From: "Saved by Windows Internet Explorer 7" Subject: NICE recommendations are not evidence based and could expose many to unnecessary harm -- Timimi et al. 337 (272): a2284 -- BMJ Date: Thu, 30 Oct 2008 21:50:28 -0000 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C93AD9.8621DC10" X-MimeOLE: Produced By Microsoft MimeOLE V6.0.6001.18049 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C93AD9.8621DC10 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.bmj.com/cgi/content/full/337/oct27_2/a2284
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Published 28 October 2008, =
doi:10.1136/bmj.a2284
Cite=20
this as: BMJ 2008;337:a2284
The National Institute for Health and Clinical Excellence=92s=20 (NICE=92s) single most important recommendation is for = medication=20 to be used as a first line treatment in "severe"=20 attention-deficit/hyperactivity disorder (ADHD).1= =20 Like other systematic reviews of ADHD medication treatment, = NICE=20 notes the inadequate reporting of study methodology, possible = bias,=20 limited reliability of results, and inadequate data regarding = adverse=20 events, correctly concluding that the evidence does not = support using=20 medication as a first line treatment for mild or moderate = ADHD. Yet=20 NICE concludes that medication should be used as a first line = treatment in "severe" ADHD, with only one reference cited in = support=20 of this2= =20 (which is a reanalysis of the data from the largest trial = comparing=20 medication and behavioural treatments), which concludes that = the more=20 severe subgroup showed a larger decrease in symptoms with=20 medication than with behaviour therapy. However, these data = were=20 gathered 14 months after the beginning of the study. Swanson = et al,=20 analysing the same group of patients after 36 months, could = not find=20 support for long term benefits of medication over behaviour=20 therapy, even in those with more severe symptoms.3= =20
These guidelines are likely to expose many children and adults = to=20 unnecessary harm. The recommendations are not supported by = the=20 evidence analysed by NICE. The evidence should lead to the=20 conclusions that ADHD is a disorder of questionable validity, = particularly as a diagnosis for adults, and use of medication = should be a "research only" recommendation.
Cite this as: BMJ 2008;337:a2284
Sami Timimi, consultant child and adolescent=20 psychiatrist1, Jon Jureidini,=20 consultant child and adolescent = psychiatrist2,=20 Jonathan Leo, associate professor of=20 neuroanatomy3
1 Lincolnshire Partnership Foundation NHS Trust, Lincoln = LN4 2HN,=20 2 Women=92s and Children=92s Hospital, Adelaide, Australia, = 3=20 Lincoln Memorial University, Harrogate, USA
stimimi{at}talk21.com