APA is facing the prospect of having to fight charges on several fronts that it conspired with Novartis to promote Ritalin sales and the diagnosis of ADHD. APA and Novartis have vehemently denied the charges.

Lawyers who made headlines when they successfully used multiple class-action lawsuits to rein in the tobacco industry have turned their sights to APA and the company that manufactures the drug Ritalin.

Apparently believing they have identified a new target for a consumer-oriented litigation campaign, the attorneys have filed class-action lawsuits against APA and Novartis Pharmaceuticals Corporation charging that the two organizations conspired to boost sales of Ritalin (methylphenidate) by promoting the diagnosis of attention deficit/hyperactivity disorder (ADHD).

The California and New Jersey lawsuits follow the filing of a similar suit in Texas in May. In that suit three parents whose children were prescribed Ritalin for ADHD sued APA along with Novartis and Ciba-Geigy on similar grounds. (Ciba-Geigy is the company that manufactured Ritalin beginning in 1955 and in 1997 merged with Sandoz to form Novartis.)

The Texas parents allege that APA and Ciba-Geigy conspired "to create, develop, promote, and confirm diagnoses" of attention deficit disorder and later ADHD. They maintain that APA included the diagnoses in its prestigious and widely used Diagnostic and Statistical Manual of Mental Disorders in large part because of the alleged conspiracy with the drug maker.

The two new lawsuits, which were filed in September, appear timed to play into the growing nationwide debate among parents, educators, and health care providers over whether Ritalin is overprescribed or appropriately prescribed for children, particularly preschool children, who exhibit ADHD symptoms.

APA President Daniel Borenstein, M.D., told Psychiatric News that what troubles him most about these lawsuits "is that they will discourage the families of children and others who need psychiatric treatment from seeking help." As for the claim that APA manufactured the ADD and ADHD diagnoses to help increase the sales of a stimulant that turned to out to be an effective treatment for hyperactive children, Borenstein pointed out that "as early as the 1930s physicians had discovered that stimulant medications were helpful to children" who manifest certain behavioral problems. "Obviously, the psychiatric community was aware of the therapeutic benefits of stimulant medications and was using them long before ADD or ADHD appeared in any version of DSM. This is hardly an APA conspiracy with a pharmaceutical firm."

"The spurious and groundless nature of these suits suggests that there are agendas other than a concern for children and their families at work here," emphasized APA Medical Director Steven Mirin, M.D. "Rather, the lawsuits appear to be a calculated attempt to discredit the enormous amount of research that underlies the development of the Diagnostic and Statistical Manual, which has enhanced our ability to diagnose and treat children with attention deficit/hyperactivity disorder."

One of the lead attorneys in the California and New Jersey lawsuits is Richard Scruggs of Mississippi, who led the charge against the tobacco industry in courts throughout the U.S. over the last several years. He gained further attention earlier this year when he announced that he was using the same tactics against the managed care industry that met with considerable success against the cigarette makers. The crux of the class-action suit targeting managed care companies is that they committed fraud by promising services to beneficiaries in exchange for their premiums but then failed to deliver the promised levels of care.

By late September APA had not been served with legal papers informing it of the specific charges included in the two new lawsuits, so it does not yet know how closely they parallel the ones in the Texas suit.