on Human Rights President Jan Eastgate (ph). This is a quote.

"Society has been under a concerted attack for decades, designed and implemented by psychiatrists. This attack claims countless lives each day. Like some malignant disease running rampant, it threatens the future of society and ultimately mankind."

Now what I'm wondering is: do you believe in this expression that I have just read to you? If both of you would comment on that, I would appreciate it.

WISEMAN: I can comment, congressman. We are a psychiatric watchdog group. We investigate and expose psychiatric abuse. And what we see going on in psychiatric hospitals, not only in the United States, but around the world, would make you weep.

I have personally investigated the abuses that go on in these hospitals, the physical abuse, the sexual abuse, the drugging people into stupors, the electroshock treatment. What psychiatry has done to our educational system, psychiatric testimony in the courtroom where murderers and rapists are let go because they're not guilty because they had an irresistible impulse, based on psychiatric testimony.

So I would certainly agree with Ms. Eastgate's (ph) comments.

PRESLEY: I personally have not seen it do any good for anyone I've ever known personally. That's just my own experience, whether it be drugging, electric shock therapy, which does still exist, which is very barbaric.

I don't think it goes -- I have my own personal issue with the subject. But that's not why I'm here right this moment. This is more related to the drugs again, which is psychiatry-based, of course.

MORELLA: So you put them all into that one category?

PRESLEY: I think they're all correlated.

MORELLA: If I could ask one other question? Several medical organizations like the AMA, the Centers for Disease Control and Prevention and the National Institutes of Health believe that Attention Deficit Hyperactive Disorder is a brain disorder that may require psychiatry or psychiatric drugs for treatment.

And I wonder: how could you explain the considerably different viewpoint that they hold, as opposed to the viewpoint of CCHR?

WISEMAN: I don't know if you're asking me or Ms. Presley, but I'll address it and she can as well.

PRESLEY: I'll address it as well.

MORELLA: Thank you.

WISEMAN: I think the operative word in your question, congresswoman, is "believe." And it's a matter of belief.

Our concern is that there is no biologic, organic, scientific basis for ADHD. These are subjective symptoms. These are behavioral symptoms. The child fidgets, he looks out the window, he butts into line.

The psychiatrist wraps these attributes up and throws a label on it. And the children are subsequently drugged. That various medical organizations believe that it's a brain disease is just that. It's a belief -- without true scientific validity.

Our point here really is parents should have an opportunity to get the other side. They need to have informed consent. They need to know, at the very least, that the diagnosis is controversial.

Ms. Presley, do you have anything to add?

PRESLEY: Yes, I haven't seen any evidence. I'm not scientific. I can't back it up scientifically. But I just have not seen -- whether it be a blood test to diagnose or any other thing to diagnose. It is not confirmed. There is no way to do it.

And there are too many people -- I would like to do a documentary on it actually one day, just to show how long it takes, when you take a child to a psychiatrist, before they whip the thing out and start writing a prescription. It's usually 10 minutes, 15 maybe? And it's usually just basically, you know, based on...

MORELLA: I could go on. And I am not a scientist. But I have always had a great belief in CDC and NIH and AMA. And you just said, "Forget it."

PRESLEY: I would like to just also point out that there is an intermingling of those three, of course. You know, the drug companies, pharmaceutical companies go along very much with the APA.

They all make money. It's a big industry, you know? To push drugs, diagnose disorders and give drugs for it. It's an industry. They're making money -- a lot of money, a lot of money.

MORELLA: Dr. Block, do you want to comment?

BLOCK: ... has stated that there is no valid test for it and that it is not a brain disorder. And also, the medical profession is based on coding. And it's coding based on getting paid by the insurance company.

So a diagnosis that can be objectively defined, such as diabetes, hypertension, things like that, there are codes for those things. The psychiatric community has made codes for their psychiatric disorders. But just because there is a code for it and doctors can diagnose it and get paid for it doesn't mean that there is an objective brain disorder going on.

MORELLA: Mr. Chairman, then I will yield back. But I would guess, Dr. Block, you would probably gain a little bit too if people were scared away from psychiatric drugs, right?

BLOCK: Do I gain?

MORELLA: You probably would gain financially.

BLOCK: I have a medical practice, working with these children. But for me, if I get them well and out of my office, they don't have to keep coming back; whereas, if they're being drugged, they do keep coming back.

MORELLA: Fine. Thank you very much, Mr. Chairman.

BURTON: Ms. Davis?

DAVIS: I have one more question for Ms. Weathers. When you took your son back to the pediatrician to get the prescription refilled, did you say he did not do a physical, he or she?

WEATHERS: No, she didn't. She did not do a physical exam to refill the prescription for Ritalin. He would have once a year physical before he started school. That was the only physical he had during the course of the year.

DAVIS: Thank you, Mr. Chairman.

BURTON: Judge Duncan?

DUNCAN: Mr. Chairman, I apologize. I had another meeting I had to go to, so I'm not going to ask any questions at this time. I'll ask them of the next witnesses.

BURTON: Let me just ask a few more questions. In particular, since Ms. Morella is still here, I would like for her to hear just a couple of things that were said in her absence.

According to the AMA, the properties of Ritalin very closely parallel cocaine, is that correct?

WISEMAN: Yes.

BURTON: And according to the AMA -- or not the AMA in this particular case -- according to some testimony that was given today, if you grind up Ritalin and make it into a powder, the effect of the Ritalin is very, very similar to the effect of cocaine. And it is habit-forming.

BLOCK: Not just the same. It is the same, not just similar.

BURTON: So cocaine and Ritalin, when put into powder form, are the same?

BLOCK: They go to the same receptor site in the brain and they provide the same high when taken in the same manner and are used interchangeably in scientific research.

BURTON: They're used interchangeably in scientific research.

BLOCK: Correct.

BURTON: OK, so when you put a child on Ritalin for a long period of time, there is a fairly good chance that that child will be addicted, just like a person who uses cocaine?

WISEMAN: Congressman, I know you asked that of Dr. Block, but if I might point out, there is a study by a Dr. Nadine Lambert at the University of California at Berkeley that followed 492 children for 26 years and found that those who were labeled with ADHD and given stimulants were 200 to 300 times more likely to abuse tobacco and cocaine in adulthood.

BURTON: They were 300 times...

WISEMAN: Two to three times more.

BURTON: Two to three times more likely to use...

WISEMAN: Tobacco and cocaine in adulthood.

BURTON: OK. Now let me ask you a question that I think we'll ask of the doctors that are going to come up here, so they will have a preview of some of the questions we're going to ask.

Has there been any autopsies on children who allegedly have ADHD to see if there was any difference between their brain and the brain of a child that had ADHD and were given these substances like Ritalin?

BLOCK: I don't know of any autopsies. I know that there are studies that have shown changes in the brain of children. But these children were taking drugs like Ritalin. And there have been studies that showed children who took cocaine had brain changes that looked like holes in their brain, just spots on the X-rays. And so the Ritalin may be making -- doing the damage that shows up in these children's brains.

BURTON: Is there any evidence, through autopsies, of brains that would show that children who have ADHD have any abnormality?

BLOCK: I know of no such studies.

WISEMAN: I know of no such, sir.

BURTON: Any other questions from -- let's see what we have here.

DAVIS: Mr. Chairman?

BURTON: Mr. Wiseman, let me just ask you a couple more questions. I'll get right back to you. Unless you want me to yield to you right now?

DAVIS: No.

BURTON: OK.

We've seen reports that Ritalin and antidepressants are being described for 2-year-olds in the Medicaid population. Are you aware of aware of any clinical trials that have evaluated the safety of these drugs in children aged 2 years old?

WISEMAN: No, sir.

BURTON: OK.

WISEMAN: In a word. And if I can say, I think it's a travesty that children, in some cases, that are still in diapers are labeled with ADHD and put on, in some cases, several mind-altering drugs. I think it's barbaric.

BURTON: So there have been no clinical trials to your knowledge?

WISEMAN: Not that I'm aware of, sir.

BURTON: Are you aware that the NIH conducted a consensus conference on ADHD several years ago? Did they look at the entire scope of treatment options? Or did they just focus on Ritalin?

WISEMAN: No, they primarily focused on Ritalin. I testified at those hearings in November of 1998. And they had three days of slides and presentations and so forth. And I read the final conclusion.

We do not have a valid, independent test for ADHD. There are no data to indicate that ADHD is due to a brain malfunction.

And finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remain speculative. That was after three days of presentations.

BURTON: But did they look at the entire scope of treatment options?

WISEMAN: No, sir.

BURTON: It was just Ritalin only.

OK. And finally, what biologic conditions can lead to an inability to concentrate in class? In the schoolroom?

WISEMAN: Well, as I mentioned in my testimony and as Dr. Block has said, there's a number of underlying physical problems, such as mercury poisoning, lead toxicity, and those kinds of things that actually can affect the nervous system and can make children act hyperactively.

BURTON: And just being kids.

WISEMAN: Yes.

BURTON: I will tell you, if they had had Ritalin when I was a boy, I have no question in my mind, as many times as I was sent to the principal's office for being out of control, that I would have been on Ritalin. I really believe that because I was a real pain in the foot.

(LAUGHTER)

Do you have any questions?

DAVIS: Yeah, if you will indulge me for a minute. You're saying that there is no proof that it's not a biological disorder. But there's no proof that it isn't. There is no proof that it's not a biological disorder as well, right?

WISEMAN: It's kind of trying to prove a negative, but that's correct.

DAVIS: What do you say to a parent who has had their child tested? There is no physical disorder, there is no mercury because there have been no fillings. There is no allergies, there's no nothing.

And you have more than -- Mr. Chairman, I believe the children who are ADHD, it's a lot more than just out of control. There's many more symptoms other than out of control.

They're not just a hyper child. What do you say to that parent who has had the child tested for everything and there is no other explanation? And then they take the Ritalin and it totally changes things?

BLOCK: I think that every parent has the right to choose what's best for their child. And the problem is they're not being made aware of the options and the possible side effects, that they are being pressured to put the child on the drug, even when they choose not to. And we are learning new things all the time because mercury doesn't just come from fillings. Mercury comes from vaccines and all children -- amongst all children that have had vaccines.

So there are many different reasons why children have these problems. And learning problems are a big one that schools often overlook. And nowadays, I'm finding out that even some of the places that used to test children for learning disabilities are now saying, "Well, they'll get them, see if they have attention deficit first. And then we'll look at that."

But it's the, you know, tail wagging the dog. It's the learning problems causing the attention and behavior problems. We need to fix those first.

DAVIS: I don't disagree with you. And just to set the record straight, Mr. Chairman, I fully believe in my heart that children are being overmedicated and everybody is being diagnosed if they're just being children.

Thank you.

BURTON: Thank you, Ms. Davis.

Yes, Ms. Morella, of course.

MORELLA: Thank you, Mr. Chairman.

BURTON: My great friend from Maryland.

MORELLA: Thank you. And it's simply that I was looking over the credentials. And I noted that the Citizens Commission on Human Rights was established by the Church of Scientology. Therefore, I wondered, how is the organization now related to Scientology? And what is the church's stance on psychiatry and psychiatric drugs?

WISEMAN: Well, Congresswoman, we're proud to have been founded by the Church of Scientology some 32 years ago. We are, however, an independent, IRS-recognized, public benefit corporation. And our role is a social reform activity to clean up the field of mental health.

So we investigate and expose psychiatric abuse and psychiatric violation of human rights.

MORELLA: Does the church have a stance on it?

PRESLEY: Can I just say no on that one? No. I mean, I personally am not here for that reason at all.

I'm here because I'm a mother and I care about children and that's it. And I knew that that was going to come up as a question in here. And I knew that it was going to be speculated that it's because you're a Scientologist, blah blah blah.

The bottom line is that I just think it's inhuman and it's not right. And it abusive and an epidemic and it needs to be looked into. It has nothing to do with religious beliefs or anything else, as far as I'm concerned.

MORELLA: No, I believe that you are motivated obviously because you care deeply about it. But I just wondered, does the church have a stand on it?

WEATHERS: Can I say something as a parent and just as a parent?

MORELLA: OK.

WEATHERS: I feel that this issue transcends all social and political and religious backgrounds. I think this is our children.

And we need to really address the issue that this is our children and this is our future generation here. This doesn't have to deal with anything other than our children.

MORELLA: I believe your motivation. I truly do. I'm a mother myself. But I am curious still about whether or not Scientology...

WISEMAN: Sure. I'm delighted to answer your question.

I've been a Scientologist for 32 years. Every Scientologist I know is very concerned about human rights abuse. But that's not really the issue from our point of view and why we're here.

Our concern is that parents aren't being given all the information and the choices. They're not given informed consent on the issue. That's really the concern, congresswoman.

BURTON: Before I yield to Mr. Gilman, let me just say, because we're going to have some votes on the floor, we had one in 10,000 children, according to CDC, that were autistic a decade or so ago. We now have one in 250 children or more that are autistic today.

We've had a fortyfold increase, 40 times increase in the number of children that are autistic in America. And there are a great many scientists and doctors that believe that some of the contents, including mercury, in vaccines are a major contributing factor.

We have an epidemic. The young lady, Ms. Weathers, talks about our kids and our future and what it's going to do to our society. Put a pencil to the amount of money it's going to take to take care of children today who are going to be adults in 15 years who are autistic, who can't get a job, who can't function properly in society.

You're talking about billions, maybe trillions of dollars. And we need to find the answers and get it straightened it out. And if mercury, as I suspect, is a major cause, then we damn well better get it out of our vaccines.

Mr. Gilman?

GILMAN: Thank you, Mr. Chairman. I'm curious, Dr. Block -- and I regret I had to go to another meeting and couldn't be here for your testimony, has there been any long-term study of the long-term effects of utilizing Ritalin?

BLOCK: No, there has not. The drug manufacturers themselves say there are no long-term studies. And the National Institutes of Health, when they had their conference, stated that most drug trials were very short, up to three months. Yet children are placed on these drugs for years and years without the knowledge that we need to know if they're safe.

GILMAN: Sounds like we have to undertake that study.

Background material provided to our committee cites American Academy of Pediatrics data that estimates four to 12 percent of children in the U.S. have some form of ADHD. Is this estimate applicable to other countries like Japan? Or this uniquely an American problem?

BLOCK: This is uniquely an American problem. Ninety percent of all Ritalin in the world is sold in the United States.

I have seen families from all over the world at my medical clinic. And those who have come from other countries always have an American connection. They were in an American school and told their child needed to be drugged.

If they moved them to the British school, they were told their child was fine. And I've seen this story occur over and over again.

GILMAN: When educators observe potential ADHD cases, how much weight is given to non-ADHD factors, such as the level of physical activity, diet, environment and other possible disorders?

BLOCK: Usually, there is not anything given to that. What is usually done is the teacher fills out a checklist describing behaviors that the child has at school. And parents may be asked to fill out this checklist.

The parents that bring their children to my office have told me that their doctor, in most cases, never did a physical exam, never listened to their child's heart, even though many of the side effects of the drugs can affect the heart.

They're not looking for other problems, not looking for allergies, learning problems, thyroid problems, anything physical or educational that might be wrong with the children, before labeling and drugging them.

GILMAN: In previous unrelated hearings covering the war on drugs, the drug enforcement Administration, DEA, has testified that many adolescent takers of Ritalin often hoard more supply and sell it to customers through an illegal secondary market. Is this a significant problem? And I address it to any of our panelists.

BLOCK: This is a significant problem. And there have been reports that indicate that Ritalin is the most abused drug in high school and colleges.

And there are other drugs, like Adderall. I don't want to just focus on Ritalin. There are many other amphetamine or amphetamine- type drugs that are abused on the street in the same way.

GILMAN: And in general, the percentage of the student body taking Ritalin or similar drugs is smaller in parochial schools than the same percentage in public schools. Why do you think that's the case?

BLOCK: Well, I can't think to exactly why. But from what I've heard, there is a great deal of discipline in many parochial schools. But I'm also seeing a change there, where the drugging of children is increasing in private and religious schools to a great extent as well.

GILMAN: Do any of our panelists want to add any comments to the questions I've just asked?

WISEMAN: Only, congressman, that last year or perhaps the year before, there was legislation proposed and I believe it passed by Congressman Holt's -- Henry Hyde's committee, excuse me -- that dealt with this issue of the abuse of Ritalin in schools. The DEA was very concerned about it.

And I don't recall the number of that legislation or its name. But I think that was in the year 2000. Legislation was actually proposed and passed, I believe, in this body that dealt with that issue.

GILMAN: Ms. Presley, did you want to comment?

PRESLEY: I don't know the statistics and the formalities of what exactly -- this is more for you two, I think.

GILMAN: Ms. Weathers, did you want to comment?

WEATHERS: No, not at this time. I don't know the statistics.

GILMAN: And Dr. Block, do you have any final statement you'd like to make?

BLOCK: Well, I think that all of us have consistently stated that we're very concerned about the abuse of these drugs and our children and the fact that parents are not given informed consent and not given all the options to look at all the possible problems that their children might have to correct those problems and not drug them. And I think that's what we'd like to see changed.

GILMAN: I want to thank our panelists for being here today and giving us your testimony. Thank you, Mr. Chairman.

BURTON: We have eight minutes and 33 seconds on the clock. I have a couple more questions for this panel and then we'll dismiss them, unless the other panelists have some questions.

We have one vote on the floor and then if you could come back, we would appreciate it. Let me just say that I really appreciate you being here.

One thing I would like to clear up is although there are people here who are members of the Church of Scientology, there are a lot of other people that you work with that are not members that share the same views. Am I correct on that?

WISEMAN: We work with allied groups across the country.

BURTON: Dr. Block, you're not a Scientologist, are you?

BLOCK: No, sir. I'm not.

BURTON: Ms. Weathers, you're not a Scientologist, are you?

WEATHERS: No, absolutely not.

BURTON: I just hope that there is no stigma attached to the people at this hearing because of their religious beliefs. We're here today to find out if -- and find evidence to find out if -- there is an abuse of Ritalin and other drugs of that type and whether or not they are habit forming and whether or not they are absolutely necessary and whether or not parents are getting adequate information so they can make an informed decision.

Those are the major issues that we're looking at here today. And I appreciate it very much.

I will have additional questions for this panel that I would like for you to submit in writing. And any legislative proposals that you think needs to be made, we'd like to have that in writing.

We can't guarantee that all of them are going to be enacted. You know the legislative process is like watching sausage being made. You don't want to watch it.

(LAUGHTER)

But we will take a look at all that.

Anything else from the committee before we recess? OK, we stand in recess to the fall of the gavel and we'll go to the next panel when we come back.

PRESLEY: Thank you very much.

(RECESS)

BURTON: The committee will reconvene. We'll now hear testimony from the second witness panel, Dr. Richard K. Nakamura. He is the acting director of the National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services.

Unfortunately, the Department of Education's witness was unable to be here today. Why is that?

OK, so doctor, would you please approach the table? Where is he? In the bathroom. OK, well, we will wait. I certainly wouldn't want to interfere with that.

Does anybody know any good jokes?

Dr. Nakamura, welcome. No, that's all right. I understand exactly. Would you please stand so you can be sworn, sir?

Do you swear to tell the whole truth and nothing but the truth, so help you God? Thank you.

I presume, after hearing the testimony of the other witnesses and the questions, you have an opening statement. OK, would you proceed? Can you turn your microphone on, sir?

NAKAMURA: Thank you, Mr. Chairman and members of the Committee on Government Reform for the opportunity to discuss an important medical condition here today. I am Richard Nakamura, the acting director of the National Institute of Mental Health. Professionally, I am a brain scientist, also called a neuroscientist.

The National Institute of Mental Health is one of the National Institutes of Health. We are the federal health institute responsible for research to reduce the burden of mental illness and other behavioral disorders. We take that responsibility seriously.

Ultimately, this hearing is about our children and helping them live full, productive lives. I come here before you both as a scientist and as a parent of children, some of whom have received services themselves.

Permit me to provide some background information from the neurosciences. We used to think that the brain simply unfolded according to strict genetic instructions. And those instructions, like body growth, ended in late adolescence and the brain was done.

From there, it was thought that it was all downhill and one could only lose neurons. But now we know that the brain is actively constructed from birth -- and even before birth -- by an interaction of genes with behavior and the environment. On the way, the brain goes through periods of massive growth and significant pruning or cell loss.

This is normal. We know that that pruning occurs to neurons that do not get incorporated into behavioral programs of the brain. Thus, we lose neurons that are not used.

Genes provide the scaffold for this growth, but the actual survival of neurons and their connections are determined by our environment and our behavior. This has important implications for disorders such as ADHD.

Parenthetically, we also know that there are some new neurons that develop in the brain every day of life, true to at least the age of 72, to help us older dogs learn new tricks.

What is ADHD or Attention Deficit Hyperactivity Disorder? There are two major components. First, there is an inattention or distractibility component. And this is the primary feature in ADD.

And then there is a hyperactivity or impulsivity component. For a diagnosis of ADHD, the diagnosis must be of long duration. It must be developmentally inappropriate. It must cause significant impairment. And it must be present in two or more settings of a child's life -- for instance, at least school and home.

When diagnosing ADHD, a clinician must be very careful to distinguish between that disorder and several other conditions that may look similar, such as sensory or learning disorders, anxiety or bipolar disorders and many others that have already been mentioned here. An adequate workup cannot be done in 15 minutes.

In this regard, I have the statement from the American Academy of Pediatrics, which has a very good guideline for how to do an adequate workup of ADHD. And I would like to submit this and some other documents for the record.

BURTON: Sure, without objection.

NAKAMURA: Three to five percent of children are diagnosed with ADHD, with boys being much more affected than girls. While some have questioned the reality of ADHD because we do not have a biological marker for the condition, the reality of individuals that cannot focus on a task for developmentally appropriate periods of time and show significant learning and job performance deficits as a result have convinced most physicians and scientists, just as most are convinced that other behavioral disorders without clear biomarkers, such as autism and schizophrenia and pain are real.

In these cases, it is the clarity and consistency of the behavioral syndrome or the effectiveness of interventions that is convincing. Many large professional and scientific bodies have looked into the topic of ADHD and have concluded that it is real.

Some of these groups, for the record, are: U.S. surgeon general, the American Medical Association, the American Psychiatry Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association and the American Academy of Pediatrics.

Also in 2002, an international consensus statement on ADHD was published by a large group of scientists who indicated their belief that the evidence for ADHD was very well justified and scientific.

What about the outcomes of untreated ADHD? There is an initiation of a trajectory because children who cannot attend or hyperactive have great trouble learning. Since learning is progressive and since our brain structures are determined by our behavior and learning, we need an active intervention to keep healthy outcomes on track.

Untreated, ADHD leads to increased medical utilization, school failure, poor social relationships, anti-social activities, use of harmful substances, brushes with the law and serious accidents.

So how is ADHD treated? Because ADHD is a chronic problem and treatments need to work for long periods, we recommend early detection and beginning with behavioral approaches, including parent and child training.

Now remember, this is after a diagnosis has been reached and all other possibilities have been eliminated through the appropriate differential diagnosis. Obviously, if behavioral approaches work, they should be employed with occasional booster training sessions.

However, in many cases, this will not result in improvement. So then we recommend a trial of a stimulant medication. In our experience, stimulant medications are highly safe and effective for properly diagnosed children and adults.

Now no choice of a stimulant medication should be made without careful consultation between parents, the children and clinicians. We do not believe that teachers, other than potentially making a suggestion that the child has a problem and it might be ADHD, beyond that teachers should not be diagnosing, nor recommending treatment for the condition.

When stimulant medications are used, there should be a long-term follow-up to ensure the continuing efficacy of treatment, proper dosing and proper adherence. What this means for children is that a trajectory that can lead to school failure -- I'm sorry, there is one other important point to make.

We have estimated and our data suggests that behavioral and/or medication treatment therapies will help 90 percent of children with ADHD. What this means for children is that a trajectory that can lead to school failure and social difficulties can be interrupted and replaced by a trajectory that can lead to more normal behavior and, therefore, more normal brain and behavioral development.

BURTON: Excuse me, Dr. Nakamura. Would it be possible for you to summarize the rest of your statement so we can get to the questions?

NAKAMURA: Sure.

BURTON: I want to get all of the substance of everything you have to say. And we will be -- all the members will be reading your statement.

NAKAMURA: I have one more paragraph.

By intervening to keep a child's development on track, many ADHD children can be helped to normal, productive lives. That is the point of our efforts.

I would like to say a final word about science. Science is a procedure that helps us learn the truth about interventions and outcomes by systematically testing ideas about the world and about human beings. This is the best way we know to learn whose ideas are right and how to keep us from continuing therapies that do not work or actually cause harm.

Ultimately, we need to move away from anecdotes to scientific tests of ideas if we are to have the best and most helpful lives.

Thank you.

BURTON: Thank you, doctor.

There are about 6 million children in America that are using Ritalin or substances very similar to that. Do you think they all need that?

NAKAMURA: We have heard different numbers. We don't know exactly how many children are being prescribed. But we have heard the number in the range of 3 million, as opposed to 6; 6 might include all the adults.

BURTON: Well, Pat...

NAKAMURA: But I won't dispute it.

BURTON: Pat Weathers, who testified, she said that her child was fine at home, but at school didn't pay much attention and was looking out the window and that sort of thing, like I did when I was a child, because I wanted to play baseball or, as I got older, chase the girl down the street. And she said that the teacher had a checklist and went through the checklist and called her in with the principal and said, "Your child has attention deficit problems. And we think that he ought to be treated," or she ought to be treated -- was it he or she?

"He ought to be treated." They went to the doctor. And she said the doctor looked at that, spent less than 15 minutes with them and prescribed Ritalin.

Now according to your testimony, that's not the way it should be done. Is that correct?

NAKAMURA: Given the description and because I don't know the particulars of this case, but given the description, no. That is not the way it should be done.

BURTON: Well, I mean, I listened to your testimony very closely. And you said that you ought to look at school. You ought to look at home. There ought to be consultation. There ought to be a whole lot of things that take place before you start using Ritalin.

Isn't that what you said?

NAKAMURA: Yes.

BURTON: Yeah. We have heard a lot of stories about teachers saying, "This child has an attention deficit problem." And they do this checklist and they send them to doctors. And the Ritalin is just a fait accompli. They're going to give it to him when they go there.

You don't think that's right, do you?

NAKAMURA: The guidelines of the American Academy of Pediatrics and the Institute's position are that you cannot make the diagnosis and you should not be writing a prescription with that little information.

BURTON: Have our health agencies informed our educational system around the country or state superintendents of public instruction or local school boards that there are certain things that should be followed? To give them a diagram on what they should do before they start giving children Ritalin and sending them to the doctor?

NAKAMURA: The information is certainly available on web sites. We have not, as an institute, sent information directly to all the schools in the country.

BURTON: Well, let me just tell you a story. One of the doctors, one of the most important doctors here on Capitol Hill, I said, "Do you know there is mercury in the vaccines you're giving us for flu?" And he said, "No, there's not."

And so I took the insert out. And I gave it to him and he looked at it and said, "Well?" And I said, "Well, thimerosal has mercury in it." Well, he didn't know that. The doctor didn't know that.

Now if we're spending all this money on our health agencies and you have a criteria that's supposed to be used for children before they go on these mind-altering drugs, then why in the heck doesn't the schools know about it? Because they don't. Many of the doctors don't even know that.

Now I want to talk to you about neurons. And I would submit to you that our health agencies, for a very low cost, could put it on their e-mail site and they could send a notification out to all state boards of education and local school boards and say, "On our e-mail site, we have the criteria that should be followed before a child starts taking Ritalin or other drugs of this type."

I don't know why you don't do it. It makes sense to me. And it would save the legislative branch a lot of time and trouble.

Now I want to talk to you a little bit about the neurons you were talking about. You talked about the neurons growing and being replaced and replicated on a very regular basis. Do you think mercury has an adverse effect on neurons?

NAKAMURA: I honestly don't know. I believe that mercury is clearly a substance you don't want in the body.

BURTON: Let me ask you this. Thimerosal, most of the vaccines we're sending overseas to all these kids in Third World countries still has it in there. And they're getting it out gradually here in the United States, but not as quickly as they ought to because we have had this absolute epidemic of children that are autistic from one in 10,000 now to one in 250.

And a lot of people say, "Well, that figure, one in 10,000, might be way off." But we do, everybody acknowledges we've got a big, big problem, even if that figure is incorrect. I don't think it is.

But we had some scientists from Canada send us a video, which I want you to give a copy to the doctor. Have you seen that video?

NAKAMURA: I don't believe so.

BURTON: It shows the neurons, which there is a sleeve on the neurons, is there not? Isn't there a sleeve?

NAKAMURA: Right.

BURTON: It shows what happens to the sleeve on the neurons when a very minute amount of mercury is introduced into the close proximity to it. And it just destroys it. It just destroys it.

And ultimately, it destroys or damages severely the neurons. Would you say that would have an impact on the brain of that child?

NAKAMURA: Yes. It certainly depends on the form of the mercury. But...

BURTON: The form? You say the form of the mercury.

NAKAMURA: There are some forms of mercury...

BURTON: Oh, I know there are two different kinds that we're talking about. Has there been testing done to show that one of them has an impact, but the other one doesn't? On neurons?

NAKAMURA: I could not tell you about that result. I do know that one form is much more destructive than the other form and that thimerosal contains the less destructive form.

However, I would agree that I would not like to see mercury...

BURTON: Well, the hearings we have had -- and I've had scientists and doctors of your caliber from all over the world. And the thimerosal and the mercury in these vaccines is very damaging. And they believe it contributes to neurological problems in these kids.

And you said it yourself. No mercury should be introduced into the human body.

And yet, they're doing it every day. And they did it to me. And they did it to every member of Congress that wanted to get a shot for flu. Why is that?

NAKAMURA: I can't offer you any explanation for that.

BURTON: You're with the Department of Health.

NAKAMURA: I am with the Department of Health. The Center for Disease Control and the FDA are the controlling organizations.

BURTON: Are they part of the Department of Health?

NAKAMURA: Yes.

BURTON: Do you ever talk?

NAKAMURA: They don't ask my advice on the issue of vaccines.

BURTON: So how do we get the message down to them besides going down there with a ball bat and hitting them in the head?

NAKAMURA: I would be happy to pass this information on through the department, to the appropriate organization.

BURTON: Well, I think they already know this.

NAKAMURA: I believe they do, too.

BURTON: Yeah, they've been to my committee before and they're going to be back here again. And they think they're going to get rid of me...

NAKAMURA: You are very, very clear.

BURTON: ... when I'm not chairman any more, but I'm going to be here. And I'm going to probably be a subcommittee chairman. And I can guarantee you, if I am, I'm going to be on the Health Subcommittee. So I'm going to have you guys back again and again.

Now let's talk about the cocaine. Is there any relationship between -- and I'm going to go to my colleagues as soon as this question is over. I've run way over, so excuse me.

Is there any connection or is there any relationship between cocaine and Ritalin? Do they have any of the same properties?

NAKAMURA: The stimulant properties of both derive from similar chemical properties.

BURTON: If a person who wanted to snort cocaine, if they ground up Ritalin and made it into a powder form, would it have a similar effect on their brain?

NAKAMURA: It would probably not do as much for them. However, yes, they would get a high from ground up methylphenidate.

BURTON: So they are similar?

NAKAMURA: They are similar in that sense, yes.

BURTON: Could you become addicted to Ritalin ground up and snorted like cocaine?

NAKAMURA: That would increase the addiction potential of the methylphenidate, yes.

BURTON: OK, so why is it that children taking Ritalin might not become addicted and become a more likely prospect for long-term addiction to more stronger drugs?

NAKAMURA: There are a couple of things going on. One is that our experience has been that this is not happening, that most children are using this appropriately, that pharmacies and physicians are being fairly careful about their prescribing practices, so they don't allow automatic renewals of prescriptions and that the number of pills are counted to make sure that the number of pills being taken by the child...

BURTON: I understand, but a lot of children get this in the early years and they spread it out maybe all the way through high school. Is there a possibility of addiction?

NAKAMURA: So far, when we have looked, there is either no increase in addiction or slightly reduced level of addiction for kids who are on medications compared to kids who are not on medications.

BURTON: You have done long-term studies on this?

NAKAMURA: We have done studies that have varied in the amount of time from 14 months to 20-something years.

BURTON: Is that right? And yet you say the properties are very similar to cocaine?

NAKAMURA: Yes.

BURTON: I don't understand that disparity there. Maybe you can explain that in the second round.

Let me yield to my colleagues.

Mr. Gilman?

GILMAN: Thank you, Mr. Chairman.

Dr. Nakamura, welcome to our panel.

NAKAMURA: Thank you.

GILMAN: In your testimony, you stated that "good treatment begins with accurate diagnosis, which can best be achieved through implementation of state-of-the-art diagnostic approaches in practice settings. We know through research that a clinically valid diagnosis of ADHD can be reached through a comprehensive and thorough evaluation done by specially trained professionals using well-tested diagnostic interview methods." That's your testimony, is it not?

NAKAMURA: Yes.

GILMAN: Basically, your testimony implies that doctors don't need to do any evaluation of possible biological issues, such as thyroid or heavy metal toxicities, things for which there are objective clinical tests, rather than a subjective interview method. Doesn't it worry you that by not doing good medicine -- in other words, biomedical evaluation -- children with biological issues are simply having the symptoms suppressed, rather than resolved?

Does that concern you at all?

NAKAMURA: By stating that a proper workup be done, we meant that proper differential diagnoses also be done. And we recommend the American Academy of Pediatrics clinical practice guidelines, which make it very clear that you need to do an adequate differential diagnosis, so you eliminate other possibilities.

Now there are, I think, reasonable questions about whether or not some areas will produce these kinds of symptoms. So I believe between ourselves and the earlier panel, there may be disagreements about how much allergies can participate in this, et cetera. But we do recommend that those be checked before making a recommendation and a diagnosis of ADHD.

GILMAN: So there should be a good biomedical evaluation. Is that what you're saying?

NAKAMURA: Yes.

GILMAN: You state that ADHD is one of the most researched conditions in children's mental health. Just how much is being spent on that kind of research at NIMH and NIH?

NAKAMURA: Well, more than NIMH just spending money, I can tell you that last year, we spent $53 million studying ADHD.

GILMAN: Is any of this research evaluating biological issues, such as mercury or lead toxicity, that our chairman has indicated?

NAKAMURA: None of this at the moment is looking at lead toxicity and mercury.

GILMAN: Is there any reason why you're not looking at it?

NAKAMURA: We have, as our process, a peer-reviewed competition for grants. We would be quite interested in getting an application which tried to look at the contributions of both lead and mercury to ADHD.

GILMAN: Do you need an application to undertake that kind of a study?

NAKAMURA: Well, we found that, in order to get studies done well, getting them in through a peer review process is very important. If any of you have investigators who have indicated that they are interested in pursuing this study...

GILMAN: Well, we're interested in this committee. Do you need an application to dig into that kind of an approach?

NAKAMURA: We need an application to make sure that the research that's proposed will answer the question.

GILMAN: Don't you initiate any studies on your own? Do you have to wait for applications if there is some problem out there?

NAKAMURA: We can initiate studies on our own.

GILMAN: Well, I suggest that maybe you ought to take a look at the mercury or lead toxicity on your own, rather than waiting for an application. Is any of the research evaluating alternative therapies, such as acupuncture, neurofeedback, massage, craniosacral therapy and special dietary approaches? Is there any research now looking at any of those?

NAKAMURA: I understand that the National Center for Complementary and Alternative Medicine is pursuing all of those.

GILMAN: They are undertaking that?

NAKAMURA: Yes.

GILMAN: I just have one or two other questions, doctor.

In a 1995 background paper from the Drug Administration, DEA, the following statement was made -- and I quote -- "It has recently come to the attention of the DEA that Ciba-Geigy, the manufacturer of Ritalin, marketing under the brand name Ritalin, contributed $748,000 to CHADD from 1991 to '94. The DEA has concerns that the depth of the financial relationship with the manufacturer was not well known to the public, including CHADD members, that have relied upon CHADD for guidance as it pertains to the diagnosis and treatment of their children."

"In a recent communication from the United Nations International Narcotics Board, INCB expressed concern about non-governmental organizations and parental associations in the U.S. that are actively lobbying for the medical use of Ritalin for children with ADHD. The UN organization further stated that financial transfer from a pharmaceutical company with the purpose to promote sales of an internationally controlled substance would be identified as hidden advertisement and in contradiction with the provisions of the 1971 convention."

"In fact, a spokesman for Ciba-Geigy stated that 'CHADD is essentially a conduit for providing information to the patient population.'" That's a direct quote from them. "The relationship between Ciba-Geigy, which is now Novartis, and CHADD raises serious questions about CHADD's motive in proselytizing the use of Ritalin."

This is what DEA had to say. And this same DEA paper states that CHADD, in conjunction with the American Academy of Neurology, submitted a petition to reschedule Ritalin from Schedule II to Schedule III under the Controlled Substances Act because controls are unduly burdensome for the manufacturer and for physicians who prescribe it and patients who need it. CHADD denied that the financial contributions received from Ciba-Geigy have any relationship to their actions.

And the DEA went on to note that of particular concern to them was that most of ADHD material prepared for public consumption by CHADD and other groups and made available to parents does not address the above potential or actual abuse or Ritalin. Instead, it is portrayed as a benign, mild substance that's not associated with abuse or any serious side effects.

The DEA went on to note in their report -- and I quote -- "In reality, however, there is an abundance of scientific literature which indicates that Ritalin shares the same abuse potential as other Schedule II stimulants. Case reports document that Ritalin abuse, like any other Schedule II stimulant, can lead to tolerance and severe, psychological dependence."

"In a review of the literature, the examination of current abuse and trafficking indicators reveals a significant number of cases where children are abusing Ritalin."

So what is your comment with regard to DEA's report?

NAKAMURA: The key thing that I would comment is it's very important to realize that when ADHD is properly diagnosed, there seems to be very little problem with substance abuse and even diversion. The GAO recently put out a report on attention disorder drugs, reported that there were few incidents of diversion or abuse identified by schools.

And that it's the experience that we have, so far, which indicates that there is not an increase in abuse by those with ADHD who are taking Ritalin. Rather, there is either a normal amount or a reduced amount of abuse by those kids. We do know that untreated ADHD kids go on to abuse drugs at high proportions.

BURTON: The gentleman's time has expired.

GILMAN: Please, can you yield? I just have one more.

BURTON: Sure, OK. Go ahead.

Yield to me just for one second, though.

GILMAN: Sure.

BURTON: Was that the only study that was done on that, that said that there was no increased abuse?

NAKAMURA: No, there were three studies.

BURTON: OK, tell me about the other two studies real quick. Weren't there other studies that showed that there was increased use?

NAKAMURA: There was one study...

BURTON: There was one study. You didn't mention that. It's interesting that you mention the one that says what you want, but you don't mention the one that says what you don't want.

And this Congress up here doesn't want you to come up here and shade things the way that the health agencies want. We want you to tell the truth for the American people. It really bothers me that you guys do this all the time. You do it all the time.

Tell the whole truth, not just the part that you want told.

What was the other thing, real quickly?

And the pharmaceutical companies, Congressman Gilman just made a strong point here. The pharmaceutical companies found an awful lot of this stuff, these studies and other things that you're talking about. You said the GAO said that there was no problem with this.

You didn't quote the DEA. The DEA is the agency that we charge to go after the drug dealers and the drug abusers and the drug problems in this country. Why is it you didn't quote the DEA instead of just a GAO study that you asked for?

NAKAMURA: I had just been given the information about DEA.

BURTON: You mean to tell me you guys don't have access to that over there?

NAKAMURA: No, I just pointed out that there was other information as well.

GILMAN: Thank you. And I'll yield in just a moment. But doctor, are you concerned about the relationship between CHADD and the pharmaceutical company? Is there any concern by NIH with regard to that?

NAKAMURA: That is not an area -- I don't believe that the NIMH has a right to interfere with that transaction. What we try and do, make very careful about NIMH, is that there is no interaction with drug companies that could influence our decisions.

GILMAN: But here we have a drug company that is influencing a parental group. And that drug company has some financial motivation. Isn't there any oversight by NIH of that kind of a relationship?

NAKAMURA: No, there is no oversight that I am aware of at NIH. NIH's job is to do good research. And that's what we try and do.

GILMAN: Well, I hope that NIH would do more than just do research and make certain that the information given to the public is factual and not motivated by any financial interest.

I'll be pleased, Mr. Chairman, to yield the balance of my time.

BURTON: Mr. Horn?

HORN: Dr. Nakamura, a study conducted at Georgetown found that children with ADHD are seven times more likely to have food allergies than other children? Isn't it true that children in an allergic state would be adversely affected in their ability to focus and concentrate?

What has NIMH and NIH done to evaluate the correlation between food allergies and attention disorders?

NAKAMURA: My understanding is that we have had some earlier studies in which we looked for allergies as related to ADHD and other kinds of externalizing or disruptive behavior disorders and found that a small proportion -- about five percent -- could be accounted for by those allergies. And certainly, we believe that where they exist, you take care of those before you develop a diagnosis.

HORN: Are you concerned that children may be misdiagnosed with ADHD?

NAKAMURA: Absolutely.

HORN: Well, that's good to know.

NAKAMURA: We would very much like to see children properly diagnosed. In our current system, physicians are compensated inadequately for working -- for doing a full workup. It is hard for physicians, as we understand it, to get more than a certain amount of money.

This might have a tendency to cause them to move a little too fast and maybe not have enough time to come up with alternative conclusions about a disease process.

HORN: Dr. Nakamura, in the Novartis PDR in Ritalin, there is a warning that Ritalin should not be used in children under the age of six years because the safety and efficacy had not been established. I am troubled that the National Institutes of Health would offer to pay parents of 3-year-olds over $600 to test Ritalin on their children.

And there is apparently -- let's see here, it was the APA meeting quote. And is the federal government testing psychotropic drugs in children under the age of 6?

NAKAMURA: Let me tell you how this study is being conducted.

HORN: Go ahead.

NAKAMURA: Because of the reports that so many children are being provided with Ritalin at younger ages, the National Institute of Mental Health decided that it needed to do a study on the safety of such drugs at those lower ages. Our IRB looked at this issue very carefully.

And we did the following: we have run the most vigorous study possible, to exclude children from this study, in the sense that we do a very vigorous examination of whether or not alternative possibilities for explaining the behavior of the children. We require that the children go through a full behavioral therapy session, that is a set of sessions, before they are begun. And only then is there a final getting the parents' permission to go ahead with the trial of Ritalin.

HORN: How many children are under six years of age?

NAKAMURA: I believe that the design is to get 100 children.

HORN: In your testimony, you talk about the studies that have been conducted on individuals with ADHD have -- quote -- "less brain electrical activity and show less reactivity to stimulation in one or more of these regions." Are you still standing by that?

Can you please tell us if any of these tests were conducted on individuals diagnosed with ADHD who had never been treated with psychotropic drugs?

NAKAMURA: In those studies, no. We are about to see a study come out in which that specific comparison has been made.

HORN: Please explain how the drugs can affect these same activities in the brain.

NAKAMURA: Pardon me, I don't understand.

HORN: Please explain how the drugs can affect these same activities in the brain.

NAKAMURA: I'm sorry, it's -- which same activities in the brain?

HORN: We'll submit it to you and put it at this point in the hearing record.

NAKAMURA: I apologize for not understanding.

BURTON: He is talking about the brain activity, less brain electrical activity.

NAKAMURA: And the drug is stimulating it.

BURTON: Yes, he is talking about how would it affect it? Go ahead.

NAKAMURA: So let me explain what we believe is going on with stimulant medications; that is, that certain portions of the brain show reduced activity compared to normal children. And this is in the area of executive function, particularly in the frontal lobes.

Unlike an earlier statement, it isn't because blood is going slower. Blood is going at the normal rate. It's the activity and the oxygen pickup of those neurons which is different, which means that the frontal lobes aren't using as much energy as those in normal.

And by a small amount of Ritalin, it increases and selectively increases the amount of energy and the activity of neurons in the frontal lobes, which provides the executive function these kids need in order to control their behavior better.

HORN: I yield back my time to the chairman.

BURTON: Thank you, Mr. Horn. We are not through questioning Dr. Nakamura, so you will have another chance.

Ms. Davis?

DAVIS: Thank you, Mr. Chairman. If I just heard you correctly, you said the Ritalin speeds up the activity in the frontal lobe. So did you hear me give the explanation earlier to the first panel about the blood flow in the frontal lobe of the brain? Can you comment on that?

NAKAMURA: Yeah. When you do certain studies, in order to look at the activity of the brain, what it actually does is looks at the flow of oxygen through the brain. It's sometimes called blood flow.

What you're really concerned about is the activity of the neurons in the brain. And so it isn't so much a problem of slow blood. It's a problem of neuroactivity, which the blood is a surrogate measure for.

What we've been finding is that frontal lobe activity in those with ADHD is reduced and that the Ritalin helps increase it. Because frontal lobes are responsible for executive function, that makes it easier for self control and for self-directed activity to go on.

DAVIS: Based on that and to go back to -- I forget who asked the question -- about the possible addiction of Ritalin because it has the similar characteristics of cocaine. It was my understanding that if you put a child -- and I'd like you to comment on it -- put a child on Ritalin who is not ADHD, it has a different effect on that child than the child who has ADHD.

For instance, our son, when we put him on Ritalin, because a normal -- had normal behavior, not slowed down, dead, lethargic or a zombie or what have you, but actually became what you would call normal. But if you put a child who was not ADHD on Ritalin, it was like giving them speed. And they actually become the opposite and become hyper.

Can you comment on that?

NAKAMURA: In general, if children, normal children, use Ritalin at normal doses and through normal pathways -- that is, ingestion -- they might have side effects of losing sleep and losing weight. But at those levels, it shouldn't become addictive. And cocaine has much less addictive properties when ingested in a slow way when you ingest it.

If you change the way it's delivered to the body, so that you figure out a way of injecting it, a way of snorting it or sniffing, that speed increases the addictive properties. I understand that one of the things that drug companies are trying to do are create a form of methylphenidate, which is less able to be ground up and used in any form other than the appropriate ingested form.

So I believe the drug companies are trying to solve the problem of the potential addictive properties if you misuse these chemicals.

DAVIS: Is there any validity to giving Ritalin to a child who is not ADHD and giving it to one who is, that there is a difference in the behavior?

NAKAMURA: I'd like to liken it to a bell-shaped curve in the sense that if performance is optimal, at the peak of a curve, for a normal child who is at the peak of the curve, you're going to push them past optimal performance. There may be some gains, in terms of being able to stay up late or do a short-term sports event. But there are more penalties to be had for those children.

For those with ADHD, it appears that they are onto the left of the curve and can be pushed up to normal performance by these drugs.

DAVIS: Thank you, Mr. Chairman. Thank you, doctor.

BURTON: Judge Duncan?

DUNCAN: Thank you, Mr. Chairman.

Dr. Nakamura, you may have heard me this morning when I stated that -- or quoted one article in which the just-retired deputy director of the Drug Enforcement Administration said that Ritalin is prescribed six times as much in the United States as in any other industrialized nation, six times as much as in Canada, Great Britain, other countries like that. Does that concern you?

Do you know of any reason why that would make any sense at all? And also, that "Time" magazine said that production of Ritalin has increased sevenfold in the past eight years and that 90 percent of it is consumed in the United States, 90 percent?

NAKAMURA: Yes, this is of concern. However, the United States is often at the leading edge of a number of things. And so it's not completely surprising that it should be happening more in the United States.

I do know that the use of Ritalin is up strongly in Europe and that it is perceived as being safe and effective. And the experience in the United States is being taken into consideration here.

DUNCAN: I have an article here that says, an article last year in the "Journal of the American Medical Association" said that psychotropic medications have tripled in preschoolers, ages two to four, during the previous five years, the past five years. More disturbing is that during the last 15 years, the use of Ritalin increased by 311 percent for those ages 15 to 19 and 170 percent for those ages five to 14. And that's from the "Journal of the American Medical Association."

And this "Insight" magazine that I quoted earlier this morning says that of approximately 46 million children in kindergarten through grade 12, 20 percent have been placed on Ritalin at some point. And your figures are much, much lower than that.

NAKAMURA: Yes. All the figures that we have on national prevalence of the use would make us very surprised if the figure surpassed five percent.

DUNCAN: But you don't question these figures from the "Journal of the American Medical Association" that say that psychotropic medications have tripled in preschoolers during the previous five years?

NAKAMURA: We accept that. And we are very concerned about what that means and how practice is being changed. Our previous director, Steve Hyman (ph), was not convinced that we knew enough about diagnosis of some of our disorders at those ages to be prescribing medications.

One of the...

DUNCAN: It says in this article here, it says, "This can be good news only for investors in the Swiss-based pharmaceutical company Novartis, which makes Ritalin." For instance if the number of children taking the drug increased fivefold, so did the drug company's resultant profits and stock value -- presumably stock value.

In a June 28, 1999 article, "Doping Kids," it was estimated that Novartis generated an increase in stock market value of $1,236 per child prescribed Ritalin. Based on these evaluations, the drug company would have enjoyed an increased stock market value of approximately $10 billion or more since '91.

NAKAMURA: I can assure you that I haven't shared in any of that.

DUNCAN: I know you meant that to be humorous. But I think this is very sad that we may be drugging or doping children and that it's all about helping a big drug giant make whopping profits.

And let me ask you this, getting more directly into your field, and I'm just curious about this. I know nothing about it.

Is there a real difference or are there significant differences between the brains of small boys and small girls?

NAKAMURA: Yes.

DUNCAN: That might cause this? Because everybody has said that there are many more small boys that are being prescribed this medication than small girls. Is there anything in your research on the brain that would help explain that?

NAKAMURA: There is no question that the hormone differences between boys and girls, which increases at early adolescence, creates differences in behavior.

DUNCAN: Early adolescence, most of these kids are being prescribed this before early adolescence.

NAKAMURA: Yes. There are hormone differences that start from birth. And one important point is that there are some who feel that attention deficit is much more prevalent in girls than we have measured and that girls have simply not been identified because they are not seen as a problem. They simply sit in the classroom and fail quietly, whereas boys tend to act out at the same time. So they come to the attention of teachers and the girls are ignored.

DUNCAN: My time is up. But let me just ask one more quick question.

I spent 7.5 years before coming to Congress as a state trial judge, trying the felony criminal cases, the most serious criminal cases. And the first day I was judge, they told me that 98 percent of the defendants in felony cases came from broken homes.

And I went through, because 96 or 97 percent of the people plead guilty and apply for probation, I went through about 10,000 cases. And I can't tell you how many thousands of times I read, "Defendant's father left home when defendant was two and never returned. Defendant's father left home to get a pack of cigarettes and never came back."

And I can tell you this: crime goes back, it's caused by drugs and alcohol and running with the wrong crowd and all that. But you can trace all the felony crimes, with very few exceptions, back to this broken home situation.

And I remember reading one article that said that, I think, 90 percent of these children that were being prescribed Ritalin were in homes from very successful, two-parent families where both parents were working. And I'm wondering -- and I don't have any doubt that some children really benefit from Ritalin and really need it.

But I'm also wondering, is somebody studying where there may be some sort of a social cause of this? That maybe this is, in some way, boys crying out for attention that they're not getting?

NAKAMURA: There is...

DUNCAN: Because there sure is a cause of the serious crime in this country, I can tell you that.

NAKAMURA: There are a lot of social changes that are going on in our country.

DUNCAN: And wouldn't that also help explain why possibly that some of these other industrialized nations are not seeing it nearly as much of this as we are because they don't have many of these -- as much of this, as much of the breakdown of the family as we do?

NAKAMURA: We don't know the answer to that. There are social changes that are going on with great rapidity in our country. And we are trying to figure out ways with which we might measure what effect these might have on subsequent behaviors.

There is a proposal for a large-scale study of a birth cohort by the National Child Health Institute, in which they would propose to look at 100,000 births, following these children, understanding everything that they are consuming, their vaccinations, how the family is structured, et cetera, to see how those might relate ultimately to disease and other behavioral problems, as well as medical problems.

So there are proposals to do that. This would be extremely expensive.

BURTON: Let me just follow up. You said that you thought 3 million children or thereabouts was on Ritalin or similar products. We've been told it's 6 million. Why is it you don't have some idea?

Can't you find out from the drug company how many prescriptions are being written for that?

NAKAMURA: Yes, we do. We are aware of how many prescriptions. Relating that to the number of individuals is a little trickier. I'm sure I could get you the information that we have for the record on what is the number that we are able to document.

BURTON: OK. Now Novartis gave $748,000 plus $100,000 last year to this organization called CHADD. You don't see anything wrong with that?

NAKAMURA: Organizations which -- many organizations receive money from companies. And I guess my feeling is that with many of it, as long as that's revealed...

BURTON: It's OK.

NAKAMURA: Right.

BURTON: Even though they're touting their own product? What about the $750,000 that the FDA gave to them for the same reason?

You know, I hope, if one thing comes out of this, that you will get information to all of the school boards in the country and the state school superintendents saying that there is a prescribed policy that should be followed before you put children on these drugs, not just some checklist that a teacher comes up with. That's very important. You think that needs to be done. But most people out there in the hinterlands don't know that.

Now my grandson -- and we all talk about our personal experiences -- he got nine shots in one day and got 47 times the amount of mercury that was tolerable in an adult. And two days later, he became autistic.

And like I told you earlier, we've gone from one in 10,000 to one in 250 kids, according to our health agencies, your health agencies, that have autism. They are autistic. So it's an absolute epidemic.

I wanted to show you, since you weren't familiar with this, a tape we got from Canada on what happens when mercury is introduced into the neurons of the brain. Can you roll that tape real quick? It will just take a minute.

(BEGIN VIDEOTAPE)

(UNKNOWN): How mercury causes brain neuron degeneration. Mercury has long been known to be a potent neurotoxic substance, whether it is inhaled or consumed in the diet as a food contaminant. Over the past 15 years, medical research laboratories have established that dental amalgam tooth fillings are a major contributor to mercury body burden.

In 1997, a team of research scientists demonstrated that mercury vapor inhalation by animals produced a molecular lesion in brain protein metabolism, which was similar to a lesion seen in 80 percent of Alzheimer-diseased brains. Recently completed experiments by scientists at the University of Calgary's faculty of medicine now reveal, with direct visual evidence from brain neuron tissue cultures, how mercury ions actually alter the cell membrane structure of developing neurons.

To better understand mercury's effect on the brain, let us first demonstrate what brain neurons look like and how they grow. In this animation, we see three brain neurons growing in a tissue culture, each with a central cell body and numerous neurite processes.

At the end of each neurite is a growth column where structural proteins are assembled to form the cell membrane. Two principal proteins involved in growth cone function are actin, which his responsible for the pulsating motion seen here, and tubulin, a major structural component of a neurite membrane.

During normal cell growth, tubulin molecules link together, end to end, to form microtubules, which surround neurofibriles (ph), another structural protein component of the neuronal axon. Shown here is the neurite of a live neuron, isolated from snail brain tissue, displaying linear growth due to growth cone activity.

It is important to note that growth cones in all animal species, ranging from snails to humans, have identical structural and behavioral characteristics and use proteins of virtually identical composition. In this experiment, neurons also isolated from snail brain tissue were grown in culture for several days, after which very low concentrations of mercury were added to the culture medium for 20 minutes.

Over the next 30 minutes, the neurite membrane underwent rapid degeneration, leaving behind the denuded neurofibriles (ph) seen here. In contrast, other heavy metals added to this same concentration, such as aluminum, lead, cadmium and manganese, did not produce this effect.

To understand how mercury causes this degeneration, let us return to our illustration. As mentioned before, tubulin proteins linked together during normal cell growth to form the microtubules which support the neurite structure. When mercury ions are introduced into the culture medium, they infiltrate the cell and bind themselves to newly synthesized tubulin molecules. More specifically, the mercury ions attach themselves to the binding site reserved toward guanosine triphosphate or GTP on the beta subunit of the affected tubulin molecules.

Since bound GTP normally provides the energy which allows tubulin molecules to attach to one another, mercury ions bound to these sites prevent tubulin proteins from linking together. Consequently, the neurite's microtubules begin to disassemble into free tubulin molecules within the neurite's supporting structure.

Ultimately, both the developing neurite and its growth cone collapse and some denuded neurofibriles (ph) form aggregates or tangles, as depicted here. Shown here is a neurite growth cone stained specifically for tubulin and actin before and after mercury exposure. Note that the mercury has caused disintegration of tubulin microtubule structure.

These new findings reveal important visual evidence as to how mercury causes neurodegeneration. More importantly, this study provides the first direct evidence that low-level mercury exposure is indeed a precipitating factor that can initiate...

(END VIDEOTAPE)

BURTON: OK, here's the point. And you're talking to a layman, not a scientist. But I can see. And we've looked at these things before. And I've had the finest minds around the world before this committee.

Mercury causes a degeneration in the brain tissues. It's a contributing factor, according to many, many scientists in Alzheimer's and autism and other neurological problems in children. Now it doesn't take a rocket scientist to be able to see that we need to get that substance out of anything going into the body.

You in the health agencies took it out of mercurochrome. You took it out of topical dressings. The reason you did that was because you said it leeches into the skin and can cause neurological problems.

And yet, you're still sticking it into our kids. And we have an epidemic that's gone from one in 10,000 to one in 250 kids in this country. And we're going to have to take care of those people. It's going to be a huge -- it's going to be a nuclear bomb on our economy at some point in the future.

Now you're talking about today Ritalin and how we need Ritalin and how all these kids in schools and these young kids are having to get it because of the way they act. A lot of that may be caused by the introduction of mercury and other toxic substances into the body.

So it seems to me logically that the first step you take in the health agencies is get mercury and these toxic substances out of our vaccines. We have not done that here in the United States.

And really, much to my chagrin, in most of the vaccines we're exporting to Third World countries, we're keeping it in there. We're not even trying to take it out, which means we're going to be causing these problems all around the world.

Now all I'd like to end up saying to you, from my perspective, is let's get mercury out of all of these vaccines. Let's look at whether or not the amalgams, as was indicated -- we all have fillings in our teeth. And these amalgams, and I've already had my mouth tested. I had five of these amalgams taken out.

But I had a very high rate of mercury vapor when I chewed and everything that was getting out in my mouth. And that would leech into the brain. Maybe that's part of my problem, I don't know.

But the point is, why don't we start, as our health agencies, to look at getting mercury out of any substance that goes into the human body or is in close proximity to it? And then, after we do that, we may not need to be giving these kids these mind-altering drugs because many of them may not be adversely affected.

Now if you do that, and you start informing our educational institutions of the criteria that should be used before you start giving these kids Ritalin, I think you'll solve a lot of these problems. And I also think our health agencies ought to take a hard look at whether or not pharmaceutical companies should have influence on the dispersion of these things and the usage of these things by using their money to create a wider body of users, which is what they're doing.

And I know that a lot of -- there's a revolving door at the health agencies where people go to the pharmaceutical companies, come over to the health agencies and go back. And we've looked at their financial disclosure forms and we've seen some things that were very curious there, people on advisory committees that have a vested interest in getting products passed into the mainstream of use here in this country.

And I'm not going to talk any more about this. But I hope that those of you from our health agencies who have heard what we had to say today -- what I had to say -- will take that message back because it's going to be a broken record. It ain't going to go away as long as I'm in the Congress and as long as we have committees like this.

And I've talked enough. Do any of my colleagues have any more questions for this gentleman?

DAVIS: Just one quick question, Mr. Chairman. In your research, have you found any difference or any discrepancies in boys versus girls with ADHD?

NAKAMURA: There are differences in behavior, but they both respond to Ritalin.

DAVIS: I guess discrepancy is not the word I wanted. Do there seem to be more boys or more girls?

NAKAMURA: Definitely more boys.

DAVIS: By a wide majority?

NAKAMURA: Four to one.

DAVIS: Thank you.

BURTON: Mr. Gilman?

GILMAN: Just one question, Mr. Chairman. Doctor, would your NIH consider a long-term study, a study of the long-term effects of Ritalin? I don't think any study has been undertaken from the testimony we have heard.

NAKAMURA: Right. We have an ongoing study of Ritalin, which is anticipated to be long term; that is, we will follow children for many years on it.

GILMAN: That's encouraging. Thank you very much.

Thank you, Mr. Chairman.

BURTON: Mr. Horn, anything else?

HORN: No, just on the last point made by Mr. Gilman, have you got the National Academy of Science and Medicine? Are they doing it? Or is it simply done within the NIH?

NAKAMURA: It's being funded by the NIH. The National Academy of Science doesn't actually conduct studies. They review studies.

HORN: Well, it might be worthwhile to get some people that are not completely involved with NIH and take a look. That's exactly what they are there for. We use them all the time here.

NAKAMURA: OK.

BURTON: Thank you, Dr. Nakamura. We have some questions we'd like to submit for the record. But if you would consent to answer those and send them back to us, we'd appreciate it.

NAKAMURA: Absolutely, sir.

BURTON: OK, thank you very much.

We have one more panel. And this last panel consists of Dr. E. Clarke Ross. He is the CEO of Children and Adults with Attention Deficit Hyperactivity Disorder. David Fassler, a doctor who is a representative of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

And who else do we have? That's it. OK, very good.

Do you gentleman have an opening statement? Oh, I'm sorry, let me swear you in. I almost forgot.

Please stand. Do you swear to tell the whole truth and nothing but the truth, so help you God?

Do you want to start, Mr. Ross?

GILMAN: Mr. Chairman, if I might interrupt, I have to go to another meeting. Could I ask just one question of Mr. Ross before I have to leave?

BURTON: Sure.

GILMAN: Mr. Ross, isn't it true that CHADD received a grant award of $750,000 from the CDC to establish and operate the National Resource Center on ADHD?

ROSS: Yes, we were awarded a $750,000 grant from the Centers for Disease Control and Prevention to operate a national resource center on ADHD.

GILMAN: And have your membership been made aware that those funds came from a pharmaceutical company?

ROSS: The money did not come from pharmaceuticals. The CDC funds came from appropriation of Congress, administered by the Centers for Disease Control and Prevention.

BURTON: If the gentleman would yield?

GILMAN: Be pleased to yield.

BURTON: If the gentleman would yield? You did get $748,000 from Novartis?

ROSS: Eighteen percent of our budget currently...

BURTON: You got that money?

ROSS: Over a three-year period in the mid-'90s, before I was there...

BURTON: Did you get $100,000 last year?

ROSS: We got $700,000 from the pharmaceutical industry in its entirety in the last year, which is 18 percent of our budget. And I didn't bring a breakout of each company. But it's on our web site. It's in our IRS returns. And I'm happy to provide it to the committee.

But 18 percent of our budget is derived, like most every other voluntary health agency in America, whether it's the Epilepsy Foundation, diabetes, cancer, heart, the National Health Council, which is the umbrella group. We try to diversify our funding. And we try to receive corporate funding, as well as membership donations and federal funds.

BURTON: Go ahead, Mr. Gilman.

GILMAN: One last comment. The DEA stated that $748,000 to CHADD from 1991 to 1994 came from the manufacturer of Ritalin. Is that correct?

ROSS: The then-owner, which has subsequently become Novartis, gave CHADD roughly that amount of money in that three-year period. Yes.

GILMAN: Was that made known to your membership?

ROSS: Yes. It is on our web site. Go right on the web site, you'll see who all our corporate donors are, how much they give and the totality of our budget.

GILMAN: Thank you.

Thank you, Mr. Chairman.

BURTON: Proceed, Mr. Ross.

ROSS: I'm here today to talk not only about the CEO of CHADD, but I'm the father of an 11-year old son, 11-year old son with inattentive type ADHD, anxiety disorder and a variety of other challenges and learning disorders. Andrew has a history of challenges. He had seizures, unprovoked seizures when he was 21 months old. At Johns Hopkins University at Kennedy Krieger, we've had a complete blood, metabolic workup when he was two and three years old to try to determine things like mercury, lead and other contributions.

Andrew has a series of developmental problems. Inattentive ADHD was not recognized until he was four in his first group learning situation. And teachers noticed that he was inattentive. He did not pay any attention to what was going on around him.

So I'm here to speak as a parent of an 11-year old son that we deal with daily with major challenges and that experience, as well as the CEO of CHADD.

Now what CHADD does -- and I do have a written statement that I'd like to have in the record. What CHADD does is disseminate the science-based information. And that's why the Centers for Disease Control and Prevention have given us a grant to do that.

And we rely on things like the United States Surgeon General Report on Mental Health and the ADHD and Dr. Nakamura and NIMH and the National Institutes of Health and the professional societies like the American Psychiatric, American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics. That's what 20,000 family members of CHADD rely on is the science, the federal agencies and the professional community.

The highest importance at the moment are guidelines that have been mentioned before. The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have issued best practice treatment guidelines on how to asses and treat ADHD.

And the recommendation of the surgeon general, the recommendation of NIMH and the recommendation of the two professional academies is what's called a multimodal treatment. It is not medication as a first entry. It is a multimodal treatment, which are: behavioral interventions, counseling interventions, special education interventions and, if needed, medication use.

We've done all of that in our family with our son, Andrew. We have also tried a variety of other complementary or so-called alternative interventions. None of them have had harm, but none of them have had any impact. And medication actually did have impact on Andrew, our son.

Andrew's life is filled with dedicated clinicians, from a pediatrician to a child psychiatrist to a child psychologist to a neurologist, to a speech pathologist and to a team of educators. Without their collective support, I cannot imagine where Andrew would be today.

Andrew is making steady progress. He is dealing with his anxiety. He is dealing with his inattentiveness. He is dealing with his learning challenges.

But he has major challenges. And for those who want to dismiss the professional community, the 20,000 family members in CHADD rely on the psychiatrist and the pediatrician and the psychologist for their professional advice.

And my wife and I rely on our clinical team. And we appreciate our clinical team. And they have made a huge difference in Andrew's quality of life and his future.

So we didn't fabricate disorders in Andrew. At age 11 months, he broke his ankle, put in a cast. When the cast came off, we all -- I've had a couple of broken ankles in my life -- when the cast comes off, we all have pain and stiffness as we try to push that ankle down.

Andrew's ankle never went down. Andrew's ankle stayed in the position of the cast. And so we went to Johns Hopkins.

Andrew has some developmental challenges. And he happens to have inattentive type of ADHD.

So the multimodal treatment study of NIMH showed that 69 percent of children with ADHD have concurring disorders. So this complicates the entire picture.

Is it ADHD? Is it bipolar disorder? Is it anxiety disorder? Is it learning disabilities? Is it a reaction to allergies and mercury?

These are very complex assessments to be made in a child. And the reason we at CHADD and the 20,000 members of CHADD advocate the pediatrician and child and adolescent psychiatry guidelines, which Dr. Fassler will talk about, is they are a comprehensive assessment. It's not a 10 minute and then medication.

At age four, when teachers told us that Andrew was not paying attention in the class and was very distractible, we went to a psychiatrist. The psychiatrist recommended Ritalin. We were not prepared to do that at age four. And we said, "No, we're going to try other interventions." And we tried a whole host of other interventions.

By age seven, with all these other interventions tried, Andrew was still inattentive. He was still easily distractible. And so we tried Ritalin. Actually, it didn't even work.

And we tried Dexedrine. It didn't even work. Then we tried Adderall. And Adderall had an immediate impact on Andrew's ability to attend to his day, to use a checklist so he can organize his immediate day, whether it's getting ready for school, going to bed at night, in school.

And so parents don't rush -- some may -- but parents, the 20,000 members of CHADD don't rush in and say, "Give us medication. We just want medication."

They have functional challenges in their child in their daily life. And they want help. And they rely on the professional community. And they rely on the science.

And in our case, we took three years of reluctance to medicate. But when we medicated, we had this immediate impact that was positive.

And so the question is: should we have medicated at age four? Or should we have waited until age seven? And that's every family's decision in consultation with their doctor.

We made it and that was our decision. And Andrew had a lot of problems from age four to seven. But that's hindsight. Every family has to figure that out.

The statistics show that stimulant medication works in 25 to 90 percent of children. So if you reverse that, it doesn't work in 10 to 25 percent of children and there are going to be side effects. And you have to seriously think about that and know that.

And Ms. Weathers' point about informed consent is basic to a family. We need to know what the positive attributes of an intervention are, including medication. And we need to know the possible side effects and communicate not every four months with your doctor, communicate a couple of times a month with the doctor on dose level, side effects.

And we have that relationship in our family with our clinical team.

BURTON: Mr. Ross, would it be possible for you to sum up so we can get on with the questions and so forth?

ROSS: Yes.

BURTON: I know you have a lot that you want to tell us about. And we'll be glad to get to that.

ROSS: I've made all the major points I want to make: the importance of the science, the importance of a clinical team, the importance of comprehensiveness, the importance of the pediatricians and child and adolescent psychiatry guidelines and how complex this is because many of these children have co-occurring disorders. So I'll rest.

BURTON: Thank you, Mr. Ross.

Dr. Fassler?

FASSLER: Thank you. My name is David Fassler. I'm a board certified child and adolescent psychiatrist practicing in Burlington, Vermont. I'm a clinical associate professor in the Department of Psychiatry at the University of Vermont College of Medicine.

I currently serve as the president of the Vermont Association of Child and Adolescent Psychiatry. I'm also a trustee of the American Psychiatric Association and a member of the governing council of the American Academy of Child and Adolescent Psychiatry.

First of all, let me thank Representative Burton and the committee for the opportunity to appear here today. My testimony is on behalf of the APA and the Academy. And I'd appreciate if my written remarks are entered into the record.

The American Psychiatric Association is a medical specialty society representing over 38,000 psychiatric physicians. The American Academy of Child and Adolescent Psychiatry is a national professional association representing over 6,500 child and adolescent psychiatrists who are physicians with at least five years of specialized training after medical school, emphasizing the diagnosis and treatment of mental illness in children and adolescents.

I'm happy to be able to talk to you about the diagnosis and treatment of Attention Deficit Hyperactivity Disorder, or ADHD, and to underscore some of the comments that you have already heard.

As a psychiatrist, when I think of ADHD, I think first of the faces of children and families who I have seen over the years. I think in particular of a seven-year old boy who is about to be left back in second grade, due to his disruptive behavior.

The teachers have labeled him "difficult to control." The other kids just call him weird. He has few friends and is already convinced that he is bad and different.

And I think of a 12-year-old girl with an IQ of 130. She is not disruptive, but she is failing seventh grade. And I think of 28-year- old administrative assistant who was relieved and appreciative when he received an accurate diagnosis and appropriate treatment for his longstanding condition. But I also remember his anger and frustration because, in his words, he missed out on 20 years of his life.

As you have already heard, according to NIMH, the National Institute of Mental Health, Attention Deficit Hyperactivity Disorder, or ADHD, is the most commonly diagnosed psychiatric disorder of childhood. It's estimated to affect approximately five percent of school-age children, although published studies have identified a prevalence rate as high as 12 percent in some populations.

As you have heard, it occurs between three and four times more often in boys than in girls.

We also know that ADHD does run in families. And contrary to previous beliefs, it doesn't always go away as you grow up. In fact, the latest research indicates that as many as half of all kids with ADHD continue to have problems into adulthood.

This is actually one of the reasons we see an increase in the overall use of medication. We are now recognizing and treating more adults with ADHD.

I have brought for the committee the Diagnostic and Statistic Manual of Mental Disorders, the DSM-4, which you have heard discussed today and which is central to our understanding of the formal diagnosis of ADHD. The key features, as has been explained, include inattention, hyperactivity and impulsivity.

I want to underscore one of the other elements that Dr. Nakamura spoke about, and that's that the symptoms must be interfering in the child's life at home, at school or at work -- at work for an adult -- or with their friends, with their peers. In two of those settings, so it's not just that you're agitated or that you're active, but that it's really interfering with your life, with your ability to function in those settings.

The diagnostic criteria are quite specific and they are well established within the field. They are the product of extensive and numerous research studies conducted at academic centers and clinical facilities throughout the country. And I have brought a number of the studies, which have already been mentioned, from the AMA, the Academy of Pediatrics and the Surgeon General's Report.

In addition, we now have a substantial body of research literature about both the genetic markers and the neuroanatomical abnormalities associated with this disorder. And you started to hear about some of it, some of the MRI, the CAT scan, the PET scan studies. And I think within the next year or two, we will even be able to use some of these in a more diagnostic way.

Let me be very clear. ADHD is not an easy diagnosis to make. And it's not a diagnosis that can be made in a five- or a 10- or a 15- minute office visit.

Many other problems, including hearing and vision problems, anxiety disorders, depression, learning disabilities, toxicity with heavy metals can all present with signs and symptoms which look similar to ADHD. There is also a high degree of comorbidity, meaning that over half of the kids who have ADHD also have a second psychiatric problem.

And as we heard this morning, the diagnosis of ADHD really requires a comprehensive assessment by a trained clinician. I don't think any of us you have heard today would disagree with that.

In addition to direct observation, the evaluation includes a review of the child's developmental, social, academic history, medical history, including evaluating the child for other medical conditions, including things like hyperthyroidism, the toxicities. We really need to rule those things out.

It also should include input from the child's parents and teachers and a review of the child's records. Schools play a critical role in identifying kids who are having problems. But as you have heard already today, schools should not be making diagnoses and they should not be dictating treatment.

ADHD is also a condition which should not be taken lightly. Without proper treatment, a child with ADHD may fall behind in schoolwork, may have problems at home and with friends.

It can have long-term effects on the child's self-esteem. It can lead to other problems in adolescence, including an increased risk of substance abuse that you've heard about, increased risk of adolescent pregnancy, increased risk of accidents, including car accidents in adolescents, school failure and increased risk of trouble with the law.

The treatment of ADHD should be comprehensive and individualized to the needs of the child in the family. Medication, including methylphenidate or Ritalin, can be extremely helpful for many children.

But consistent with the opening comments from Ms. Davis, medication alone is rarely the appropriate treatment for complex child psychiatric disorders, such as ADHD. Medication should only be used as part of a comprehensive treatment plan, which will usually include individual therapy, family support and counseling and work with the schools.

In terms of methylphenidate, we have literally hundreds of studies over 30 years clearly demonstrating the effectiveness of this medication on many of the target symptoms of ADHD. As you have also heard, it is generally well tolerated by children with minimal side effects.

Nonetheless, I share the concern that some children may be placed on medication without a comprehensive evaluation and accurate and specific diagnosis or an individualized treatment plan. Let me also be very clear that I am similarly concerned about the many children with ADHD and other psychiatric disorders who would benefit from treatment -- including treatment with medication, if appropriate -- but who go unrecognized and undiagnosed and who are not receiving the help that they need.

Let me turn specifically to the question of overdiagnosis and overtreatment. Just last week, a review article written by Peter Jensen was published which addressed this issue in detail. And I have included Dr. Jensen's article in the background materials.

Dr. Jensen is currently at Columbia University. He was formerly the associate director for child and adolescent research at the National Institute of Mental Health. He reviews all of the available scientific studies on this issue.

He notes that most studies and media reports have not been based on actual diagnostic data, where people actually sat and interviewed children and reviewed records, but they have relied instead on information from an HMO or a Medicaid medication database.

Dr. Jensen and his colleagues actually performed comparative evaluations on 1,285 children in four communities -- Atlanta, New Haven, Westchester and San Juan, Puerto Rico -- to determine the prevalence of ADHD, as well as the forms of treatment utilized. The results were that 5.1 percent of children and adolescents between the ages of nine and 17 met the diagnostic criteria for ADHD. Yet, only 12.1 percent of these children, or approximately one in eight, were being treated with medication.

So the majority of children with ADHD in this carefully controlled study were not being treated with medication, suggesting that at least in these communities, medication is currently underprescribed. These authors also found eight children out of these 1,285 who were receiving medication who did not meet the full diagnostic criteria for ADHD, although they did have high levels of ADHD symptoms.

Dr. Jensen concludes -- and I would concur -- that on the basis of these results, there is no evidence of widespread overtreatment with medication. On the contrary, it appears that, at least in these communities, the majority of children with ADHD are not receiving what we would consider to be appropriate and effective treatment.

There is a second study from the Mayo Clinic in Rochester, Minnesota, which is in the background materials. In the interest of time, I will skip the details, other than to mention that in that study, of all children on medication for ADHD, only .2 percent, which is two children in 1,000, had no evidence of the disorder whatsoever.

So again, the second study, carefully conducted study, simply doesn't support the argument that ADHD is generally overdiagnosed or overtreated. This is not to say that overdiagnosis or overtreatment doesn't happen in any areas of any communities, which is why we all need to continue our collective efforts to improve public awareness and to ensure access to comprehensive assessment services and individualized treatment, using the kinds of evidence-based guidelines which you have been hearing about and which have now been developed.

BURTON: Dr. Fassler, can you summarize? We have some votes on the floor.

FASSLER: I am summarizing with my recommendations. The APA and the Academy would offer the following specific recommendations for your consideration.

First, we fully support and would underscore the importance of accurate diagnosis and treatment, which requires access to clinicians with appropriate training and expertise and sufficient time to permit a comprehensive assessment. Next, we fully support the increased emphasis of the FDA and the NIMH on research on the appropriate use of medication in the psychiatric treatment of children and adolescents. And we welcome the expanded clinical trials and the longitudinal studies, which you have been hearing about.

We also fully support the passage of comprehensive parity legislation at both the state and the federal level. We fully support and welcome all efforts to sustain and expand training programs for all child mental health professionals, including programs for child and adolescent psychiatrists.

And finally, we fully support and appreciate the efforts of the current administration, through the new Freedom Commission on Mental Health, to focus increased attention on the diagnosis and treatment of all psychiatric conditions, including those which affect children and adolescents.

In summary, let me emphasize that child psychiatric disorders, including ADHD, are very real and diagnosable illnesses, which affect lots of kids. The good news is that they are also highly treatable.

We can't cure all the kids we see. But with comprehensive, individualized intervention, we can significantly reduce the extent to which their conditions interfere with their lives. The key for parents and teachers is to identify kids with problems as early as possible and to make sure that they get the help that they need.

Thank you.

BURTON: Thank you, doctor.

Do you have a few questions you'd like to ask, real quickly? Let me -- I'd like to ask you a whole bunch of questions, but unfortunately, we've got two votes on the floor. And you've been here all day and I don't want to keep you all any longer than we have to.

We have 6 million children that are using these drugs right now. I don't know how we got through all this when I was younger, but we did. And the society did fairly well.

Did you find any mercury in your son's blood work?

ROSS: No. We were hoping to find some toxic element so that we could have a simple explanation for the fact that he was having seizures and that he had a hypotonia and a lot of problems. No, we did not find...

BURTON: Found no mercury?

ROSS: No.

BURTON: Had he had all of this childhood vaccines?

ROSS: Yes. We contracted with our pediatrician two months before we delivered Andrew. And he has had the same pediatrician and...

BURTON: So he had all of his childhood vaccinations.

ROSS: He had all his childhood vaccinations. Now he was tested when he was two and three. And he has subsequent vaccinations.

BURTON: But the thing is, I wonder if you could contact your pediatrician and find out the lot numbers of those vaccinations. I would just be curious, I would like to see those, because mercury has been in these childhood vaccinations for 30, 40 years. And if he got a number of these vaccinations, as my grandson did, it's hard for me to believe that he didn't get some mercury injected into him.

ROSS: Well, what the doctor would have told me is not there wasn't some, is if it was abnormal. We were told there was not abnormal levels of mercury, lead and a whole bunch of things.

I don't know. I didn't see the result and I'm not a physician.

BURTON: I think most parents who have had these shots given to their children and who have autistic children would really argue with what is an acceptable level of mercury in the body. That's a subjective thing and it may vary from person to person.

So that's something that I'm sure would be debated.

You agree, Dr. Fassler, that there ought to be a thorough analysis of a child before they go on medication?

FASSLER: Yes. My bottom line would be that kids need a comprehensive evaluation before there is any treatment plan in place and that parents need to be advocates for kids to try and make sure that...

BURTON: I don't think anybody disagrees with that.

FASSLER: Right.

BURTON: And your organization also agrees with that?

ROSS: Yes. Every child should have a complete, comprehensive examination.

BURTON: Why is it then that around the country, we have school corporations that have this checklist where a teacher checks off the problems with a child, the child is taken to a doctor and it's a perfunctory thing for the doctor to say, "Well, it appears as though he needs Ritalin." And they write out a prescription for that.

That's not a thorough examination.

(UNKNOWN): And that's not what either of us or any of us who you have heard would support. There are checklists where teachers report what they're seeing in the classroom. But there shouldn't be a diagnosis made just on the basis of reviewing that checklist.

BURTON: My grandson never had a complete psychological analysis. He became autistic, as I said, right after getting all these shots. And yet, the school recommended, because he was difficult -- he was in a special ed class -- that he should be put on Ritalin. And they had a doctor also subscribe to that.

Of course, he wasn't put on Ritalin. We didn't allow that. And he seems to be doing all right on other ways that we're dealing with him.

But the fact of the matter is, in my own personal experience, that was the case: recommendation by the teacher and the doctor went along with that. How do we educate our educators around the country to understand that this has to be something that's done in a very thorough manner before you start putting these kids on these drugs?

(UNKNOWN): I think it's an excellent point. And I think collectively we need to work on getting that message to the schools. And part of it is our job, going into the schools, teaching teachers about the kinds of things to look for and when kids should be referred.

I think we need to do a better job at recognizing the signs and symptoms earlier and, you know, getting help for kids before they have major problems. Because often, you know, we all wait too late. And we may see things in adolescence that we may have been able to help with earlier in life.

BURTON: Let me just say that I hope you and CHADD and our health agencies will figure out some way -- I know how much time is left -- our health agencies will figure out a way to make sure that every school corporation, every superintendent of public instruction in all 50 states understand that there should be a thorough analysis before they put these kids on these drugs. If you would do that, I think you would eliminate a lot of the problems.

The other thing is I hope you'll agree that we shouldn't be introducing mercury or other toxic substances into people's bodies, whether they're kids or adults. And if we could get that point across, we might solve a lot of these problems.

I have a lot of questions I would like to submit to you for the record, Dr. Fassler and Mr. Ross.

I would also like to end by saying, Mr. Ross, we had what was called the "Keating Five" here in Washington. We had five senators that met with Mr. Keating on the savings and loan crisis.

And I don't believe any of those senators really intentionally did anything wrong. But the appearance of impropriety was very great and they got a heck of a lot of bad publicity when the savings and loan debacle took place.

And for you to get hundreds of thousands of dollars from Novartis, which manufactures Ritalin and your organization does advocate that children should use that, it gives the appearance of...

ROSS: We do not advocate any one drug. We advocate a multimodal treatment, which may include medication and...

BURTON: I understand.

ROSS: And the products are never discussed.

BURTON: Regardless, I understand. But the appearance is that they're feeding you to deal with this problem in that way. And I would just suggest, if there is a better way to fund your organization, even if it's only 18 percent, it would be helpful. Because if you was in the United States Senate or the House and that happened, you would have a heck of a problem.

With that, let me just say to you I really appreciate your being here. We will submit questions for the record. And we appreciate your response.

Thank you very much.

We are adjourned.

END

NOTES:
[????] - Indicates Speaker Unknown
   [--] - Indicates could not make out what was being said.[off mike] - Indicates could not make out what was being said.

PERSON:  DAN L BURTON (94%); BENJAMIN A GILMAN (57%); CHRISTOPHER SHAYS (57%); CONSTANCE MORELLA (57%); ILEANA ROS-LEHTINEN (56%); JOHN MICHAEL MCHUGH (56%); CHRIS JOHN (55%); THOMAS M DAVIS (55%); JOE SCARBOROUGH (54%); MARK E SOUDER (54%); STEVEN C LATOURETTE (54%); DAN MILLER (53%); JO ANN DAVIS (52%); TODD PLATTS (51%); ADAM PUTNAM (50%); 

LOAD-DATE: October 5, 2002

 

Copyright 2002 eMediaMillWorks, Inc.
(f/k/a Federal Document Clearing House, Inc.)  
FDCH Political Transcripts

 

September 26, 2002 Thursday


TYPE: COMMITTEE HEARING

LENGTH: 32279 words

COMMITTEE: HOUSE GOVERNMENT REFORM COMMITTEE

HEADLINE: U.S. REPRESENTATIVE DAN BURTON (R-IN) HOLDS HEARING ON THE OVERMEDICATION OF HYPERACTIVE CHILDREN

SPEAKER:
U.S. REPRESENTATIVE DAN BURTON (R-IN), CHAIRMAN

LOCATION: WASHINGTON, D.C.

WITNESSES:

NEIL BUSH, FOUNDER, CHAIRMAN AND CEO, IGNITE! INC.
LISA-MARIE PRESLEY, SPOKESPERSON, CITIZEN'S COMMISSION FOR HUMAN RIGHTS
BRUCE WISEMAN, PRESIDENT, CITIZEN'S COMMISSION ON HUMAN RIGHTS, CO-CHAIRMAN, NATIONAL FOUNDATION FOR WOMEN LEGISLATORS, EDUCATION TASK FORCE
MARY ANN BLOCK, AUTHOR "NO MORE ADHD"
PATRICIA WEATHERS, PRESIDENT, PARENTS FOR A LABEL AND DRUG FREE EDUCATION
DR. RICHARD NAKAMURA, ACTING DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH, NATIONAL INSISTUTES OF HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES
E. CLARKE ROSS, CEO, CHILDREN AND ADULTS WITH ATTENTION-DEFICIT/, HYPERACTIVITY DISORDER
DR. DAVID FASSLER, AMERICAN PSYCHIATRIC ASSOCIATION

BODY:

(CORRECTED COPY)
 
HOUSE COMMITTEE ON GOVERNMENT REFORM HOLDS A HEARING ON THE
OVERMEDICATION OF HYPERACTIVE CHILDREN
 
SEPTEMBER 26, 2002

SPEAKERS:
U.S. REPRESENTATIVE DAN BURTON (R-IN)
CHAIRMAN
U.S. REPRESENTATIVE BENJAMIN A. GILMAN (R-NY)
U.S. REPRESENTATIVE CONSTANCE MORELLA (R-MD)
U.S. REPRESENTATIVE CHRISTOPHER SHAYS (R-CT)
U.S. REPRESENTATIVE ILEANA ROS-LEHTINEN (R-FL)
U.S. REPRESENTATIVE JOHN MCHUGH (R-NY)
U.S. REPRESENTATIVE STEVE HORN (R-CA)
U.S. REPRESENTATIVE JOHN L. MICA (R-FL)
U.S. REPRESENTATIVE THOMAS M. DAVIS III (R-VA)
U.S. REPRESENTATIVE MARK E. SOUDER (R-IN)
U.S. REPRESENTATIVE JOE SCARBOROUGH (R-FL)
U.S. REPRESENTATIVE STEVEN C. LATOURETTE (R-OH)
U.S. REPRESENTATIVE BOB BARR (R-GA)
U.S. REPRESENTATIVE DAN MILLER (R-FL)
U.S. REPRESENTATIVE DOUG OSE (R-CA)
U.S. REPRESENTATIVE RON LEWIS (R-KY)
U.S. REPRESENTATIVE JO ANN DAVIS (R-VA)
U.S. REPRESENTATIVE TODD PLATTS (R-PA)
U.S. REPRESENTATIVE DAVE WELDON (R-FL)
U.S. REPRESENTATIVE CHRIS CANNON (R-UT)
U.S. REPRESENTATIVE ADAM PUTNAM (R-FL)
U.S. REPRESENTATIVE C.I. "BUTCH" OTTER (R-ID)
U.S. REPRESENTATIVE EDWARD L. SCHROCK (R-VA)
U.S. REPRESENTATIVE JOHN J. DUNCAN, JR. (R-TN)
 
U.S. REPRESENTATIVE HENRY WAXMAN (D-CA)
RANKING MEMBER
U.S. REPRESENTATIVE TOM LANTOS (D-CA)
U.S. REPRESENTATIVE MAJOR R. OWENS (D-NY)
U.S. REPRESENTATIVE EDOLPHUS TOWNS (D-NY)
U.S. REPRESENTATIVE PAUL E. KANJORSKI (D-PA)
U.S. REPRESENTATIVE PATSY MINK (D-HI)
U.S. REPRESENTATIVE CAROLYN B. MALONEY (D-NY)
U.S. DELEGATE ELEANOR HOLMES NORTON (D-DC)
U.S. REPRESENTATIVE ELIJAH E. CUMMINGS (D-MD)
U.S. REPRESENTATIVE DENNIS J. KUCINICH (D-OH)
U.S. REPRESENTATIVE ROD R. BLAGOJEVICH (D-IL)
U.S. REPRESENTATIVE DANNY K. DAVIS (D-IL)
U.S. REPRESENTATIVE JOHN F. TIERNEY (R-MA)
U.S. REPRESENTATIVE JIM TURNER (D-TX)
U.S. REPRESENTATIVE THOMAS H. ALLEN (D-ME)
U.S. REPRESENTATIVE JANICE D. SCHAKOWSKY (D-IL)
U.S. REPRESENTATIVE WILLIAM LACY CLAY (D-MO)
U.S. REPRESENTATIVE DIANE E. WATSON (D-CA)
U.S. REPRESENTATIVE STEPHEN LYNCH (D-MA)
 


*


BURTON: Good morning. A quorum being present, the Committee on Government Reform will come to order. And I ask unanimous consent that all members' and witnesses' written and opening statements be included in the record. And without objection, so ordered.

I ask unanimous consent that all articles, exhibits and extraneous or tabular materials being referred be included in the record. Without objection, so ordered.

Today, we're going to be discussing a very important issue that affects many, many children in the United States. As all of us know, our children are our future. I doubt there is a single member of Congress that doesn't feel strongly that we need to do our dead level best to protect and ensure the health and wellbeing of the children of this nation.

Today, we're going to talk about a group of symptoms known as Attention Disorder. In the last two decades, we've heard more and more attention about Attention Deficit Disorder, ADD and Attention Deficit Hyperactive Disorder, ADHD.

The most common treatment for this disorder is a drug called Ritalin. This drug is being given to more and more children in this country. It has become very controversial.

There has been over a 500 percent increase in the use of Ritalin in the United States since 1990. It's estimated that 4 to 6 million children in the United States take Ritalin every single day.

On one side of this issue, we're going to hear from the associations of psychiatrists and a parent's organization known as Children and Adults with Attention Deficit Hyperactivity Disorder or CHADD. They believe that 13 percent of the U.S. population, adults and children, suffer from an attention disorder and that it should be treated with medication.

At the other end of the discussion is the Citizens Commission for Human Rights. They challenge the legitimacy of calling ADHD a neurobiological disorder. They raise serious questions about giving strong medication to young children.

Also in the discussion are concerned parents. Imagine being a parent of a young child and receiving a note from your school instructing you to take your child to their pediatrician for evaluation. In this note from the school, there's a checklist for you to take to the doctor. The school officials have diagnosed your child as possibly having ADHD.

They make this diagnosis because your child makes careless mistakes on homework, does not follow through on instruction, fails to finish schoolwork, has difficulty organizing tasks, loses things and is forgetful in daily activities.

That sounds like me when I was in grade school. I did not take Ritalin. I became a congressman.

(LAUGHTER)

When you take your child to a doctor, instead of blood tests and a thorough medical evaluation, you have a conversation with a doctor about the school's checklist. And you leave a few minutes later with a prescription for your young child for a psychotropic drug.

Did the doctor test your child for a thyroid disorder? Did your doctor test your child for a heavy metal toxicity? Did you doctor talk to you about your child's allergies?

Did your doctor even mention nutrition or possible food sensitivity? Did your doctor ask if your child's IQ had been tested and if he was gifted? Probably not.

We all know that prescription drugs continue to command a greater percentage of the overall healthcare dollar. According to the Department of Health and Human Services, prescription drugs accounted for nine percent of all U.S. healthcare expenditures in fiscal year 2001. This is a 14.7 percent increase in one year.

Ritalin, as you know, is classified as a Schedule II stimulant under the Federal Controlled Substances Act. In order for a drug to be classified as a Schedule II, it must meet three criteria: one, it has to have a high potential for abuse; two, it has to have a currently accepted medical use in treatment in the United States; and three, it has to show that abuse may lead to severe psychological or physical dependence.

This is a Schedule II drug. And this is the definition.

Some of the things we've heard about Ritalin cause me to have some concerns. And I'd like to hear from all of our witnesses today about those issues.

The -- quote -- "experts" tell us that Ritalin is a -- quote -- "mild stimulant." However, research published in 2001 in the "Journal of the American Medical Association" showed that Ritalin was a more potent transport inhibitor than cocaine.

This isn't me saying this. This was in the "Journal of the American Medical Association." It said that Ritalin was a more potent transport inhibitor than cocaine.

The big difference appears to be the time it takes for the drug to reach the brain. Inhaled or injected cocaine hits the brain in seconds, while pills of Ritalin normally consumed take about an hour to reach the brain. Like cocaine, chronic use of Ritalin produces psychomotor stimulant toxicity, including aggression, agitation, disruption of food intake, weight loss, stereotypic movements and death.

There have been only two large epidemiological studies on the long-term dopamine effects of taking Ritalin for years. One study found more drug addiction in children with ADHD who took Ritalin, compared with children with ADHD who took no drug, while the other study shows the opposite result. So they are inconclusive at this moment.

The question that remains to be answered, according to the authors of this study, is whether the chronic use of Ritalin will make someone more vulnerable to decreased dopamine brain activity, as cocaine does, thus putting them at risk for drug addiction.

Even more disturbing than the prescribing of Ritalin to school age children is a trend to prescribe this medication to preschoolers. A study published in the "Journal of the American Medical Association" in 2000 offered some key insights into this dangerous new trend. Fifty-seven percent of 223 Michigan Medicaid enrollees younger than four years of age with a diagnosis of ADHD received at least one psychotropic medication to treat the condition during a 15-month period in 1995 to 1996.

Ritalin and clonadine were prescribed most often. Additionally, the authors found that in the Midwestern states' Medicaid population, there was a threefold increase in total prescribing of stimulants between 1991 and 1995, a 300 percent increase.

There was a threefold increase in prescribing Ritalin, a 28-fold increase in prescribing clonadine and a 2.2-fold increase in prescribing of antidepressants. This is children between the ages of two and four years old.

These are trends that I think we ought to be concerned about. Is it safe to give these drugs to very young children? What will the long-term effects be? Are children being diagnosed correctly?

I hope we can shed some light on all of these issues today.

In concluding, let me just say, over the last four years, this committee has looked at numerous health issues. We've looked at the role of dietary supplements, nutrition and physical activity in improving health. We've looked at the role of complementary and alternative medicine in our healthcare system.

We've looked at pharmaceutical influence on advisory committees at the Department of Health and Human Services. And we've looked at the possible relationship between childhood vaccines and the autism epidemic.

It's obvious to me that we can no longer ignore that our healthcare system is in need of major overhaul and attitude change. We have a generation of doctors who have not been trained in nutrition. We have statistics that show that 85 percent of the illnesses Americans face are related to lifestyle. We have camps of conventional doctors who are trained to suppress symptoms through drugs and camps of complementary and alternative medical professionals, including doctors, who are trained to look at the whole person and their environment.

It's time that we put the labels of conventional and alternative aside and think about an integral approach, a complete approach, to care. We owe it to all of us, but especially our children.

I am pleased that we have such a stellar list of witnesses today. Mr. Neil Bush, the brother of the president, was going to be here with us. But unfortunately, he could not be. So what we have done is we have a tape of an interview that was conducted with Mr. Bush that we show at the outset of our hearing, before we hear from our witnesses.

As everybody knows, he is not only the brother of the president, but he is the CEO of Ignite! Learning and the son and brother of two presidents and was supposed to be here, but unfortunately, he couldn't. He did have a family experience with a misdiagnosis of ADHD.

Ms. Lisa Marie Presley, I'm sure everybody knows who Ms. Presley is. She is not only a very talented young lady and a very attractive young lady, she is the daughter of Elvis Presley and his lovely wife. And she is here today to testify. And we are looking forward to her testimony.

She is a concerned mother and the international spokesperson for the Citizens Commission on Human Rights.

Ms. Patti (ph) Weathers, who is here with us and we're glad to have you. She will share her family's story about a school trying to force medication as a condition of school participation.

Dr. Mary Ann Block, the author of "No More ADHD" is here. And we appreciate your being here as well.

And of course, we have Mr. Wiseman, who has been active in this issue for a long time. And we appreciate your attendance as well, Mr. Wiseman.

WISEMAN: Thank you.

BURTON: I want to thank all of our witnesses for being here today. And I look forward to your testimony. And the hearing record will remain open until October the 10th.

Mr. Waxman is not here at the present time, so I'll now yield to the distinguished gentleman from New York, my colleague, Mr. Gilman.

GILMAN: Thank you, Mr. Chairman. And I want to thank Chairman Burton for holding this important hearing to examine the issue of medicating school children in the treatment of Attention Deficit Hyperactive Disorder.

As a congressional member who has long been interested in the ongoing war on illicit drugs, I'm surprised by the extensiveness of the use of use of controlled substances such as Ritalin with a high potential for abuse and the propensity for its dependence to treat psychiatric disorders in children. This issue is surrounded by substantial controversy, a debate that we fully expect to be highlighted by today's witnesses.

And while we recognize the merits of the positions argued by each side, my concerns lie in another area. I don't doubt that there are many children with genuine illnesses or disorders that could benefit from a treatment regime involving Ritalin and similar drugs.

I am concerned, however, with a number of other issues. The first of these is a trend toward treating younger and younger children with these dependent drugs. Ritalin is generally not recommended for children under age six. Yet there was a threefold increase in its prescription for children aged two to four between 1991 and 1995.

Also of concern is that parents are being pressured into having their children take these drugs when a diagnosis is made by a teacher or other school official and not by any medical professional. As a result, the potential for abuse is enormous.

Educators want conformity in the classroom. But the desire for order needs to be balanced against the health of the children.

The heavy advertising that the extensive lobbying of school districts by drugs companies for these products is very distressing. The decisions involving treatment need to be made by medical personnel who know the individual patient and not by someone with some financial stake in the system.

Moreover, we've not seen any evidence that suggests the medical profession has any significant knowledge about the long-term effects of these drugs. Given that this is a relatively recent phenomenon, it's possible that long-term studies have not been undertaken. And if that's the case, we could be setting ourselves up for a potential disaster down the road.

Once again, Mr. Chairman, thank you for holding this important hearing this morning. And I look forward to the testimony of our witnesses.

BURTON: Thank you, Mr. Gilman.

Ms. Watson, do you have an opening statement?

WATSON: Yes, I do.

BURTON: Ms. Watson, you are recognized.

WATSON: I want to thank you, Mr. Chairman. And I have a few observations I'd like to share based on an experience while I was teaching and as a school psychologist.

Although fidgeting and not paying attention are normal and common childhood behaviors, a diagnosis of ADHD may be required for children in whom frequent behavior produces persistent dysfunction. The challenge is to evaluate, inform the parents and consider the alternatives before choosing an invasive and artificial drug treatment.

An adequate diagnostic evaluation requires histories to be taken from multiple sources -- from the parents, from children, from teachers and from others that associated with the child -- a medical evaluation of general and neurological health, a full cognitive assessment, including school history, use of parent and teacher rating scales and all necessary adjunct evaluation, such as an assessment of speech and language patterns, et cetera. These evaluations take time and require multiple clinical skills.

Regrettably, there is a lack of appropriate trained professionals and monetary resources in the current school system. As a school psychologist in Los Angeles, for every 10 students that I worked with, there were approximately four or maybe even five on Ritalin.

It was very frustrating to see many of the medicated children completely numb to stimuli. In many cases, they were almost like robots.

Drugs should not be overly prescribed or seen as the only solution to these problems. The American Academy of Pediatrics published a policy statement in 1996 on the use of medication for children with attention disorders, concluding that the use of medication should not be considered the complete treatment program for a child with ADHD and should be prescribed only after a careful evaluation.

Because stimulants are also drugs of abuse and because children with ADHD are at an increased risk of substance abuse disorder, I have concerns about the potential for the abuse of stimulants by children taking the medication or diversions of drugs to others. Just yesterday, I read in the "Washington Post" sports section that the Hall of Fame Pittsburgh Steeler Mike Webster pleaded "no contest" in September 1999 to forging prescriptions to obtain Ritalin.

And I finally say that this point has to be made. And it goes to the fact that this great athlete is probably someone who, early on, showed hyperactivity. And probably because he was bored in class or whatever the circumstances might have been, but he now has an addiction that I think in some ways could be equated with the use of cocaine, which is so prevalent in my district and in the school district that I represent.

So I am very, very concerned that we are bringing our children up in a drug culture. And you can't turn on the television or the radio or read a newspaper that we're not pushing something to wake you up, put you sleep. You know, "Want your z's? Take this."

And so children are surrounded by this culture. We need not have this particular effect in our schools.

So Mr. Chairman, thank you very much for holding this hearing. And I look forward to hearing the presenters.

BURTON: Thank you very much, doctor. I appreciate that.

Mr. Horn?

HORN: Mr. Chairman, I thank you for this further series of where there has been misuse of pharmaceuticals. And I agree completely with what my colleague, Mr. Gilman -- we've been all over Europe and everywhere else to see that drugs -- and when it's used for small children and they have no say about it and when it's wrong, we should make sure that doctors are properly put together, have what type of either adolescents or the others.

So I would commend you and would hope that we can get soon to the witnesses, since they're outstanding.

BURTON: Thank you, Mr. Horn.

Mr. Cummings?

CUMMINGS: Thank you very much, Mr. Chairman. I want to thank you for holding this hearing. I bring a very interesting perspective to this hearing, in that as a young African-American boy in South Baltimore, I know that what happened to a lot of us is we were actually pushed into special education. We were given all kinds of drugs. And they said that we were hyperactive and told that, you know, that our hyperactivity could not be controlled.

But what they failed to understand -- and in this poor neighborhood in South Baltimore -- was that we didn't have the playgrounds. We didn't have them. We played on glass. G-L-A-S-S.

We didn't have the leagues, the baseball leagues, that stuff that little boys would normally do to get that energy out of them. And so what happened, as is happening today in my district, are little children are being drugged to keep them stable, so they say, so that they can learn.

And I think I agree with Congresswoman Watson that we've got a situation where we have to bring this whole situation under control. And Mr. Chairman, I applaud you for bringing attention to it because it's a very serious thing.

Just today, I was listening to one of our national stations. And they were talking about how there are over 1 million African-American men in prison -- 1 million. There are more African-American men in prison than there are in college.

And you have to wonder how many of them may have started off with folks saying that, "There's something wrong with you." And we have to understand, when you tell a child that there is something wrong with them, it goes with them until they die.

And it's not -- I've often said -- it's not the deed, it's the memory that haunts folks. And so I think that perhaps -- I don't know whether our witnesses will touch on this -- I think that perhaps we categorize children at an early age. And we misdiagnose them. And then we put them on a train, on a track, that leads to nowhere.

And so that's why, Mr. Chairman, I'm glad we're exploring this. I think that it took a lot of foresight on your part to even open up this door so that we could peek in. Because I can tell you that I know of a lot of children right now who are sitting in classrooms and they've been drugged. And they don't know -- they're not sure what's going on with them. All they know is that they have been labeled.

And last but not least, Mr. Chairman, let me say this. In our society today, too often, what we do is we look at a child's behavior and say to our selves that that behavior is a deficit as opposed to an asset.

And I can recall, as a young boy, one of the reasons why they put me in special education and put me to the side is because they said I talked too much.

(LAUGHTER)

They said, "You talk too much." And I'm so glad that there were some people that saw it as an asset.

(LAUGHTER)

Did not drug me to quiet me and said to use this asset that God has given you so that you can help to bring benefit to the rest of society. And so, for those reasons, I take it very personal what we're doing here today because there are so many people that don't get off of that train leading to nowhere.

And so with that, Mr. Chairman, I yield back.

BURTON: Thank you, Mr. Cummings. And I'd just like to say that your testimony parallels some of the things I heard about me when I was in school. And I guess I still talk too much sometimes.

Let's see, Ms. Davis?

DAVIS: Thank you, Mr. Chairman. I appreciate you holding this hearing. And I want to bring an entirely different perspective to what has been said. I'm the mom of an ADHD son who is now 21. I would have given anything, back when he was six or seven, if someone from the school would have sent a note home and said, "Have your son tested or checked out."

Instead, we went for several years thinking we were bad parents; something was wrong; we could not control our child; we didn't know what was wrong with him. And it was at the end of his second grade, when his teacher said he was below grade level and she passed him because she just didn't want to deal with him anymore.

And it was a struggle at home. It was a strain on our marriage. This is our younger son. We couldn't handle him. We couldn't control him.

And during that summer, I happened to be talking to a lady who asked me had I ever had my son tested for Attention Deficit Hyperactivity Disorder, which I had never heard of. I took him to a psychologist -- I took him to my pediatrician, who sent me to a psychologist.

We wrestled with putting our son on Ritalin. I did not want to medicate my child. My husband didn't want to medicate him. We wrestled with that a great deal.

The first day of school in third grade, he was sent to the principal's office for acting up. That went on for a week. And it wasn't acting up like bad behavior. It was he just couldn't control himself.

And long story short, the second week, we put him on Ritalin. We did not tell the school. Back then, the teachers in our area were not trained on Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder. They didn't know much about it.

At the end of the first nine weeks, when the report card came out -- keep in mind, this is the young man they wanted to hold back in second grade or said he was below grade level. We received a call to come to the school.

I went to the school, met the principal, the reading specialist and the third grade teacher, who said our son was a brilliant, gifted child and wanted to put him in the gifted learning class. He made straight A's.

We then told them we did not want him in the gifted class. We explained the Ritalin. And I will tell you that Ritalin was a savior to us for our son.

We tried everything. We tried the diet. We tried the behavior changes. We tried everything before we succumbed to the Ritalin.

We didn't keep him on it during the holidays. We didn't keep him on it during the summer. He did great. The psychologist said it was all right not to have him on it during the summer and during the holidays.

He did great. When he was in high school, he opted to go off the Ritalin. We've had no trouble with our son. He has not had a problem with drugs.

In fact, just the opposite. We explained to him that, with the Ritalin, if he were to ever try drugs, it could totally harm him. And I believe that, in this country, we have a tendency to swing from one end to the other. I do believe we've swung to the other.

We've gone from when people didn't know about Ritalin and Attention Deficit Disorder to now any time you have a child who is active at all, we put him on Ritalin. I would not want to see the children going on Ritalin at age two, three, four, five.

It was a hard decision for us at eight to put our son on Ritalin. I do believe that, in some cases, Ritalin is what helps. It doesn't -- and one thing we explained -- and I don't mean to take up too much time.

But one thing we explained to our son is that the Ritalin didn't make him smart. It didn't make him get the A's. It just helped him to concentrate, to be able to use the abilities that he already had.

I do think there are children and parents who will need to put their children on Ritalin. But I don't think it's anywhere near the number of kids that I see on Ritalin today.

And I appreciate you holding this hearing. And I hope and pray that before parents put their children on Ritalin, they will have them tested in every respect. They will talk it out with everyone before they do it and that they know it would just be the last resort.

For us, it was a lifesaver. He's 21. He's doing great. He's not on Ritalin, hasn't been on it since 10th grade. But it was a lifesaver, Mr. Chairman.

So I would hope we wouldn't outlaw it altogether, but that we would take a serious check on our conscience before we put our kids on the Ritalin. And I thank you, Mr. Chairman.

BURTON: Thank you very much, Ms. Davis.

Dr. Weldon?

Excuse me, Mr. Duncan, I think you're next, then we'll go to Dr. Weldon.

You want to go to Dr. Weldon? OK, Dr. Weldon?

WELDON: Mr. Chairman, I want to commend you for holding this hearing and just mention that you are taking us into a very complicated but very, very important arena. And I am very, very appreciative of the lady from Virginia's testimony.

My perception is that Ritalin is, to a certain degree, a victim of its own success. It has helped a lot of children. But there are many children who are being placed on it unnecessarily.

I think there is a broader issue that I would like to see the committee address, though I expect we will not be able to in the confines of the amount of time remaining on the calendar, and that is: is there some other underlying process going on to account for the larger and larger number of kids that are being labeled with these behavioral and learning disorders? And I'm specifically talking about something in the environment, something in the food that could be playing a role. Vaccines is another thing worth considering.

And again, thank you very much for convening this hearing. I'm looking forward to hearing the testimony of our witnesses. And I yield back.

BURTON: If we don't get to those other issues you referred to, Dr. Weldon, we'll try to hopefully do that in the coming year.

Judge Duncan?

DUNCAN: Mr. Chairman, first of all, I want to thank you and the staff for calling this hearing. I don't believe there is any committee in the Congress that has held hearings on a wider variety of really important topics than this committee has under your chairmanship.

I listened very closely and intently, as all of us did, to Ms. Davis' statement. I can tell you that I remember having lunch one day in the House dining room with a family that told me almost the exact same story. And I have no doubt that there are some children in this country -- many children, perhaps, in this country -- that have benefited from Ritalin.

But I also have spoken -- I've spoken on the floor of the House twice about this subject because I believe that this drug -- I have to believe that this drug is way overprescribed in this country. And I believe it's all really about money.

I mentioned in one of my floor statements that I had read an article in 1998 by the former second ranking official of the Drug Enforcement Administration who had retired to Knoxville. And he wrote an article in the "Knoxville News Sentinel" and said that Ritalin was being prescribed in the United States six times more than in any other industrialized nation in the world. And he said in this article that Ritalin had the same properties basically as some of the most addictive drugs there are.

I read in 1999, in "Time" magazine that production of Ritalin had increased sevenfold -- seven times -- in the past eight years and that 90 percent of it was being consumed in the United States. And "Time" magazine said in that article -- quote -- "The growing availability of the drug raises the fear of the abuse. More teenagers try Ritalin by grinding it up and snorting it for $5 a pill than get it by prescription."

Then I read in "Insight" magazine, which has had several articles about this, that almost every one of the teenager shooters that we've read about in recent years have been boys who were at the time or who had recently been taking Ritalin or other similar mind-altering drugs.

And late last year, the same magazine, "Insight" magazine had an article, which said 30 years ago, the World Health Organization concluded that Ritalin was pharmacologically similar to cocaine in the pattern of abuse it fostered and cited it as a Schedule II drug, the most addictive in medical use.

The Department of Justice also cited Ritalin as a Schedule II drug under the Controlled Substances Act. And the Drug Enforcement Administration warned that -- quote -- "Ritalin substitutes for cocaine and the amphetamine in a number of behavioral paradigms."

I also read one study that said that almost all Ritalin was being prescribed to young boys who came from -- who were the children of very successful parents, both of whom were working full time outside of the house. Now I say again, I know that there are people for whom Ritalin has been a lifesaving drug.

But I also know that I think -- and I have a family that has many teachers in it -- but I know sometimes that, you know, there are some poor teachers who I think have recommended Ritalin just because they personally couldn't properly handle a young boy that was being, what we used to say, "He's all boy." He's very, very active.

And I've known personally two or three of these young boys that have been put on Ritalin. And they have appeared to me to be in zombie-like states.

And so I think we need to look very closely at this. I don't believe we need to outlaw Ritalin. But I believe it needs to be greatly, greatly reduced in its usage.

And I'll say it again, I believe it's being overprescribed in this country just because of the profit factor, the money that's out there that the drug companies want to make.

Thank you very much.

BURTON: Thank you, judge.

What I'd like to do is take the committee to the five-minute mark. We have almost 12 minutes left on the clock. And then we will have to recess for three votes. And I would urge all members to come back so we can hear our witnesses, if it's at all possible.

And with that, I'd like have our witnesses stand and be sworn in. Would you please rise? Raise your right hand.

Do you swear to tell the whole truth and nothing but the truth, so help you God?

Be seated. I'd like to start off by showing a tape of Neil Bush, who could not be with us today, because he had some things he wanted to say. And we'd like to show that real quickly.

So would we put our attention on the monitors?

(BEGIN VIDEOTAPE)

(UNKNOWN): If you'd like to be in our studio audience when you're in New York, send an e-mail to ABC News.com.

Diane?

(UNKNOWN): All right, Tony. Well, he calls himself the lowest profile member of the Bush family. But President Bush's brother Neil can't entirely hide from the spotlight. And this morning, he joins us to put the spotlight on something else, schools overprescribing drugs like Ritalin to treat students with Attention Deficit Disorder or problems.

And he should know. He says it almost happened to his son, Pierce. And I ran up the stairs this morning, too. I'm not in as good of shape as I thought.

Neil, it's great to see you this morning.

BUSH: Thank you very much for having me.

(UNKNOWN): What happened with Pierce?

BUSH: Pierce is, like millions of kids, very bright, very engaging. He kind of cruised through elementary school on the pure power of his personality.

He got into middle school, where the rubber meets the road, where kind of the strict, kind of hard work of learning kicks in, where the textbook, test, memorize and forget model of education is there. And he started doing more poorly.

And the knee-jerk reaction of schools -- not just private, but public schools; not just poor, but good schools -- is to label kids like that with ADD and to literally prescribe drugs to them.

(UNKNOWN): And he was prescribed Ritalin, but he didn't take it?

BUSH: And he refused to take Ritalin. He wouldn't take, you know, an aspirin for a headache. So he refused. And it's changed my life.

I've put a lot of time into thinking about this. And I think we do overprescribe Ritalin. And we way overdiagnose ADD. It's a very subjective diagnosis.

It's not like somebody can take a blood sample or a CAT scan and analyze. And it's just sad to me. It's sad that we drug over 6 million kids in this country with mind-altering drugs to have them be more compliant in a school system.

(UNKNOWN): Well, I want to talk about some of the alternatives. But as we do it, I know one of the things you felt with Pierce, that he just wasn't being challenged enough. And that, as soon as he got challenged, it all changed.

I want to show everybody a clip of him. He was on "Larry King," not so long ago, talking about Uncle President George.

(UNKNOWN): Now what you have been saying is that it's very important to examine the kind of teaching that is taking place for a child before automatically prescribing a drug. You've even said that textbooks are kind of an ultimate villain in this for not engaging kids?

BUSH: Well, textbooks are used for 75 to 80 percent of the communication of the curriculum. And textbooks clearly fail to engage kids the way kids learn best. We have a 19th century system of education, teaching kids that are 21st century thinkers, who are engaged outside of school in so many intriguing ways.

And so it's just really, really sad to me that we haven't changed the way we instruct and engage kids. If you engage a child in school, the symptoms of ADD go away.

(UNKNOWN): And in fact, you were dyslexic as a kid.

BUSH: I was. Right.

(UNKNOWN): And you say that your mother really applied a full court press.

BUSH: Yeah, well, my mother, the best thing she ever did was never lose hope in me, never lose faith in me as a human being and as a learner. A lot of dyslexics, by the way, because they have trouble reading, have a hard time staying engaged in school and therefore, are labeled ADD.

When you lack attention and when you appear to be disorganized, when you're not on task, any symptom that exists whenever you're bored to death, then you're labeled and drugged. And it's really sad to me.

I was dyslexic. I read stuff with a passion, though, that I care about. And I care deeply about how kids learn and how we can reform the system so that kids are truly engaged.

(UNKNOWN): And you're, in fact, working on a -- you have a company?

BUSH: I do. I have a company, Ignitelearning.com. We are building courseware that is built first around how we know kids think and learn. And then secondly, it's integral to what a teacher is teaching in school. So when they're teaching history, kids are using music and animation.

It's really exciting to see that light turn on in kids. Every kid has a gift for learning. Not one kid should be left behind. And we need to arm teachers with 21st century tools, you know, to help them be more successful.

(UNKNOWN): I have to turn to one other Neil Bush child.

(END VIDEOTAPE)

BURTON: I want to thank ABC for providing that tape to us. And we are now at a point where we have to recess. Please forgive me -- you on the panel and everybody in the audience. We'll get back here just as quickly as possible.

We have three votes. The first one will be through in about 10 minutes and then we have two five-minute votes. So we'll be back here in about 25 minutes.

So get a cup of coffee or a glass of water and forgive us for having to recess. We'll be right back.

Stand in recess to the call of the gavel.

(RECESS)

BURTON: The committee will once come to order. There will be other members coming back besides me and Ms. Davis, but we just had votes on the floor and we rushed back. So they will be wandering in. Those things happen.

Before we start with the panel, who are on their way out, as I understand it, I want to thank Sam Brunelli for helping me arrange this. For those of you who don't know who Sam Brunelli is, he was an all-pro football player for some team out west called the Denver Broncos. Is that what it was, Sam?

Yeah, well. Sam did a great job for them. He was all-pro. But I think this year, they're going to be whipped by the Indianapolis Colts in that division.

And Sam's thinking over there, "Not in your lifetime."

(LAUGHTER)

In any event, you've all been sworn. And I want to thank you for being patient with us while we were gone.

What's the order?

I think what we'll do is we'll start right down the list there. Ms. Weathers, why don't you start with your testimony? And if you can, keep your testimony to five minutes. But we won't kill you if you go just a few seconds over.

WEATHERS: OK. My name is Patricia Weathers. I am a mother from New York State. I have considerable concern regarding the outcome of this hearing because my son, Michael, was one of the children profiled for ADHD by our school district.

When Michael was in kindergarten, I began getting reports that he was having behavioral problems. What was meant by this is that Michael was talking out of turn, climbing around in class and apparently not sitting still.

The following year, while Michael was in first grade, his teacher told me that his learning development was not normal and that he would not be able to learn unless he was put on medication. Near the end of first grade, the school principal took me into her office and said that unless I agreed to put Michael on medication, she would find a way to transfer him to a special education center.

I felt intimidated, scared and unsure of what to do as a result of the school's coercive tactics. At no time was I offered any alternatives to my son's needs, such as tutoring or standard medical testing. The school's one and only solution was to have my child drugged.

At this point, his teacher filled out an actor's profile for boys, which is an ADHD checklist, and sent it to his pediatrician. This checklist, along with a 15-minute evaluation by the pediatrician, led to my son being diagnosed with ADHD and put on Ritalin.

After a while, my son started to exhibit serious side effects from the drug. He was not socializing, became withdrawn and began chewing on various objects. His eating and his sleeping were sporadic and of great concern to me.

Instead of recognizing the side effects of the drugs, the school psychologist claimed Michael now had either bipolar disorder or social anxiety disorder and needed to see a psychiatrist. She produced a name and a number of the psychiatrist I was to call. The psychiatrist talked to my son and I for a short period. And again, with the aid of school reports, diagnosed him with social anxiety disorder.

She handed me a prescription for an antidepressant, telling me it was a wonder drug for kids. Those were her exact words.

There was no information about the serious side effects associated with this drug. The drug cocktail that was to follow caused even more horrendous side effects, making his behavior more and more out of character. I could no longer recognize my own son.

Fearing what these drugs had done to him, I stopped them. Through this whole ordeal, the school psychologist's favorite saying was that it was trial and error. If one drug didn't work, try another.

Realizing that I was no longer willing to fall in line and give my child drugs, the school threw him out. For a final blow, they proceeded to call Child Protective Services on my husband and I, charging us with medical neglect for refusing to drug our child. This charge was later ruled unfounded.

On August 7 of this year, the "New York Post" featured my son's story and the fact that I had decided to file a lawsuit against the school system on behalf of my son, Michael's ordeal. On Friday, September 20, this lawsuit was officially filed in federal court.

Within just a few days of the "New York Post" article being published, over 65 parents came forward to describe their own personal stories of coercion and intimidation used by school districts to strong arm them into drugging their children. Since then, many more have come forward.

Through my family's experience, I feel the issue of informed consent is crucial. As a parent, I was simply not provided with accurate and critical information regarding the issue of ADHD. I was never made aware of the controversy surrounding this disorder, whereby many medical professionals do not validate it as a true medical condition.

I was never provided with the information that there is no independent, valid test for ADHD. I was never given any warnings about the documented side effects that could occur with the drugs used to treat it. I was never informed that there are studies showing the correlations between stimulant use and later drug use.

As a final point, I was at no time made aware that this drug use could bar my child from future military service. As a mother, I should have been given all of this information to make an informed decision on behalf of my child.

After all, it is we who are ultimately responsible for the nurture, care and protection of our children. We are unable to fulfill this obligation and make sound educated decisions without getting all the facts.

Accountability is what I am seeking. I would never have subjected my son to being labeled with a mental disorder if I had known that it was a subjective diagnosis. I would not have allowed my son to be administered drugs if I had been given full information about the documented side effects and the risks.

It is for this reason that I am asking this committee to fully investigate these matters as they relate to the issue of informed consent and to enact legal safeguards so that parents can fulfill their obligations to shield their children from any potential harm.

Thank you.

BURTON: Thank you very much, Ms. Weathers. I think that was a very, very important statement. And we really appreciate your coming here today.

And I'd like to -- Dr. Block?

BLOCK: I am Dr. Mary Ann Block, an osteopathic physician from Texas. For those of you who are unfamiliar with the osteopathic profession, let me tell you a little bit about us.

We are fully licensed physicians, with the ability to write prescriptions, perform surgery and be residency trained in all the same specialties as MDs. The difference between MDs and DOs is twofold. One, as a DO I have 150 more hours in medical school than MDs. Osteopathic physicians tend to be more holistic in their approach because of the philosophy that teaches us that the body and mind should be viewed as a unit.

Because of my medical training, my goal as a physician is to look for and treat the underlying cause of a patient's problem, rather than just covering the symptoms with drugs. I have seen and treated thousands of children from all over the United States who had previously been labeled ADHD and treated with amphetamine drugs.

By taking a thorough history and giving these children a complete physical exam, as well as doing lab tests and allergy testing, I have consistently found that these children do not have ADHD, but instead have allergies, dietary problems, nutritional deficiencies, thyroid problems and learning difficulties that are causing their symptoms.

All of these medical and educational problems can be treated, allowing the child to be successful in school and in life without being drugged. The American Osteopathic Association has published my program as the osteopathic approach to treating the symptoms called ADHD.

This approach is supported in the medical literature as well. The "Annals of Allergy" reported in 1993 that children with allergies perform less successfully in school across the board than children who do not have allergies. Yet doctors prescribe amphetamines without ever checking the child for allergies.

A study in the "Journal of Pediatrics" in 1995 reported that children who ate sugar had an increase in adrenaline levels that caused difficulty concentrating, irritability and anxiety. A double blind crossover study published in "Biological Psychiatry" found that Vitamin B-6 was actually more effective than Ritalin in a group of hyperactive children.

Another study found that children with magnesium deficiencies were characterized by excess fidgeting and learning difficulties. There are many more studies in the medical literature that indicate an association between nutritional deficiencies and attention and behavioral problems. Yet, doctors prescribe amphetamines without checking a child's diet.

There is no valid test for ADHD. The diagnosis called ADHD is completely subjective.

While some like to compare ADHD to diabetes, there really is no comparison. Diabetes is an insulin deficiency that can be objectively measured. Insulin is a hormone manufactured by the body and needed for life. ADHD cannot be objectively measured. And amphetamines are not made by the body, nor are they needed for life.

The prescription drugs that are used to treat symptoms of attention and behavior come with a host of potential side effects. According to the manufacturers of the drugs, the following side effects can and do occur: insomnia, anorexia, nervousness, seizures, headaches, heart palpitations, cardiac arrhythmias, psychosis, angina, abdominal pain, hepatic coma, anemia, depressed mood, hair loss, weight loss, tachycardia, increased blood pressure, cardiomyopathy, dizziness and tremor, to just name a few.

These drugs are classified as Schedule II controlled substances with high abuse potential. According to reports in the "Journal of the American Medical Association," the drug Ritalin has been found to be very similar to and more potent than cocaine.

Ritalin and cocaine are so similar that they are used interchangeably in scientific research. There are no long-term studies on the safety and effectiveness of these amphetamine drugs, though millions of children are treated with them for years at a time.

When I was in school and when my children were in school, there was no need to drug millions of children. While there are children who have attention and behavioral problems and these problems may have increased due to poor diets, an increase in sodas and candy in our schools, an increase in allergies due to changes in our environment and an increase in learning problems, it does not mean these children have a psychiatric disorder called ADHD.

It means they have medical and educational problems that can be fixed. Most of the children I have seen who have been prescribed these drugs have never had a physical exam. No doctor listened to their heart, even though many of the side effects of the drugs are heart related.

Since there is no valid test for ADHD, most doctors get the information for the diagnosis from the child's teacher in the form of a checklist. If the teacher wants the child to be taking these drugs, all she or he has to do is fill out the checklist indicating that the child has many problems in the classroom.

One child was diagnosed as ADHD and prescribed Ritalin. But I got to treat him instead. Once his allergies and learning problems were corrected, he went on to become a National Merit finalist and accepted to an Ivy League university.

Every child deserves that opportunity. Many of the parents of these children have told me that the teachers and principals have pressured them to put their children on these drugs, threatening to report them to Child Protective Services if they do not comply.

CPS actually removed a child from his home after the school reported the mother for not giving the child his drug. The ironic thing was she had been giving him the drug. The drug made him worse, not better.

I cannot imagine any reason to give a child an amphetamine to cover up symptoms when the problem can be fixed and no drug is required. Let's give our children the medical and educational evaluations they need to diagnose the real problems.

Let's treat these real problems and give our children the future they deserve without drugs. I will show a brief video, which shows a child's disruptive behavior, caused from allergies. And I'm also submitting, as part of my written evidence, my latest book, "No More ADHD: 10 Steps to Help your Child's Attention and Behavior Without Drugs."

Thank you.

(BEGIN VIDEOTAPE)

BLOCK: This is a video of a 9-year-old boy, undergoing allergy testing. He uses the noise to distract himself. We ask the children to sit still and concentrate for 10 minutes.

The reaction to this first allergy shot makes him feel bad. It causes him to be uncooperative, belligerent, unable to sit still or concentrate.

After 10 minutes, he is given another dose of the same allergen. But this time, it is a dose that makes his symptoms go away. After receiving the correct dose, he can sit still, he can focus and concentrate and he is no longer angry or belligerent.

(END VIDEOTAPE)

BURTON: Does that conclude your testimony? Thank you very much.

Ms. Presley?

PRESLEY: Thank you very much, Congressman Burton and committee members for the opportunity to address this hearing. I'm here as a mother mostly because I have to put my children in school and I have also had direct contact with these children who are medicated. And I can tell by their behavior that they are.

They're usually manic, very destructive, very interested in destruction. You know, we've already said it a hundred times, but between 6 and 8 million American children are being given Schedule II narcotics and/or mind-altering antidepressants.

It's not just ADHD. Some of them cause -- the other ones -- cause tics, cause this which goes into a spiral of OCD, Tourette's, this, that and the other thing. And all these normal behaviors for children are now -- everything is a disorder. I mean, I basically will have everything under the sun at this point.

Yeah, I'll stand up and testify to that too.

But anyway, I'm just saying, I have personally seen the side effects of these drugs. Ritalin, for example, can cause nervousness, loss of appetite, weight loss and manic behavior. Even the manufacturer warns that it can cause psychotic episodes. Suicide is a risk during withdrawal.

Some of these drugs are advertised as non-addictive. But I have known numerous people who have been to rehab centers to get off of them.

Teenagers on powerful psychiatric drugs committed more than half of the recent teenage shooting sprees. That's very alarming, resulting in 19 deaths and 51 wounded. I don't think there has been a correlation made in the media with that one, but it seems awfully coincidental, not coincidental.

Parents need to be informed of drug-free alternatives to the problems of attention, behavior and learning. A child could be fidgety in class or simply bored with what they are learning and then diagnosed with a learning disorder and put on drugs.

Some of these disorders, from what I understand, are also -- you know, they raise their hand and decide something is a disorder, that it's not factually, scientifically proven to be such. There is no blood test. There has been no autopsies to confirm brain -- what is it called? -- chemical imbalance.

A child could have allergies, lead poisoning, eyesight or hearing problems and be simply in need of tutoring or something even more basic than that, which could be phonics. I have not seen one happy and well-adjusted child as a result of these drugs. That's just my personal experience.

What is basically happening is that we are relying on a chemical to change the mood of a child. At least one of these drugs is more potent than cocaine. And we are turning them into drug addicts at a very young age.

My hope is that the committee will recommend legislation that prevents school personnel from coercing parents into placing their children on to mind-altering drugs. They become dependent on them and then, you know, it leads to further drug addiction, which then leads to crime, which leads to all the other terrible things that we always have to deal with in life.

And ultimately, that we don't allow that into the schools -- period. Our schools should only be there to educate our children and not to diagnose any -- have the ability or the right to diagnose children with mental health problems.

It's way overprescribed, way overdone. And I think that, at least, even the people, from what I've seen here today that have a disagreement -- you know, want to go on the other side of the fence still see that it's a situation and it's a problem.

And that's all I have to say. It's a concern.

BURTON: And you have been the head of this organization or one of the leading spokesmen for some time now?

PRESLEY: Yeah. Actually, no, I'm just becoming. I mean, I have done a lot of things with them before on this front. But I have now taken the title as the spokesperson for this committee.

BURTON: Very good, very good.

Mr. Wiseman?

WISEMAN: Thank you, Chairman Burton and members of the committee for the opportunity to speak today. For over 30 years, CCHR's observations and conclusions have been drawn from speaking to hundreds of thousands of parents, doctors, teachers and others.

For example, at seven, Matthew Smith (ph) was diagnosed through his school as having ADHD. His parents were told he needed a stimulant to help him focus and that non-compliance could bring criminal charges for neglecting their son's educational and emotional needs.

On March 21, 2000, while skateboarding, Matthew (ph) tragically died from a heart attack. The coroner determined that he had died from the long-term use of the prescribed stimulant.

We all know that there are children who are troubled, who do need care. But what that care is or should be is the point of contention.

In 1999, in the wake of the Colombine school shootings, CCHR worked with Colorado State Board of Education member Mrs. Patty Johnson (ph), who had a precedent-setting resolution passed that recommended academic, rather than drug solutions for behavioral and learning problems in the classroom.

Mrs. Johnson (ph) stated -- and I quote -- "The diagnosing of children with mental disorders is not the role of school personnel. Nor is recommending the use of psychiatric drugs." The resolution told educators that their role was to teach and pursue academic and disciplinary solutions for problems of attention and learning.

In 2000, Jennifer L. Wood (ph), chief legal counsel for the Rhode Island Department of Education, issued a letter to all schools that under the Individuals with Disabilities Education Act -- quote -- "It is not lawful for school personnel to require that a child continue or initiate a course of taking medication as a condition of attending school."

School personnel cannot require, suggest or imply that a student take medication as a condition of attending school. Yet this is violated across the nation.

Millions of children are being drugged with powerful stimulants and antidepressants, placing our nation's children at risk. In 2001, the "Journal of the AMA" reported that Ritalin can act much like and is chemically similar to cocaine. It admits that while psychiatrists have used this drug to treat ADHD for 40 years, they have never known how or why it worked.

As a result of overmedicating our children and the fact that so many parents were being forced to place their child on such drugs, currently more than half of our states have introduced and/or passed some type of legislation or regulation to restrict the use of psychiatric drugs for children. I am submitting a selection of these for the committee's review, one of which cites the 1998 NIH Conference on ADHD, which said in part, "We don't," -- and I'm quoting -- "we don't have an independent, valid test for ADHD."

"There are no data to indicate that ADHD is due to a brain malfunction. And finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remain speculative."

This is perhaps the crux of the problem. We are relying on a diagnosis that is subjective and open to abuse.

Evidence reviewed by the National Academy of Sciences this year indicates that toxic chemicals contribute to learning or behavioral problems, including lead, mercury, industrial chemicals and certain pesticides. Furthermore, thousands of children put on psychiatric drugs are simply smart.

The late Dr. Sydney Walker (ph), psychiatrist and author, said -- and I quote -- "These students are bored to tears. And people who are bored fidget, wiggle, scratch, stretch and start looking for ways to get into trouble."

All of this information should be made available to parents when making an informed choice about the medical or educational needs of their child. This is in keeping with U.S. Public Law 96-88, which states -- quote -- "Parents have the primary responsibility for the education of their children. And states, localities and private institutions have the primary responsibility for supporting that parental role."

As senior government officials, you represent the lives of all citizens. Families are grieving for the loss of children because they are not provided with all the facts about mental health treatments, especially psychotropic drugs, and were denied access to alternative and workable solutions.

We respectfully request that the Government Reform Committee recommend federal legislation that: a) makes it illegal for parents or guardians to be coerced into placing their child on psychotropic drugs as a requisite for his or her remaining in school; b) protects parents or guardians against their child being removed from their custody if they refuse to administer a psychotropic drug to their child; c) provides parents the right of informed consent, which includes all information about alternatives to behavioral programs and psychotropic drugs, including tutoring, vision testing, phonics, nutritional guidance, medical examinations, allergy testing, standard disciplinary procedures and other remedies known to be effective and harmless; and finally, that such informed consent procedure must include informing parents about the diverse medical opinion about the scientific validity of ADHD and other learning disorders.

Thank you.

BURTON: Thank you very much.

Let me just start with you, Mr. Wiseman. You indicated that -- are there some states that don't allow the dismissal of a child because of the parents' refusal to use these mind-altering substances?

WISEMAN: That don't allow the dismissal of a child?

BURTON: Are there some states that have some kind of a last right of refusal for parents to keep the child in school if they refuse to take these mind-altering substances?

WISEMAN: Well, there are states -- if I'm understanding the question correctly -- states have started, in 1999, to actually pass legislation and regulations prohibiting schools from doing that. But it has been a problem, so much of a problem that there are now 27 states that have passed or have legislation or resolutions in progress that address this issue.

So it was enough of a problem that, as I say, more than half the states in the country have actually had to address the problem with legislation because it was being abused. Parents were being coerced.

BURTON: Well, the reason I ask that question is many school districts in many states around the country, they require children to get inoculations for as many as 26 different childhood diseases. My grandson received nine shots in one day. And I think, in total, the number of shots that he would receive prior to going to first grade would be around 26.

WISEMAN: My word.

BURTON: He received 47 times the amount of mercury that is tolerable in an adult in one day. And two days later, he became autistic. And of course, he's -- well, we're hoping he's going to recover. He may be permanently damaged.

And I guess the point I'm trying to make is these requirements are at the school board level or at the county level or at the state level. They're not requirements that the federal government imposes.

And so I'm wondering, you're asking for legislation at the federal level that would give parents the right to refuse these mind- altering substances. And one of the problems that we will have with some of our colleagues is that that will be looked upon as an infringement of the local school boards' or states' rights.

And I just wondered if you had given that any thought?

WISEMAN: Well...

BURTON: It's not that I'm opposed, you understand, to trying to do what we can here at the federal level to deal with the problem after we hear all the testimony. But each individual state has, up to this point, been dealing with childhood problems like this.

WISEMAN: Yes. Unfortunately -- and not to be repetitious, but unfortunately, we hear in our organization mothers calling in that are being coerced. And the abuses is tragic.

Parents are being threatened with either criminal charges, as I mentioned in my testimony, or in some cases the loss of their children because they're not put on mind-altering drugs. I mean, we're at the dawn here of the 21st century. And there are some children who aren't permitted to go into school unless they're on a mind-altering drug.

The federal legislation that bears on this is the Individuals with Disabilities Education Act. The problem is that the definitions in that law and the definitions that filter down to the school districts under that law are so subjective that, you know, the disorder is in the eye of the beholder. There are no objective tests for this, as has been testified here this morning and from folks on the panel.

There is no scientifically-based studies that enable somebody to make such a diagnosis. So because they are so subjective, it's open to abuse.

BURTON: Well, what I would like to have from you, Mr. Wiseman, is some proposed language that we can take a look at that might be appropriate at the federal level. We approach stepping into states' rights with great trepidation, at least on this side of the aisle. So this is something we would have to take a hard look at.

But I will look at it and see if we can fashion something that will maybe encourage the states to be more concerned about parental rights and how the children are handled and whether or not they're completely, properly tested before they start putting these drugs into them.

WISEMAN: As a former teacher of American history, I share one, your love of the Constitution and your concern for states' rights very, very much. But with somewhere on the order of 6 million children in this country being placed on these Schedule II narcotics, I do think it's something the federal government should look for. And we'll be happy to provide you with some suggested wording.

BURTON: Very good.

Ms. Weathers -- and I'll get to you, Ms. Davis, in just a minute, as soon as we finish this first tranche of questions, OK? Be with you in just a second.

Ms. Weathers, you stated that your son's school pressured you to medicate your son and that, at the time, you trusted them because they were -- quote, unquote -- "the experts." At any time, did the school or your son's doctor talk to you about the potential side effects of those drugs?

WEATHERS: Absolutely not. The most the pediatrician had told me was that there was possible appetite suppression and possible insomnia. She never at any time advised me that there are deaths related to this. There is cardiac problems, heart problems related to these drugs, that his growth would be seriously impaired.

When I took Michael off these drugs, within three weeks, he grew three sizes. So nobody can tell me that those drugs didn't have a great, a tremendous, a horrendous effect on him.

BURTON: OK.

Did your doctor also recommend any behavioral modification training or counseling for your son?

WEATHERS: Absolutely not. She did not. Basically, I had to go in, I believe, every three to four months for a prescription refill.

BURTON: So they just didn't check any of that out? They just said, "These are the things that you have to do," and prescribed the drugs.

WEATHERS: All she did was ask me how he was doing.

BURTON: Did the doctor ever do any blood tests or objective medical evaluation to look at any possible biological basis for his behavior?

WEATHERS: I don't believe there was. I think early on there was a blood test taken. But once again, you don't have a blood test to determine ADHD. You can only have a blood test to rule out underlying causes.

And I believe the only thing they did rule out was lead toxicity.

BURTON: Dr. Block, what have you found that the schools do specifically to encourage the use of medications for attention and behavior?

BLOCK: The parents that come to me report consistently that the teachers and the principals and even the school nurses pressure them to go to a physician and get their child labeled and drugged. In addition, even though the state of Texas Board of Education has passed one of these state resolutions concerning being concerned about the drugging of children, it appears to me that the teachers are not yet aware of it because nothing seems to have changed since that resolution has passed.

Some schools are giving lectures to parents, inviting parents to come hear talks about diagnosing and drugging their children for ADHD. Another thing that has recently occurred, it's not unusual for me to make recommendations for certain nutrients or other things that the child may need to naturally help their body and mind work better. And I will write a prescription for that child to receive that nutrient at school.

What is happening now, though, is that the schools are denying my medical prescription and saying that they will not give a child anything at school except a drug. That, to me, is practicing medicine without a license.

And unfortunately, physicians themselves, according to the FDA, less than one percent of doctors actually know the side effects of the drugs that they are prescribing. Pharmaceutical reps that come to my office have told me more than once that I'm the only doctor they've called on that asked what the side effects of the drug was that they were repping to me.

BURTON: Let me -- I see I'm running out of time here and I want to get to Ms. Davis.

Do you have any idea how physicians are influenced by the pharmaceutical companies to prescribe these medications for kids?

BLOCK: Yes, as a physician, I see this influence all the time. For one thing, I don't think any of us can turn on the television, radio, open up a newspaper or magazine without seeing multiple advertisements for prescription drugs. They go so far as to say, "Ask your doctor if this drug is right for you," encouraging the public to go to the doctor to get a drug.

But in addition, I don't believe the public is aware of the strong influence the pharmaceutical industry has on physicians. From the time we start medical school until the day we stop our practice, we are strongly influenced or attempted to be strongly influenced by the pharmaceutical industry. Our medical journals, which are purported to be unbiased, usually have about 60 percent of their pages as full-page ads from the pharmaceutical industry.

If I go to a continuing medical education meeting, which is required by law that I attend so many hours each year, the doctors who are talking to us are being paid by the pharmaceutical industry to give those lectures. Many doctors are being paid in their offices to do research for the pharmaceutical industries as well.

They also give money to different groups who go out and promote the use of these drugs for our children. So the pharmaceutical companies have a tremendous influence on our society and especially on physicians.

And it is concerning when doctors don't even know the side effects. There is no way that they can tell a patient if they don't know them themselves.

BURTON: I will yield to Ms. Davis. But let me just say, my son- in-law is a doctor. And I've gone to a number of these lectures that are put on by pharmaceutical companies. And I can tell you, as one who goes -- and they're very nice dinners they put on and very expensive in many cases, have great wines and all those sorts of things -- they do have doctors that come in and talk about the attributes and the positives about these drugs. So they are very effective in selling their products to the doctors and the doctors writing those prescriptions.

Ms. Davis?

Incidentally, we'll have a second round of questions because I have some more questions for the panel.

Ms. Davis?

DAVIS: Thank you, Mr. Chairman. I don't have too many.

I tried to state at the beginning that we just have this tendency in our country to go from one end to the other and we never seem to find the right balance. And I think that's where we are right now with the ADHD and the Ritalin. Like I said, when my son was put on it, the teachers didn't even know about ADHD. And I understand now they're even training the teachers in school or something.

And my concern is -- in fact, my son's pediatrician wasn't even that familiar with it. He sent me to a psychologist. And we did a lot of testing.

It was explained to me -- and Dr. Block, this is for you -- it was explained to me that with the ADHD, the child has the blood in the frontal lobe of his brain, I guess, just goes so slow that that's why he can't concentrate. He's seeing like three different pictures or what have you.

And that's why they can sit in front of a TV for hours because so much is going on. And that the Ritalin would speed up the blood flow and then cause them to be able to concentrate.

Have you ever heard that?

BLOCK: I certainly have heard that. And it is an interesting theory. But it has never been proven.

And in fact, drugs like Ritalin and other amphetamine-type substances, one of the basic things they do is make you focus. They can make you overfocus.

But it's been found that anyone who takes this type of drug will have a similar effect because that's what it is. It doesn't prove that someone needs the drug because they have that effect.

But there are many theories going and there is many people who are looking at all kinds of brain scans and everything else. But when you look at the child in my video who was reacting to an allergy, I assure you if you did a brain scan of him at the time when he's reacting, you would see reactions.

And so my focus is really on information, informed consent, that parents be told what all their options are, that they be told all the possible side effects to any treatment. And you know, I think parents always care so much for their children, they're going to do what's right for their child if they're given all the information.

DAVIS: I agree with you. And we were told the side effects of Ritalin when we gave it to our son. That's why it took us so long to give it to him because we didn't want to do it. And it was actually a last resort for us to do that. And it did work for him.

Ms. Weathers, I had a question for you. And if you'll give me a second, it will come back to me.

You said that the teachers all said your son had a problem. Did you every find out what the problem is or was? Is this just recent?

WEATHERS: No, this isn't recent. You know, in my opinion, Michael is extremely bright. He was not reading at grade level. There was a lot of factors that were playing a role in his behavior that were not even addressed by the teachers.

When he was going into fifth grade, he was reading at a second grade, eighth month level, OK? That isn't normal. They were putting him in a special ed room and not teaching him phonics. And I think that's horrendous, I really do.

DAVIS: Did you have problems with him at home?

WEATHERS: No, I would never, ever -- and I'm going to make this perfectly clear for everybody in this room -- I would never have contemplated drugging my child, ever.

He never had behavior problems at home. The minute he entered school, that's when the trouble started.

That is when I was coerced. I felt under pressure. I felt like everyone was telling me that this was the best thing.

I was a single mom. I was scared. I was unsure. And I felt these are the experts. They know children. And I know and I get hundreds of phone calls throughout the country, hundreds from other parents in the same -- having the same experience that I have endured and my family and my son has endured.

And as far as Hawaii, I have a woman in the state of Hawaii who had to leave the state of Washington because she was so pressured. She wanted to pick the state with the lowest consumption of Ritalin use. And she flew her entire family to Hawaii.

Her name is Susan Perry (ph). And I'm in contact with her now. And we are fighters. And I'm going to fight this issue until the very end because parents are not informed nowadays.

We're not told the side effects. We are just not. And it's just tragic because our children are suffering. And our children are what counts.

DAVIS: Thank you, Ms. Weathers. I totally agree with you. And as a mom, there is nothing more important to me than our kids. And I know how you feel.

Thank you, Mr. Chairman.

BURTON: We'll have a second round of questions.

Let me just tell you something that's of interest that you might find interesting, Ms. Weathers. Mercury is in a lot of our vaccines. Mercury is a toxic substance. And I've talked to a number of doctors, including doctors here on the Hill that treat congressmen. And I told them, I said, "Do you know that in our flu shots that we get, there is mercury?"

And some of the doctors said, "No, no, there's no mercury in there." And I took the insert out and I showed it to them. And it says, "Thimerosal." And they said, "See, there's no mercury in there."

I said, "Thimerosal contains mercury." Has never been properly tested since 1929. It was tested on 27 people who all were dying from meningitis. All of them died. And so they say that the mercury didn't cause it.

But they've never tested it ever since. And it's been given to our children. My grandson got nine shots, many containing mercury, in one day. And two days later, he was autistic and may be maimed for life. He is not responding as we would like.

And so you are absolutely correct. Parents need to be informed about the substances in the vaccines and in the pills and all the other treatments they're getting. And if they don't get that, then shame on us.

And doctors need to be given the proper information from the Food and Drug Administration. And the Food and Drug Administration has been derelict in their responsibilities of doing it.

And I'm very sorry we don't have the FDA here today because the FDA's responsibility is not only to test these things, to do double blind studies and everything else before we start administering these things to the population and our children, but they're also supposed to inform people. And they haven't been doing that as well.

And that's one of the reasons why we've had so many problems with them over the years. But we will be contacting the FDA about that.

What? What is it?

Let me ask you, Dr. Block, one more question. As you know, we -- and I will have other questions I would like to submit to you for the record that you can answer later.

As you know, we've learned that a government-funded study found a correlation between the use of thimerosal, mercury-containing vaccines and a diagnosis of ADD. Do you think that every child that is referred to a child for ADD evaluation should be tested for heavy metals?

BLOCK: Yes. I do think every child should be. In addition to seeing a lot of children with attention and behavioral problems in my practice, I see a lot of children who have been diagnosed as autistic. And through testing these children for heavy metals and often finding mercury and lead and other heavy metals, begin testing the children who have attention and behavior problems and often find the same thing with them as well.

I think that these problems are on a continuum where one child has severe symptoms and gets the autistic label, while another child gets an ADHD label. But I'm finding the same underlying problems in all of these children.

BURTON: Heavy metals being one of them?

BLOCK: Heavy metals being a major one, yes.

BURTON: So it would be your opinion that these preservatives they're putting in that contain aluminum and mercury, in particular, should be taken off the market? They should take those things off the market.

BLOCK: They should be taken off the market. They were supposed to be taken off the market, was my understanding. But they have not been taken off the market.

Many pediatricians actually believe they have been taken off the market. So they have not looked to see if the thimerosal is in the vaccine.

But they are still in the vaccines. Children are still getting as many as eight or nine different diseases immunized against in a single visit to the doctor's office. And many of those vaccines do contain the mercury and aluminum, which work together to make the problem even worse.

Let me just say that we suspect -- and in fact, I'm pretty sure -- that while they're starting to get mercury out of children's vaccines here in the United States, we send vaccines all over the world to Third World countries. And we send them with multiple vaccines in one vial. And they are still using the mercury, the thimerosal in those almost entirely around the world.

And so while we're starting to get them out of our vaccines, we're continuing to inject mercury into children all over the world in Third World countries, which I think is almost criminal.

Let me ask Mr. Wiseman a couple -- oh, Ms. Presley a question here. Why did you choose to get involved in this discussion of ADHD? Have you had a family that was misdiagnosed?

PRESLEY: Yes, I have. I have also had experience with mercury. I had nine fillings at one point.

And I went two years almost going crazy, getting every asthma, this that, hypoglycemia, candida, all these troubles. I've baffled every doctor from one coast to the next. And then when I finally got the diagnosis that I had -- you're supposed to have between zero and three normal in a human body. And I had 1,000-plus.

And the doctor called me. And the term "mad as a hatter" is from people who used to work in felt factories where they would be exposed to mercury and they'd go crazy.

Now I had experience with that. And the moment I started taking things either naturally or a chelation agent to get it out, all the symptoms stopped. So I've had personal experience with that. And I do know that they are not only in the vaccines, they are in fillings that children -- they still use it in the mouth.

BURTON: Amalgams.

PRESLEY: Yes, amalgams.

BURTON: And most people don't know that 50 percent of the silver fillings in your mouth, 50 percent of those are mercury.

PRESLEY: Yes. Yes, sir.

BURTON: And a lot of people don't know that.

PRESLEY: Other than that, the reason I got involved was because I've had personal experience around children who are medicated. And I see their behavior. And I see that it's usually something very obvious. They do have allergies.

I've seen them on it. I've seen them manic, crazy. And then they come off it and there's a whole another story. If you actually find the reason, there's always a simple explanation for it.

And I just don't want to see our future generation being drugged. And I also don't like to see it being promoted as something non- addictive when it absolutely is.

BURTON: One last question to Mr. Wiseman and I may ask a few more after we get through with my colleagues here. Are teachers qualified to diagnose medical conditions?

WISEMAN: Absolutely not, congressman. We have talked to people at the Department of Education who say that that's DOE policy. And virtually every state has that as a policy. Yet it's happening across the country.

BURTON: We actually have teachers in schools using a checklist that go to a doctor. And they are making a direct or indirect recommendation to the doctor that this child be put on Ritalin?

WISEMAN: Yes, they have checklists that come out of the Diagnostic Statistical Manual for ADHD. I have seen them.

BURTON: And the doctors, many times, follow the recommendations of the teachers?

WISEMAN: Of course.

BURTON: Ms. Morella, do you have questions?

MORELLA: I do, sir.

BURTON: Ms. Morella?

MORELLA: Thank you. Thank you, Mr. Chairman. And thank you for calling this hearing. And I wanted to thank the witnesses also for calling this hearing. And I wanted to thank the witnesses also for coming together to offer their comments on it.

What I particularly like is that you brought in witnesses that have various perspectives from all sides of the debate. And I think it's important that we listen to arguments from those who believe Attention Deficit Disorder is not a brain disorder and those who believe it is and warrants medication along the lines of Ritalin.

And considering that there has been a 500 percent increase in the use of Ritalin in the United States since 1990 and roughly 4 to 6 million children may be using it daily, I think it's important that we ascertain the root causes of ADHD and how to best alleviate its effects.

I want to ask a couple of questions, if I may. One -- you know, I might ask it of Ms. Presley. It's a pleasure to see you in person.

PRESLEY: Thank you.

MORELLA: Thank you for being here. And also to Mr. Wiseman, because I have before me a statement that has been made by the International Citizens Commission on Human Rights President Jan Eastgate (ph). This is a quote.

"Society has been under a concerted attack for decades, designed and implemented by psychiatrists. This attack claims countless lives each day. Like some malignant disease running rampant, it threatens the future of society and ultimately mankind."

Now what I'm wondering is: do you believe in this expression that I have just read to you? If both of you would comment on that, I would appreciate it.

WISEMAN: I can comment, congressman. We are a psychiatric watchdog group. We investigate and expose psychiatric abuse. And what we see going on in psychiatric hospitals, not only in the United States, but around the world, would make you weep.

I have personally investigated the abuses that go on in these hospitals, the physical abuse, the sexual abuse, the drugging people into stupors, the electroshock treatment. What psychiatry has done to our educational system, psychiatric testimony in the courtroom where murderers and rapists are let go because they're not guilty because they had an irresistible impulse, based on psychiatric testimony.

So I would certainly agree with Ms. Eastgate's (ph) comments.

PRESLEY: I personally have not seen it do any good for anyone I've ever known personally. That's just my own experience, whether it be drugging, electric shock therapy, which does still exist, which is very barbaric.

I don't think it goes -- I have my own personal issue with the subject. But that's not why I'm here right this moment. This is more related to the drugs again, which is psychiatry-based, of course.

MORELLA: So you put them all into that one category?

PRESLEY: I think they're all correlated.

MORELLA: If I could ask one other question? Several medical organizations like the AMA, the Centers for Disease Control and Prevention and the National Institutes of Health believe that Attention Deficit Hyperactive Disorder is a brain disorder that may require psychiatry or psychiatric drugs for treatment.

And I wonder: how could you explain the considerably different viewpoint that they hold, as opposed to the viewpoint of CCHR?

WISEMAN: I don't know if you're asking me or Ms. Presley, but I'll address it and she can as well.

PRESLEY: I'll address it as well.

MORELLA: Thank you.

WISEMAN: I think the operative word in your question, congresswoman, is "believe." And it's a matter of belief.

Our concern is that there is no biologic, organic, scientific basis for ADHD. These are subjective symptoms. These are behavioral symptoms. The child fidgets, he looks out the window, he butts into line.

The psychiatrist wraps these attributes up and throws a label on it. And the children are subsequently drugged. That various medical organizations believe that it's a brain disease is just that. It's a belief -- without true scientific validity.

Our point here really is parents should have an opportunity to get the other side. They need to have informed consent. They need to know, at the very least, that the diagnosis is controversial.

Ms. Presley, do you have anything to add?

PRESLEY: Yes, I haven't seen any evidence. I'm not scientific. I can't back it up scientifically. But I just have not seen -- whether it be a blood test to diagnose or any other thing to diagnose. It is not confirmed. There is no way to do it.

And there are too many people -- I would like to do a documentary on it actually one day, just to show how long it takes, when you take a child to a psychiatrist, before they whip the thing out and start writing a prescription. It's usually 10 minutes, 15 maybe? And it's usually just basically, you know, based on...

MORELLA: I could go on. And I am not a scientist. But I have always had a great belief in CDC and NIH and AMA. And you just said, "Forget it."

PRESLEY: I would like to just also point out that there is an intermingling of those three, of course. You know, the drug companies, pharmaceutical companies go along very much with the APA.

They all make money. It's a big industry, you know? To push drugs, diagnose disorders and give drugs for it. It's an industry. They're making money -- a lot of money, a lot of money.

MORELLA: Dr. Block, do you want to comment?

BLOCK: ... has stated that there is no valid test for it and that it is not a brain disorder. And also, the medical profession is based on coding. And it's coding based on getting paid by the insurance company.

So a diagnosis that can be objectively defined, such as diabetes, hypertension, things like that, there are codes for those things. The psychiatric community has made codes for their psychiatric disorders. But just because there is a code for it and doctors can diagnose it and get paid for it doesn't mean that there is an objective brain disorder going on.

MORELLA: Mr. Chairman, then I will yield back. But I would guess, Dr. Block, you would probably gain a little bit too if people were scared away from psychiatric drugs, right?

BLOCK: Do I gain?

MORELLA: You probably would gain financially.

BLOCK: I have a medical practice, working with these children. But for me, if I get them well and out of my office, they don't have to keep coming back; whereas, if they're being drugged, they do keep coming back.

MORELLA: Fine. Thank you very much, Mr. Chairman.

BURTON: Ms. Davis?

DAVIS: I have one more question for Ms. Weathers. When you took your son back to the pediatrician to get the prescription refilled, did you say he did not do a physical, he or she?

WEATHERS: No, she didn't. She did not do a physical exam to refill the prescription for Ritalin. He would have once a year physical before he started school. That was the only physical he had during the course of the year.

DAVIS: Thank you, Mr. Chairman.

BURTON: Judge Duncan?

DUNCAN: Mr. Chairman, I apologize. I had another meeting I had to go to, so I'm not going to ask any questions at this time. I'll ask them of the next witnesses.

BURTON: Let me just ask a few more questions. In particular, since Ms. Morella is still here, I would like for her to hear just a couple of things that were said in her absence.

According to the AMA, the properties of Ritalin very closely parallel cocaine, is that correct?

WISEMAN: Yes.

BURTON: And according to the AMA -- or not the AMA in this particular case -- according to some testimony that was given today, if you grind up Ritalin and make it into a powder, the effect of the Ritalin is very, very similar to the effect of cocaine. And it is habit-forming.

BLOCK: Not just the same. It is the same, not just similar.

BURTON: So cocaine and Ritalin, when put into powder form, are the same?

BLOCK: They go to the same receptor site in the brain and they provide the same high when taken in the same manner and are used interchangeably in scientific research.

BURTON: They're used interchangeably in scientific research.

BLOCK: Correct.

BURTON: OK, so when you put a child on Ritalin for a long period of time, there is a fairly good chance that that child will be addicted, just like a person who uses cocaine?

WISEMAN: Congressman, I know you asked that of Dr. Block, but if I might point out, there is a study by a Dr. Nadine Lambert at the University of California at Berkeley that followed 492 children for 26 years and found that those who were labeled with ADHD and given stimulants were 200 to 300 times more likely to abuse tobacco and cocaine in adulthood.

BURTON: They were 300 times...

WISEMAN: Two to three times more.

BURTON: Two to three times more likely to use...

WISEMAN: Tobacco and cocaine in adulthood.

BURTON: OK. Now let me ask you a question that I think we'll ask of the doctors that are going to come up here, so they will have a preview of some of the questions we're going to ask.

Has there been any autopsies on children who allegedly have ADHD to see if there was any difference between their brain and the brain of a child that had ADHD and were given these substances like Ritalin?

BLOCK: I don't know of any autopsies. I know that there are studies that have shown changes in the brain of children. But these children were taking drugs like Ritalin. And there have been studies that showed children who took cocaine had brain changes that looked like holes in their brain, just spots on the X-rays. And so the Ritalin may be making -- doing the damage that shows up in these children's brains.

BURTON: Is there any evidence, through autopsies, of brains that would show that children who have ADHD have any abnormality?

BLOCK: I know of no such studies.

WISEMAN: I know of no such, sir.

BURTON: Any other questions from -- let's see what we have here.

DAVIS: Mr. Chairman?

BURTON: Mr. Wiseman, let me just ask you a couple more questions. I'll get right back to you. Unless you want me to yield to you right now?

DAVIS: No.

BURTON: OK.

We've seen reports that Ritalin and antidepressants are being described for 2-year-olds in the Medicaid population. Are you aware of aware of any clinical trials that have evaluated the safety of these drugs in children aged 2 years old?

WISEMAN: No, sir.

BURTON: OK.

WISEMAN: In a word. And if I can say, I think it's a travesty that children, in some cases, that are still in diapers are labeled with ADHD and put on, in some cases, several mind-altering drugs. I think it's barbaric.

BURTON: So there have been no clinical trials to your knowledge?

WISEMAN: Not that I'm aware of, sir.

BURTON: Are you aware that the NIH conducted a consensus conference on ADHD several years ago? Did they look at the entire scope of treatment options? Or did they just focus on Ritalin?

WISEMAN: No, they primarily focused on Ritalin. I testified at those hearings in November of 1998. And they had three days of slides and presentations and so forth. And I read the final conclusion.

We do not have a valid, independent test for ADHD. There are no data to indicate that ADHD is due to a brain malfunction.

And finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remain speculative. That was after three days of presentations.

BURTON: But did they look at the entire scope of treatment options?

WISEMAN: No, sir.

BURTON: It was just Ritalin only.

OK. And finally, what biologic conditions can lead to an inability to concentrate in class? In the schoolroom?

WISEMAN: Well, as I mentioned in my testimony and as Dr. Block has said, there's a number of underlying physical problems, such as mercury poisoning, lead toxicity, and those kinds of things that actually can affect the nervous system and can make children act hyperactively.

BURTON: And just being kids.

WISEMAN: Yes.

BURTON: I will tell you, if they had had Ritalin when I was a boy, I have no question in my mind, as many times as I was sent to the principal's office for being out of control, that I would have been on Ritalin. I really believe that because I was a real pain in the foot.

(LAUGHTER)

Do you have any questions?

DAVIS: Yeah, if you will indulge me for a minute. You're saying that there is no proof that it's not a biological disorder. But there's no proof that it isn't. There is no proof that it's not a biological disorder as well, right?

WISEMAN: It's kind of trying to prove a negative, but that's correct.

DAVIS: What do you say to a parent who has had their child tested? There is no physical disorder, there is no mercury because there have been no fillings. There is no allergies, there's no nothing.

And you have more than -- Mr. Chairman, I believe the children who are ADHD, it's a lot more than just out of control. There's many more symptoms other than out of control.

They're not just a hyper child. What do you say to that parent who has had the child tested for everything and there is no other explanation? And then they take the Ritalin and it totally changes things?

BLOCK: I think that every parent has the right to choose what's best for their child. And the problem is they're not being made aware of the options and the possible side effects, that they are being pressured to put the child on the drug, even when they choose not to. And we are learning new things all the time because mercury doesn't just come from fillings. Mercury comes from vaccines and all children -- amongst all children that have had vaccines.

So there are many different reasons why children have these problems. And learning problems are a big one that schools often overlook. And nowadays, I'm finding out that even some of the places that used to test children for learning disabilities are now saying, "Well, they'll get them, see if they have attention deficit first. And then we'll look at that."

But it's the, you know, tail wagging the dog. It's the learning problems causing the attention and behavior problems. We need to fix those first.

DAVIS: I don't disagree with you. And just to set the record straight, Mr. Chairman, I fully believe in my heart that children are being overmedicated and everybody is being diagnosed if they're just being children.

Thank you.

BURTON: Thank you, Ms. Davis.

Yes, Ms. Morella, of course.

MORELLA: Thank you, Mr. Chairman.

BURTON: My great friend from Maryland.

MORELLA: Thank you. And it's simply that I was looking over the credentials. And I noted that the Citizens Commission on Human Rights was established by the Church of Scientology. Therefore, I wondered, how is the organization now related to Scientology? And what is the church's stance on psychiatry and psychiatric drugs?

WISEMAN: Well, Congresswoman, we're proud to have been founded by the Church of Scientology some 32 years ago. We are, however, an independent, IRS-recognized, public benefit corporation. And our role is a social reform activity to clean up the field of mental health.

So we investigate and expose psychiatric abuse and psychiatric violation of human rights.

MORELLA: Does the church have a stance on it?

PRESLEY: Can I just say no on that one? No. I mean, I personally am not here for that reason at all.

I'm here because I'm a mother and I care about children and that's it. And I knew that that was going to come up as a question in here. And I knew that it was going to be speculated that it's because you're a Scientologist, blah blah blah.

The bottom line is that I just think it's inhuman and it's not right. And it abusive and an epidemic and it needs to be looked into. It has nothing to do with religious beliefs or anything else, as far as I'm concerned.

MORELLA: No, I believe that you are motivated obviously because you care deeply about it. But I just wondered, does the church have a stand on it?

WEATHERS: Can I say something as a parent and just as a parent?

MORELLA: OK.

WEATHERS: I feel that this issue transcends all social and political and religious backgrounds. I think this is our children.

And we need to really address the issue that this is our children and this is our future generation here. This doesn't have to deal with anything other than our children.

MORELLA: I believe your motivation. I truly do. I'm a mother myself. But I am curious still about whether or not Scientology...

WISEMAN: Sure. I'm delighted to answer your question.

I've been a Scientologist for 32 years. Every Scientologist I know is very concerned about human rights abuse. But that's not really the issue from our point of view and why we're here.

Our concern is that parents aren't being given all the information and the choices. They're not given informed consent on the issue. That's really the concern, congresswoman.

BURTON: Before I yield to Mr. Gilman, let me just say, because we're going to have some votes on the floor, we had one in 10,000 children, according to CDC, that were autistic a decade or so ago. We now have one in 250 children or more that are autistic today.

We've had a fortyfold increase, 40 times increase in the number of children that are autistic in America. And there are a great many scientists and doctors that believe that some of the contents, including mercury, in vaccines are a major contributing factor.

We have an epidemic. The young lady, Ms. Weathers, talks about our kids and our future and what it's going to do to our society. Put a pencil to the amount of money it's going to take to take care of children today who are going to be adults in 15 years who are autistic, who can't get a job, who can't function properly in society.

You're talking about billions, maybe trillions of dollars. And we need to find the answers and get it straightened it out. And if mercury, as I suspect, is a major cause, then we damn well better get it out of our vaccines.

Mr. Gilman?

GILMAN: Thank you, Mr. Chairman. I'm curious, Dr. Block -- and I regret I had to go to another meeting and couldn't be here for your testimony, has there been any long-term study of the long-term effects of utilizing Ritalin?

BLOCK: No, there has not. The drug manufacturers themselves say there are no long-term studies. And the National Institutes of Health, when they had their conference, stated that most drug trials were very short, up to three months. Yet children are placed on these drugs for years and years without the knowledge that we need to know if they're safe.

GILMAN: Sounds like we have to undertake that study.

Background material provided to our committee cites American Academy of Pediatrics data that estimates four to 12 percent of children in the U.S. have some form of ADHD. Is this estimate applicable to other countries like Japan? Or this uniquely an American problem?

BLOCK: This is uniquely an American problem. Ninety percent of all Ritalin in the world is sold in the United States.

I have seen families from all over the world at my medical clinic. And those who have come from other countries always have an American connection. They were in an American school and told their child needed to be drugged.

If they moved them to the British school, they were told their child was fine. And I've seen this story occur over and over again.

GILMAN: When educators observe potential ADHD cases, how much weight is given to non-ADHD factors, such as the level of physical activity, diet, environment and other possible disorders?

BLOCK: Usually, there is not anything given to that. What is usually done is the teacher fills out a checklist describing behaviors that the child has at school. And parents may be asked to fill out this checklist.

The parents that bring their children to my office have told me that their doctor, in most cases, never did a physical exam, never listened to their child's heart, even though many of the side effects of the drugs can affect the heart.

They're not looking for other problems, not looking for allergies, learning problems, thyroid problems, anything physical or educational that might be wrong with the children, before labeling and drugging them.

GILMAN: In previous unrelated hearings covering the war on drugs, the drug enforcement Administration, DEA, has testified that many adolescent takers of Ritalin often hoard more supply and sell it to customers through an illegal secondary market. Is this a significant problem? And I address it to any of our panelists.

BLOCK: This is a significant problem. And there have been reports that indicate that Ritalin is the most abused drug in high school and colleges.

And there are other drugs, like Adderall. I don't want to just focus on Ritalin. There are many other amphetamine or amphetamine- type drugs that are abused on the street in the same way.

GILMAN: And in general, the percentage of the student body taking Ritalin or similar drugs is smaller in parochial schools than the same percentage in public schools. Why do you think that's the case?

BLOCK: Well, I can't think to exactly why. But from what I've heard, there is a great deal of discipline in many parochial schools. But I'm also seeing a change there, where the drugging of children is increasing in private and religious schools to a great extent as well.

GILMAN: Do any of our panelists want to add any comments to the questions I've just asked?

WISEMAN: Only, congressman, that last year or perhaps the year before, there was legislation proposed and I believe it passed by Congressman Holt's -- Henry Hyde's committee, excuse me -- that dealt with this issue of the abuse of Ritalin in schools. The DEA was very concerned about it.

And I don't recall the number of that legislation or its name. But I think that was in the year 2000. Legislation was actually proposed and passed, I believe, in this body that dealt with that issue.

GILMAN: Ms. Presley, did you want to comment?

PRESLEY: I don't know the statistics and the formalities of what exactly -- this is more for you two, I think.

GILMAN: Ms. Weathers, did you want to comment?

WEATHERS: No, not at this time. I don't know the statistics.

GILMAN: And Dr. Block, do you have any final statement you'd like to make?

BLOCK: Well, I think that all of us have consistently stated that we're very concerned about the abuse of these drugs and our children and the fact that parents are not given informed consent and not given all the options to look at all the possible problems that their children might have to correct those problems and not drug them. And I think that's what we'd like to see changed.

GILMAN: I want to thank our panelists for being here today and giving us your testimony. Thank you, Mr. Chairman.

BURTON: We have eight minutes and 33 seconds on the clock. I have a couple more questions for this panel and then we'll dismiss them, unless the other panelists have some questions.

We have one vote on the floor and then if you could come back, we would appreciate it. Let me just say that I really appreciate you being here.

One thing I would like to clear up is although there are people here who are members of the Church of Scientology, there are a lot of other people that you work with that are not members that share the same views. Am I correct on that?

WISEMAN: We work with allied groups across the country.

BURTON: Dr. Block, you're not a Scientologist, are you?

BLOCK: No, sir. I'm not.

BURTON: Ms. Weathers, you're not a Scientologist, are you?

WEATHERS: No, absolutely not.

BURTON: I just hope that there is no stigma attached to the people at this hearing because of their religious beliefs. We're here today to find out if -- and find evidence to find out if -- there is an abuse of Ritalin and other drugs of that type and whether or not they are habit forming and whether or not they are absolutely necessary and whether or not parents are getting adequate information so they can make an informed decision.

Those are the major issues that we're looking at here today. And I appreciate it very much.

I will have additional questions for this panel that I would like for you to submit in writing. And any legislative proposals that you think needs to be made, we'd like to have that in writing.

We can't guarantee that all of them are going to be enacted. You know the legislative process is like watching sausage being made. You don't want to watch it.

(LAUGHTER)

But we will take a look at all that.

Anything else from the committee before we recess? OK, we stand in recess to the fall of the gavel and we'll go to the next panel when we come back.

PRESLEY: Thank you very much.

(RECESS)

BURTON: The committee will reconvene. We'll now hear testimony from the second witness panel, Dr. Richard K. Nakamura. He is the acting director of the National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services.

Unfortunately, the Department of Education's witness was unable to be here today. Why is that?

OK, so doctor, would you please approach the table? Where is he? In the bathroom. OK, well, we will wait. I certainly wouldn't want to interfere with that.

Does anybody know any good jokes?

Dr. Nakamura, welcome. No, that's all right. I understand exactly. Would you please stand so you can be sworn, sir?

Do you swear to tell the whole truth and nothing but the truth, so help you God? Thank you.

I presume, after hearing the testimony of the other witnesses and the questions, you have an opening statement. OK, would you proceed? Can you turn your microphone on, sir?

NAKAMURA: Thank you, Mr. Chairman and members of the Committee on Government Reform for the opportunity to discuss an important medical condition here today. I am Richard Nakamura, the acting director of the National Institute of Mental Health. Professionally, I am a brain scientist, also called a neuroscientist.

The National Institute of Mental Health is one of the National Institutes of Health. We are the federal health institute responsible for research to reduce the burden of mental illness and other behavioral disorders. We take that responsibility seriously.

Ultimately, this hearing is about our children and helping them live full, productive lives. I come here before you both as a scientist and as a parent of children, some of whom have received services themselves.

Permit me to provide some background information from the neurosciences. We used to think that the brain simply unfolded according to strict genetic instructions. And those instructions, like body growth, ended in late adolescence and the brain was done.

From there, it was thought that it was all downhill and one could only lose neurons. But now we know that the brain is actively constructed from birth -- and even before birth -- by an interaction of genes with behavior and the environment. On the way, the brain goes through periods of massive growth and significant pruning or cell loss.

This is normal. We know that that pruning occurs to neurons that do not get incorporated into behavioral programs of the brain. Thus, we lose neurons that are not used.

Genes provide the scaffold for this growth, but the actual survival of neurons and their connections are determined by our environment and our behavior. This has important implications for disorders such as ADHD.

Parenthetically, we also know that there are some new neurons that develop in the brain every day of life, true to at least the age of 72, to help us older dogs learn new tricks.

What is ADHD or Attention Deficit Hyperactivity Disorder? There are two major components. First, there is an inattention or distractibility component. And this is the primary feature in ADD.

And then there is a hyperactivity or impulsivity component. For a diagnosis of ADHD, the diagnosis must be of long duration. It must be developmentally inappropriate. It must cause significant impairment. And it must be present in two or more settings of a child's life -- for instance, at least school and home.

When diagnosing ADHD, a clinician must be very careful to distinguish between that disorder and several other conditions that may look similar, such as sensory or learning disorders, anxiety or bipolar disorders and many others that have already been mentioned here. An adequate workup cannot be done in 15 minutes.

In this regard, I have the statement from the American Academy of Pediatrics, which has a very good guideline for how to do an adequate workup of ADHD. And I would like to submit this and some other documents for the record.

BURTON: Sure, without objection.

NAKAMURA: Three to five percent of children are diagnosed with ADHD, with boys being much more affected than girls. While some have questioned the reality of ADHD because we do not have a biological marker for the condition, the reality of individuals that cannot focus on a task for developmentally appropriate periods of time and show significant learning and job performance deficits as a result have convinced most physicians and scientists, just as most are convinced that other behavioral disorders without clear biomarkers, such as autism and schizophrenia and pain are real.

In these cases, it is the clarity and consistency of the behavioral syndrome or the effectiveness of interventions that is convincing. Many large professional and scientific bodies have looked into the topic of ADHD and have concluded that it is real.

Some of these groups, for the record, are: U.S. surgeon general, the American Medical Association, the American Psychiatry Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association and the American Academy of Pediatrics.

Also in 2002, an international consensus statement on ADHD was published by a large group of scientists who indicated their belief that the evidence for ADHD was very well justified and scientific.

What about the outcomes of untreated ADHD? There is an initiation of a trajectory because children who cannot attend or hyperactive have great trouble learning. Since learning is progressive and since our brain structures are determined by our behavior and learning, we need an active intervention to keep healthy outcomes on track.

Untreated, ADHD leads to increased medical utilization, school failure, poor social relationships, anti-social activities, use of harmful substances, brushes with the law and serious accidents.

So how is ADHD treated? Because ADHD is a chronic problem and treatments need to work for long periods, we recommend early detection and beginning with behavioral approaches, including parent and child training.

Now remember, this is after a diagnosis has been reached and all other possibilities have been eliminated through the appropriate differential diagnosis. Obviously, if behavioral approaches work, they should be employed with occasional booster training sessions.

However, in many cases, this will not result in improvement. So then we recommend a trial of a stimulant medication. In our experience, stimulant medications are highly safe and effective for properly diagnosed children and adults.

Now no choice of a stimulant medication should be made without careful consultation between parents, the children and clinicians. We do not believe that teachers, other than potentially making a suggestion that the child has a problem and it might be ADHD, beyond that teachers should not be diagnosing, nor recommending treatment for the condition.

When stimulant medications are used, there should be a long-term follow-up to ensure the continuing efficacy of treatment, proper dosing and proper adherence. What this means for children is that a trajectory that can lead to school failure -- I'm sorry, there is one other important point to make.

We have estimated and our data suggests that behavioral and/or medication treatment therapies will help 90 percent of children with ADHD. What this means for children is that a trajectory that can lead to school failure and social difficulties can be interrupted and replaced by a trajectory that can lead to more normal behavior and, therefore, more normal brain and behavioral development.

BURTON: Excuse me, Dr. Nakamura. Would it be possible for you to summarize the rest of your statement so we can get to the questions?

NAKAMURA: Sure.

BURTON: I want to get all of the substance of everything you have to say. And we will be -- all the members will be reading your statement.

NAKAMURA: I have one more paragraph.

By intervening to keep a child's development on track, many ADHD children can be helped to normal, productive lives. That is the point of our efforts.

I would like to say a final word about science. Science is a procedure that helps us learn the truth about interventions and outcomes by systematically testing ideas about the world and about human beings. This is the best way we know to learn whose ideas are right and how to keep us from continuing therapies that do not work or actually cause harm.

Ultimately, we need to move away from anecdotes to scientific tests of ideas if we are to have the best and most helpful lives.

Thank you.

BURTON: Thank you, doctor.

There are about 6 million children in America that are using Ritalin or substances very similar to that. Do you think they all need that?

NAKAMURA: We have heard different numbers. We don't know exactly how many children are being prescribed. But we have heard the number in the range of 3 million, as opposed to 6; 6 might include all the adults.

BURTON: Well, Pat...

NAKAMURA: But I won't dispute it.

BURTON: Pat Weathers, who testified, she said that her child was fine at home, but at school didn't pay much attention and was looking out the window and that sort of thing, like I did when I was a child, because I wanted to play baseball or, as I got older, chase the girl down the street. And she said that the teacher had a checklist and went through the checklist and called her in with the principal and said, "Your child has attention deficit problems. And we think that he ought to be treated," or she ought to be treated -- was it he or she?

"He ought to be treated." They went to the doctor. And she said the doctor looked at that, spent less than 15 minutes with them and prescribed Ritalin.

Now according to your testimony, that's not the way it should be done. Is that correct?

NAKAMURA: Given the description and because I don't know the particulars of this case, but given the description, no. That is not the way it should be done.

BURTON: Well, I mean, I listened to your testimony very closely. And you said that you ought to look at school. You ought to look at home. There ought to be consultation. There ought to be a whole lot of things that take place before you start using Ritalin.

Isn't that what you said?

NAKAMURA: Yes.

BURTON: Yeah. We have heard a lot of stories about teachers saying, "This child has an attention deficit problem." And they do this checklist and they send them to doctors. And the Ritalin is just a fait accompli. They're going to give it to him when they go there.

You don't think that's right, do you?

NAKAMURA: The guidelines of the American Academy of Pediatrics and the Institute's position are that you cannot make the diagnosis and you should not be writing a prescription with that little information.

BURTON: Have our health agencies informed our educational system around the country or state superintendents of public instruction or local school boards that there are certain things that should be followed? To give them a diagram on what they should do before they start giving children Ritalin and sending them to the doctor?

NAKAMURA: The information is certainly available on web sites. We have not, as an institute, sent information directly to all the schools in the country.

BURTON: Well, let me just tell you a story. One of the doctors, one of the most important doctors here on Capitol Hill, I said, "Do you know there is mercury in the vaccines you're giving us for flu?" And he said, "No, there's not."

And so I took the insert out. And I gave it to him and he looked at it and said, "Well?" And I said, "Well, thimerosal has mercury in it." Well, he didn't know that. The doctor didn't know that.

Now if we're spending all this money on our health agencies and you have a criteria that's supposed to be used for children before they go on these mind-altering drugs, then why in the heck doesn't the schools know about it? Because they don't. Many of the doctors don't even know that.

Now I want to talk to you about neurons. And I would submit to you that our health agencies, for a very low cost, could put it on their e-mail site and they could send a notification out to all state boards of education and local school boards and say, "On our e-mail site, we have the criteria that should be followed before a child starts taking Ritalin or other drugs of this type."

I don't know why you don't do it. It makes sense to me. And it would save the legislative branch a lot of time and trouble.

Now I want to talk to you a little bit about the neurons you were talking about. You talked about the neurons growing and being replaced and replicated on a very regular basis. Do you think mercury has an adverse effect on neurons?

NAKAMURA: I honestly don't know. I believe that mercury is clearly a substance you don't want in the body.

BURTON: Let me ask you this. Thimerosal, most of the vaccines we're sending overseas to all these kids in Third World countries still has it in there. And they're getting it out gradually here in the United States, but not as quickly as they ought to because we have had this absolute epidemic of children that are autistic from one in 10,000 now to one in 250.

And a lot of people say, "Well, that figure, one in 10,000, might be way off." But we do, everybody acknowledges we've got a big, big problem, even if that figure is incorrect. I don't think it is.

But we had some scientists from Canada send us a video, which I want you to give a copy to the doctor. Have you seen that video?

NAKAMURA: I don't believe so.

BURTON: It shows the neurons, which there is a sleeve on the neurons, is there not? Isn't there a sleeve?

NAKAMURA: Right.

BURTON: It shows what happens to the sleeve on the neurons when a very minute amount of mercury is introduced into the close proximity to it. And it just destroys it. It just destroys it.

And ultimately, it destroys or damages severely the neurons. Would you say that would have an impact on the brain of that child?

NAKAMURA: Yes. It certainly depends on the form of the mercury. But...

BURTON: The form? You say the form of the mercury.

NAKAMURA: There are some forms of mercury...

BURTON: Oh, I know there are two different kinds that we're talking about. Has there been testing done to show that one of them has an impact, but the other one doesn't? On neurons?

NAKAMURA: I could not tell you about that result. I do know that one form is much more destructive than the other form and that thimerosal contains the less destructive form.

However, I would agree that I would not like to see mercury...

BURTON: Well, the hearings we have had -- and I've had scientists and doctors of your caliber from all over the world. And the thimerosal and the mercury in these vaccines is very damaging. And they believe it contributes to neurological problems in these kids.

And you said it yourself. No mercury should be introduced into the human body.

And yet, they're doing it every day. And they did it to me. And they did it to every member of Congress that wanted to get a shot for flu. Why is that?

NAKAMURA: I can't offer you any explanation for that.

BURTON: You're with the Department of Health.

NAKAMURA: I am with the Department of Health. The Center for Disease Control and the FDA are the controlling organizations.

BURTON: Are they part of the Department of Health?

NAKAMURA: Yes.

BURTON: Do you ever talk?

NAKAMURA: They don't ask my advice on the issue of vaccines.

BURTON: So how do we get the message down to them besides going down there with a ball bat and hitting them in the head?

NAKAMURA: I would be happy to pass this information on through the department, to the appropriate organization.

BURTON: Well, I think they already know this.

NAKAMURA: I believe they do, too.

BURTON: Yeah, they've been to my committee before and they're going to be back here again. And they think they're going to get rid of me...

NAKAMURA: You are very, very clear.

BURTON: ... when I'm not chairman any more, but I'm going to be here. And I'm going to probably be a subcommittee chairman. And I can guarantee you, if I am, I'm going to be on the Health Subcommittee. So I'm going to have you guys back again and again.

Now let's talk about the cocaine. Is there any relationship between -- and I'm going to go to my colleagues as soon as this question is over. I've run way over, so excuse me.

Is there any connection or is there any relationship between cocaine and Ritalin? Do they have any of the same properties?

NAKAMURA: The stimulant properties of both derive from similar chemical properties.

BURTON: If a person who wanted to snort cocaine, if they ground up Ritalin and made it into a powder form, would it have a similar effect on their brain?

NAKAMURA: It would probably not do as much for them. However, yes, they would get a high from ground up methylphenidate.

BURTON: So they are similar?

NAKAMURA: They are similar in that sense, yes.

BURTON: Could you become addicted to Ritalin ground up and snorted like cocaine?

NAKAMURA: That would increase the addiction potential of the methylphenidate, yes.

BURTON: OK, so why is it that children taking Ritalin might not become addicted and become a more likely prospect for long-term addiction to more stronger drugs?

NAKAMURA: There are a couple of things going on. One is that our experience has been that this is not happening, that most children are using this appropriately, that pharmacies and physicians are being fairly careful about their prescribing practices, so they don't allow automatic renewals of prescriptions and that the number of pills are counted to make sure that the number of pills being taken by the child...

BURTON: I understand, but a lot of children get this in the early years and they spread it out maybe all the way through high school. Is there a possibility of addiction?

NAKAMURA: So far, when we have looked, there is either no increase in addiction or slightly reduced level of addiction for kids who are on medications compared to kids who are not on medications.

BURTON: You have done long-term studies on this?

NAKAMURA: We have done studies that have varied in the amount of time from 14 months to 20-something years.

BURTON: Is that right? And yet you say the properties are very similar to cocaine?

NAKAMURA: Yes.

BURTON: I don't understand that disparity there. Maybe you can explain that in the second round.

Let me yield to my colleagues.

Mr. Gilman?

GILMAN: Thank you, Mr. Chairman.

Dr. Nakamura, welcome to our panel.

NAKAMURA: Thank you.

GILMAN: In your testimony, you stated that "good treatment begins with accurate diagnosis, which can best be achieved through implementation of state-of-the-art diagnostic approaches in practice settings. We know through research that a clinically valid diagnosis of ADHD can be reached through a comprehensive and thorough evaluation done by specially trained professionals using well-tested diagnostic interview methods." That's your testimony, is it not?

NAKAMURA: Yes.

GILMAN: Basically, your testimony implies that doctors don't need to do any evaluation of possible biological issues, such as thyroid or heavy metal toxicities, things for which there are objective clinical tests, rather than a subjective interview method. Doesn't it worry you that by not doing good medicine -- in other words, biomedical evaluation -- children with biological issues are simply having the symptoms suppressed, rather than resolved?

Does that concern you at all?

NAKAMURA: By stating that a proper workup be done, we meant that proper differential diagnoses also be done. And we recommend the American Academy of Pediatrics clinical practice guidelines, which make it very clear that you need to do an adequate differential diagnosis, so you eliminate other possibilities.

Now there are, I think, reasonable questions about whether or not some areas will produce these kinds of symptoms. So I believe between ourselves and the earlier panel, there may be disagreements about how much allergies can participate in this, et cetera. But we do recommend that those be checked before making a recommendation and a diagnosis of ADHD.

GILMAN: So there should be a good biomedical evaluation. Is that what you're saying?

NAKAMURA: Yes.

GILMAN: You state that ADHD is one of the most researched conditions in children's mental health. Just how much is being spent on that kind of research at NIMH and NIH?

NAKAMURA: Well, more than NIMH just spending money, I can tell you that last year, we spent $53 million studying ADHD.

GILMAN: Is any of this research evaluating biological issues, such as mercury or lead toxicity, that our chairman has indicated?

NAKAMURA: None of this at the moment is looking at lead toxicity and mercury.

GILMAN: Is there any reason why you're not looking at it?

NAKAMURA: We have, as our process, a peer-reviewed competition for grants. We would be quite interested in getting an application which tried to look at the contributions of both lead and mercury to ADHD.

GILMAN: Do you need an application to undertake that kind of a study?

NAKAMURA: Well, we found that, in order to get studies done well, getting them in through a peer review process is very important. If any of you have investigators who have indicated that they are interested in pursuing this study...

GILMAN: Well, we're interested in this committee. Do you need an application to dig into that kind of an approach?

NAKAMURA: We need an application to make sure that the research that's proposed will answer the question.

GILMAN: Don't you initiate any studies on your own? Do you have to wait for applications if there is some problem out there?

NAKAMURA: We can initiate studies on our own.

GILMAN: Well, I suggest that maybe you ought to take a look at the mercury or lead toxicity on your own, rather than waiting for an application. Is any of the research evaluating alternative therapies, such as acupuncture, neurofeedback, massage, craniosacral therapy and special dietary approaches? Is there any research now looking at any of those?

NAKAMURA: I understand that the National Center for Complementary and Alternative Medicine is pursuing all of those.

GILMAN: They are undertaking that?

NAKAMURA: Yes.

GILMAN: I just have one or two other questions, doctor.

In a 1995 background paper from the Drug Administration, DEA, the following statement was made -- and I quote -- "It has recently come to the attention of the DEA that Ciba-Geigy, the manufacturer of Ritalin, marketing under the brand name Ritalin, contributed $748,000 to CHADD from 1991 to '94. The DEA has concerns that the depth of the financial relationship with the manufacturer was not well known to the public, including CHADD members, that have relied upon CHADD for guidance as it pertains to the diagnosis and treatment of their children."

"In a recent communication from the United Nations International Narcotics Board, INCB expressed concern about non-governmental organizations and parental associations in the U.S. that are actively lobbying for the medical use of Ritalin for children with ADHD. The UN organization further stated that financial transfer from a pharmaceutical company with the purpose to promote sales of an internationally controlled substance would be identified as hidden advertisement and in contradiction with the provisions of the 1971 convention."

"In fact, a spokesman for Ciba-Geigy stated that 'CHADD is essentially a conduit for providing information to the patient population.'" That's a direct quote from them. "The relationship between Ciba-Geigy, which is now Novartis, and CHADD raises serious questions about CHADD's motive in proselytizing the use of Ritalin."

This is what DEA had to say. And this same DEA paper states that CHADD, in conjunction with the American Academy of Neurology, submitted a petition to reschedule Ritalin from Schedule II to Schedule III under the Controlled Substances Act because controls are unduly burdensome for the manufacturer and for physicians who prescribe it and patients who need it. CHADD denied that the financial contributions received from Ciba-Geigy have any relationship to their actions.

And the DEA went on to note that of particular concern to them was that most of ADHD material prepared for public consumption by CHADD and other groups and made available to parents does not address the above potential or actual abuse or Ritalin. Instead, it is portrayed as a benign, mild substance that's not associated with abuse or any serious side effects.

The DEA went on to note in their report -- and I quote -- "In reality, however, there is an abundance of scientific literature which indicates that Ritalin shares the same abuse potential as other Schedule II stimulants. Case reports document that Ritalin abuse, like any other Schedule II stimulant, can lead to tolerance and severe, psychological dependence."

"In a review of the literature, the examination of current abuse and trafficking indicators reveals a significant number of cases where children are abusing Ritalin."

So what is your comment with regard to DEA's report?

NAKAMURA: The key thing that I would comment is it's very important to realize that when ADHD is properly diagnosed, there seems to be very little problem with substance abuse and even diversion. The GAO recently put out a report on attention disorder drugs, reported that there were few incidents of diversion or abuse identified by schools.

And that it's the experience that we have, so far, which indicates that there is not an increase in abuse by those with ADHD who are taking Ritalin. Rather, there is either a normal amount or a reduced amount of abuse by those kids. We do know that untreated ADHD kids go on to abuse drugs at high proportions.

BURTON: The gentleman's time has expired.

GILMAN: Please, can you yield? I just have one more.

BURTON: Sure, OK. Go ahead.

Yield to me just for one second, though.

GILMAN: Sure.

BURTON: Was that the only study that was done on that, that said that there was no increased abuse?

NAKAMURA: No, there were three studies.

BURTON: OK, tell me about the other two studies real quick. Weren't there other studies that showed that there was increased use?

NAKAMURA: There was one study...

BURTON: There was one study. You didn't mention that. It's interesting that you mention the one that says what you want, but you don't mention the one that says what you don't want.

And this Congress up here doesn't want you to come up here and shade things the way that the health agencies want. We want you to tell the truth for the American people. It really bothers me that you guys do this all the time. You do it all the time.

Tell the whole truth, not just the part that you want told.

What was the other thing, real quickly?

And the pharmaceutical companies, Congressman Gilman just made a strong point here. The pharmaceutical companies found an awful lot of this stuff, these studies and other things that you're talking about. You said the GAO said that there was no problem with this.

You didn't quote the DEA. The DEA is the agency that we charge to go after the drug dealers and the drug abusers and the drug problems in this country. Why is it you didn't quote the DEA instead of just a GAO study that you asked for?

NAKAMURA: I had just been given the information about DEA.

BURTON: You mean to tell me you guys don't have access to that over there?

NAKAMURA: No, I just pointed out that there was other information as well.

GILMAN: Thank you. And I'll yield in just a moment. But doctor, are you concerned about the relationship between CHADD and the pharmaceutical company? Is there any concern by NIH with regard to that?

NAKAMURA: That is not an area -- I don't believe that the NIMH has a right to interfere with that transaction. What we try and do, make very careful about NIMH, is that there is no interaction with drug companies that could influence our decisions.

GILMAN: But here we have a drug company that is influencing a parental group. And that drug company has some financial motivation. Isn't there any oversight by NIH of that kind of a relationship?

NAKAMURA: No, there is no oversight that I am aware of at NIH. NIH's job is to do good research. And that's what we try and do.

GILMAN: Well, I hope that NIH would do more than just do research and make certain that the information given to the public is factual and not motivated by any financial interest.

I'll be pleased, Mr. Chairman, to yield the balance of my time.

BURTON: Mr. Horn?

HORN: Dr. Nakamura, a study conducted at Georgetown found that children with ADHD are seven times more likely to have food allergies than other children? Isn't it true that children in an allergic state would be adversely affected in their ability to focus and concentrate?

What has NIMH and NIH done to evaluate the correlation between food allergies and attention disorders?

NAKAMURA: My understanding is that we have had some earlier studies in which we looked for allergies as related to ADHD and other kinds of externalizing or disruptive behavior disorders and found that a small proportion -- about five percent -- could be accounted for by those allergies. And certainly, we believe that where they exist, you take care of those before you develop a diagnosis.

HORN: Are you concerned that children may be misdiagnosed with ADHD?

NAKAMURA: Absolutely.

HORN: Well, that's good to know.

NAKAMURA: We would very much like to see children properly diagnosed. In our current system, physicians are compensated inadequately for working -- for doing a full workup. It is hard for physicians, as we understand it, to get more than a certain amount of money.

This might have a tendency to cause them to move a little too fast and maybe not have enough time to come up with alternative conclusions about a disease process.

HORN: Dr. Nakamura, in the Novartis PDR in Ritalin, there is a warning that Ritalin should not be used in children under the age of six years because the safety and efficacy had not been established. I am troubled that the National Institutes of Health would offer to pay parents of 3-year-olds over $600 to test Ritalin on their children.

And there is apparently -- let's see here, it was the APA meeting quote. And is the federal government testing psychotropic drugs in children under the age of 6?

NAKAMURA: Let me tell you how this study is being conducted.

HORN: Go ahead.

NAKAMURA: Because of the reports that so many children are being provided with Ritalin at younger ages, the National Institute of Mental Health decided that it needed to do a study on the safety of such drugs at those lower ages. Our IRB looked at this issue very carefully.

And we did the following: we have run the most vigorous study possible, to exclude children from this study, in the sense that we do a very vigorous examination of whether or not alternative possibilities for explaining the behavior of the children. We require that the children go through a full behavioral therapy session, that is a set of sessions, before they are begun. And only then is there a final getting the parents' permission to go ahead with the trial of Ritalin.

HORN: How many children are under six years of age?

NAKAMURA: I believe that the design is to get 100 children.

HORN: In your testimony, you talk about the studies that have been conducted on individuals with ADHD have -- quote -- "less brain electrical activity and show less reactivity to stimulation in one or more of these regions." Are you still standing by that?

Can you please tell us if any of these tests were conducted on individuals diagnosed with ADHD who had never been treated with psychotropic drugs?

NAKAMURA: In those studies, no. We are about to see a study come out in which that specific comparison has been made.

HORN: Please explain how the drugs can affect these same activities in the brain.

NAKAMURA: Pardon me, I don't understand.

HORN: Please explain how the drugs can affect these same activities in the brain.

NAKAMURA: I'm sorry, it's -- which same activities in the brain?

HORN: We'll submit it to you and put it at this point in the hearing record.

NAKAMURA: I apologize for not understanding.

BURTON: He is talking about the brain activity, less brain electrical activity.

NAKAMURA: And the drug is stimulating it.

BURTON: Yes, he is talking about how would it affect it? Go ahead.

NAKAMURA: So let me explain what we believe is going on with stimulant medications; that is, that certain portions of the brain show reduced activity compared to normal children. And this is in the area of executive function, particularly in the frontal lobes.

Unlike an earlier statement, it isn't because blood is going slower. Blood is going at the normal rate. It's the activity and the oxygen pickup of those neurons which is different, which means that the frontal lobes aren't using as much energy as those in normal.

And by a small amount of Ritalin, it increases and selectively increases the amount of energy and the activity of neurons in the frontal lobes, which provides the executive function these kids need in order to control their behavior better.

HORN: I yield back my time to the chairman.

BURTON: Thank you, Mr. Horn. We are not through questioning Dr. Nakamura, so you will have another chance.

Ms. Davis?

DAVIS: Thank you, Mr. Chairman. If I just heard you correctly, you said the Ritalin speeds up the activity in the frontal lobe. So did you hear me give the explanation earlier to the first panel about the blood flow in the frontal lobe of the brain? Can you comment on that?

NAKAMURA: Yeah. When you do certain studies, in order to look at the activity of the brain, what it actually does is looks at the flow of oxygen through the brain. It's sometimes called blood flow.

What you're really concerned about is the activity of the neurons in the brain. And so it isn't so much a problem of slow blood. It's a problem of neuroactivity, which the blood is a surrogate measure for.

What we've been finding is that frontal lobe activity in those with ADHD is reduced and that the Ritalin helps increase it. Because frontal lobes are responsible for executive function, that makes it easier for self control and for self-directed activity to go on.

DAVIS: Based on that and to go back to -- I forget who asked the question -- about the possible addiction of Ritalin because it has the similar characteristics of cocaine. It was my understanding that if you put a child -- and I'd like you to comment on it -- put a child on Ritalin who is not ADHD, it has a different effect on that child than the child who has ADHD.

For instance, our son, when we put him on Ritalin, because a normal -- had normal behavior, not slowed down, dead, lethargic or a zombie or what have you, but actually became what you would call normal. But if you put a child who was not ADHD on Ritalin, it was like giving them speed. And they actually become the opposite and become hyper.

Can you comment on that?

NAKAMURA: In general, if children, normal children, use Ritalin at normal doses and through normal pathways -- that is, ingestion -- they might have side effects of losing sleep and losing weight. But at those levels, it shouldn't become addictive. And cocaine has much less addictive properties when ingested in a slow way when you ingest it.

If you change the way it's delivered to the body, so that you figure out a way of injecting it, a way of snorting it or sniffing, that speed increases the addictive properties. I understand that one of the things that drug companies are trying to do are create a form of methylphenidate, which is less able to be ground up and used in any form other than the appropriate ingested form.

So I believe the drug companies are trying to solve the problem of the potential addictive properties if you misuse these chemicals.

DAVIS: Is there any validity to giving Ritalin to a child who is not ADHD and giving it to one who is, that there is a difference in the behavior?

NAKAMURA: I'd like to liken it to a bell-shaped curve in the sense that if performance is optimal, at the peak of a curve, for a normal child who is at the peak of the curve, you're going to push them past optimal performance. There may be some gains, in terms of being able to stay up late or do a short-term sports event. But there are more penalties to be had for those children.

For those with ADHD, it appears that they are onto the left of the curve and can be pushed up to normal performance by these drugs.

DAVIS: Thank you, Mr. Chairman. Thank you, doctor.

BURTON: Judge Duncan?

DUNCAN: Thank you, Mr. Chairman.

Dr. Nakamura, you may have heard me this morning when I stated that -- or quoted one article in which the just-retired deputy director of the Drug Enforcement Administration said that Ritalin is prescribed six times as much in the United States as in any other industrialized nation, six times as much as in Canada, Great Britain, other countries like that. Does that concern you?

Do you know of any reason why that would make any sense at all? And also, that "Time" magazine said that production of Ritalin has increased sevenfold in the past eight years and that 90 percent of it is consumed in the United States, 90 percent?

NAKAMURA: Yes, this is of concern. However, the United States is often at the leading edge of a number of things. And so it's not completely surprising that it should be happening more in the United States.

I do know that the use of Ritalin is up strongly in Europe and that it is perceived as being safe and effective. And the experience in the United States is being taken into consideration here.

DUNCAN: I have an article here that says, an article last year in the "Journal of the American Medical Association" said that psychotropic medications have tripled in preschoolers, ages two to four, during the previous five years, the past five years. More disturbing is that during the last 15 years, the use of Ritalin increased by 311 percent for those ages 15 to 19 and 170 percent for those ages five to 14. And that's from the "Journal of the American Medical Association."

And this "Insight" magazine that I quoted earlier this morning says that of approximately 46 million children in kindergarten through grade 12, 20 percent have been placed on Ritalin at some point. And your figures are much, much lower than that.

NAKAMURA: Yes. All the figures that we have on national prevalence of the use would make us very surprised if the figure surpassed five percent.

DUNCAN: But you don't question these figures from the "Journal of the American Medical Association" that say that psychotropic medications have tripled in preschoolers during the previous five years?

NAKAMURA: We accept that. And we are very concerned about what that means and how practice is being changed. Our previous director, Steve Hyman (ph), was not convinced that we knew enough about diagnosis of some of our disorders at those ages to be prescribing medications.

One of the...

DUNCAN: It says in this article here, it says, "This can be good news only for investors in the Swiss-based pharmaceutical company Novartis, which makes Ritalin." For instance if the number of children taking the drug increased fivefold, so did the drug company's resultant profits and stock value -- presumably stock value.

In a June 28, 1999 article, "Doping Kids," it was estimated that Novartis generated an increase in stock market value of $1,236 per child prescribed Ritalin. Based on these evaluations, the drug company would have enjoyed an increased stock market value of approximately $10 billion or more since '91.

NAKAMURA: I can assure you that I haven't shared in any of that.

DUNCAN: I know you meant that to be humorous. But I think this is very sad that we may be drugging or doping children and that it's all about helping a big drug giant make whopping profits.

And let me ask you this, getting more directly into your field, and I'm just curious about this. I know nothing about it.

Is there a real difference or are there significant differences between the brains of small boys and small girls?

NAKAMURA: Yes.

DUNCAN: That might cause this? Because everybody has said that there are many more small boys that are being prescribed this medication than small girls. Is there anything in your research on the brain that would help explain that?

NAKAMURA: There is no question that the hormone differences between boys and girls, which increases at early adolescence, creates differences in behavior.

DUNCAN: Early adolescence, most of these kids are being prescribed this before early adolescence.

NAKAMURA: Yes. There are hormone differences that start from birth. And one important point is that there are some who feel that attention deficit is much more prevalent in girls than we have measured and that girls have simply not been identified because they are not seen as a problem. They simply sit in the classroom and fail quietly, whereas boys tend to act out at the same time. So they come to the attention of teachers and the girls are ignored.

DUNCAN: My time is up. But let me just ask one more quick question.

I spent 7.5 years before coming to Congress as a state trial judge, trying the felony criminal cases, the most serious criminal cases. And the first day I was judge, they told me that 98 percent of the defendants in felony cases came from broken homes.

And I went through, because 96 or 97 percent of the people plead guilty and apply for probation, I went through about 10,000 cases. And I can't tell you how many thousands of times I read, "Defendant's father left home when defendant was two and never returned. Defendant's father left home to get a pack of cigarettes and never came back."

And I can tell you this: crime goes back, it's caused by drugs and alcohol and running with the wrong crowd and all that. But you can trace all the felony crimes, with very few exceptions, back to this broken home situation.

And I remember reading one article that said that, I think, 90 percent of these children that were being prescribed Ritalin were in homes from very successful, two-parent families where both parents were working. And I'm wondering -- and I don't have any doubt that some children really benefit from Ritalin and really need it.

But I'm also wondering, is somebody studying where there may be some sort of a social cause of this? That maybe this is, in some way, boys crying out for attention that they're not getting?

NAKAMURA: There is...

DUNCAN: Because there sure is a cause of the serious crime in this country, I can tell you that.

NAKAMURA: There are a lot of social changes that are going on in our country.

DUNCAN: And wouldn't that also help explain why possibly that some of these other industrialized nations are not seeing it nearly as much of this as we are because they don't have many of these -- as much of this, as much of the breakdown of the family as we do?

NAKAMURA: We don't know the answer to that. There are social changes that are going on with great rapidity in our country. And we are trying to figure out ways with which we might measure what effect these might have on subsequent behaviors.

There is a proposal for a large-scale study of a birth cohort by the National Child Health Institute, in which they would propose to look at 100,000 births, following these children, understanding everything that they are consuming, their vaccinations, how the family is structured, et cetera, to see how those might relate ultimately to disease and other behavioral problems, as well as medical problems.

So there are proposals to do that. This would be extremely expensive.

BURTON: Let me just follow up. You said that you thought 3 million children or thereabouts was on Ritalin or similar products. We've been told it's 6 million. Why is it you don't have some idea?

Can't you find out from the drug company how many prescriptions are being written for that?

NAKAMURA: Yes, we do. We are aware of how many prescriptions. Relating that to the number of individuals is a little trickier. I'm sure I could get you the information that we have for the record on what is the number that we are able to document.

BURTON: OK. Now Novartis gave $748,000 plus $100,000 last year to this organization called CHADD. You don't see anything wrong with that?

NAKAMURA: Organizations which -- many organizations receive money from companies. And I guess my feeling is that with many of it, as long as that's revealed...

BURTON: It's OK.

NAKAMURA: Right.

BURTON: Even though they're touting their own product? What about the $750,000 that the FDA gave to them for the same reason?

You know, I hope, if one thing comes out of this, that you will get information to all of the school boards in the country and the state school superintendents saying that there is a prescribed policy that should be followed before you put children on these drugs, not just some checklist that a teacher comes up with. That's very important. You think that needs to be done. But most people out there in the hinterlands don't know that.

Now my grandson -- and we all talk about our personal experiences -- he got nine shots in one day and got 47 times the amount of mercury that was tolerable in an adult. And two days later, he became autistic.

And like I told you earlier, we've gone from one in 10,000 to one in 250 kids, according to our health agencies, your health agencies, that have autism. They are autistic. So it's an absolute epidemic.

I wanted to show you, since you weren't familiar with this, a tape we got from Canada on what happens when mercury is introduced into the neurons of the brain. Can you roll that tape real quick? It will just take a minute.

(BEGIN VIDEOTAPE)

(UNKNOWN): How mercury causes brain neuron degeneration. Mercury has long been known to be a potent neurotoxic substance, whether it is inhaled or consumed in the diet as a food contaminant. Over the past 15 years, medical research laboratories have established that dental amalgam tooth fillings are a major contributor to mercury body burden.

In 1997, a team of research scientists demonstrated that mercury vapor inhalation by animals produced a molecular lesion in brain protein metabolism, which was similar to a lesion seen in 80 percent of Alzheimer-diseased brains. Recently completed experiments by scientists at the University of Calgary's faculty of medicine now reveal, with direct visual evidence from brain neuron tissue cultures, how mercury ions actually alter the cell membrane structure of developing neurons.

To better understand mercury's effect on the brain, let us first demonstrate what brain neurons look like and how they grow. In this animation, we see three brain neurons growing in a tissue culture, each with a central cell body and numerous neurite processes.

At the end of each neurite is a growth column where structural proteins are assembled to form the cell membrane. Two principal proteins involved in growth cone function are actin, which his responsible for the pulsating motion seen here, and tubulin, a major structural component of a neurite membrane.

During normal cell growth, tubulin molecules link together, end to end, to form microtubules, which surround neurofibriles (ph), another structural protein component of the neuronal axon. Shown here is the neurite of a live neuron, isolated from snail brain tissue, displaying linear growth due to growth cone activity.

It is important to note that growth cones in all animal species, ranging from snails to humans, have identical structural and behavioral characteristics and use proteins of virtually identical composition. In this experiment, neurons also isolated from snail brain tissue were grown in culture for several days, after which very low concentrations of mercury were added to the culture medium for 20 minutes.

Over the next 30 minutes, the neurite membrane underwent rapid degeneration, leaving behind the denuded neurofibriles (ph) seen here. In contrast, other heavy metals added to this same concentration, such as aluminum, lead, cadmium and manganese, did not produce this effect.

To understand how mercury causes this degeneration, let us return to our illustration. As mentioned before, tubulin proteins linked together during normal cell growth to form the microtubules which support the neurite structure. When mercury ions are introduced into the culture medium, they infiltrate the cell and bind themselves to newly synthesized tubulin molecules. More specifically, the mercury ions attach themselves to the binding site reserved toward guanosine triphosphate or GTP on the beta subunit of the affected tubulin molecules.

Since bound GTP normally provides the energy which allows tubulin molecules to attach to one another, mercury ions bound to these sites prevent tubulin proteins from linking together. Consequently, the neurite's microtubules begin to disassemble into free tubulin molecules within the neurite's supporting structure.

Ultimately, both the developing neurite and its growth cone collapse and some denuded neurofibriles (ph) form aggregates or tangles, as depicted here. Shown here is a neurite growth cone stained specifically for tubulin and actin before and after mercury exposure. Note that the mercury has caused disintegration of tubulin microtubule structure.

These new findings reveal important visual evidence as to how mercury causes neurodegeneration. More importantly, this study provides the first direct evidence that low-level mercury exposure is indeed a precipitating factor that can initiate...

(END VIDEOTAPE)

BURTON: OK, here's the point. And you're talking to a layman, not a scientist. But I can see. And we've looked at these things before. And I've had the finest minds around the world before this committee.

Mercury causes a degeneration in the brain tissues. It's a contributing factor, according to many, many scientists in Alzheimer's and autism and other neurological problems in children. Now it doesn't take a rocket scientist to be able to see that we need to get that substance out of anything going into the body.

You in the health agencies took it out of mercurochrome. You took it out of topical dressings. The reason you did that was because you said it leeches into the skin and can cause neurological problems.

And yet, you're still sticking it into our kids. And we have an epidemic that's gone from one in 10,000 to one in 250 kids in this country. And we're going to have to take care of those people. It's going to be a huge -- it's going to be a nuclear bomb on our economy at some point in the future.

Now you're talking about today Ritalin and how we need Ritalin and how all these kids in schools and these young kids are having to get it because of the way they act. A lot of that may be caused by the introduction of mercury and other toxic substances into the body.

So it seems to me logically that the first step you take in the health agencies is get mercury and these toxic substances out of our vaccines. We have not done that here in the United States.

And really, much to my chagrin, in most of the vaccines we're exporting to Third World countries, we're keeping it in there. We're not even trying to take it out, which means we're going to be causing these problems all around the world.

Now all I'd like to end up saying to you, from my perspective, is let's get mercury out of all of these vaccines. Let's look at whether or not the amalgams, as was indicated -- we all have fillings in our teeth. And these amalgams, and I've already had my mouth tested. I had five of these amalgams taken out.

But I had a very high rate of mercury vapor when I chewed and everything that was getting out in my mouth. And that would leech into the brain. Maybe that's part of my problem, I don't know.

But the point is, why don't we start, as our health agencies, to look at getting mercury out of any substance that goes into the human body or is in close proximity to it? And then, after we do that, we may not need to be giving these kids these mind-altering drugs because many of them may not be adversely affected.

Now if you do that, and you start informing our educational institutions of the criteria that should be used before you start giving these kids Ritalin, I think you'll solve a lot of these problems. And I also think our health agencies ought to take a hard look at whether or not pharmaceutical companies should have influence on the dispersion of these things and the usage of these things by using their money to create a wider body of users, which is what they're doing.

And I know that a lot of -- there's a revolving door at the health agencies where people go to the pharmaceutical companies, come over to the health agencies and go back. And we've looked at their financial disclosure forms and we've seen some things that were very curious there, people on advisory committees that have a vested interest in getting products passed into the mainstream of use here in this country.

And I'm not going to talk any more about this. But I hope that those of you from our health agencies who have heard what we had to say today -- what I had to say -- will take that message back because it's going to be a broken record. It ain't going to go away as long as I'm in the Congress and as long as we have committees like this.

And I've talked enough. Do any of my colleagues have any more questions for this gentleman?

DAVIS: Just one quick question, Mr. Chairman. In your research, have you found any difference or any discrepancies in boys versus girls with ADHD?

NAKAMURA: There are differences in behavior, but they both respond to Ritalin.

DAVIS: I guess discrepancy is not the word I wanted. Do there seem to be more boys or more girls?

NAKAMURA: Definitely more boys.

DAVIS: By a wide majority?

NAKAMURA: Four to one.

DAVIS: Thank you.

BURTON: Mr. Gilman?

GILMAN: Just one question, Mr. Chairman. Doctor, would your NIH consider a long-term study, a study of the long-term effects of Ritalin? I don't think any study has been undertaken from the testimony we have heard.

NAKAMURA: Right. We have an ongoing study of Ritalin, which is anticipated to be long term; that is, we will follow children for many years on it.

GILMAN: That's encouraging. Thank you very much.

Thank you, Mr. Chairman.

BURTON: Mr. Horn, anything else?

HORN: No, just on the last point made by Mr. Gilman, have you got the National Academy of Science and Medicine? Are they doing it? Or is it simply done within the NIH?

NAKAMURA: It's being funded by the NIH. The National Academy of Science doesn't actually conduct studies. They review studies.

HORN: Well, it might be worthwhile to get some people that are not completely involved with NIH and take a look. That's exactly what they are there for. We use them all the time here.

NAKAMURA: OK.

BURTON: Thank you, Dr. Nakamura. We have some questions we'd like to submit for the record. But if you would consent to answer those and send them back to us, we'd appreciate it.

NAKAMURA: Absolutely, sir.

BURTON: OK, thank you very much.

We have one more panel. And this last panel consists of Dr. E. Clarke Ross. He is the CEO of Children and Adults with Attention Deficit Hyperactivity Disorder. David Fassler, a doctor who is a representative of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

And who else do we have? That's it. OK, very good.

Do you gentleman have an opening statement? Oh, I'm sorry, let me swear you in. I almost forgot.

Please stand. Do you swear to tell the whole truth and nothing but the truth, so help you God?

Do you want to start, Mr. Ross?

GILMAN: Mr. Chairman, if I might interrupt, I have to go to another meeting. Could I ask just one question of Mr. Ross before I have to leave?

BURTON: Sure.

GILMAN: Mr. Ross, isn't it true that CHADD received a grant award of $750,000 from the CDC to establish and operate the National Resource Center on ADHD?

ROSS: Yes, we were awarded a $750,000 grant from the Centers for Disease Control and Prevention to operate a national resource center on ADHD.

GILMAN: And have your membership been made aware that those funds came from a pharmaceutical company?

ROSS: The money did not come from pharmaceuticals. The CDC funds came from appropriation of Congress, administered by the Centers for Disease Control and Prevention.

BURTON: If the gentleman would yield?

GILMAN: Be pleased to yield.

BURTON: If the gentleman would yield? You did get $748,000 from Novartis?

ROSS: Eighteen percent of our budget currently...

BURTON: You got that money?

ROSS: Over a three-year period in the mid-'90s, before I was there...

BURTON: Did you get $100,000 last year?

ROSS: We got $700,000 from the pharmaceutical industry in its entirety in the last year, which is 18 percent of our budget. And I didn't bring a breakout of each company. But it's on our web site. It's in our IRS returns. And I'm happy to provide it to the committee.

But 18 percent of our budget is derived, like most every other voluntary health agency in America, whether it's the Epilepsy Foundation, diabetes, cancer, heart, the National Health Council, which is the umbrella group. We try to diversify our funding. And we try to receive corporate funding, as well as membership donations and federal funds.

BURTON: Go ahead, Mr. Gilman.

GILMAN: One last comment. The DEA stated that $748,000 to CHADD from 1991 to 1994 came from the manufacturer of Ritalin. Is that correct?

ROSS: The then-owner, which has subsequently become Novartis, gave CHADD roughly that amount of money in that three-year period. Yes.

GILMAN: Was that made known to your membership?

ROSS: Yes. It is on our web site. Go right on the web site, you'll see who all our corporate donors are, how much they give and the totality of our budget.

GILMAN: Thank you.

Thank you, Mr. Chairman.

BURTON: Proceed, Mr. Ross.

ROSS: I'm here today to talk not only about the CEO of CHADD, but I'm the father of an 11-year old son, 11-year old son with inattentive type ADHD, anxiety disorder and a variety of other challenges and learning disorders. Andrew has a history of challenges. He had seizures, unprovoked seizures when he was 21 months old. At Johns Hopkins University at Kennedy Krieger, we've had a complete blood, metabolic workup when he was two and three years old to try to determine things like mercury, lead and other contributions.

Andrew has a series of developmental problems. Inattentive ADHD was not recognized until he was four in his first group learning situation. And teachers noticed that he was inattentive. He did not pay any attention to what was going on around him.

So I'm here to speak as a parent of an 11-year old son that we deal with daily with major challenges and that experience, as well as the CEO of CHADD.

Now what CHADD does -- and I do have a written statement that I'd like to have in the record. What CHADD does is disseminate the science-based information. And that's why the Centers for Disease Control and Prevention have given us a grant to do that.

And we rely on things like the United States Surgeon General Report on Mental Health and the ADHD and Dr. Nakamura and NIMH and the National Institutes of Health and the professional societies like the American Psychiatric, American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics. That's what 20,000 family members of CHADD rely on is the science, the federal agencies and the professional community.

The highest importance at the moment are guidelines that have been mentioned before. The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have issued best practice treatment guidelines on how to asses and treat ADHD.

And the recommendation of the surgeon general, the recommendation of NIMH and the recommendation of the two professional academies is what's called a multimodal treatment. It is not medication as a first entry. It is a multimodal treatment, which are: behavioral interventions, counseling interventions, special education interventions and, if needed, medication use.

We've done all of that in our family with our son, Andrew. We have also tried a variety of other complementary or so-called alternative interventions. None of them have had harm, but none of them have had any impact. And medication actually did have impact on Andrew, our son.

Andrew's life is filled with dedicated clinicians, from a pediatrician to a child psychiatrist to a child psychologist to a neurologist, to a speech pathologist and to a team of educators. Without their collective support, I cannot imagine where Andrew would be today.

Andrew is making steady progress. He is dealing with his anxiety. He is dealing with his inattentiveness. He is dealing with his learning challenges.

But he has major challenges. And for those who want to dismiss the professional community, the 20,000 family members in CHADD rely on the psychiatrist and the pediatrician and the psychologist for their professional advice.

And my wife and I rely on our clinical team. And we appreciate our clinical team. And they have made a huge difference in Andrew's quality of life and his future.

So we didn't fabricate disorders in Andrew. At age 11 months, he broke his ankle, put in a cast. When the cast came off, we all -- I've had a couple of broken ankles in my life -- when the cast comes off, we all have pain and stiffness as we try to push that ankle down.

Andrew's ankle never went down. Andrew's ankle stayed in the position of the cast. And so we went to Johns Hopkins.

Andrew has some developmental challenges. And he happens to have inattentive type of ADHD.

So the multimodal treatment study of NIMH showed that 69 percent of children with ADHD have concurring disorders. So this complicates the entire picture.

Is it ADHD? Is it bipolar disorder? Is it anxiety disorder? Is it learning disabilities? Is it a reaction to allergies and mercury?

These are very complex assessments to be made in a child. And the reason we at CHADD and the 20,000 members of CHADD advocate the pediatrician and child and adolescent psychiatry guidelines, which Dr. Fassler will talk about, is they are a comprehensive assessment. It's not a 10 minute and then medication.

At age four, when teachers told us that Andrew was not paying attention in the class and was very distractible, we went to a psychiatrist. The psychiatrist recommended Ritalin. We were not prepared to do that at age four. And we said, "No, we're going to try other interventions." And we tried a whole host of other interventions.

By age seven, with all these other interventions tried, Andrew was still inattentive. He was still easily distractible. And so we tried Ritalin. Actually, it didn't even work.

And we tried Dexedrine. It didn't even work. Then we tried Adderall. And Adderall had an immediate impact on Andrew's ability to attend to his day, to use a checklist so he can organize his immediate day, whether it's getting ready for school, going to bed at night, in school.

And so parents don't rush -- some may -- but parents, the 20,000 members of CHADD don't rush in and say, "Give us medication. We just want medication."

They have functional challenges in their child in their daily life. And they want help. And they rely on the professional community. And they rely on the science.

And in our case, we took three years of reluctance to medicate. But when we medicated, we had this immediate impact that was positive.

And so the question is: should we have medicated at age four? Or should we have waited until age seven? And that's every family's decision in consultation with their doctor.

We made it and that was our decision. And Andrew had a lot of problems from age four to seven. But that's hindsight. Every family has to figure that out.

The statistics show that stimulant medication works in 25 to 90 percent of children. So if you reverse that, it doesn't work in 10 to 25 percent of children and there are going to be side effects. And you have to seriously think about that and know that.

And Ms. Weathers' point about informed consent is basic to a family. We need to know what the positive attributes of an intervention are, including medication. And we need to know the possible side effects and communicate not every four months with your doctor, communicate a couple of times a month with the doctor on dose level, side effects.

And we have that relationship in our family with our clinical team.

BURTON: Mr. Ross, would it be possible for you to sum up so we can get on with the questions and so forth?

ROSS: Yes.

BURTON: I know you have a lot that you want to tell us about. And we'll be glad to get to that.

ROSS: I've made all the major points I want to make: the importance of the science, the importance of a clinical team, the importance of comprehensiveness, the importance of the pediatricians and child and adolescent psychiatry guidelines and how complex this is because many of these children have co-occurring disorders. So I'll rest.

BURTON: Thank you, Mr. Ross.

Dr. Fassler?

FASSLER: Thank you. My name is David Fassler. I'm a board certified child and adolescent psychiatrist practicing in Burlington, Vermont. I'm a clinical associate professor in the Department of Psychiatry at the University of Vermont College of Medicine.

I currently serve as the president of the Vermont Association of Child and Adolescent Psychiatry. I'm also a trustee of the American Psychiatric Association and a member of the governing council of the American Academy of Child and Adolescent Psychiatry.

First of all, let me thank Representative Burton and the committee for the opportunity to appear here today. My testimony is on behalf of the APA and the Academy. And I'd appreciate if my written remarks are entered into the record.

The American Psychiatric Association is a medical specialty society representing over 38,000 psychiatric physicians. The American Academy of Child and Adolescent Psychiatry is a national professional association representing over 6,500 child and adolescent psychiatrists who are physicians with at least five years of specialized training after medical school, emphasizing the diagnosis and treatment of mental illness in children and adolescents.

I'm happy to be able to talk to you about the diagnosis and treatment of Attention Deficit Hyperactivity Disorder, or ADHD, and to underscore some of the comments that you have already heard.

As a psychiatrist, when I think of ADHD, I think first of the faces of children and families who I have seen over the years. I think in particular of a seven-year old boy who is about to be left back in second grade, due to his disruptive behavior.

The teachers have labeled him "difficult to control." The other kids just call him weird. He has few friends and is already convinced that he is bad and different.

And I think of a 12-year-old girl with an IQ of 130. She is not disruptive, but she is failing seventh grade. And I think of 28-year- old administrative assistant who was relieved and appreciative when he received an accurate diagnosis and appropriate treatment for his longstanding condition. But I also remember his anger and frustration because, in his words, he missed out on 20 years of his life.

As you have already heard, according to NIMH, the National Institute of Mental Health, Attention Deficit Hyperactivity Disorder, or ADHD, is the most commonly diagnosed psychiatric disorder of childhood. It's estimated to affect approximately five percent of school-age children, although published studies have identified a prevalence rate as high as 12 percent in some populations.

As you have heard, it occurs between three and four times more often in boys than in girls.

We also know that ADHD does run in families. And contrary to previous beliefs, it doesn't always go away as you grow up. In fact, the latest research indicates that as many as half of all kids with ADHD continue to have problems into adulthood.

This is actually one of the reasons we see an increase in the overall use of medication. We are now recognizing and treating more adults with ADHD.

I have brought for the committee the Diagnostic and Statistic Manual of Mental Disorders, the DSM-4, which you have heard discussed today and which is central to our understanding of the formal diagnosis of ADHD. The key features, as has been explained, include inattention, hyperactivity and impulsivity.

I want to underscore one of the other elements that Dr. Nakamura spoke about, and that's that the symptoms must be interfering in the child's life at home, at school or at work -- at work for an adult -- or with their friends, with their peers. In two of those settings, so it's not just that you're agitated or that you're active, but that it's really interfering with your life, with your ability to function in those settings.

The diagnostic criteria are quite specific and they are well established within the field. They are the product of extensive and numerous research studies conducted at academic centers and clinical facilities throughout the country. And I have brought a number of the studies, which have already been mentioned, from the AMA, the Academy of Pediatrics and the Surgeon General's Report.

In addition, we now have a substantial body of research literature about both the genetic markers and the neuroanatomical abnormalities associated with this disorder. And you started to hear about some of it, some of the MRI, the CAT scan, the PET scan studies. And I think within the next year or two, we will even be able to use some of these in a more diagnostic way.

Let me be very clear. ADHD is not an easy diagnosis to make. And it's not a diagnosis that can be made in a five- or a 10- or a 15- minute office visit.

Many other problems, including hearing and vision problems, anxiety disorders, depression, learning disabilities, toxicity with heavy metals can all present with signs and symptoms which look similar to ADHD. There is also a high degree of comorbidity, meaning that over half of the kids who have ADHD also have a second psychiatric problem.

And as we heard this morning, the diagnosis of ADHD really requires a comprehensive assessment by a trained clinician. I don't think any of us you have heard today would disagree with that.

In addition to direct observation, the evaluation includes a review of the child's developmental, social, academic history, medical history, including evaluating the child for other medical conditions, including things like hyperthyroidism, the toxicities. We really need to rule those things out.

It also should include input from the child's parents and teachers and a review of the child's records. Schools play a critical role in identifying kids who are having problems. But as you have heard already today, schools should not be making diagnoses and they should not be dictating treatment.

ADHD is also a condition which should not be taken lightly. Without proper treatment, a child with ADHD may fall behind in schoolwork, may have problems at home and with friends.

It can have long-term effects on the child's self-esteem. It can lead to other problems in adolescence, including an increased risk of substance abuse that you've heard about, increased risk of adolescent pregnancy, increased risk of accidents, including car accidents in adolescents, school failure and increased risk of trouble with the law.

The treatment of ADHD should be comprehensive and individualized to the needs of the child in the family. Medication, including methylphenidate or Ritalin, can be extremely helpful for many children.

But consistent with the opening comments from Ms. Davis, medication alone is rarely the appropriate treatment for complex child psychiatric disorders, such as ADHD. Medication should only be used as part of a comprehensive treatment plan, which will usually include individual therapy, family support and counseling and work with the schools.

In terms of methylphenidate, we have literally hundreds of studies over 30 years clearly demonstrating the effectiveness of this medication on many of the target symptoms of ADHD. As you have also heard, it is generally well tolerated by children with minimal side effects.

Nonetheless, I share the concern that some children may be placed on medication without a comprehensive evaluation and accurate and specific diagnosis or an individualized treatment plan. Let me also be very clear that I am similarly concerned about the many children with ADHD and other psychiatric disorders who would benefit from treatment -- including treatment with medication, if appropriate -- but who go unrecognized and undiagnosed and who are not receiving the help that they need.

Let me turn specifically to the question of overdiagnosis and overtreatment. Just last week, a review article written by Peter Jensen was published which addressed this issue in detail. And I have included Dr. Jensen's article in the background materials.

Dr. Jensen is currently at Columbia University. He was formerly the associate director for child and adolescent research at the National Institute of Mental Health. He reviews all of the available scientific studies on this issue.

He notes that most studies and media reports have not been based on actual diagnostic data, where people actually sat and interviewed children and reviewed records, but they have relied instead on information from an HMO or a Medicaid medication database.

Dr. Jensen and his colleagues actually performed comparative evaluations on 1,285 children in four communities -- Atlanta, New Haven, Westchester and San Juan, Puerto Rico -- to determine the prevalence of ADHD, as well as the forms of treatment utilized. The results were that 5.1 percent of children and adolescents between the ages of nine and 17 met the diagnostic criteria for ADHD. Yet, only 12.1 percent of these children, or approximately one in eight, were being treated with medication.

So the majority of children with ADHD in this carefully controlled study were not being treated with medication, suggesting that at least in these communities, medication is currently underprescribed. These authors also found eight children out of these 1,285 who were receiving medication who did not meet the full diagnostic criteria for ADHD, although they did have high levels of ADHD symptoms.

Dr. Jensen concludes -- and I would concur -- that on the basis of these results, there is no evidence of widespread overtreatment with medication. On the contrary, it appears that, at least in these communities, the majority of children with ADHD are not receiving what we would consider to be appropriate and effective treatment.

There is a second study from the Mayo Clinic in Rochester, Minnesota, which is in the background materials. In the interest of time, I will skip the details, other than to mention that in that study, of all children on medication for ADHD, only .2 percent, which is two children in 1,000, had no evidence of the disorder whatsoever.

So again, the second study, carefully conducted study, simply doesn't support the argument that ADHD is generally overdiagnosed or overtreated. This is not to say that overdiagnosis or overtreatment doesn't happen in any areas of any communities, which is why we all need to continue our collective efforts to improve public awareness and to ensure access to comprehensive assessment services and individualized treatment, using the kinds of evidence-based guidelines which you have been hearing about and which have now been developed.

BURTON: Dr. Fassler, can you summarize? We have some votes on the floor.

FASSLER: I am summarizing with my recommendations. The APA and the Academy would offer the following specific recommendations for your consideration.

First, we fully support and would underscore the importance of accurate diagnosis and treatment, which requires access to clinicians with appropriate training and expertise and sufficient time to permit a comprehensive assessment. Next, we fully support the increased emphasis of the FDA and the NIMH on research on the appropriate use of medication in the psychiatric treatment of children and adolescents. And we welcome the expanded clinical trials and the longitudinal studies, which you have been hearing about.

We also fully support the passage of comprehensive parity legislation at both the state and the federal level. We fully support and welcome all efforts to sustain and expand training programs for all child mental health professionals, including programs for child and adolescent psychiatrists.

And finally, we fully support and appreciate the efforts of the current administration, through the new Freedom Commission on Mental Health, to focus increased attention on the diagnosis and treatment of all psychiatric conditions, including those which affect children and adolescents.

In summary, let me emphasize that child psychiatric disorders, including ADHD, are very real and diagnosable illnesses, which affect lots of kids. The good news is that they are also highly treatable.

We can't cure all the kids we see. But with comprehensive, individualized intervention, we can significantly reduce the extent to which their conditions interfere with their lives. The key for parents and teachers is to identify kids with problems as early as possible and to make sure that they get the help that they need.

Thank you.

BURTON: Thank you, doctor.

Do you have a few questions you'd like to ask, real quickly? Let me -- I'd like to ask you a whole bunch of questions, but unfortunately, we've got two votes on the floor. And you've been here all day and I don't want to keep you all any longer than we have to.

We have 6 million children that are using these drugs right now. I don't know how we got through all this when I was younger, but we did. And the society did fairly well.

Did you find any mercury in your son's blood work?

ROSS: No. We were hoping to find some toxic element so that we could have a simple explanation for the fact that he was having seizures and that he had a hypotonia and a lot of problems. No, we did not find...

BURTON: Found no mercury?

ROSS: No.

BURTON: Had he had all of this childhood vaccines?

ROSS: Yes. We contracted with our pediatrician two months before we delivered Andrew. And he has had the same pediatrician and...

BURTON: So he had all of his childhood vaccinations.

ROSS: He had all his childhood vaccinations. Now he was tested when he was two and three. And he has subsequent vaccinations.

BURTON: But the thing is, I wonder if you could contact your pediatrician and find out the lot numbers of those vaccinations. I would just be curious, I would like to see those, because mercury has been in these childhood vaccinations for 30, 40 years. And if he got a number of these vaccinations, as my grandson did, it's hard for me to believe that he didn't get some mercury injected into him.

ROSS: Well, what the doctor would have told me is not there wasn't some, is if it was abnormal. We were told there was not abnormal levels of mercury, lead and a whole bunch of things.

I don't know. I didn't see the result and I'm not a physician.

BURTON: I think most parents who have had these shots given to their children and who have autistic children would really argue with what is an acceptable level of mercury in the body. That's a subjective thing and it may vary from person to person.

So that's something that I'm sure would be debated.

You agree, Dr. Fassler, that there ought to be a thorough analysis of a child before they go on medication?

FASSLER: Yes. My bottom line would be that kids need a comprehensive evaluation before there is any treatment plan in place and that parents need to be advocates for kids to try and make sure that...

BURTON: I don't think anybody disagrees with that.

FASSLER: Right.

BURTON: And your organization also agrees with that?

ROSS: Yes. Every child should have a complete, comprehensive examination.

BURTON: Why is it then that around the country, we have school corporations that have this checklist where a teacher checks off the problems with a child, the child is taken to a doctor and it's a perfunctory thing for the doctor to say, "Well, it appears as though he needs Ritalin." And they write out a prescription for that.

That's not a thorough examination.

(UNKNOWN): And that's not what either of us or any of us who you have heard would support. There are checklists where teachers report what they're seeing in the classroom. But there shouldn't be a diagnosis made just on the basis of reviewing that checklist.

BURTON: My grandson never had a complete psychological analysis. He became autistic, as I said, right after getting all these shots. And yet, the school recommended, because he was difficult -- he was in a special ed class -- that he should be put on Ritalin. And they had a doctor also subscribe to that.

Of course, he wasn't put on Ritalin. We didn't allow that. And he seems to be doing all right on other ways that we're dealing with him.

But the fact of the matter is, in my own personal experience, that was the case: recommendation by the teacher and the doctor went along with that. How do we educate our educators around the country to understand that this has to be something that's done in a very thorough manner before you start putting these kids on these drugs?

(UNKNOWN): I think it's an excellent point. And I think collectively we need to work on getting that message to the schools. And part of it is our job, going into the schools, teaching teachers about the kinds of things to look for and when kids should be referred.

I think we need to do a better job at recognizing the signs and symptoms earlier and, you know, getting help for kids before they have major problems. Because often, you know, we all wait too late. And we may see things in adolescence that we may have been able to help with earlier in life.

BURTON: Let me just say that I hope you and CHADD and our health agencies will figure out some way -- I know how much time is left -- our health agencies will figure out a way to make sure that every school corporation, every superintendent of public instruction in all 50 states understand that there should be a thorough analysis before they put these kids on these drugs. If you would do that, I think you would eliminate a lot of the problems.

The other thing is I hope you'll agree that we shouldn't be introducing mercury or other toxic substances into people's bodies, whether they're kids or adults. And if we could get that point across, we might solve a lot of these problems.

I have a lot of questions I would like to submit to you for the record, Dr. Fassler and Mr. Ross.

I would also like to end by saying, Mr. Ross, we had what was called the "Keating Five" here in Washington. We had five senators that met with Mr. Keating on the savings and loan crisis.

And I don't believe any of those senators really intentionally did anything wrong. But the appearance of impropriety was very great and they got a heck of a lot of bad publicity when the savings and loan debacle took place.

And for you to get hundreds of thousands of dollars from Novartis, which manufactures Ritalin and your organization does advocate that children should use that, it gives the appearance of...

ROSS: We do not advocate any one drug. We advocate a multimodal treatment, which may include medication and...

BURTON: I understand.

ROSS: And the products are never discussed.

BURTON: Regardless, I understand. But the appearance is that they're feeding you to deal with this problem in that way. And I would just suggest, if there is a better way to fund your organization, even if it's only 18 percent, it would be helpful. Because if you was in the United States Senate or the House and that happened, you would have a heck of a problem.

With that, let me just say to you I really appreciate your being here. We will submit questions for the record. And we appreciate your response.

Thank you very much.

We are adjourned.

END

NOTES:
[????] - Indicates Speaker Unknown
   [--] - Indicates could not make out what was being said.[off mike] - Indicates could not make out what was being said.

PERSON:  DAN L BURTON (94%); BENJAMIN A GILMAN (57%); CHRISTOPHER SHAYS (57%); CONSTANCE MORELLA (57%); ILEANA ROS-LEHTINEN (56%); JOHN MICHAEL MCHUGH (56%); CHRIS JOHN (55%); THOMAS M DAVIS (55%); JOE SCARBOROUGH (54%); MARK E SOUDER (54%); STEVEN C LATOURETTE (54%); DAN MILLER (53%); JO ANN DAVIS (52%); TODD PLATTS (51%); ADAM PUTNAM (50%); 

LOAD-DATE: October 5, 2002