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The quote says:

> a wider range of treatment options than an endless litany of stimulants

Notice the "than an endless litany of stimulants" part. Saying something like:

> so it all boils down to the pharma companies not creating enough drugs for ADHD?

afterwards almost seems like you are intentionally misconstruing this.

Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments rather than just cranking out "yet another stimulant?" Is it not possible that the author wants more non-medicinal treatments to be explored?

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That said, I think that "Big Pharma" has earned its negative moniker. Just look at the front-page story from yesterday about EpiPen prices being jacked up to the point where people may not be able to afford them. I don't think that being against price gouging a "captive audience" in a way that possibly threatens their health is the same thing as being against "a pharmaceutical company selling a product."

> Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments

Or society to do that; relying on Big Pharma to spend money directly contrary to Big Pharma's interests doesn't seem like it makes a lot of sense.

Whether you consider the opinion right or wrong is beside the point that I was making (that the parent to my post seemed to be "tilting at windmills"). Saying that the author has an inconsistent position of "there are too many drugs" and "there need to be more drugs" seems like a poor reading of that sentence.

I understand the point you are making, but in reality drugs will get developed based on their likely risk/reward ratio only.

If you want more diversity, unless there is a non-market force (which honestly shouldn't be needed here, there is high demand), pharma companies will just keep picking at the lowest hanging fruit.

Eventually, they'll get up to the non-stimulant variety, but developing an entirely new class of drugs is a Herculean effort with very low likelihood of payoff. To make it work, you need more data on the disease (e.g. more time), and some luck out of academia (which is where 99% of drugs come from anyway). They will also need a lot of money to do it, so anything they can produce in the meantime is essentially on that track. Thus, the wording "even more drugs".

A couple of points:

Referring to an industry as "them" is not constructive. Comcast has a horrible reputation for internet service, does that mean we are all a part of "big tech" out to screw the little guy?

Pharma companies will develop drugs that they think they can sell. If it were possible to create a stimulant variant profitably, companies would do so like any other rational actor.

The epipen story is sad, I agree, and it would be nice if it were easier to get a generic onto the market. The money for more drug research has to come from somewhere, though, so more profitability for the industry will have a positive long term affect even if the short term is highly unfortunate for the patients.

> The money for more drug research has to come from somewhere, though

The EpiPen has been on the market for awhile. Why the sudden price hike? Were they operating at a loss before?

This does not seem like a case of "we have to recover our costs" and comes across more of a case of "we are a monopoly so fuck you, give us your money."

Yes, but that is capitalism.

These companies primarily get created because investors want to see a return, the side effect is that they produce novel drugs.

So, no, they probably don't need to raise prices. Because they now have a temporary monopoly they are finding the monopoly price point as you say.

Having said that, try coming up with a better system to produce drugs.

That is not capitalism. The existence of the FDA ensures that it is not a free market. Trying to label it as such is disingenuous.

The EpiPen product is basically a plastic housing around a syringe to make it easily injectable. There is no high sky-high R&D cost here.

Well that was impassioned :).

An unregulated free market is not the same thing as capitalism.

There is nothing preventing you or anyone from developing a generic epipen, especially since it is just a plastic housing around a syringe. It just takes time and money.

Also, R&D costs are already paid for. If they are using money for R& D it will be for something else. Profitability in the pharma industry is generally low, there are lots of failed drugs that have to be paid for by something. Arguing that companies have a moral responsibility to price products low is unfortunately not true.

>> "...But he believes that those who are disabled by the condition deserve a wider range of treatment options"

> so it all boils down to the pharma companies not creating enough drugs for ADHD?

Conflating "treatment options" with "drugs" is kind of the central thesis of Schwarz's critique...

> to me it feels like the author is just manufacturing conflict for the sake of selling a book.

If you've ever worked in or around a private practice doctor's office, you're aware of the pressure to proscribe.

Many, many doctors are high-quality professionals who make decisions solely in the best interest of the patient. Many other doctors are only interested in pushing as many people through the office as possible, spending less than a minute per customer and quickly writing a script for whatever the pharma rep is selling. A little bit for the perks, but mostly because it's a way to push as many people through the office as possible. The pharma rep provides fantastic marketing and "educational" material that does the doctor's job for him, allowing him to push more people through than if he had to sit down and discuss an array of treatment options with the patient.

Regardless of the author's motivations, his critique isn't without merit (and certainly isn't specific to ADHD).

I 100% agree. We use the drugs we do because they're effective, they're cheap, and they're relatively safe. If he thinks that we should be using non-stimulant drugs, then what classes of drugs should we be looking into? Is there (at least preliminary) research to show that another class of drugs is effective for treating ADHD?

This sounds like "I don't like the way things are, so buy my book and you can read all about how I don't propose a solution!"

> But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta.

> ... Great, so it all boils down to the pharma companies not creating enough drugs for ADHD?

"a wider range of treatment options than an endless litany of stimulants" is not the same as "more drugs". Now, that could include non-stimulant drugs if those would be effective treatments for the condition, but the obvious meaning seems to be that the excessive pushing of stimulant drugs as a treatment has swamped non-pharmacological treatment options for ADHD.

It upsets at how anti-science and anti-technology some of my friends have become. Some of them believe that vaccines shouldn't be used. Some of them reject medicine and medications. Some of them avoid GMO foods. They use essential oils and 'natural' products that may potentially cause more harm than good.

But, it makes sense. I guess they fear what they don't understand, and others take advantage of that fear.

That isn't to say that we shouldn't be extremely careful with new technology and inventions. But, we also shouldn't be scared.

> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD?

By "wider range of treatment options" he doesn't mean more drugs, he means nonpharmaceutical methods as well.

No, the problem is that 'wide range of treatment options' != 'wide range of drugs'. Without reading the book, I'm certain that it has to do with the pharmaceutical industry's interest in having doctors prescribe medicine more frequently than might be in their patient's best interest, instead of adequately considering non-pharmacological treatment.

> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD?

No, some people will benefit from parenting classes or therapy as well as meds.

The author is saying that meds alone are not enough for some people.