We all remember Bob Dole in the Viagra commercial and the Zen exercising for Celebrex. We have gotten used to the idea that drug companies will advertise their products directly to us, even when these are prescription medications.

But until this fall, the major pharmaceutical houses had respected a long-standing United Nations treaty prohibiting the direct advertisement to parents of powerful and highly addictive drugs such as Ritalin for attention deficit/hyperactivity disorder, or ADHD.

Now, the manufacturers of drugs other than Ritalin have broken the treaty and are marketing directly to parents. The ads, picturing happy boys in idyllic families, appear in back-to-school issues of magazines such as Good Housekeeping and clearly are intended to encourage parents to ask their children's physicians to prescribe the drugs. The drugs, although not substantially different from Ritalin in content, contain a time-release mechanism so that one morning dose can get a child through the day. In contrast, children on Ritalin typically need to see the school nurse for a second dose. The Drug Enforcement Administration recently added Ritalin to its list of "drugs of concern," a list that includes cocaine, Ecstasy, marijuana, methamphetamine and other legal and illegal drugs. Ritalin now has become one of the drugs most abused by adolescents.

With direct advertising to parents, drug companies are aiming at a vulnerable group. Often confused and overwhelmed by their children's behavior, parents may grasp at something that seems to come with medical legitimacy as well as a promise of results.

Yet there are many reasons why parents may be overwhelmed by the activity level of their children and there are many possible responses that do not involve drugs.

Parents trying to cope with the multiple demands of everyday life and parenting may see ADHD even when the real problem is less severe. Nor are drugs the only or best way to respond to high levels of activity in children. Common sense points out some of the initial steps--making sure the children are eating well (low sugar and caffeine, high protein) and getting plenty of sleep and exercise. These are effective treatments with no side effects. Structured programs of behavior modification also can be effective. Turning too quickly and exclusively to drugs promotes the belief that drugs offer a quick fix for our problems. Also, it fails to look at the underlying environmental and social factors that may encourage hyperactivity.

Furthermore, such drugs are most effective when monitored by skilled child and adolescent psychiatrists. The drugs have different optimal levels for cognitive and motor functioning. What may help Johnny think best may not slow him down sufficiently to please his parents or teachers; what may slow Johnny down physically also may turn him into a very dull boy.

Spurred on by these ads, parents will be asking family physicians and pediatricians with much less training in the subtleties of the drugs to prescribe them.

The allure of drugs is that they offer seemingly simple answers to complex questions. Direct advertisements muddy waters that are already difficult to navigate, solely in the name of increased market share in a lucrative business. Such ads should be banned by Food and Drug Administration regulations, not just international treaties with no enforcement provisions.

Los Angeles Times, November 18, 2001