In his own words
by Barry Blackwell
On January 26, 2017, five months before his death, I spoke with Keith Connors for more than 30 minutes to obtain his general views on Alan Shwartz’s book ADHD Nation, as well as his specific opinions concerning the overall field of ADHD, the role played by Paul Wender and manner in which this is portrayed by Swartz.
At the time of my interview Keith was an inpatient on a cardiac care unit where he had been hospitalized for almost two weeks. He was quite lucid and thoughtful and gave permission to cite his opinions as a personal communication. I indicated that if this were to occur I would share any material prior to posting on INHN.org. We did this and he approved of what follows.
I was surprised to learn that Keith Conners had become a close confidant of Alan Shwartz, had not only provided much of the material in the book, but had been instrumental in persuading Shwartz to write it. He expressed admiration for the author’s statistical skills and decision to leave journalism to become a high school math teacher.
At the same time Keith gave a fair-minded appraisal of the book noting that Schwartz had adopted a tone and theme that earned a Pulitzer Prize nomination. It is structured like a novel, (almost a detective story), in which Keith is a sympathetic lead character and Paul Wender is portrayed as a foil and “firebrand.”
With regard to the whole ADHD controversy Keith saw it as an “eye of the beholder” phenomenon in which folks could view the same data differently and even the same person might “flip images.” Keith saw himself as starting as a “true believer,” originally a Big Pharma KOL, who eventually realized he had made a terrible mistake in what had become a tragedy for the profession. Paul Wender’s role had been more nuanced but less volatile. Like Keith, he began as a true believer and remained one, far too much an independent thinker to become a KOL, whose research was funded more by NIMH than industry.
Keith believed Paul felt that the pharmaceutical industry had made skilled use of complicit academic psychiatrists in inflating the prevalence of ADHD and use of stimulants in children, including memberships in associations promoting increased drug usage.
In Paul’s involvement with the 1980 revision of DSM III he was ahead of his time in noting the different ADHD symptom profiles between genders with the virtual absence of hyperactivity in girls. Another major contribution was Paul’s advocacy for extending the ADHD diagnosis to adults. Keith regarded Paul as a brilliant and innovative clinician with a sharp wit and provocative style whose valid clinical observations were categorized by Shwartz as designed to inflate usage of stimulants. At the same time Keith agreed with Shwartz that the DSM criteria might contribute to inflating the prevalence of ADHD by advocating a “stripped down” version of the Conner’s Scale using duplicative symptom criteria.
Keith also felt that industry had developed its own poorly validated and corrupt rating scales used by KOLs and pharma reps to train primary care providers in the presumptive diagnosis of ADHD and use of stimulants.
Paul Wender’s other major but still controversial contribution was his advocacy for extending ADHD diagnosis to adults. The epidemiologic evidence for an inflated prevalence of ADHD diagnosis and use of stimulants in children (particularly boys) is convincing in some sub-populations but its presence, symptomatology and response to treatment in adults is still not well defined. However, research in New Zealand has recently confirmed that in up to a third of children with ADHD symptoms persist as adults, with a reduction in over activity but persistence of internal restlessness. A type of adult onset ADHD clearly occurs and can persist into the 80s but response to stimulants is more variable. Keith notes this adult ADHD population may be double in size to childhood forms creating a large, lucrative and appealing target for industry abetted by KOLs and new rating scales.
ADHD Nation was published in 2016 and Paul Wender died of a heart attack in July. Keith did not know if he knew or not of the book’s existence and the unjust role Schwartz assigned him.
Keith died at age 84 on July 5th, 2017 (my own 83rd birthday). Shortly before his death he collaborated with Allen Frances and Bernie Carroll who helped him write his own Obituary for the British Medical Journal, a final warning about the over diagnosis of ADHD and inappropriate over prescribing of stimulant drugs engineered by the pharmaceutical companies abetted by compliant academic psychiatrists bribed to be Key Opinion Leaders (KOL’s).
November 30, 2017