Research
Links to additional research:
*Note: some of the following links will require you to register through Medscape in order to view them. I do not know a way around this due to copywrite issues. In my opinion it is a fantastic resource and does a great job keeping up with emerging research articles and registration is free.
-The following link is a great overview of where things currently stand. Note section 4.
http://www.medscape.com/viewarticle/566132
- Good expert interview that highlights some important points with respect to diagnosis, possible co-existing conditions, and the management of treatment. As it pertains to adults with ADD/ADHD, I found it interesting that of the 8 or 9 million adults with ADHD, less than one million are believed to be diagnosed and treated.
http://cme.medscape.com/viewarticle/505629
-Another expert interview but also with great objective data. Perhaps the most amazing statistic (but not unexpected) showed that subjects taking stimulant medication actually had an incidence of sudden cardiac death BELOW that of the general population. It is also worth noting here that the cutoff for "significant" is normally considered to be 1%. Thus, in this study the threshold for significance with respect to sudden cardiac death was nowhere near being eclipsed in either the background population or the studied popluation.
http://cme.medscape.com/viewarticle/527857
-This article repeats some of the same things as the others, however it highlights the effectiveness of treatment. There is littls doubt the treatment is effective. Conversely, there is little if any evidence that potential side effects manifest themselves with any notable frequency. It also points out the importance of treatment from a functional impairment perspective. How this applies to aviation is obvious.
http://cme.medscape.com/viewarticle/549971 |
-This article points out misperceptions regarding the frequency in which stimulant medications are abused. There is a distinct difference between medication use and medication abuse, which is partially why these medications require a prescription and monitoring.
http://www.medscape.com/viewarticle/406791
- During my NTSB hearing much was made of the Adderall potentially leading to incapacitation in a pilot if he or she were taking the medication. I also felt the FAA took issue with the dose of medication I was taking at the time. This article is included to point out the appropriate dosing of medications. It also lists the most common adverse events related to stimulant medication use. While worth noting and being aware of these potential side effects, it seems appropriate to make the case that none of them would render a person incapacitated or unable to pilot their aircraft, especially after having sufficient time to adjust to the medication.
http://cme.medscape.com/viewarticle/558549
-This article discusses both the appropriateness of drug holidays as well the important point regarding the benfits of treatment outweighing mild side and tolerable side effects. One sentence states, "Many parents who fear medicine because they have heard critiques by pseudo-experts will often be so focused on the possibility of harm that they fail to see the benefit derived from pharmacotherapy." The FAA seems to be of the same opinion. It also states, "suspending the treatment that improves these conditions is not in a patients best interest." Finally, the last paragraph notes, "Nothing replaces sound clinical judment. The vicissitudes of clinical practice usually preclude algorithmic solutions." In the case of aviation and medication use I interpret this to mean that the physician and the unique patient situation are better able to determine the most appropriate treatment, medication or not. It should not be blanket FAA policy that dictates this in one direction or another.
http://cme.medscape.com/viewarticle/519331
-Another article discussing side effects. Note that in the majority of patients it is common to not experience any side effects.
http://www.medscape.com/viewarticle/546866
-Short article about medications and substance abuse.
http://www.aafp.org/afp/20030415/tips/17.html
-Information about Adderall specifically. Note page 6 of the article. I includ this to show the pharmacokinetics (how fast the medication is metabolized by the body) because the FAA's expert witness testified that Adderall was unsafe because the amount of medication and it's concentration could fluctuate from moment to moment and that it couldn't be measured like other medications the FAA allows (i.e. coumadin). The graph was published from the Physicians Desk Reference. It also shows quite clearly that the pharmacokinetics are understood quite well and that concentrations in the bloodstream change over hours, not minute to minute or moment to moment.
http://www.rxlist.com/adderall-xr-capsules-drug.htm
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