Letter of the Week: Joan Hoover Says Amphetamines Should Not Be Prescribed to Stop Onset of Type 2 in Overweight Children

Patient advocacy advisor and frequent contributor to Diabetes Health, Joan Hoover, adds her opinion to the discussion of whether Adderall should be used to help obese children avoid developing type 2 diabetes.

May 22, 2008

Editor's Note: This week's letter is from Joan Hoover, one of our favorite and most outspoken board members. Joan is also our patient advocate advisor. She is a tireless diabetes educator and advocate for people's access to clear, accurate, and unbiased information about the disease. When Joan speaks, we sit up and listen! Her letter is addressed to Editor-in-Chief Scott King and Diabetes Health pharmacy advisory board member R. Keith Campbell. Campbell had commented favorably on news that a doctor had successfully treated obesity in children by prescribing amphetamines.

The article to which Joan is responding discussed the growing problem of teenage obesity. Not only does obesity make teens susceptible to type 2 diabetes, but it's also very hard on the teens themselves. They are often bullied or ostracized because of their weight.

One physician has found success with such patients by prescribing off-label Adderall, an amphetamine that's meant to be used for attention-deficit disorder. Dr. Fuad Ziai, a pediatric endocrinologist, has prescribed Adderall to over 800 overweight children and teens, more than ninety percent of whom have lost weight. He believes that the drug, combined with Glucophage, has helped the children avoid type 2 diabetes, and he believes that there was no other option.

A sidebar in the article printed excerpts from Scott King’s video interview on DiabetesHealthTV with Keith Campbell, RPh, CDE, about the use of amphetamines to help children lose weight. Keith had a surprising opinion; he said that if the beneficial impact of the drug greatly outweighs its side effects, then we should be willing to explore its potential.

And now, here is Joan Hoover’s letter:

Dear Scott and Keith:

You have GOT to be kidding!

Are you really suggesting that we take a chubby diabetic kid and turn him into a skinny drug addict? Dealing with his addiction will certainly take his mind off the problems of coping with his diabetes... and probably everything else.

Of course if he were very, very careful with the dosage and the timing and kept everything in exquisite balance... just maybe. Adolescents are known to be so good at that sort of thing, right? On the other hand, he might just drive his car at 100 miles per hour into a tree – but at least he'd be thin.

As for there being "no other option," that's just not true. Diet and exercise have proven to work much better than anything else. That translates into less junk food and fewer video games, which is without question hard work and much less fun than illegal drugs. But the bottom line is that he will actually get to grow up and have a LIFE! For the rest of his days he will be able to look back and be sure he made a very good choice.

Joan Hoover,
Patient Advocacy Advisor
Frequent contributor to Diabetes Health.

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Categories: Amphetamines, Diabetes, Diabetes, Food, Letters to the Editor, Losing weight, Type 2 Issues, Type 2 Medications

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Posted by Anonymous on 23 May 2008

Dear Scott and Keith,
What are you ON?

Dear Joan,
Glad you are not on what they are on.

Posted by runstr8t on 23 May 2008

I am not a registered user, but am an RD, CDE and Certified Eating Disorders Specialist. I am dismayed, dismayed that we would even go here. Our country is filled with adults who as children who went down the road of amphetamines in the 70's for weight control. Most of them, now adults, do not recommend it. Many have eating disorders today. Why, oh why, are we wondering why we have an obesity epidemic in kids? We give our kids fat free cereal loaded with sugar and fat free milk (what is there to blunt the glycemic index?). They get inadequate protein and inadequate good fats which are needed for CCK and satiety, and we wonder why they are always eating. They are not getting "real" food with "real nutrition" so they are not getting the vitamins and mineral cofactors they need for their bodies to function properly. They are living on chicken nuggets, french fries and sodas. With their high sugar,high trans fat, high glycemic diet loaded with soft drinks and candy used as a reward, insulin levels are through the roof. Why wouldn't they be getting insulin resistant, gaining weight and developing diabetes. These kids are drinking sodas instead of milk. When these kids hit their teens they will have diabetes, osteoporosis, and dentures. I read an article from a weight conference in England. And one of the speeches was entitled "Are we sacrificing our children on the altar of the free market economy?" and to that I would answer a resounding YES!

Posted by David Darell Galbraith on 11 November 2008

I just spent 4 hours writing a comment on Joan's letter

Before posting my comment I rated Joan's letter and my letter and all my work just disapeared.

Did you get this letter, I really wanted a copy for my own files

Please contact me ASAP as I am freaked out at the loss.

David Galbraith

Posted by Diabetes Health Webmaster on 11 November 2008

Sorry David, but we don't have any record of the comment you tried to post. Apologies; it's best to send a form before doing anything else on the page.

Posted by David Darell Galbraith on 11 November 2008

November 11th,2008

Dear Joan,

I am a 55 year old man with Type II Diabetes.

I am a drug addict. I am addicted to Glipizide, Metformin, Actos, Januvia, and Lantus to control my blood sugars.

I am also addicted to Lipitor to control my cholesterol, and Zestril because my kidneys are throwing off proteins.

It saddens me to know that you are the patient advocate advisor because I found your letter, to Scott and Keith, inflammatory, inaccurate and devoid of empathy for overweight people and people addicted to drugs.

In your letter, your statements, "diet and exercise" and "hard work and much less fun" made it clear to me that you are one of those people that think that overweight people are lazy, lack will power, and would rather be having "fun" using "illegal drugs" so they can drive into trees at 100 MPH.

I found your information biased and deliberately misdirecting. It seemed to me like you didn't even read the article to which you were responding. Didn't you read about the 800 children successfully treated. And there was so much more.

You made it sound like Scott and Keith were advocating the use of street drugs for children. I am absolutly sure that you know that amphetamine prescribed by a doctor is a legal drug. Yet you calculatingly chose the word "illegal" to refer to what was clearly stated as a, drug prescribed by a thoughtful and caring Doctor, in what seemed like an attempt to defame or criminalize him by suggesting that the good Doctor is taking "chubby diabetic kids" and turning them into "skinny drug addicts".

Illegal street drugs have two serious problems. First of all they are cut with unknown fillers that could be poisons, or the poisons could be impurities from improper manufacturing. The second problem is that there is no way do determine dosages. These are not problems with prescription drugs.

There is another problem with illegal drugs. When people are denied help from their doctors because of short sighted views like yours, sometimes they turn to illegal drugs because they don't really understand my first two reasons and how they can exasperate a problem rather than help.

Then of course there is the forth problem of law enforcement, which brings on a whole new set of problems.

Attitudes, like yours, create more problems, and help no one. These attitudes make it harder for people to get the health care they need, and prevent real addicts from seeking or finding the help they need.

One of the most lacking of commodities in the health care field is EMPATHY. It reminds me of when I worked as a carpenter's helper. When I hit my thumb with a hammer the carpenter would say to me, "I didn't feel a thing". God, it would be nice if more medical providers could feel their patients pain, at least on an emotional level.

After reading your letter, I started to wonder if you were freighted by some fat drug addicted "Human Being" when you were a child.

You are right, diet and exercise is the best answer, but diet and exercise "alone" are "not" the only answers for everyone, just like amphetamines are not the answer for everyone.

When you get right down to it, at this point, there may be nothing that anyone can do for some people.

Another thing I found dishonest about your letter was the way you implied that the doctor said there was "no other option", when what he said was that none of the other options worked with the particular children he prescribed for. While they sound similar, they are in deed, completely different.

I would have preferred that a person with your responsibilities as a "diabetes educator and advocate for people's access to clear, accurate, and unbiased information about the disease", write in a more professional style. In stead this was a personal attack on the good doctor, Scott, Keith, and of course, those lazy-no-will-powered-fat-people everywhere (me being one of them), that will not diet and exercise.

I am 5ft 9in tall and pushing 270lbs. at the beginning of this year I weighed around 230lbs. I am bigger than I ever have been and feel ugly, physically and emotionally. I am also very frightened. If not for my beautiful loving wife and a son I love more than I could ever describe, I don't know where I would be.

I have asked my doctor to prescribe an amphetamine for me, called Dexedrine, because I am thinking about eating and wanting to eat, all of the time. I can finish eating, and be full, right now, and be thinking about what else can I eat. Its very distracting and maddening.

I really don't know why I have this eating problem. I just know I do. I also feel that a prescription for Dexedrine will go a long way toward correcting this and many other problems and threats to my life and limbs, ect... I would much rather be addicted to this one prescribed and monitored drug that will help me to live longer by helping me to live a healthier lifestyle, rather than be addicted to all of these other drugs that are most likely shortening my time on Earth.

I am also tired all of the time. I can sleep for 10 hours and wake up and stay tired. It could be because of the diabetes and the sugar in my blood not being turned into energy, or because all of my medicines cause drowsiness, or maybe because of one of my biggest fears, the onset of kidney disease that blocks proteins from reentering the blood and throwing them away in my urine (recently my ankles have been swelling which is a sign of kidney problems, or maybe the Actos is building up fluids in my body threatening my heart).

I can't get myself out of bed. Not because I'm lazy, but because I am exhausted. I have so much I want to do and no energy to do anything. Just sitting here writing (one of my joys) is extremely difficult and my ankles and feet just keep getting bigger.

My diabetic drugs all cause weight gain and cause drowsiness. To me this is very perplexing and counter-productive. All of these drugs by themselves are mortally dangerous to the point that I have to have several blood test every 3 to 6 months to see if they are damaging my organs. No one is really sure what risk the combinations of drugs could exhibit.

I have read on the internet that over 70% of beriatric patients that had diabetes before the procedure did not have diabetes within days of having the procedure. The surgery limits the food intake to about an ounce at a time, so it only makes since to me that sugar levels would be reduced dramatically, eliminating diabetic conditions, and my need to take all of these drugs.

I feel that with Dexedrine I could achieve the same results, without the surgery that I have no interest in, at all. My hope is to improve my diet and exercise regiment to a point where my weight is normal, and eliminate my diabetic conditions, while I work to ween myself off of all of these medications. Of course I fully intend to work with my doctor and a nutritionist, and I will have to continuously test my blood to prevent hyperglycemia.

I would hate to see any child go through being over weight or experience diabetes. I also pray they never have to deal with the cruelty they have to endure from other children, and even childish adults, because they are fat or different, like a fat kid with diabetes. I was a slightly fat kid compared to how fat I am now and was humiliated to an extreme degree by other children.

I hope you will reconsider your position, because you have extremely important responsibilities.

Joan, not all fat people can be cured with diet and exercise alone.

And Joan, not all people that use amphetamines are addicts. Some of them are called patients with needs.

Respectfully submitted,

David Darell Galbraith

P.S. I am interested in all comments regarding my letter.

Posted by David Darell Galbraith on 16 November 2008

I was doing research on DiabetesHealth.com and I would appreciate, very much, if I could get the opinions of Scott King and Nadia Al-Samarrie regarding my letter to Joan and especially my plan to use amphetamines, that I mentioned in this letter. I also am interested in any other articles on the subject.

Thank you.

David Darell Galbraith

Posted by Anonymous on 27 January 2011

I could have avoided diabetes if I had been given amphetamines because there was no other recourse for me. Surgery was not an option because I was not 100 pounds overweight at the time and diet/exercise just did not work for me with my busy schedule. Sorry to say it, but that is the truth, period. Believe you me, if I could have stopped eating, I would have because I lived in constant fear of getting diabetes for four years until I finally got it. I was totally helpless and nobody helped me because I "might" get addicted. Well they knew I "would" get diabetes... and I did. Even now, I face possible complications because no one will help me lose weight. When weight loss is the cure for diabetes, at least for a while, why don't doctors help us?

Is there a doctor out there who will prescribe me amphetamines? I will be responsible. I don't even drink! I would rather not get on dialysis or die from a heart attack, to tell you the truth.

Lets get real, people, it is very hard to lose weight. Even now, when, once again, I am desperate to do so, and I have time off from work, I can't seem to stick with a diet. Believe, me... once I am thin, I will NEVER gain weight again (despite what statistics say).

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