TIME medicine

Study: Children Given Codeine in ER Despite Risks

Too many kids are getting codeine in emergency rooms, say the authors of a new study, which estimates that at least half-a-million children receive prescriptions each year

The painkiller codeine is prescribed to kids in at least half-a-million emergency room visits, a new study suggests, despite recommendations in place to limit its use among children.

Only 3% of children’s ER trips in 2010 resulted in a codeine prescription, but with kids making 25 million ER visits each year, authors of the study say too many children are getting the opiate, the Associated Press reports.

The study, published Monday in Pediatrics, analyzed national data from 2000 to 2010 on emergency room visits by children between the ages of 3 to 17. The study’s authors say the annual number of visits that led to codeine prescriptions ranged from approximately 560,000 to 877,000, though the frequency of codeine treatment slightly declined during the study.

A pediatric drug expert told the AP that codeine use has likely declined further since the study ended after last year’s strict warning from the Food and Drug Administration about the drug’s risks and possible complications.


TIME medicine

Cleveland Clinic’s New Medicine

At one Ohio hospital, patients get herbs as well as drugs

Lora Basch, 59, sometimes suffers from poor sleep and anxiety. She’s uncomfortable with the side effects of drugs, so she’s tried acupuncture and magnesium supplements, but with only minimal success. After years of low energy, she went a different route altogether: gui pi tang, a mix of licorice root, ginseng and ginger meant to rejuvenate the body. Three months later, the Cleveland native is finally falling asleep at night, and she has more energy during the day. “The remedy is a huge relief,” she says. “I have a more stable life.”

Though herbal therapy has been practiced in China for centuries, it is still an afterthought in the U.S., in part because pharmaceutical remedies are usually easier to obtain. Now that’s beginning to change: in January, the Cleveland Clinic opened a Chinese herbal-therapy ward. In the past three months, therapists at the clinic have seen patients suffering from chronic pain, fatigue, poor digestion, infertility and, in the case of Basch, sleep disorders. “Western medicine may not have all the answers,” says Daniel Neides, the clinic’s medical director.

A certified herbalist runs the unit under the supervision of multiple Western-trained M.D.s. Patients must be referred to the clinic by their physician, who in accordance with Ohio law must oversee their treatment for at least a year. Executives at Cleveland say the clinic is the first of its kind to be affiliated with a Western hospital. “We’re incorporating ancient knowledge into patient care,” says in-house herbalist Galina Roofener.

Cleveland is starting modestly: its clinic is a single room with bright pillows, a tapestry, candles and a cot reserved for procedures like acupuncture. The center doesn’t take walk-ins and primarily sees patients with conditions that Western medicine has, for whatever reason, failed to remedy. “For something like acute pneumonia, Western antibiotics may be faster and more cost-effective,” says Roofener. “But if someone has antibiotic resistance, we can strengthen their immune system.”

All herbal formulas at the clinic are encapsulated for easy consumption. (By contrast, in China, patients are usually sent home with raw herbs to brew themselves.) The FDA doesn’t regulate herbs and supplements, so finding pharmacies that can both supply them and still meet hospital safety standards was a top priority. After a lengthy search, the clinic tapped a Kaiser Pharmaceutical subsidiary out of Taiwan as well as a Chinese herb–specific compounding pharmacy in Massachusetts and California that specializes in custom blends.

The primary uncertainty in herbal medicine is the prospect of an unpleasant or dangerous herb-drug interaction, which is why the clinic requires herbalists and physicians to have joint access to patients’ electronic medical records. To become an herbal therapist requires three to four years of master’s-degree-level education in Chinese medicine and a series of certification exams in Oriental medicine, herbology and biomedicine.

As it happened, I was battling a cold when I visited the clinic, so I signed up for the $100 consultation. Roofener spent 30 minutes reviewing my medical history, sleep routine, diet and even my spirituality–I was asked about what I practice and whether I meditate. She took my pulse Chinese-style: holding my wrists, she measured what she said were the multiple “pulses” of my organ systems. “Did you eat breakfast?” she asked. “The pulse on your stomach position is very weak.” I had eaten half a slice of toast.

I left the clinic with my own herbal remedy: 80 capsules of a diverse mixture of ingredients ranging from Lonicera flower to mint leaf, with instructions to take two pills four times a day for 10 days. Though an over-the-counter drug usually does the trick for me, my symptoms were cleared on the herbs alone. Now if only I could find an herb to make me taller.

TIME The Weekend Read

Parent Like a Mad Scientist

Taking them to my alma mater, U.C. Berkeley, where upon Yo announced, ÒDad, thereÕs no way I am going here. My days of attending the schools you went to are over.Ó
Me with my daughter, E, and my son, Yo. I gave the kids unique names based on research showing that this might endow them with superior impulse control. Stephen P. Hudner

Give your kids weird names, expose them to raw sewage, and still be the world’s best dad

As an immigrant society with no common culture, we Americans have always been blessed with the ability to make things up as we go, be it baseball, jazz, the Internet … even Mormonism. Yet, when it comes to parenting, we’ve become obsessed with finding the one best way — whether it’s learning to raise our kids like the Chinese, the French, Finns, or whatever other group is in fashion today. It’s time to stop. No one culture has parenting down pat; there’s no one best model that we can look to for all the answers. And that’s a good thing. Parenting should be an adventure. And more importantly, if we want to keep America’s culture young and prosperous and innovative, parenting should be an experiment.

Yo engaged by something his mother is demonstrating to him; E mad for some reason. Courtesy Dalton Conley

I should know. I’m a bit of a mad-scientist parent myself — just ask my kids, E and Yo.

As a dual-doctorate professor of sociology and medicine at New York University, I gave my kids “unique” names based on research about impulse control. I exposed them to raw sewage (just a little!) and monkeys (O.K., just one!) to build up their immune systems based on the latest research on allergies and T-cell response. I bribed them to do math inspired by a 2005 University of Pennsylvania study of Mexican villagers that demonstrated the effectiveness of monetary incentives for schooling outcomes. And don’t think my offspring were the only ones bearing the brunt of all this trial and error: I got myself a vasectomy based on research showing that fewer kids may mean smarter kids.

There’s a method to my madness (namely, the scientific method). Parentology — as I call this approach to raising kids — involves three skills: first, knowing how to read a scientific study; second, experimenting on your kids by deploying such research; and third, involving your kids in the process, both by talking to them about the results and by revising your hypotheses when necessary.

Kids raised this way won’t necessarily end up with 4.0 GPAs, but they almost certainly will become inquisitive, creative seekers of truth.

Dalton Conley's kids, Yo, left, and E, right.
Often we are asked if E (right) and Yo (left) are twins; they are not. Despite knowing that narrow birth spacing may be disadvantageous, we popped our kids out a mere 18 months apart. Courtesy Dalton Conley

“Parentology” in Practice

My son’s name: Yo Xing Heyno Augustus Eisner Alexander Weiser KnucklesI put my approach into practice more or less immediately upon becoming a father, throwing out my copy of Dr. Spock and instead conducting a series of experiments on my two young children, now 16 and 14. No, I didn’t raise one in the woods with wolves and the other in a box. But I did give my children weird names — E (my daughter) and Yo (my son, full name: Yo Xing Heyno Augustus Eisner Alexander Weiser Knuckles) — to teach them impulse control. Evidence shows that kids with unusual names learn not to react when their peers tease them (at least in elementary school). What’s more, a 1977 analysis of Who’s Who by psychologist Richard Zweigenhaft found that unusual names were overrepresented, even after factoring out the effect of social class and background.

Meanwhile, after exploring the literature on verbal development, I decided not to teach my kids to read, but instead I read aloud to them constantly. It turns out that exposure to novel words, complex sentences and sustained narratives are what predict verbal ability later on, not whether a 4-year-old can decode words on a page. And the best predictor of later verbal skills is the number of total and unique words a child hears before kindergarten. Psychologists Betty Hart and Todd Risley observed how poor and middle-class parents interact with their toddlers. They estimated that the middle-class kids heard an average of 45 million words over a four-year period, while the poor children heard a mere 13 million. This difference, in turn, explained later achievement gaps. Unable to mimic Robin Williams and babble away, I decided the best thing was to read to my kids constantly. So while E and Yo were both behind their peers in reading in first grade, by fourth grade they had the best scores in their respective classes.

Dalton Conley reads to his son, Yo.
Reading is fundamental. Though I never taught them to decode words on the page, I was a human Kindle before there were such things. I never stopped reading to them. Courtesy Dalton Conley

Of course, not all my experiments have been successful. (If they were all successful, they’d hardly be experiments.) When my son was 11, his school wanted to medicate him for what administrators suspected was ADHD. I thought there might be a way around it. Scientific studies reviewed by University of California, San Diego, professor Andrew Lakoff in 2002 show that psychopharmacological placebo effects are almost as big as those of the actual drugs. And even student-teacher interaction is not immune to such Pygmalion-like dynamics. In one classic 1968 study, researchers Robert Rosenthal and Lenore Jacobson lied to teachers, telling them that they had identified a new test that could pick out genius kids with remarkable accuracy. Then they randomly picked certain pupils and informed the teachers that these particular kids had aced the test. Lo and behold, when the scientists showed up a year later, the scores of the kids who had received the “teacher placebo” treatment had jumped 15 points in their actual IQs relative to the control-sample kids.

Worried about sleep apnea and its potential role in causing ADHD, we took Yo in for an evaluation. My attempt to cure ADHD with a placebo came to naught. Courtesy Dalton Conley

With this research in mind and fearful of the risks of actual medication, I lied to the school, his sister and my son himself, telling them all that I was giving him a powerful stimulant (when it was actually a vitamin), hoping that if they all thought he was calmer and more attentive, they would treat him as such and his behavior would improve. While his teachers noted an improvement in his concentration and behavior for a few weeks after I started my placebo protocol, he backslid — prompting calls from the school about his inappropriate behavior — and was ultimately given a formal ADHD diagnosis. The real stimulants worked. However, I did decide to experiment with only giving him the drugs during the school week (in order to mitigate against long-term effects and possible habituation to the drug), which has been successful so far.

Customizing to the Kid

As you can see, while knowing how to read the existing science is important, even more critical is being able to properly experiment on your own young. What works for one kid (or one population of kids) may not work for all, and your family may require customization in order to make a technique work or just to be comfortable with what you’re doing.

Even when there’s research on a topic, you can’t be sure how it will apply to your own kids. You need to experiment.Even when there is a clear scientific consensus on, say, the importance of breast-feeding, we don’t often know the distribution of those effects. If a particular intervention — say, paying a child to do a half hour of math a day, like I did — is shown in a randomized, controlled trial to raise math scores by 20%, that could mean that all the kids in the bribery group saw their scores jump by a fifth. Or it could mean that for 80% of the kids, the bribes did not make a whit of difference, but for 20% it doubled their scores. This is what researchers call heterogeneous treatment effects.

Some kids are car-truck-train kids; others are animal kids. Guess which ours are. Courtesy Dalton Conley

Other times, results vary across studies and methods. One 2005 study of Mexican families found that cash rewards that were conditional on school attendance were hugely effective in improving child outcomes such as health and educational attainment. But an effort to replicate this in New York City showed only minor educational benefits in 2009. And a third study, published in the Review of Economics and Statistics in 2010, focused on elementary-school students in Coshocton, Ohio, found that it worked to pay the students themselves (as opposed to their families) based on how well they did on outputs (i.e., test scores). But the largest U.S. study of all — conducted in 2011 by Harvard economist Roland Fryer in Chicago, Dallas, New York City and Washington — found that when rewards were focused on outcomes like passing tests, they failed to produce meaningful improvements. But in that study, when the rewards were based on performing input tasks like reading a book or being on time to class, then they worked. (Even in this study, however, results were not consistent across cities, age groups or race.)

In short, even when there’s research on a topic, you can’t be sure how it will apply to your own kids — so it’s necessary to embrace experimentation. While I may never know what explains why some studies found big gains from bribery and others failed to, I was able to bribe both my kids to do extra math. I simply adjusted the rewards to fit the kid (something that would be impossible for researchers to do in a big study). As a parent, I could play on my son’s love of video games to offer a minute-for-minute swap of online math problems in exchange for World of Warcraft time. For my daughter, the enticement was gummy bears.

I did worry that by providing external motivation in the form of bribery, I might erode their internal motivation for mathematics, as some psychology research has suggested can happen. But that was a risk I was willing to take because — unlike with reading, for instance — they weren’t exactly clamoring for math problems. Here was a case of customizing the existing research to one’s own children. I may or may not have eroded their internal motivation to do math (and I doubt either will end up a professional mathematician), but at least they passed the big tests they needed to in order to get into high school.

How to Know What Matters

Lots of folks think being a scientist is knowing a bunch of esoteric facts that fit together, like how the Earth’s tilt causes the seasons or what mitochondria do or how, exactly, light can be both a wave and a particle. But the scientific method is what’s most important — especially when it comes to parenting. Particularly important, especially for middle- and upper-class parents, is knowing how to read a study and sift out causal relationships from the chaff of mere correlations. (It turns out a lot of great outcomes are correlated with being born in good economic circumstances to well-educated parents, but you want to figure out how to cause better outcomes.)

To assuage my own anxieties, I just keep reminding myself just how unimportant going to Harvard really is.For instance, take my educational choices for my kids — or, more accurately, their choices. That is, after all the extra math prep I bribed them to do to get them into Stuyvesant (the prestigious New York City high school that students must test into), I allowed them to decide if they actually wanted to go or not.

This may seem, at first blush, to be more like 1970s-style laissez-faire parenting. But actually I was following the latest cutting-edge research in ceding educational choice to my kids. Two studies by economists Stacy Dale and Alan Krueger in 2002 and 2011 showed that if you are white and middle class (which we are), it does not make a difference where you go to college. While it is true that graduates of more-selective institutions fare better in terms of income and wealth later on, compared with graduates of less selective schools, it turns out that this is an artifact of what we scientists call selection bias. It’s not that Harvard is adding so much value to your education as compared with the University of Nebraska — it’s that Harvard admissions is good at picking winners.

This research was about college, but my intuition that it also applied to high school was confirmed when MIT economist Joshua Angrist obtained the data from the selective exam-admission schools in Boston and New York City. He examined the data for what we call regression discontinuities. The logic is the following: if the cutoff to get into Stuyvesant is, say, 560 in a given year, then it is really pretty random whether an individual scores 559 or 560. It could be the difference of a good breakfast or a single vocabulary word that was in one kid’s stack of flash cards by chance. In other words, it probably does not reflect a major difference in innate ability. But the consequences of that point difference determine which school the kid ends up attending. By comparing two groups — the one just above and the one just below the line — we can see how big the “treatment effect” of attending the “better” school is. And it turns out not to matter at all, in either Boston or New York.

So, though both my kids gained admission to the most prestigious math and science high school in the country, I let them choose whether they went there or not. I figured, with no overall treatment effect, why not let them go where they sensed they would feel the most comfortable? They knew what environment was best for them. My daughter turned down her offer of admission, while my son decided to go. I, meanwhile, am taking notes to see how this next phase of the experiment turns out. (She is a sophomore and he is a freshman.) Meanwhile, to assuage my own anxieties, I just keep reminding myself just how unimportant going to Harvard really is.

One of the many cross-species interactions that take place in our home. No underworked immune systems here. Courtesy Dalton Conley

The Path to Enlightening Kids

One of the few fake animals in our house. Courtesy Dalton Conley

Finally, perhaps the most important part of parentology is to involve the kids themselves. Whether that means discussing the research about standing desks and their role in preventing obesity, giving them an opportunity to help design the experiment or debriefing them about its results (like when I confessed to my son that I had been giving him a placebo and not the real ADHD medication), the teachable moment is, actually, the most valuable part of the entire experiment.

Turn your rug rats into lab rats — they might not go Ivy, but they’ll be a lot more fun.Having a kid who knows how to separate out causation from mere correlation is more important than having one who can memorize a list of amino acids or Egyptian pharaohs. This is the real goal of experimental parenting: indoctrinating one’s kids into the Enlightenment way of thinking. Helping them learn to question — not authority necessarily: this isn’t 1960s hippie-dippie parenting, after all — but knowledge itself.

So, where tradition fails us (after all, what does the Bible have to say about kids and cell phones?), we can and should resort to the scientific method. Hypothesis formation, trial, error and revision. That is, we should experiment on our own kids.

Worried that screens may be disrupting your teen’s sleep? Do a controlled study in which you take the iPad away at night for two weeks and chart what happens. Want to encourage better study habits? Set up a marketplace for grades or effort and fine-tune the rewards and punishments in real time. Want to exercise the self-discipline muscles of your kids’ brains? Make them wear a mitten on their dominant hand for a couple of hours a day. Want to boost their performance before a big test? Prime them with positive stereotypes about their ethnic and gender identities. Today it is easier than ever — with Google Scholar and the like — to immerse oneself in the most cutting-edge research and apply it to one’s kids.

Like with patient-driven medicine, in which informed patients advocate to their doctor rather than just passively receiving information, I predict that American parents and their children will increasingly shun authorities — even good old Dr. Spock — and instead interpret and generate the scientific evidence for themselves.

Rather than a rigid formula of 10,000 hours of violin practice or a focus on a single socially sanctioned pathway to success, American parents should pursue an insurgency strategy: more flexibility and fluidity; attention to often counterintuitive, myth-busting research; and adaptation to each child’s unique and changing circumstances.

E working on her novel. Perhaps my reading-out-loud experiments worked. Courtesy Dalton Conley

If you approach your rug rats this way, by turning them into lab rats, I can’t guarantee they will get into Columbia. But I can predict with statistical confidence that they will be creative, fulfilled members of society and that you will have a lot more fun raising them along the way.

Dalton Conley is a professor of sociology and medicine at New York University and author of Parentology: Everything You Wanted to Know About the Science of Raising Children but Were Too Exhausted to Ask.

Parentology Quiz


Wikipedia Founder Sticks It To ‘Lunatic’ Holistic Healers

Wikipedia founder Jimmy Wales gives a lecture in Hanover, Germany, March 14, 2014.
Wikipedia founder Jimmy Wales gives a lecture in Hanover, Germany, March 14, 2014. Christoph Schmidt—Zumapress

Jimmy Wales rejected a Change.org petition calling for more information on holistic medicinal therapies. "Every single person who signed this petition needs to...think harder about what it means to be honest, factual, truthful," he said

Wikipedia founder Jimmy Wales responded definitively to a Change.org petition from holistic healing supporters to “allow for true scientific discourse” on the online encyclopedia.

The petitioners say the representation of holistic healing on Wikipedia is biased, and they have not been allowed to amend the information. The petition, which has over 7,790 supporters, states:

“Wikipedia is widely used and trusted. Unfortunately, much of the information related to holistic approaches to healing is biased, misleading, out-of-date, or just plain wrong. For five years, repeated efforts to correct this misinformation have been blocked and the Wikipedia organization has not addressed these issues. As a result, people who are interested in the benefits of Energy Medicine, Energy Psychology, and specific approaches such as the Emotional Freedom Techniques, Thought Field Therapy and the Tapas Acupressure Technique, turn to your pages, trust what they read, and do not pursue getting help from these approaches which research has, in fact, proven to be of great benefit to many.”

Wales responded to the petition on Sunday, and was unapologetic for the way holistic medicine is covered on Wikipedia, saying it will only publish evidence rooted in science. He responds:

No, you have to be kidding me. Every single person who signed this petition needs to go back to check their premises and think harder about what it means to be honest, factual, truthful.

Wikipedia’s policies around this kind of thing are exactly spot-on and correct. If you can get your work published in respectable scientific journals – that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately.

What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse”. It isn’t.

Now perhaps he’ll tell us how he really feels.


Do You Think the CIA Infected African Americans With HIV? You’re Not Alone

Half of all Americans believe in that, or one of five other medical conspiracy theories


About half of the grownup population in the U.S. believes at least one medical conspiracy theory, a new survey from the University of Chicago shows.

In the study, 1,351 adults were asked about whether they had heard of, and agreed or disagreed with, six popular medical conspiracy theories, such as those that hold that U.S. regulators prevent people from getting natural cures, that the U.S. government knows cell phones cause cancer but does nothing about it, and that the CIA infected a large number of African Americans with HIV.

About 49% of the people agreed with at least one of the theories, which all had distrust of the government or large corporations as the common characteristic.

According to the study’s lead author, J. Eric Oliver, the reason so many people believe in medical conspiracy theories is that they are easier to understand than science. He added that people who believe in one or more of these theories are more likely to use alternative instead of conventional medicine.



Doctor: ADHD Does Not Exist

Getty Images

Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Raising a generation of children — and now adults — who can't live without stimulants is no solution

This Wednesday, an article in the New York Times reported that from 2008 to 2012 the number of adults taking medications for ADHD increased by 53% and that among young American adults, it nearly doubled. While this is a staggering statistic and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over my 50-year career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school or work and diagnosing themselves with ADHD.

And why shouldn’t they?

If someone finds it difficult to pay attention or feels somewhat hyperactive, attention-deficit/hyperactivity disorder has those symptoms right there in its name. It’s an easy catchall phrase that saves time for doctors to boot. But can we really lump all these people together? What if there are other things causing people to feel distracted? I don’t deny that we, as a population, are more distracted today than we ever were before. And I don’t deny that some of these patients who are distracted and impulsive need help. What I do deny is the generally accepted definition of ADHD, which is long overdue for an update. In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist.

Allow me to explain what I mean.

Ever since 1937, when Dr. Charles Bradley discovered that children who displayed symptoms of attention deficit and hyperactivity responded well to Benzedrine, a stimulant, we have been thinking about this “disorder” in almost the same way. Soon after Bradley’s discovery, the medical community began labeling children with these symptoms as having minimal brain dysfunction, or MBD, and treating them with the stimulants Ritalin and Cylert. In the intervening years, the DSM changed the label numerous times, from hyperkinetic reaction of childhood (it wasn’t until 1980 that the DSM-III introduced a classification for adults with the condition) to the current label, ADHD. But regardless of the label, we have been giving patients different variants of stimulant medication to cover up the symptoms. You’d think that after decades of advancements in neuroscience, we would shift our thinking.

Today, the fifth edition of the DSM only requires one to exhibit five of 18 possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list, look it up. It will probably bother you. How many of us can claim that we have difficulty with organization or a tendency to lose things; that we are frequently forgetful or distracted or fail to pay close attention to details? Under these subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts they’re a normal part of the human condition.

However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive-compulsive disorder and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.

What’s so bad about stimulants? you might wonder. They seem to help a lot of people, don’t they? The article in the Times mentions that the “drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.” But this is only part of the picture.

First, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace — a trademark of addictive substances. I worry that a generation of Americans won’t be able to concentrate without this medication; Big Pharma is understandably not as concerned.

Second, there are many side effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide. But there are also consequences that are even less well known. For example, many patients on stimulants report having erectile dysfunction when they are on the medication.

Third, stimulants work for many people in the short term, but for those with an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.

In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about. 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. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living over the long term.

For my second group of patients with severe attention issues, I require a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.

It’s time to rethink our understanding of this condition, offer more thorough diagnostic work and help people get the right treatment for attention deficit and hyperactivity.

Dr. Richard Saul is a behavioral neurologist practicing in the Chicago area. His book, ADHD Does Not Exist, is published by HarperCollins.

TIME medicine

Bring the Doctor with You

The logical next step in managing chronic disease is technology that tracks our vitals and guides us to better health

Chronic disease affects 2 out of 3 adults in the U.S., and it is estimated that 8% of the American population suffers from diabetes. Sixty-nine percent of Americans say they would like direct access to their health records. People want to keep track of their health–and we’d be better off as a society if people had an easy way to do so.

As luck would have it, mobile technology is bringing us closer to the day when we’ll be able to essentially wear our doctors. So when TIME asked me to propose an idea for how design can improve the world, my thoughts quickly turned to medicine. I call my concept–and for now, it is only that–LifeTiles: a wearable kit of sensors for monitoring individual health.

The sensors–designed to be aesthetically pleasing–would noninvasively monitor the user’s physical activity, environment and bloodstream. The information would be sent automatically to the cloud, where specialized algorithms could be used to monitor it and notify the individual with personalized feedback.

A user could also volunteer to donate his or her data, which would be made anonymous and shared with medical experts. Researchers could use the data to look for patterns, understand how disease works and find ways to prevent and cure it. Our doctors would always be with us–and everyone would benefit.

Béhar is the founder of Fuseproject and leads design and brand at Jawbone


Running Out the Clock

Getty Images

In our ongoing 'Doctor-in-Training' series, time is of the essence in more ways than one for a medical student conducting a routine physical on an elderly patient

I’m running out of time. It was right there on the vital signs monitor clock: 30 minutes left to finish the patient’s history and do her physical. And here she was, a real talker, expounding on the pros and cons of Obamacare. I pressed ahead with my questions about her health, not rushing her, but taking advantage of her pauses to steer the conversation in the direction of the information I needed to present in less than an hour to my supervising doctor.

A classmate and I had been assigned to this patient–I’ll call her Mrs. G.–as part of our course on the physical exam. She lay in her bed on the inpatient cardiac ward, frail under gown and blanket, an IV dribbling into her arm. We worked systematically, with lots of ground to cover. At this stage of our medical education, year two, nothing we do is for the patient’s benefit. Not the barrage of questions, not the poking and prodding for findings we’re only just beginning to understand. It’s all for our training. We find our patients catch-as-catch can. Sometimes one of our physician teachers will ask a patient to let us perform an examination. Other times the nurses tell us which of their charges that day are the nicest, and we ask those patients to put up with us. Invariably, they do. Though sicker than sick, they generously act as guinea pigs so we can learn the skills to help our future patients.

Mrs. G. was hoarse but still chatty as she answered our questions about her heart problems. “Have you experienced any palpitations?” I asked. “Only twice. Right before I came to the hospital, and the first time I saw my husband,” she deadpanned. They’d been married, she said, 63 years. As my classmate and I prepared to move from taking the history to doing the physical exam, it struck me that Mrs. G. was doing me a favor—allowing me to learn by practicing my budding physical exam skills on her frail form. And she was even entertaining. But I couldn’t repay her with the open-ended listening she was clearly hoping for. It’s starting, I found myself thinking. This is why everyone says doctors are always in a rush.

She was still talking. “They say I may go down in days,” she said. “I’m just hoping to get to Christmas with my grandkids.”

It was a mental slap on the wrist. I’m running out of time? I thought. My cheeks warm, I contemplated how few hours she could have left on this earth. A few hundred, probably. If she was lucky. And yet, here she was, spending one of those hours helping me grow into a doctor.

TIME tobacco

E-Cigarettes Don’t Discourage Smoking Among Teens

E-Cigarettes Become Increasingly Popular Amongst Smokers
Consumers smoke electronic cigarettes at a mall on June 30, 2013 in Manila, Philippines. Dondi Tawatao—Getty Images

Adolescents who use e-cigarettes are more likely to smoke other tobacco products and regular cigarettes, a new study finds, suggesting that e-cigarettes may not be the lesser of two evils that some had hoped

Are e-cigarettes the lesser of two evils, or just another method of nicotine exposure?

It’s a question public health experts are debating. Some question the benefits of steering smokers towards less harmful products on the nicotine product spectrum. And a new study published in JAMA Pediatrics suggests what medical experts dread: that people who use e-cigarettes are also likely to be regular cigarette users.

Adolescents who use e-cigarettes are more likely to smoke other tobacco products and regular cigarettes. The researchers surveyed 17,353 middle and high school students in 2011, and 22,529 young people in 2012 as part of the National Youth Tobacco Survey.

Youth who reported ever using e-cigarettes or currently using them had a greater likelihood of experimenting with regular cigarettes, smoking on a regular basis, or being a current cigarette smoker. Among young people who had used tobacco cigarettes, trying an e-cigarette was linked to being an established smoker. The researchers also found that teens who used e-cigarettes were more likely to want to quit smoking the next year, but they were also less likely to abstain from cigarettes all together.

The study didn’t look at whether young people are initiating smoking with regular cigarettes and then switching to e-cigarettes, or the other way around. However, e-cigarettes aren’t “discouraging use of conventional cigarettes,” the researchers say.

In September, numbers from the CDC showed that the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012.

“While much remains to be learned about the public health benefits and /or consequences of [electronic nicotine delivery systems] use, their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policy makers need to act quickly,” Frank J. Chaloupka of the University of Illinois at Chicago wrote in a corresponding editorial.

Most recently, Los Angeles extended its city-wide smoking ban to include e-cigarettes.


Doctors Believe a Second Baby Is Cured of HIV

Dr. Deborah Persaud of Johns Hopkins' Children's Center in Baltimore.
Dr. Deborah Persaud of Johns Hopkins' Children's Center in Baltimore. Johns Hopkins Medicine—AP

A baby born infected with human immunodeficiency virus in Los Angeles who received treatment shortly after birth is still showing no signs of the disease a year later, doctors say. The child's mother was not taking her HIV medication while she was pregnant

A baby infected with HIV at birth has been cured of the disease, doctors believe.

The baby, who was born in Los Angeles, received treatment within a few hours after birth, and is still virus-free a year later, doctors announced Wednesday at the Conference on Retroviruses and Opportunistic Infections in Boston. The mother had not been taking her HIV medication while pregnant, doctors say.

Although it’s too early to know for certain whether the child is just in remission, doctors say the baby’s vitals are displaying differently compared with patients with suppressed HIV. The baby is currently in foster care.

This is the second baby doctors believe to be cured of the disease with very early treatment. Another child from Mississippi received similar treatment when her mother was discovered to be HIV-positive during labor. The child is now 3 1/2 years old and appears to be cured, even though her mother was not administering the baby her HIV medication at follow-up.


Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser

Get every new post delivered to your Inbox.

Join 45,333 other followers