Dr Trevor Mudge, AMA Vice President, with Pamela Francis, Radio 5AA

Dr Trevor Mudge is the Federal Vice-President of the Australian Medical Association, and he joins me now. Good afternoon Trevor.

MUDGE: Yeah, hi Pamela.

FRANCIS: Trevor, why is Ritalin prescribed first of all, and what does it actually do what does it achieve?

MUDGE: Ritalin's a behaviour-modifying drug that fits into the psychotropic group, of which speed and amphetamines are part, and cocaine, are part of the same class of drugs. Now for reasons that we don't clearly understand, in some children with Attention Deficit Disorder, ADD so-called, do get a dramatic response to this drug, and other drugs. In Australia, probably Dexamphetamine's more used than Ritalin. But some people do get a dramatic response. Of course, this is a disorder which can lay waste to family behaviour sometimes. It really can be a major problem for some families.

FRANCIS: Now you see, I'm immediately confused, because my layman's understanding of the drugs that we're talking about - you talk about Speed and Amphetamines etc, - my understanding is that they speed-up your behaviour. But your actual activity and your behaviour, people take them when they want to speed up their metabolic rate for losing weight. It causes lack of sleep, it's an energiser, it's an upper, as it goes. And yet people with ADD already exhibit some aspects of this type behaviour, and yet you're saying that Ritalin has a very beneficial reaction on them?

MUDGE: Yeah, it doesn't make sense does it?

FRANCIS: No.

MUDGE: But lots of things in life and medicine tend not to make sense, and I guess this is one of them. It says something about the change in brain function and these sort of conditions that we don't yet understand.

FRANCIS: So how widely is it actually prescribed? You said it wasn't the preferred prescription drug. How widely is it used throughout Australia?

MUDGE: Well, I mean Attention Deficit Disorder is a syndrome which is sometimes over-diagnosed, or sometimes under-diagnosed, depending on the point of view of the expert that looks at it. In America, in some areas, some 25 per cent of children are taking a drug for ADD. What a terrifying prospect.

FRANCIS: It is, yeah.

MUDGE: In Australia it's much less common, but should we say, at least, it is not rare for children to be taking one of this class of drugs for ADD.

FRANCIS: And what sort of age are we looking at, that they would start on this sort of drug, Trevor?

MUDGE: Oh, we're looking at children as young as seven or eight, into the adolescent range.

FRANCIS: Because there's a quote that I read in the paper, that, the article about it, the drug this morning - there was a quote from overseas saying children have been given it daily for many years. How many years is 'many years'? You say they start at seven or eight into adolescence. So are we looking at eight years, ten years that a child…?

MUDGE: Well it would depend a lot on the child. I mean ADD is a very variable behavioural disorder and some children will only need medication for very brief periods of time, others will need it intermittently. I mean, I think it's important for your listeners to understand that, especially with this sort of behavioural disorder, there is no single drug which is a magic bullet to cure it. I mean, medication for Attention Deficit Disorder is part of a range of strategies which will include counselling, and psychiatric help, and family support, things that are actually much more expensive and difficult to organise than the simple taking of a tablet. Tablets by themselves are never the sole cure for a problem.

FRANCIS: Well as I understand it, the taking of this drug though doesn't actually cure the disorder. What it does is help control the consequences of the disorder.

MUDGE: Um, but that's the same…

FRANCIS: Modify the behaviour.

MUDGE: …that's the same for most drugs though isn't it? After all insulin doesn't cure diabetes, but it prevents you dying for the lack of it.

FRANCIS: Yes, yes, exactly, blood pressure and medication the same. So it falls into that category.

MUDGE: Yes, yes, the same.

FRANCIS: So what does this report actually mean? What does this new research mean?

MUDGE: Probably not very much, I think. These researchers have studied the brains of new-born rats and found some changes in the structure of the brain. Well, you know, these results are not surprising. After all, the drug that most commonly causes permanent changes in nervous tissue is alcohol.

FRANCIS: Yep.

MUDGE: Now, we don't stop drinking because some researchers reported that it affects the appearance of the brain. And these are new-born rats, these are not humans. We know that extrapolating from one species to another is difficult, if not impossible. So I don't think that there should be any hysteria amongst your listeners, especially those whose families may have used, or be using this particular class of drug. It's a reason to look carefully at further research and long-term studies, and that's something we need to do all the time in medicine. It's a great shame that we don't do more of it. Only 0.02 per cent of our health care budget is actually spent on research. Without research we don't have quality health care. But there you go.

FRANCIS: That's right. And you say that it's hard to cross it from one species to another. But starting off with the animals in the test tube variety, and rats are very commonly used, is usually the starting point for any of this sort of testing. Trevor, when I said that it's considered clinically Ritalin to be short-acting, am I interpreting that as meaning that it has no, that it doesn't stay in, and become an addictive source, that it starts to feed on itself and that the body needs to rely on this and it becomes an addictive?

MUDGE: We're only just starting to get a handle on what causes addiction, and what particular class of the drugs can be addictive. I mean, addiction can happen with almost any drug, or almost any behaviour, but some forms, some drugs, and some forms of behaviour are more addictive than others. And addiction probably does involve a genetic component, and probably structural changes in the brain. Some people are far more susceptible to addiction than others. It's not thought that Ritalin is a particularly addictive substance, when compared say, with cocaine or the amphetamines, themselves. It's not a particularly end, but I'd sooner say that you know, we need more research on all of these things. The addiction story is going to be a very interesting one. There is the hope that we can actually manipulate people's susceptibility to be addicted to various substances, and perhaps there may be, say, a cure for heroin addiction, which involves gene therapy to switch off the mechanisms that make some people addicted. After all, you know, only about a third of people who use heroin end up becoming addicted to it.

FRANCIS: Right.

MUDGE: Like smoking really. I mean, a third of smokers are able to abandon the habit, they don't get addicted for whatever reason. It's the two-thirds that do…

FRANCIS: …that are the problem.

MUDGE: …that are the problem, yeah.

FRANCIS: So when, when - any listeners who are listening at the moment whose children do suffer from ADD, and they are being treated as part of their treatment with Ritalin, and they see headlines such as I've got in the paper in front of me at the moment saying 'Ritalin may affect brain, like cocaine', your message to them is not to panic, and see that headline for what it is?

MUDGE: Yeah, I think so. I mean every drug is going to have a risk and benefit. Remember that we know that alcohol causes these sorts of changes in the brains of humans, for example, not neo-natal rats. Talk to your doctor about it. As with all drugs, there are risks and benefits. Risks that we know about, and risks that we maybe don't know about, and they have to be stacked up against the benefits, and I'd reckon a lot of your listeners who do have children with ADD, by no means all of them, but a lot of them, would have seen a transformation in the lives of both their child and the rest of the family, as a consequence of good management of ADD, including medication.

FRANCIS: And that's what matters at the moment, indeed, because there's nothing at this stage for them to try and balance that?

MUDGE: No there isn't.

FRANCIS: Thank you very much for your time.

MUDGE: You're welcome, Pamela, 'bye 'bye.

FRANCIS: Thank you. That's why we wanted to talk to Dr Trevor Mudge, because I can appreciate as a parent, if you do have a child under those circumstances, and maybe you'd like to ring and tell us about it on 82240000. And you see headlines such as that in the paper, and you read about research, and the possibilities and the consequences of research, which is as yet, as we've just heard from Dr Trevor Mudge, very, very, unsubstantiated and in the early days. And you read something like that, it's very, very, threatening to a parent whose child is on any form of medication. So at the moment, take it all, take it on the advice of your doctor. And that's the best advice we can give you.

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