Leonard Sax, M.D., Ph.D.

Monday, December 22, 2008

Drug companies' hidden influence

In chapter 4 of Boys Adrift, I expressed my concern about the growing number of boys who are being treated with medications such as Adderall, Ritalin, Concerta, Metadate, etc. In the past few months (fall of 2008), there have been a series of revelations about the extent to which drug companies have influenced "opinion leaders" in pediatrics. Drug companies don't wine and dine lowly primary care practitioners very much any more. Instead they go after the big fish, the famous doctors -- chairs of departments of pediatrics and child psychiatry, that sort of thing. We're talking millions of dollars changing hands, and the doctors don't have to tell anybody. I think that hidden influence may be a factor in the explosion in the prescribing of these medications for children. I wrote about this for the New York Daily News last week. I'm honored that my article was the #1 most e-mailed article at the NY Daily News web site from Sunday Dec 14 (when it appeared) through Wednesday Dec 17. You can read the article, and readers' comments, at this link.

Change of subject: I just received my copy of the softcover edition of Boys Adrift. I'm really pleased with it. The publisher agreed to add lots of new and updated material, including an afterword which puts this problem in an international perspective. I hope you'll check it out. It goes on sale January 5.

Change of subject: if you'd like to send me an e-mail, or call our office, you can do so via this contact page. I hope to hear from you!



Thursday, May 1, 2008

Bisphenol A in the headlines

In recent weeks (April 2008) there has been a blitz of articles about the risks of bisphenol A, prompted by a report from the National Institutes of Health.
Click here to read the NIH press release on the report; you can download the full text of the report (a PDF file that runs 69 pages) by clicking at the link of the top-right hand corner of the press release.

If you have already read chapter 5 of Boys Adrift, nothing in the report will come as a surprise. There was nothing new in the report. More precisely: what was new in this report was not what the report said, but who said it. This is the first time that any agency of the US federal government has published an official report expressing concern about the health risks of bisphenol A. As the Washington Post observed in a front page article published April 27 2008, more than one hundred peer-reviewed scholarly articles had already documented health concerns about bisphenol A, particularly for children; but until now, federal agencies -- particularly the FDA and the Environmental Protection Agency -- had relied on just two studies, both funded by the chemical industry, playing down the risks of bisphenol A.

The quantity of media attention devoted to this topic has been remarkable. Unfortunately, most of these reporters don't seem to know much about this issue. So, they have focused on the question of whether bisphenol A increases the risk of certain kinds of cancer, or whether bisphenol A may promote the onset of puberty in girls. These are valid concerns; but what has been missing from the news coverage is the effect of bisphenol A, and other endocrine disruptors, on BOYS. In chapter 5 of Boys Adrift, I cite research suggesting that these chemicals may disrupt or delay the onset of puberty in boys; more importantly, these chemicals may actually effect the developing brain in juvenile males differently than they do in females, specifically with regard to curiosity and motivation. In some studies, juvenile males exposed to these substances lost their motivation and/or their curiosity; no such negative effect was seen in the females.

I haven't seen any media reports which have even mentioned this research. Again, as I stress in the book, I think the lack of media attention regarding adverse effects on boys is NOT any kind of conspiracy. It's not deliberate. The lack of coverage comes about simply because most reporters don't know very much about the topic.

I will try to read and respond to all posts on this blog which request a response from me. If you would like to send me an e-mail directly, send your e-mail to leonardsax AT prodigy.net (type "@" in place of "AT" of course).

Hope to hear from you soon.


Tuesday, December 18, 2007

Milwaukee's newspaper, the Journal-Sentinel, recently published two LENGTHY articles, documenting the risk associated with environmental endocrine disruptors. The first article really is an excellent introduction to the whole topic, with lots of charts and a very large amount of information about PHTHALATES. The second article presents a wealth of information about the increasingly well-documented risks of BISPHENOL A. The various reporters who contributed to these articles also do a good job of documenting how these substances disrupt endocrine development, particularly in males.

Of the five factors I describe in Boys Adrift, I have found that this factor -- endocrine disruptors -- is the one which Americans struggle with the most. I have found that people in Australia, New Zealand, and western Europe are much more open to the idea that substances in our food and water may be adversely affecting boys development.

I highly recommend these two articles for anybody who wants to learn more about the risks associated with endocrine disruptors.

Friday, August 10, 2007

Dr. Sax summarizes his second book, Boys Adrift

I have been a practicing physician for 21 years. For the past 17 years, I have worked in a suburb of Washington DC. Ten years ago, I began noticing something odd. I'd find a particular family where the daughter was motivated, hardworking, and successful - while her brother was an under-achiever. I've now documented this pattern hundreds of times just in my own practice. Emily is a straight-A student determined to get into a good college, while her brother - just as smart as Emily - has none of her drive.

In the past seven years, I have visited over 200 schools around the United States, Canada, and Australia. I have met with teachers, spoken with parents, and listened to children and teenagers from every demographic group. I've found that this pattern - "driven girls, directionless boys" to use Professor Judy Kleinfeld's phrase - is becoming more common everywhere you look. You'll find it in cities, in suburbs and in rural areas; among White, Black, and Latino families; and in affluent, middle-income and low-income neighborhoods. Boys whose families have recently immigrated from East Asia or South Asia - from Japan, China, Singapore, India, Pakistan, etc. - appear to have some degree of immunity to this emerging epidemic. But the longer those boys live in this country, the more likely they are to begin manifesting this weird syndrome of apathy and lack of motivation.)

What's going on?

I've spent every available moment for the past seven years researching this question. I've published scholarly articles for the American Psychological Association and the American Academy of Family Physicians. I've written op-eds for newspapers such as the Washington Post, the Los Angeles Times, the Minneapolis Star-Tribune and the Philadelphia Daily News; and I've corresponded with more than a thousand parents and their sons. I've seen this question grow from my own personal mission to become a national topic of debate and the central theme of movies such as Failure to Launch.

And now, finally, I think I've figured it out. I've identified five factors which are driving this phenomenon. And I've seen what works: what parents can do to turn this thing around and get their sons back on track.

Tuesday, July 31, 2007

The Truth about Boys

According to the cover story for TIME Magazine dated August 6, 2007, boys today are doing just great, "better than ever" (p. 44) -- not only at school, but in their personal lives as well. The author, David von Drehle, provides three bits of evidence (and only three) to support his assertion that boys are doing "better than ever" at school.
  1. Reading scores for 4th-grade boys have risen.
  2. The proportion of boys graduating from high school has increased 4% (four percent) since 1980.
  3. More boys are going straight to college after finishing high school.
So, what about those reading scores? Reading scores for fourth-grade boys have indeed risen; but (as the TIME cover story concedes), reading scores for twelfth-grade boys have plummeted, so that "many boys are leaving [high] school functionally illiterate" (p. 44). Not to worry, though. After all, those fourth-grade boys are doing better. As those fourth-grade boys move up to the higher grades, we can confidently "expect gains in the higher grades soon." (p. 44).

Such a comment betrays a stunning lack of understanding both of the reasons behind the rise in fourth-grade test scores and the corresponding decline in the scores of high school boys. These two phenomena are closely linked. Over the past 20 years, there has been an acceleration of the early elementary curriculum, coupled with a narrowing of the focus of elementary education (for more detail on this point, with supporting references, please see chapter 2 of Boys Adrift)

Recess has been cut back. There's less music, less art, less physical education, and more reading drills, writing drills, and arithmetic exercises. (This is less true at elite private schools than at most public schools.) When you turn elementary school into year-round test-prep, you will see test scores rise. But that improvement comes at a price. Some students, especially boys, tune out. They lose interest. They no longer read for fun. (See chapter 2 of Boys Adrift for more documentation of the lower propensity of boys to read for fun today compared with 1980.)

And they stop paying attention. Over the same 20 years during which we've seen this acceleration and intensification of the early elementary curriculum, there has been an explosion in the number of kids, especially boys, being diagnosed with attention-deficit disorder. The United States has about 5% of the world's population but consumes about 90% of the total global production of ADHD medications such as Adderall, Ritalin, Concerta, and Metadate. (Please see chapter 4 of Boys Adrift more more facts and figures about the overdiagnosis and over-prescribing of medications for ADHD in the United States). The TIME cover story praises the "enlightened teaching and robust encouragement" which Mr. Von Drehle believes now characterizes American education (p. 45). But what's so enlightened about an educational system which drives many parents to drug their children, especially their sons? The number of boys on stimulant medications for ADHD has increased roughly 30-fold (i.e. by 3000%) over the past 20 years. In affluent suburbs, it's now common to find one in three middle-school boys on these "academic steroids." From my perspective as a practicing family physician, listening to the concerns of parents who feel pressured to put their sons on Adderall or Concerta, it's hard to share the enthusiasm of the TIME cover story for our supposedly "enlightened" system. In my experience, it's usually not the boys who have something broken and in need of fixing. It is instead more often the school which needs to be brought back into alignment with the reality of what's developmentally appropriate for kids to learn, and how best to inspire kids to become lifelong learners rather than mere test-takers.

Graduation rates: Regarding the supposed 4% increase in graduation rates: The TIME cover story accepts without question the US Department of Education's estimate that 89% of boys graduate from high school today, up from 85% in 1980. Both these figures are substantially inflated, in the view of people who study the messy issue of graduation rates. In May 2007, the Bill & Melinda Gates Foundation helped to fund a “National Summit to End America’s Silent Dropout Epidemic.” According to the scholars who presented at this summit, "graduation rates are, at best, 70 percent nationally, and for black and Latino students, especially boys, closer to 50 percent." (The quote is from the article in Education Week entitled "Conference Focuses on 'Silent Epidemic' of Dropouts", May 16 2007. It's remarkable that TIME magazine would run a cover story using the Administration's optimistic figure, without even mentioning the fact that most scholars believe these inflated figures have little contact with reality. One wonders: was Mr. Von Drehle unaware of the scholarly work on graduation rates in this country, or was he aware of it but chose to ignore it?

But at least more boys are going to college than before, right? The "favorite statistic" in the TIME cover story, the statistic which Mr. Von Drehle says serves to "sum up all the others," is the one which supposedly proves that "fewer boys today are deadbeats" (p. 45). This statistic refers to the fact that more boys between the ages of 16 and 19 today are in school or working than was the case 20 years ago. That's true, primarily because more boys today attend college than in the 1980's. The TIME cover story concludes that boys therefore "are pulling themselves up."

But such a conclusion neglects the larger picture. It's true that more boys are going to college than was the case 20 years ago. In affluent suburbs, in particular, essentially every boy goes to college. The only requirement for a boy to go to college, after all, is a parent whose checks don't bounce. A more meaningful parameter is how well boys do at college. According to a recent front-page article in the New York Times, at many colleges and universities, roughly 4 out of 5 students earning high honors now are women. According to the latest report from the US Department of Education, only 30% of men who enroll at a four-year college or university will earn a degree within four years, compared with 39.7% of women. According to a May 2007 report underwritten by the Pew Charitable Trusts, young men today (age 30 to 35 years of age) will be the first generation of American men to earn significantly less than their fathers did at the same age. They are also the first generation of American men ever to be less well-educated than their sisters. In this age group, 32% of women have earned a 4-year college degree, compared with only 23% of men. Please see chapters 6 and 7 of Boys Adrift for more information about the end result of our current educational system: a growing proportion of young men who "fail to launch."