Big Pharma
This drug is the ‘breakthrough of the year’ — and it could mean the end of the HIV epidemic
For decades, the global fight against HIV has been a complex journey of scientific innovation and societal challenges. Despite remarkable strides, millions of new infections are reported each year, keeping the epidemic far from eradication. But what if there was a single breakthrough that could shift the narrative—a solution so effective that it could redefine prevention on a global scale?
A new drug has emerged, capturing the attention of scientists and advocacy groups alike for its potential to revolutionize HIV prevention. Its promise has been hailed as a turning point, raising the question: Could this be the key to finally ending the epidemic?
How Lenacapavir Works
Lenacapavir represents a novel class of HIV treatment known as capsid inhibitors, targeting the virus’s protective shell—the capsid protein. By binding directly to the interface between HIV-1 viral capsid protein (p24) subunits in capsid hexamers, lenacapavir interferes with essential steps of viral replication. This interference includes capsid-mediated nuclear uptake of HIV-1 proviral DNA, virus assembly and release, production of capsid protein subunits, and capsid core formation.
This mechanism disrupts the virus’s life cycle at multiple stages:
- Inhibition of Nuclear Import: By stabilizing the capsid structure, lenacapavir prevents the disassembly required for the viral DNA to enter the host cell’s nucleus, thereby blocking integration into the host genome.
- Disruption of Viral Assembly: Lenacapavir interferes with the proper formation of new viral particles, leading to the production of defective viruses incapable of infecting new cells.
The development of lenacapavir was informed by detailed structural studies of the HIV capsid, which revealed potential sites for therapeutic intervention. By targeting these sites, lenacapavir offers a potent means to suppress HIV replication, providing a promising option for both treatment-experienced patients and those seeking pre-exposure prophylaxis (PrEP).
As noted in a 2024 article by Science, “Lenacapavir interacts with the capsid proteins that form a protective cone around the viral RNA,” effectively disrupting the virus’s ability to replicate.
Clinical Trial Success
Lenacapavir has demonstrated remarkable efficacy in preventing HIV infections across diverse populations through pivotal clinical trials.
PURPOSE 1 Trial
The Phase 3 PURPOSE 1 trial evaluated lenacapavir’s effectiveness as a pre-exposure prophylaxis (PrEP) among cisgender women in sub-Saharan Africa. The interim analysis revealed zero HIV infections among participants receiving lenacapavir, indicating 100% efficacy. This led to the trial’s early unblinding due to meeting key efficacy endpoints.
PURPOSE 2 Trial
PURPOSE 2, another Phase 3 trial, assessed lenacapavir’s efficacy among cisgender men, transgender men, transgender women, and gender non-binary individuals who have sex with partners assigned male at birth. Conducted across multiple countries, including Argentina, Brazil, Mexico, Peru, South Africa, Thailand, and the United States, the trial reported a 96% reduction in HIV infections compared to background incidence. Specifically, there were only two incident cases among 2,180 participants, corresponding to 99.9% of participants not acquiring HIV infection in the lenacapavir group.
Superiority to Daily PrEP
In both trials, lenacapavir demonstrated superiority to daily oral PrEP options, such as Truvada. The convenience of a twice-yearly injection addresses adherence challenges associated with daily medications, potentially enhancing real-world effectiveness.
Advantages Over Daily PrEP
Lenacapavir offers significant benefits compared to traditional daily pre-exposure prophylaxis (PrEP) methods, addressing key challenges in HIV prevention.
Daily oral PrEP requires consistent daily intake, which can be hindered by factors such as forgetfulness, stigma, and lifestyle constraints. Lenacapavir, administered via a subcutaneous injection every six months, simplifies adherence by reducing dosing frequency. In the PURPOSE 2 trial, 91% of participants received timely injections, indicating high adherence levels.
Clinical trials have demonstrated lenacapavir’s superior efficacy over daily oral PrEP. The PURPOSE 2 study reported a 96% reduction in HIV infections among participants receiving lenacapavir compared to those on daily oral PrEP.
Daily PrEP pills can be associated with stigma, as their use may inadvertently disclose one’s HIV prevention efforts. Lenacapavir’s biannual injection offers a more discreet option, potentially reducing stigma and increasing acceptance among users.
The biannual administration of lenacapavir alleviates the daily burden of pill-taking, enhancing convenience for users. This is particularly beneficial for individuals with busy lifestyles or those who struggle with daily medication routines.
Global Impact Potential
Lenacapavir’s introduction marks a significant advancement in global HIV prevention efforts, particularly for high-risk populations. Its biannual injection schedule offers a practical and effective alternative to daily oral pre-exposure prophylaxis (PrEP), which has faced adherence challenges. The World Health Organization (WHO) acknowledges that lenacapavir can expand the toolkit for global HIV prevention, especially in regions with high HIV incidence.
The drug’s efficacy has been demonstrated in diverse populations. In the PURPOSE 1 trial, lenacapavir was 100% effective in preventing HIV among cisgender women in sub-Saharan Africa. Similarly, the PURPOSE 2 trial reported a 96% reduction in HIV infections among cisgender men, transgender men, transgender women, and gender non-binary individuals who have sex with partners assigned male at birth.
However, the global impact of lenacapavir will depend on its accessibility and affordability. Gilead Sciences, the manufacturer, has not yet announced a price for lenacapavir as a prevention method. As an HIV treatment in the United States, its cost was $42,250 per patient per year in 2023, whereas oral PrEP drugs can cost less than $4 a month.
To address these concerns, initiatives are underway to expand access. The Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) have announced plans to reach two million people with lenacapavir, contingent upon regulatory approvals.
The Cost Barrier
While lenacapavir presents a promising advancement in HIV prevention, its current pricing poses significant challenges to widespread accessibility, particularly in low- and middle-income countries.
In the United States, lenacapavir is approved for treating multi-drug-resistant HIV, with an annual cost exceeding $40,000 per patient.
Such high costs render lenacapavir inaccessible in regions with limited healthcare budgets. For instance, in countries like Uganda, where the annual healthcare expenditure per person is approximately $12, the current price of lenacapavir is prohibitively expensive.
Research indicates that lenacapavir could be mass-produced at a significantly lower cost. Studies suggest that, with economies of scale and generic manufacturing, the drug could be produced for as little as $41 to $94 per person per year.
To address these cost barriers, Gilead Sciences has entered into royalty-free licensing agreements with six generic manufacturers to produce and distribute lenacapavir in 120 low- and lower-middle-income countries. This initiative aims to enhance affordability and accessibility in regions heavily impacted by HIV.
Future Steps and Challenges
Lenacapavir’s journey from clinical trials to a globally accessible HIV prevention method involves several critical steps and potential obstacles.
- Regulatory Approvals: Gilead Sciences plans to submit data from the PURPOSE 1 and PURPOSE 2 trials to regulatory agencies worldwide, aiming for approvals that would authorize lenacapavir for HIV prevention across diverse populations. These submissions are expected to commence by the end of 2024.
- Manufacturing and Distribution: The production of lenacapavir, particularly its injectable form, is complex. Gilead has partnered with six generic manufacturers experienced in producing high-quality generic medicines for HIV and other infectious diseases to ensure efficient manufacturing and distribution.
- Healthcare Infrastructure: Administering lenacapavir requires healthcare systems capable of delivering biannual injections and maintaining patient follow-up. In resource-limited settings, strengthening healthcare infrastructure is essential to support the effective delivery of this preventive treatment.
- Community Engagement and Education: Addressing potential stigma and ensuring community acceptance are vital. Comprehensive education campaigns are necessary to inform communities about lenacapavir’s benefits and to encourage uptake among those at risk.
A Path Forward in the Fight Against HIV
The emergence of lenacapavir marks a pivotal moment in the global effort to combat HIV. Its groundbreaking efficacy, simplified administration, and potential to overcome the barriers of traditional prevention methods make it a beacon of hope for millions worldwide. However, the journey toward eradicating HIV is far from over.
Achieving widespread impact requires a collective effort to address the challenges of cost, accessibility, and infrastructure. Governments, advocacy groups, and healthcare providers must collaborate to ensure this innovative drug reaches the populations that need it most. Community education will also play a critical role in overcoming stigma and fostering trust in lenacapavir as a revolutionary prevention method.
While lenacapavir may not single-handedly end the HIV epidemic, it represents a transformative step forward. By significantly reducing new infections and offering a more convenient prevention option, it brings us closer to a world where HIV/AIDS no longer devastates communities. The success of lenacapavir could redefine the future of HIV prevention, offering hope for a healthier, more equitable tomorrow.
Big Pharma
New York Hospital Charges A Young Woman $40 For Crying During Her Visit
The cost of healthcare in the United States has always been a hot-button issue, but every so often, a story emerges that leaves people questioning the boundaries of reason. One such story recently went viral, involving a young woman who was charged for something so seemingly ordinary that it shocked thousands online. This unexpected fee wasn’t for a test, a procedure, or even a consultation—it was for an emotional response. As the details unfolded, it became clear that this wasn’t just an isolated case but a window into the broader complexities and frustrations of navigating the American healthcare system.
The $40 Charge: What Happened?
In early 2022, Camille Johnson, a 25-year-old content creator from Brooklyn, New York, shared a startling experience involving her younger sister’s medical visit. Her sister, who had been grappling with a rare health condition, finally secured a doctor’s appointment. Overwhelmed by the situation, she shed a tear during the consultation. Later, when reviewing the itemized medical bill, they discovered a $40 charge labeled as a “brief emotional/behavioral assessment.” Camille expressed her frustration on Twitter, stating, “One tear in and they charged her $40 without addressing why she is crying, trying to help, doing any evaluation, any prescription, nothing.”
This incident is not isolated. A 2020 study published in JAMA found that 1 in 5 insured adults in the U.S. received an unexpected medical bill from an out-of-network provider in the past two years.
The public reaction to Camille’s tweet was swift and widespread, with many sharing similar experiences of unexpected medical charges. One user recounted being billed $1,902 for a pregnancy test labeled as “Women’s services,” while another mentioned a $44 fee for “skin to skin contact” after childbirth.
Understanding Emotional/Behavioral Assessments
The $40 charge labeled as a “brief emotional/behavioral assessment” on Camille Johnson’s sister’s medical bill corresponds to CPT code 96127. This code is defined as a brief emotional or behavioral assessment using standardized instruments, including scoring and documentation. It’s commonly used for screenings related to depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and substance abuse.
The implementation of CPT code 96127 aligns with the Affordable Care Act (ACA), which mandates that mental health services be included as essential benefits in all insurance plans. This initiative aims to ensure that mental health screenings are a routine part of medical care, promoting early detection and intervention for mental health conditions.
However, in the case of Johnson’s sister, the application of this code appears to have been misused. According to Johnson, her sister was not evaluated for any mental health conditions during the visit. She stated, “They did not evaluate her for depression or other mental illnesses, nor did they discuss her mental health with her.” This discrepancy highlights a potential issue where the code may be applied without the corresponding service being provided, leading to unexpected charges for patients.
A study published in the Journal of Behavioral Health Services & Research emphasizes that while the ACA has expanded coverage for mental health services, the consistent and appropriate application of these services remains a challenge. Ensuring that patients receive the assessments they’re billed for is crucial for maintaining trust in the healthcare system.
The Broader Issue: Healthcare Transparency
A significant factor contributing to this opacity is the use of chargemasters—comprehensive lists of billable services and their prices maintained by healthcare providers. These lists are typically not disclosed to patients, leading to confusion and mistrust when unexpected charges appear on medical bills. As noted in a New Yorker article, the complexity and secrecy surrounding chargemasters have been criticized for contributing to the high costs of healthcare.
The lack of transparency in medical billing has tangible consequences. A study published in the Journal of Medical Internet Research found that despite mandates for hospitals to publish pricing information, the data is often presented in formats that are not user-friendly, hindering patients’ ability to make informed decisions about their care.
The implications of opaque billing practices are profound. Patients may delay or forgo necessary medical care due to fear of unforeseen costs, potentially leading to worsened health outcomes. Moreover, unexpected medical bills can contribute to financial strain, with medical debt being a leading cause of bankruptcy in the United States.
Addressing these challenges requires systemic changes to promote transparency and rebuild trust between patients and healthcare providers. Implementing clear, accessible billing practices and ensuring patients are informed about potential costs upfront are essential steps toward a more equitable healthcare system.
The Public Reaction and Online Debate
The public reaction to Camille Johnson’s revelation about her sister being charged $40 for crying during a doctor’s appointment was swift and widespread. Many individuals shared their own experiences with unexpected medical charges, highlighting systemic issues within the U.S. healthcare system.
One Twitter user recounted, “I got charged over $2,000 for an emergency room trip for a nosebleed that wouldn’t stop. I had to wait so long, the nurse moved me into a room because I was bleeding all over the waiting room. Doc never saw me; it stopped bleeding before he arrived.”
Another individual shared, “My daughter was charged $44 for ‘skin-to-skin contact.’ In other words, when they flopped my grandson up onto her chest after the umbilical cord was cut. I guess the cheaper alternative was letting him fall on the floor?”
These personal accounts resonated with many, prompting discussions about the transparency and ethics of medical billing practices. The collective outrage underscored a growing demand for systemic reforms to address the financial burdens imposed on patients.
In response to the widespread attention, Camille Johnson emphasized the need for change, stating, “We need a drastic change in the healthcare industry, and I thought that sharing a real-life story online would be a good way to open up the conversation and help advocate for change.”
The online debate highlighted a pervasive sentiment: that the commodification of basic human experiences within the healthcare system is both ethically questionable and indicative of deeper systemic issues. As one commenter aptly put it, “Tell me you live in America without telling me that you live in America.”
Tips for Navigating Medical Bills
Navigating medical bills can be daunting, especially when unexpected charges arise. Here are some practical steps to help manage and potentially dispute such bills:
- Request an Itemized Bill: Always ask for a detailed breakdown of charges. This allows you to identify any discrepancies or unexpected fees, such as the $40 charge for a “brief emotional/behavioral assessment” in Camille Johnson’s sister’s case.
- Review Bills for Errors: Billing errors are not uncommon. Common mistakes include double billing, upcoding, or charges for services not rendered. A study in JAMA Health Forum highlights that self-advocacy in identifying and correcting these errors can lead to financial relief.
- Understand Your Insurance Coverage: Familiarize yourself with your insurance policy to know what services are covered and to what extent. This knowledge can help you spot charges that should have been covered by your insurer.
- Communicate with Healthcare Providers: If you identify an unexpected charge, contact the billing department of the healthcare provider. A respectful and clear inquiry can often resolve misunderstandings or errors. As noted by Patient Fairness, preparing and sending a letter of dispute promptly can obligate the provider to address your concerns.
- Negotiate Bills: Don’t hesitate to negotiate medical bills. Many providers offer discounts for prompt payment or can set up interest-free payment plans to ease financial strain.
- Seek Financial Assistance: Hospitals and clinics often have financial assistance programs for patients facing financial hardships. Inquire about eligibility to reduce your medical expenses.
- Document All Communications: Keep detailed records of all interactions with healthcare providers and insurance companies, including dates, names of representatives, and summaries of discussions. This documentation can be crucial if disputes escalate.
- Consult a Patient Advocate: If the process becomes overwhelming, consider seeking help from a patient advocate. They can assist in understanding bills, disputing charges, and negotiating with providers. Patient advocates can improve health outcomes and prevent errors by facilitating communication between patients and healthcare providers.
- Be Aware of Legal Protections: Familiarize yourself with laws designed to protect patients from unfair billing practices, such as the No Surprises Act, which aims to prevent unexpected medical bills.
- Stay Informed and Proactive: Regularly review medical statements and Explanation of Benefits (EOBs) from your insurer. Prompt attention to discrepancies can prevent minor issues from becoming significant financial burdens.
A Call for Compassion in Healthcare
The story of Camille Johnson’s sister being charged $40 for crying during a medical visit has become a symbol of the broader issues plaguing the American healthcare system. From a lack of transparency in billing practices to unexpected fees that exacerbate financial and emotional burdens, the challenges patients face are undeniable.
At its core, healthcare should prioritize empathy and patient well-being. The commodification of basic human experiences, such as an emotional response, highlights the urgent need for systemic reforms. Greater transparency, clear communication, and ethical billing practices are essential steps toward restoring trust and dignity in healthcare.
As public outrage over stories like these grows, it’s clear that change is possible, but it requires collective action. Patients, advocates, and policymakers must work together to ensure that the healthcare system reflects its ultimate purpose: to heal, support, and care for those in need, without undue financial strain or unnecessary distress. This story serves as a reminder that every voice counts in the fight for a more compassionate and transparent system.
Opinion
The ADHD Over-Diagnosis Epidemic Is a Schooling Problem, Not a Child One
(FEE) Opinion – Childhood exuberance is now a liability. Behaviors that were once accepted as normal, even if mildly irritating to adults, are increasingly viewed as unacceptable and cause for medical intervention. High energy, lack of impulse control, inability to sit still and listen, lack of organizational skills, fidgeting, talking incessantly—these typical childhood qualities were widely tolerated until relatively recently. Today, children with these characteristics are being diagnosed with, and often medicated for, Attention-Deficit/Hyperactivity Disorder (ADHD) at an astonishing rate.
The ADHD Medical Dragnet
While ADHD may be a real and debilitating ailment for some, the startling upsurge in school-age children being labeled with and medicated for this disorder suggests that something else could be to blame. More research points to schooling, particularly early schooling, as a primary culprit in the ADHD diagnosis epidemic.
Over the last several decades, young people are spending more time in school and school-like activities than ever before. They are playing less and expected to do more at very young ages. When many of us were kids, kindergarten was mellow, playful, and short with few academic expectations.
Now, 80 percent of teachers expect children to learn to read in kindergarten. It’s not the teachers’ fault. They are responding to national curriculum frameworks and standardized testing requirements that over the past two decades have made schooling more oppressive—particularly for young children.
The youngest children are the ones most often caught in the ADHD medical dragnet. Last fall, Harvard researchers found that early school enrollment was linked to significantly higher rates of ADHD diagnosis. In states with a September 1 school enrollment age cutoff, children who entered school after just turning five in August were 30 percent more likely to be diagnosed with ADHD than children born in September who were about to turn six. Immaturity, not pathology, was the real factor.
The ADHD Fallacy
Marilyn Wedge, author of A Disease Called Childhood: Why ADHD Became An American Epidemic, sounds the alarm on ADHD over-diagnosis. In a Time Magazine article called “The ADHD Fallacy,” she writes:
By nature, young children have a lot of energy. They are impulsive, physically active, have trouble sitting still, and don’t pay attention for very long. Their natural curiosity leads them to blurt out questions, oblivious in their excitement to interrupting others. Yet we expect five- and six-year-old children to sit still and pay attention in classrooms and contain their curiosity. If they don’t, we are quick to diagnose them with ADHD.
According to the US Centers for Disease Control and Prevention (CDC), the percent of very young children (ages two to five) who were diagnosed with ADHD increased by over 50 percent between 2007/2008 and 2011/2012. As of 2016, data show that 9.4 percent of all American children, or over six million kids, had been diagnosed with ADHD, and almost two-thirds of current ADHD-diagnosed children were taking medication for it. A March 2019 report on ADHD by Blue Cross and Blue Shield found that among commercially insured children of all ages, ADHD diagnosis rates increased 30 percent in just eight years.
While the symptoms of ADHD may be troublesome, looking first at the environment, rather than the child, may be an important step toward curbing the ADHD diagnosis epidemic. In his book, ADHD Does Not Exist, Dr. Richard Saul, a Chicago behavioral neurologist, explains that individuals diagnosed with ADHD either have external factors that exacerbate normal symptoms or have some other underlying condition that should be identified and treated. In the latter instance, he finds that once the underlying condition is discovered and treated, the ADHD symptoms usually disappear. In the former instance, changing the environment is a key step toward improvement. This is true for both children and adults with an ADHD diagnosis. Dr. Saul writes:
Like many children who act out because they are not challenged enough in the classroom, adults whose jobs or class work are not personally fulfilling or who don’t engage in a meaningful hobby will understandably become bored, depressed and distracted. In addition, today’s rising standards are pressuring children and adults to perform better and longer at school and at work.
An Environmental Mismatch
Addressing an environmental mismatch for ADHD-diagnosed adults could mean switching one’s job or field of study or pursuing a true passion. Maybe you’re an accountant who wants to be a carpenter or a nurse who wants to be an entrepreneur. For ADHD children, changing the environment could mean removing children from restrictive schooling altogether. As Boston College psychology professor Peter Gray writes:
What does it mean to have ADHD? Basically, it means failure to adapt to the conditions of standard schooling. Most diagnoses of ADHD originate with teachers’ observations.
Jennifer Walenski saw firsthand how transformative removing her ADHD-diagnosed child from standard schooling could be. She shares her family’s journey at The Bus Story and told me:
Our kids were actually in public school originally. Our son also was diagnosed with both ADHD and autism while he was in the school system. And they wanted to medicate him. But we said no. Then we took him and his sister out of school and began homeschooling them. Fast forward several years, he has absolutely no need at all for medication. He is just a normal boy who did not belong in that kind of environment. And most of us don’t. Think about it.
Walenski’s experience echoes that of other parents who removed their ADHD-diagnosed children from standard schooling. In an informal survey analysis, Gray discovered that when ADHD-labeled children left school for homeschooling, most of them no longer needed medication for ADHD symptoms. Their ADHD characteristics often remained but were no longer problematic outside of the conventional classroom.
Self-Directed Learning
Gray’s analysis also revealed that the ADHD-labeled young people who fared best outside of standard schooling were those who were able to learn in a more self-directed way. He found that the
few kids in this sample who were still on ADHD medications during homeschooling seemed to be primarily those whose homeschooling was structured by the parent and modeled after the education one would receive in a conventional school.
Replicating school-at-home can also replicate the problematic behaviors found at school, whereas moving toward unschooling, or self-directed education, can give young people the freedom to flourish.
Ending the ADHD overdiagnosis epidemic depends on a societal reality check where we no longer pathologize normal childhood behaviors. Much ADHD-labeling originates from forced schooling environments with learning and behavioral expectations that are developmentally inappropriate for many children. Freeing young people from restrictive schooling and allowing them to learn and grow through their own self-directed curiosity can lead to happier and healthier families and children.
Kerry Mcdonald, FEE, Used with Permission.
Awareness
The ADHD Overdiagnosis Epidemic: What You Need to Know
(FEE) — Childhood exuberance is now a liability. Behaviors that were once accepted as normal, even if mildly irritating to adults, are increasingly viewed as unacceptable and cause for medical intervention. High energy, lack of impulse control, inability to sit still and listen, lack of organizational skills, fidgeting, talking incessantly—these typical childhood qualities were widely tolerated until relatively recently. Today, children with these characteristics are being diagnosed with, and often medicated for, Attention-Deficit/Hyperactivity Disorder (ADHD) at an astonishing rate.
The ADHD Medical Dragnet
While ADHD may be a real and debilitating ailment for some, the startling upsurge in school-age children being labeled with and medicated for this disorder suggests that something else could be to blame. More research points to schooling, particularly early schooling, as a primary culprit in the ADHD diagnosis epidemic.
Over the last several decades, young people are spending more time in school and school-like activities than ever before. They are playing less and expected to do more at very young ages. When many of us were kids, kindergarten was mellow, playful, and short with few academic expectations. Now, 80 percent of teachers expectchildren to learn to read in kindergarten. It’s not the teachers’ fault. They are responding to national curriculum frameworks and standardized testing requirements that over the past two decades have made schooling more oppressive—particularly for young children.
The youngest children are the ones most often caught in the ADHD medical dragnet. Last fall, Harvard researchers found that early school enrollment was linked to significantly higher rates of ADHD diagnosis. In states with a September 1 school enrollment age cutoff, children who entered school after just turning five in August were 30 percent more likely to be diagnosed with ADHD than children born in September who were about to turn six. Immaturity, not pathology, was the real factor.
The ADHD Fallacy
Marilyn Wedge, author of A Disease Called Childhood: Why ADHD Became An American Epidemic, sounds the alarm on ADHD overdiagnosis. In a Time Magazine article called “The ADHD Fallacy,” she writes:
By nature, young children have a lot of energy. They are impulsive, physically active, have trouble sitting still, and don’t pay attention for very long. Their natural curiosity leads them to blurt out questions, oblivious in their excitement to interrupting others. Yet we expect five- and six-year-old children to sit still and pay attention in classrooms and contain their curiosity. If they don’t, we are quick to diagnose them with ADHD.
According to the US Centers for Disease Control and Prevention (CDC), the percent of very young children (ages two to five) who were diagnosed with ADHD increased by over 50 percent between 2007/2008 and 2011/2012. As of 2016, data show that 9.4 percent of all American children, or over six million kids, had been diagnosed with ADHD, and almost two-thirds of current ADHD-diagnosed children were taking medication for it. A March 2019 report on ADHD by Blue Cross and Blue Shield found that among commercially insured children of all ages, ADHD diagnosis rates increased 30 percent in just eight years.
While the symptoms of ADHD may be troublesome, looking first at the environment, rather than the child, may be an important step toward curbing the ADHD diagnosis epidemic. In his book, ADHD Does Not Exist, Dr. Richard Saul, a Chicago behavioral neurologist, explains that individuals diagnosed with ADHD either have external factors that exacerbate normal symptoms or have some other underlying condition that should be identified and treated. In the latter instance, he finds that once the underlying condition is discovered and treated, the ADHD symptoms usually disappear. In the former instance, changing the environment is a key step toward improvement. This is true for both children and adults with an ADHD diagnosis. Dr. Saul writes:
Like many children who act out because they are not challenged enough in the classroom, adults whose jobs or class work are not personally fulfilling or who don’t engage in a meaningful hobby will understandably become bored, depressed and distracted. In addition, today’s rising standards are pressuring children and adults to perform better and longer at school and at work.
An Environmental Mismatch
Addressing an environmental mismatch for ADHD-diagnosed adults could mean switching one’s job or field of study or pursuing a true passion. Maybe you’re an accountant who wants to be a carpenter or a nurse who wants to be an entrepreneur. For ADHD children, changing the environment could mean removing children from restrictive schooling altogether. As Boston College psychology professor Peter Gray writes:
What does it mean to have ADHD? Basically, it means failure to adapt to the conditions of standard schooling. Most diagnoses of ADHD originate with teachers’ observations.
Jennifer Walenski saw firsthand how transformative removing her ADHD-diagnosed child from standard schooling could be. She shares her family’s journey at The Bus Story and told me:
Our kids were actually in public school originally. Our son also was diagnosed with both ADHD and autism while he was in the school system. And they wanted to medicate him. But we said no. Then we took him and his sister out of school and began homeschooling them. Fast forward several years, he has absolutely no need at all for medication. He is just a normal boy who did not belong in that kind of environment. And most of us don’t. Think about it.
Walenski’s experience echoes that of other parents who removed their ADHD-diagnosed children from standard schooling. In an informal survey analysis, Gray discovered that when ADHD-labeled children left school for homeschooling, most of them no longer needed medication for ADHD symptoms. Their ADHD characteristics often remained but were no longer problematic outside of the conventional classroom.
Self-Directed Learning
Gray’s analysis also revealed that the ADHD-labeled young people who fared best outside of standard schooling were those who were able to learn in a more self-directed way. He found that the
few kids in this sample who were still on ADHD medications during homeschooling seemed to be primarily those whose homeschooling was structured by the parent and modeled after the education one would receive in a conventional school.
Replicating school-at-home can also replicate the problematic behaviors found at school, whereas moving toward unschooling, or self-directed education, can give young people the freedom to flourish.
Ending the ADHD overdiagnosis epidemic depends on a societal reality check where we no longer pathologize normal childhood behaviors. Much ADHD-labeling originates from forced schooling environments with learning and behavioral expectations that are developmentally inappropriate for many children. Freeing young people from restrictive schooling and allowing them to learn and grow through their own self-directed curiosity can lead to happier and healthier families and children.
By Kerry McDonald | FEE.org
The views in this article may not reflect editorial policy of The Mind Unleashed.
Big Pharma
Feeling Intense Emotions like Depression Doesn’t Necessarily Mean You’re Crazy, It Means You’re Human.
“The thing about people who are truly and malignantly crazy: their real genius is for making the people around them think they themselves are crazy. In military science this is called Psy-Ops, for your info.” –David Foster Wallace, ‘Infinite Jest’
When we utilize critical thinking and question whether what society tells us is true or not, we are called “paranoid.” When a major tragedy strikes, we are conditioned to automatically accept what authority figures and the media tell us without question, lest we wish to be cast into the tainted demographic of society known as “conspiracy theorists” –basically, a manipulation of the term “free-thinkers,” insinuating a person’s open mind is instead a psychologically deranged prison. When we feel sad, we put on brave faces like we were taught to do; and we certainly do not let others see us “break” down, as to do so would be socially unacceptable. We fail to realize this, in reality, is the very definition of weakness. The truly brave thing to do would be to embrace and listen to our feelings, otherwise known as embracing our innate human nature. Rarely do we consider that by repeatedly denying ourselves the opportunity to “break” down and feel our emotions in their entirety, we are simultaneously sealing our fate to break down on a chronic basis in the future, as the accumulated negative energies within us from our repressed emotions will eventually reach full capacity and burst.
When we fail to thoroughly work through and resolve our emotions, their energies remain stuck within us and accumulate until all we feel is their collective darkness, as there is not much room left inside us for anything else. This, of course, is quite frequently the working definition of “chronic depression.” Since we masked our sadness and anger so many times, we seemingly have no root cause for our chronic depression. Once repressed emotions from various experiences become piled up within, it is close to impossible to distinguish one from another and trace each one back to their origin. As a result, there is no identifiable root cause of our now unrelenting depression –and rightfully so, as there are many. Of course, the doctors we go to when such depression befalls us typically only lend to the notion that there is no root cause, and in no way promote healthy methods of taking responsibility for the management of our emotions in the future. However, they nonetheless claim they can help us –and they do, they help us to further gloss over uncomfortable feelings by placing us on psychiatric medications such as anti-depressants. Unfortunately, anti-depressants not only take away feelings of sadness, they to some degree take away all feelings in general.
When it really comes down to it, the choice to escape darkness is at the same time the choice to escape light. To knowingly opt out of painful emotions is to unknowingly opt out of pleasurable ones as well. Unfortunately, this numb state of existence promoted by modern day society is all too easy to fall victim to –especially when medical experts we quite literally trust with our lives tell us it is a correct and healthy way of being, generously giving us substances to feed our desire to not feel pain of any sort. So, who and what is really crazy here?
“Our education from the start has taught us a certain range of emotions, what to feel and what not to feel, and how to feel the feelings we allow ourselves to feel. All the rest is non-existent.” –D.H. Lawrence, ‘A Propos of Lady Chatterley’s Lover’
Since we are taught from a young age which feeling are acceptable to feel, what emotions are safe to express, what heart driven behaviors are appropriate to act upon without deviating from the “norm,” doing otherwise seems incredibly dangerous and can easily invoke paralyzing fear. However, subduing parts of ourselves by cutting off certain feelings and prohibiting emotions from arising past a certain level is the truly dangerous thing to do. It prevents us from fulfilling one of our primary obligations in life –to give birth to all parts of ourselves, to emerge into the world as beings alive in every sense of the word, and to then share with the world our unique gifts stemming from the deep sense of luminous aliveness radiating within.
Allowing Ourselves To Fully Feel
How do we go about allowing ourselves to feel our emotions in their entirety though, and how do we do so without letting ourselves become consumed by the negative energy of the more painful ones? For starters, we stop telling ourselves that feeling any emotion too intensely is wrong, because perhaps there is actually no such thing as feeling TOO intensely, there is only feeling something intensely and not knowing how to then work through those feelings. Perhaps it is not the feelings themselves that are the problem, but our inability to deal with those feelings. Perhaps there is no clearly defined right or wrong way to feel, there is only feeling what it means to be alive in its entirety. And whether or not those feelings are painful or pleasurable will not matter much in the end. What will matter is we can rest assured that we did not take life for granted, knowing we seized every opportunity to fully live.
Next, we must cease to resist strong emotions out of fear, often resulting from a subconscious awareness that surrendering to them will inevitably change us within on a deep level, as anything of depth in life always does –and we certainly must stop worrying that allowing profound changes within may cause others to no longer accept us. After all, any love with conditions is limiting, and thus does not embody the true definition of love. Those who do not love us unconditionally and who hold a firm picture of how we should live our lives do not serve our true nature, and should in no way be allowed to influence who we are or what we do or do not become. Ultimately, we must die to the false belief that a way of life that is safe even exists. As Michael Meade so eloquently put it, “a false sense of security is the only kind there is.”
Once we dissolve the fear of allowing ourselves to fully feel due to the desire to be socially accepted and the like, and begin the process of feeling our emotions in their entirety and journeying deeper into our hearts, we often run into the problem of subconsciously resisting from fully engaging in the process because it is uncomfortable at times. However, at this stage of journeying deeper into our hearts to reclaim our capacity to feel, it is crucial to acknowledge that the only reason we feel this discomfort is because we have been conditioned to believe we should avoid discomfort and pain –much less take responsibility for working through our pain, especially when emotional in nature- at any cost. Basically, we must become comfortable with being uncomfortable. A strange thing happens when we do this –feeling uncomfortable begins to dissipate entirely, as we have given ourselves permission to feel and surrendered to its existence, thus dissolving its power over us. No longer feeling uncomfortable over, well, the act of feeling in itself, sends a signal to our subconscious minds that there are really no “good” or “bad” emotions, there are just emotions. In this, we learn “good” and “bad” are merely a matter of subjective perception, and many of our perceptions regarding what is good and bad are actually not our own that were born out of our own self-discovery and life lessons, but are ones that were instilled within us from a young age via conditioning from others.
It is our inherent birthright to explore life and use our personal experiences to formulate our own perceptions in life. In order to cultivate such experiences, the manner in which we live must stem from the deep sense of aliveness within that can only be accessed when we feel intensely and allow ourselves to be flooded with passion. Inevitably, this leads many to find there is really no such thing as “bad” feelings, in the sense that they are intended to harm us. Rather, the feelings we once revered as “bad” are intended to deliver specific messages to us, signaling certain areas in our lives are not in alignment with the true nature of our souls.
Beginning to work with our feelings rather than against them, and exploring them to unveil the messages they are attempting to reveal, is the process of working with our different ego states –not dissolving our egos entirely, but transforming them. Eric Berne, who developed the idea of Transactional Analysis and Structural analysis, was the first to really bring to light the idea of observable egoic states within individuals –the parent, adult, and child egoic states. Using this theory, we can begin to identify the different ego states within and learn what role each one plays, essentially allowing us to work with and nurture the expressions of all of them rather than suppress them. The ultimate goal is to bring to surface and heal the fragmented parts of ourselves we have repressed, and essentially reintegrate these parts of ourselves into the whole. You can learn more about this process and the different techniques for working with ego states and reintegrating fragmented parts of the self into the whole to cultivate a healthier internal state here.
To feel is to be human, to be alive. To not feel is to be less human, to be less alive. This is a grotesquely reckless way to live, as it involves taking life for granted. In fact, it may be one of the most damaging forms of abuse humans are capable of inflicting upon themselves. I in no way expect you to accept my words and the concepts they shape as absolute truths. In fact, I beg of you to do the exact opposite –to consider them, but not adopt them, and instead go out and find your own personal truths.
©2015 The Mind Unleashed, Inc, all rights reserved. For permission to re-print this article contact contactthemindunleashed@gmail.com , or the respective author.
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