Val: [00:00:00] Welcome to Stories, Labels and Misconceptions with me Val Barrett. 

Dr Jeremy: And I'm Dr. Jeremy Anderson.

Val: And this week, Dr. Jeremy is taking over the episode. Would you like to say what the episode's about? 

Dr Jeremy: So today we're doing a follow up from last week where I think I mentioned last week that there was this surge in interest in mental health support at universities.

Dr Jeremy: And one of the potential reasons for that is there's a lot more people being diagnosed with ADHD. And we talked about maybe some reasons for why that might be. There's probably many factors but I saw a follow up article this week. Pointing out that drug treatments for ADHD have wider life benefits.

Dr Jeremy: in preventing negative outcomes, at least among people who are predisposed to those. And so I thought I would talk about that. I found that very interesting. 

Val: Let's get into today's episode.

 Dr Jeremy: Remember last week, I mentioned [00:01:00] an increase in demand for mental health services at universities.

Dr Jeremy: And part of this was driven by increased diagnosis of ADHD. And then I saw on the BBC this week, there was a story showing that the effectiveness of the medications for people with ADHD. And it was saying that ADHD drugs particularly stimulants like methylphenidate, which is Ritalin, which is the most common prescribed medication, I think for have wider life benefits, studies suggests.

Dr Jeremy: So I looked at this study and I have to say I'm a bit critical of the BBC. I think they could have provided a link to the article if they wanted, but I did find it. 

Val: I don't know. Did you found it? 

Dr Jeremy: I found it. It was in the British Medical Journal. So I went to the website and looked for it.

Dr Jeremy: This was an article. It was it was released this week in the BMJ and the title of that study is ADHD Drug Treatment and Risk of Suicidal Behaviors, Substance Misuse, Accidental Injuries, Transport Accidents and [00:02:00] Criminality.

Val: Couldn't they shorten it?

Dr Jeremy: No I guess not. They could have tried. So what's interesting about the study at least as reported in the BBC article. was that medication for ADHD, it's not just about, it helps you sit still or improves your own reported quality of life, but it actually was linked to reductions. Of instances of suicidal behavior by 17%, substance misuse by 15%, transport accidents, 12 percent and criminal behavior by 13%. And then when they analyzed it for sort of repetitive instances, those numbers went even higher. So there was a 25 percent reduction. in criminal behavior. And so I thought , I don't understand this. Are they saying that they saw like a 25 percent reduction in their crime rate? I don't think that's correct. 

Val: How would they know? If you got arrested [00:03:00] for a crime, is there something that says, do you have ADHD? There's some crime that they don't even report the ethnicity. 

Dr Jeremy: Yeah, strange. Exactly. So I think what people should do when you see a study like this, and if you're interested, go and find the actual study, because the way it's reported in the media, Yeah. Can be misleading or incomplete or confusing. And so I found the study and I actually used Microsoft Copilot to try to help me understand this because I'm not an epidemiologist or I don't do population health. That's not my area of expertise. And so I needed some help in trying to figure out what they were doing. 

Val: Yeah. And 

Dr Jeremy: so what they did was they had a national level dataset. So the study is from Sweden and they had a dataset of something like 140, 000 people. with ADHD. And so they compared to the group that started on a drug treatment, namely mostly methylphenidate or Ritalin [00:04:00] and or who didn't. And so what they found were about, I think it was about 56 or 57 percent of people started treatment. So it's a good sized group. 

Val: It is. 

Dr Jeremy: And they were, the findings were reported in terms of so for example it says drug treatment for ADHD was associated with reduced rates of first occurrence suicidal behaviors.

Dr Jeremy: Weighted incidence rates of 14. 5 per 1000 person years. I don't know what a person year is and or what that means. I had to actually plug it into AI and try to figure out what's going on here. So the way copilot explains it is saying, so imagine we're tracking a thousand people for one year.

Val: Okay. 

Dr Jeremy: That is 1000 person years. If you track 500 people for two years, that's 1000 person years. It's a way of measuring they found 14.5 suicidal [00:05:00] behaviors per 1000 person years. For every 1000 people followed over a year. About 14.5, had a suicidal episode.

Val: Before the study?

Dr Jeremy: The study. Meant in the comparison with suicidal ideation. It was 14. 5 in the treated group versus 16. 9 in the untreated group.

Val: So more people in the untreated group try to commit suicide.

Dr Jeremy: Yeah. And so what that means is if you compare people getting treated or not, it seems like about two or three people per 1000 person years were saved by putting them on treatment. And so then I started thinking about how do we, Describe this to people because that seems, that still seems strange 

Val: I'm struggling with the suicide thing. Can I ask a question? 

Dr Jeremy: Sure. 

Val: As soon as I saw ADHD, I [00:06:00] assumed everyone in the study has ADHD. 

Dr Jeremy: It's a data set of 140, 000 people, all diagnosed with ADHD. 

Val: So the suicide they've mentioned, what about people that don't have ADHD that commit suicide. Because what this says to me is people that commit suicide have ADHD. 

Dr Jeremy: Yeah. 

Val: Exactly. It doesn't make sense. 

Dr Jeremy: No, it doesn't. And I think that's the really important thing. That wasn't really addressed in the BBC article. 

Val: Yeah. 

Dr Jeremy: It's this idea of thinking about what are the absolute numbers. So the results do not suggest that individuals with ADHD are likely to experience them. The vast majority will not. For those vulnerable, especially with prior history, medication can reduce their risk. A 17 or 25 percent reduction, what they're [00:07:00] talking about is among the people who, if they're not treated, they're at a higher risk of developing They go on to do these things. Those people could be helped by putting them on treatment, right? It also means, if you think it's, you're saving say two or three people per 1000 if you extend that to, 84, 000 people treated they've probably saved 200 people a year. It was a two year study. Probably saved 400 people. 

Val: Can I ask another question? 

Dr Jeremy: Sure. 

Val: What if, now, because it says ADHD treatment, we know through previous episodes when we've talked about certain medication, like the blue pill 

Dr Jeremy: viagra? Like for? Like 

Val: Viagra. Viagra wasn't initially made for what it is used for today.

Dr Jeremy: It was originally a blood pressure medication. 

Val: So what I'm saying now is the ADHD , treatment, if this [00:08:00] is the result for people with ADHD, I think it would have been good if they had done it side by side with people that have probably tried to commit suicide in the past that don't have ADHD.

Val: ADHD to see if that treatment alone can work for people that don't have it. If the outcome has already shown that it's lessened people with ADHD trying to commit suicide. Am I saying it right? Do you know what I mean? I know it's a treatment for people with ADHD, but we know that there are treatment that are originally made for certain things are used for other things.

Dr Jeremy: The treatment for ADHD is a stimulant, right? That sounds counterintuitive, if you think of someone with ADHD or attention deficit hyperactivity disorder, if someone's. Super active. Why would they need something to stimulate them? Wouldn't you want calm them down? 

Val: Do [00:09:00] people want to be calmed down? 

Dr Jeremy: No, actually. 

Val: Yeah. Yeah, exactly. Is that an issue? Some people say, I'm too much. Say bloody what? Is that an issue? No, it's not. 

Dr Jeremy: Well, if you try to, calm people down. With something to depress them that would probably actually make it worse because the idea with ADHD is their brain is under stimulated. It's not regulating itself. as it should. And so the hyperactivity, the self stimulation, the distractibility, that's actually the brain's attempt to stimulate itself, to better regulate itself. The metaphor is if you've ever had a car, where the engine idles too low and is prone to stalling. What you do when you have a car like that is you're always revving the engine, trying to keep the engine running fast enough to keep going. 

Val: Yeah. 

Dr Jeremy: And if you could fix [00:10:00] the motor, you wouldn't have to keep revving it, right? But you need to keep it going so it stays steady. And that's the idea that stimulants are having with ADHD is they're providing a little extra stimulation so the person can actually sit still. They don't have to constantly be distracted.

Val: But some people's ADHD work to their advantage, depending what it is they actually do. Because it's stating to me that society says you have to be a certain way, or we're going to medicate you. 

Dr Jeremy: Right. 

Val: To bring you down. Make you more acceptable, which I think is wrong in many cases. 

Dr Jeremy: Yeah. I think. I think what's interesting about the article is that it's not merely about, okay, we're going to overmedicate you just to make you acceptable. If you choose to take this medication, none were medicated against their will, but what it's saying is that [00:11:00] actually. And I'm just grabbing the some of the results here. So like I said, with the suicidal behavior it represented somewhere between 200 and 400 lives saved. But they didn't just look at suicide. 

Dr Jeremy: They looked at. I'm just looking at looking at recurrent behaviors there were probably, 1, 750 fewer instances of substance misuse, almost 600 fewer accidental injuries about 650 fewer traffic accidents. And nearly 2, 200 fewer instances of criminality. Again, what

Val: Okay. Say somebody just caught this part of what you're saying. This could be related to any group. I'm trying to look on the other side. It's like we're labeling. Even though yeah. We will talk about that we're [00:12:00] labeling people with ADHD and thinking of crime, the worst possible things. Loads of people out there do crime, I personally don't know. . If they have ADHD. 

Dr Jeremy: Yeah. 

Val: What am I trying to say? This treatment? 

Dr Jeremy: Yeah. 

Val: If the outcome has presented all of this then this treatment could be used on a different group that don't have ADHD, because if it's brought down the numbers of people committing suicide, people being run over, people committing crime, substance abuse, that happens anyway. 

Dr Jeremy: I think it would be worth seeing if these medications could help anyone. So for instance, if someone with ADHD takes Ritalin they can focus better and get a higher score on their exam. 

Val: Yeah. 

Dr Jeremy: It might be that people who don't have ADHD, if they take Ritalin, they can focus better and get higher grades. So it could be that, that [00:13:00] this medication is actually just good for everybody.

Val: An example, the weight loss drug for people with diabetes. They've changed the study now about weight loss. So this study could have done two things at the same time to two different groups. see what I mean? 

Dr Jeremy: Yeah.

Val: And it would have made a better study. You never know. 

Dr Jeremy: Yeah, that's a perfect example, you have a medication that's designed for people with diabetes. And yes, it does help people with diabetes. But it really helps with weight loss and it can help you with weight loss even if you don't have diabetes. 

Val: Yes. Exactly. 

Dr Jeremy: And I think this study was really interesting for me because it was using this target trial emulation. And so it was this data set. So if you had a drug and you wanted to see what's the effect on people in this case with ADHD, do they take it? Do they [00:14:00] not take it? What's the effect? The gold standard that you would use. Would be what's called a randomized controlled trial where you take one, two groups of people with ADHD and you randomly assign them to either get the drug or don't take the drug. And by making it random, so no one can choose whether they take the drug and you compare the two groups, that's the gold standard. The problem with that is you can't do that practically ethically. You can't just make someone take a drug whether they want to or not. Nor can you deny people the drug if they want to take it. If it's a bona fide treatment for them, right?

Dr Jeremy: So you can't do that. But what they did was they did this interesting statistical method where they assigned people to both groups. . And did some complicated statistical waiting to make sure the two groups are the same at baseline. They followed people for two years to see what they did. Did they take the drug or not? They eliminated them from the other group. And by doing [00:15:00] that and with this statistical weighting where they remove the variation between the groups, it mimics, randomization even though they can't actually randomize.

Dr Jeremy: So it's not quite as good as randomized control trial, but it's a lot better than just watching and seeing what happens. So it really does produce more conservative estimates. I just found it a very interesting study from a statistical point of view. But I think probably the thing to emphasize with this is what they're not saying people with ADHD are particularly likely to commit crime or get into accidents. We're talking about two people out of a thousand, a very small number. 

Val: Very small. 

Dr Jeremy: That is very small, right? I think they were saying 14 to 17. A difference of two or three people out of a thousand, right? If you expand this to, 85, 000 or, 140, 000 people, [00:16:00] will the numbers get big? Saving 400 lives? That's pretty good. It's not the biggest effect but not having 400 suicides every couple of years. Seems important, no? 

Val: Do you have the figures for people that commit suicide? 

Dr Jeremy: The figures overall? 

Val: Yeah. 

Dr Jeremy: No, I guess I would need it for Sweden. 

Dr Jeremy: This was a Swedish study saying in two years there'd be 200 or 400 fewer suicides. I don't know how many suicides Sweden has in a year. 

Val: That's supposed to be high in happiness. 

Dr Jeremy: Yeah. 

Val: Every year more than 1, 200 people die by suicide in Sweden. 

Dr Jeremy: Sorry, 100,000? 

Val: 1000. 

Dr Jeremy: Okay. 

Val: 1,200. 

Dr Jeremy: 1,200 die. Yes. I suppose for everyone who dies, there's probably a lot of [00:17:00] attempts, right? There's probably a lot mores than there are.

Dr Jeremy: Yeah. Yeah. People who complete suicide. Yeah. Because it 

Val: says people who die. Yeah. An additional 300. Classified as underdetermined intent of which many may have been suicide. 

Dr Jeremy: Yeah. 

Val: In 2023, 10 children under the age of 15. Died by suicide. 

Dr Jeremy: Yeah. 

Val: Wow. 

Dr Jeremy: Yeah, I'm just looking this up now. So if we look at Sweden the numbers I'm getting is in 2022, Sweden recorded 7, 383 suicide attempts requiring inpatient care.

Val: Yeah. 

Dr Jeremy: I would expect even more suicidal behavior, self harming. But maybe weren't hospitalized. .

Val: What I'm trying to say is I don't believe, and you might not [00:18:00] believe the only people that commit suicide have ADHD. I don't know if it's because we're more aware of what ADHD is, 

Dr Jeremy: Yes. They're 

Val: know that more people, especially adults, are probably self diagnoised This is from what I've read. I'm not saying it myself. This is what I've read, are self diagnosing. 

Dr Jeremy: Yes. 

Val: Not being officially diagnosed. 

Dr Jeremy: Yes. So there's a few different things going on there. One is there's greater awareness of it some people are self diagnosing without the diagnostic process.

Dr Jeremy: The criteria for diagnosis have changed. So I think we talked last week, it's become a spectrum. So it's actually easier to get a diagnosis than it used to be. And that might be because. Maybe we're overdiagnosing or maybe the diagnosis , was always there. We were just missing it before, right?

Dr Jeremy: Or maybe we're actually living in a society that for whatever reason, the way it's structured, it's [00:19:00] actually creating more ADHD than we used to have. So there's probably many different factors contribute towards the diagnosis. But I think what this study shows that, even if we.

Dr Jeremy: Even if we're concerned about over treating people, we should know, particularly for people for whom this kind of stuff is an issue, like if someone is already self harming getting them, if it seems like they also have ADHD, getting them on treatment could be really important.

Val: Oh yeah, of course, I'm not denying that.

Dr Jeremy: If someone already has a risk factor, this could help them or prevent disaster, 

Val: what treatment do you think is only medication, is the best way? 

Dr Jeremy: This study looked at medication only, it didn't ask about other kinds of treatment. There are other kinds of treatment. And when there's ADHD in kids, the psychological treatment for that is parent training. It's [00:20:00] teaching parents things they can do to help the child learn to concentrate. If diagnosed as an adult, there are things the person can do to help practice paying attention. And I'm reminded in fact, there was one, I think it's for ADHD.

Dr Jeremy: It was a FDA approved video game. They call it a digital therapeutic. Used for treating ADHD. And what they found is that by having kids playing this game, which it basically required them to perform a game task practicing kind of divided attention. So they really had to concentrate and pay attention to a couple of different things at once.

Dr Jeremy: And really practice. focusing on one thing despite being distracted. And that was that was very effective. There really are things people can do

Val: before they're going down the medication route. 

Dr Jeremy: Yeah. Or even if they have taken the medication, maybe it doesn't work or there's some other [00:21:00] reason why they don't want to take that medication.

Val: Exactly. 

Dr Jeremy: They could do something so they could stop taking the medication. 

Val: Don't you think sometimes as a society, we should try not to always go down the medication route before we try other therapies. I don't know.

Dr Jeremy: Yeah.

Val: That game you mentioned some children just have a lot of energy. 

Dr Jeremy: Right. 

Val: Does that mean that child has ADHD or just a lot of energy. 

Dr Jeremy: Yeah. And just 

Val: needs to be doing something. To burn off that energy, use their mind whatever it is. I'm just conscious of the fact that we seem to rely on medication. Yeah. 

Dr Jeremy: Well, we don't know everything about this condition. There's a lot more that we could do to [00:22:00] understand why people have it, how they get it and what can be done to fix it. No, I wouldn't say medication is certainly the only thing that we should be doing.

Val: I'm picking up on that. Fix it. Some people, I'm going to be on the other side now because nobody here has ADHD. It's when people say things like that with people with disability. A person with, let's say a person with ADHD might say, fix what? I'm not broken.

Dr Jeremy: Yeah. 

Val: It's like when that new bill was passed the, Oh, the new dying bill. 

Dr Jeremy: Oh, assisted dying.

Val: Yeah. People are afraid it will move on to people with disabilities and the elderly it's this fixed thing. You're broken. Not like the majority. Therefore we have to fix you when some people it's to their [00:23:00] advantage. Just have, I just, because my son has learning needs and people used to look at him and. Oh why does he say certain things? Why does he act a lot younger than he is? For years I thought I had to fix him because of people's attitudes. And I realized, no, I bloody well don't. You need to be fixed with your attitude. Our attitude to others, our attitude to people that don't look like us, that don't behave like us. 

Dr Jeremy: Yeah. 

Val: Don't sit still. So what? It's not the end of the world, when you think of what a lot of people are going through, somebody being fidgety I don't know.

Val: It's up to families to decide. A parent can go to the child's doctor and doctors might say, medication. Parents need to know there may be other choices because each case is [00:24:00] different.

Dr Jeremy: Certainly if we're talking about adults getting diagnosed, I wouldn't want the message to be that, people need to run out and get medicated because otherwise they might commit crimes or kill themselves or have a car accident or something.

Dr Jeremy: If you're someone who's, you just has a diagnosis with ADHD and never had those problems before. You probably won't have those problems, right? Because they've never happened, right? But if you're someone who, has a couple of DUIs, has had a couple of accidents, maybe beat up their partner because you get angry and you're not regulating your emotions and, oh, you just got a diagnosis of ADHD. Maybe you want to consider treating that even with medication you might but you know maybe if you're someone who just finds it difficult to make Good choices. Because of your ADHD, maybe you'd want to get treated because you don't want to go back to jail. 

Val: Can you hear barking?

Dr Jeremy: Yes. Oh, you can. 

Val: Oh, gosh, it's loud. 

Dr Jeremy: This is Very loud. My microphone picks up [00:25:00] everything. Sorry, I am just going to grab her because she's kidding me. Let's see if we can find somebody. Maybe she needs some medication. Ha 

Val: Don't you dare! Ha 

Dr Jeremy: So maybe she needs some Ritalin. 

Bond. Yeah little sausage dog.

Val: I'm just going to give you something I found online. It's got nothing to do with having ADHD, but it's about suicide rates. 

Dr Jeremy: Okay. 

Val: And I give you a quiz. Do you think between Russia and Greenland, which has the highest suicide rates in the world? 

Dr Jeremy: Between 

Val: Russia and Greenland 

Dr Jeremy: and Greenland, the highest rates. I haven't looked at anything like that. I'm going to guess greenland because the population is very small. You tend to get big swings. 

Val: It is Greenland! Small population. They have 59. 6 per 100, 000 and Russia has [00:26:00] 24. 1 per 100, 000.

Dr Jeremy: Yeah. Yeah the Russian suicide rate must be higher because they keep falling out of windows.

Val: But Greenland is the highest, 

Dr Jeremy: is highest. It's 

Val: Greenland. Guyana. Lithuania, South Korea, then Russia. Wow. 

Dr Jeremy: That's it. And it's from, really places, there's some, very Northern like Greenland is very far North. Then you have, Guyana and South Korea, which are pretty, relatively more, equatorial. So it's not seasonal affective disorder kind of thing, like lack of sunlight but yeah, big cultural differences, 

Val: blimey. So there's a big difference. The UK is way down on the list. Way, way down. We've got 8. 47 per 100, 000. Does that say [00:27:00] what year? Yeah. Which is low, but people are still committing to, but then that doesn't add up the ones that have been trying. 

Dr Jeremy: Exactly. Yeah. Yeah. But I was interested in this procedure. Yeah. Just this way of doing an observational study. I thought the way it was originally presented, it was very much a kind of, this thing causes another thing. And I thought really to make a causal argument, you really do need the randomized control trial. And it took me several rounds.

Val: What is a randomized control trial compared to another trial? 

Dr Jeremy: Yeah, if you just had two groups of people. One group chooses to take the drug and another group chooses not to, and you just see which group has a different effect. For example, for anything, not just ADHD, but [00:28:00] for, if you found a difference in outcome, like one group had more heart attacks or one group lost more weight than the other, right? 

Val: Yeah. 

Dr Jeremy: You could conclude the effect was the drug they were taking.

Val: Okay. 

Dr Jeremy: But you don't know that. Maybe, 

Val: because you don't know the diets. 

Dr Jeremy: The same people who take the drug are also more likely to eat healthier, or they're interested in health generally, maybe they're more likely to exercise just because you see a difference in the group doesn't mean that you can be confident that the difference is because of the medication. You haven't ruled out of the things. 

Val: Okay. 

Dr Jeremy: And we know there's the placebo effect, if people think they're getting treatment, they report feeling better even if they're not. Maybe that's accounting for the difference. To control for that you don't let people choose whether they get the treatment or not.

Val: Okay. 

Dr Jeremy: You randomly [00:29:00] assign them. You don't decide all blondes go in the treatment group and brunettes, in the placebo group.

Dr Jeremy: So 

Val: they didn't do this. 

Dr Jeremy: No. 

Val: Oh, no. Okay. 

Dr Jeremy: So with the ADHD study, no, that's not what they did.

Val: Why I thought they had two different groups. 

Dr Jeremy: Yeah. So that's the interesting thing, right? For some kinds of studies, you can do this randomized controlled trial where you control all factors that you think could be influencing the outcome, including you randomize people to which condition for some, if you're looking at, a drug to treat hair loss you can randomly assign people to that. That's an elective. procedure. Nobody's going to die because they do or don't get their hair back or whatever. You have some 

Val: hair, some hair loss to begin with, haven't you? Yeah. 

Dr Jeremy: You probably have some hair loss to begin with, right? So you can randomly assign people to a condition, but there's other things that, for just practical reasons, [00:30:00] ethical reasons, you can't, or, this study was 140, 000 people.

Dr Jeremy: There's no research study. That's a huge number so it wasn't that they, recruited people, put them in a group and decided what drug they got or didn't get. What they did was they had a data set. They just had a list of people that, that have ADHD. 

Val: Oh. 

Dr Jeremy: Right?

Val: Yeah. 

Dr Jeremy: And then they just follow the data because in Sweden there's all these data reporting things. So they get a bunch of data look at these people follow them over two years and see what happens.

Val: Okay. 

Dr Jeremy: It was hard to wrap my head around exactly what are they doing that isn't just seeing whether people take a drug. How is that different from people choosing on their own? How does that deal with threats to validity? 

Val: Did these people know they were on a study? Were they just skipping the medication? Did they go to a center? And watch them take it. 

Dr Jeremy: No, so they would have been [00:31:00] prescribed the medication, by the GP 

Val: prescribed something. How many times cause I'm guilty of being prescribed a medication, taking it halfway through feeling better and I stopped taking it. 

Dr Jeremy: Yeah. So certainly for 140, 000 people, there was nobody standing over their shoulder making sure they take their medication. But the way the study works is if someone is in the treatment group, 

Val: Yeah 

Dr Jeremy: moment it's reported that they stopped taking their medication, they're weeded out of the study. They're checked out. Okay, 

Val: but how do they know that they stopped taking the medication? If 

Dr Jeremy: it's reported that they stopped, right?

Dr Jeremy: So if So it has to be, 

Val: again, it's relying on it being reported. 

Dr Jeremy: Yep, exactly, right? Yeah, a lot of these things, it's, there's always issues of of self report. 

Val: Really?

Dr Jeremy: Yeah, When I 

Val: look online, when I look at studies, that pharmas are doing. They ask you to come in and you may take, they may give you the injection, give you the medication, you go home, they follow you up by phone call, video call, whatever. But the [00:32:00] main thing is, they see you take it. Do you see what I mean? So that's why I find this as well. I'm looking at this a bit weird. 

Dr Jeremy: Yeah it's different. This is population health. 

Val: Yeah. It's such a shame because they, it was such an, I think probably the downside of it is it's such a large amount of people that were in the study. They probably couldn't have done it any other way, which means should they have been so ambitious? In the amount of people that they had. On this study because if you're gonna do something like this, 

Dr Jeremy: yeah. 

Val: You want it to be Yeah. Controlled at some sort. Yeah. So you bring the numbers down. I dunno why they were so obsessed if having such a large number.

Dr Jeremy: It's because their population health researchers, that's the level of analysis that they're okay they're working at. So there, the question isn't so much about the individuals. But it's more about, if we do this at the level of the population. What is the result going to be? They found a small result, but significant because it is just so many people involved.

Val: [00:33:00] Yeah. 

Dr Jeremy: So what they found was, there was this case of some people, it's going to be reported that they stopped taking their medication. They get chucked off the study. And so just the way that they they omit people who don't follow the protocol or at least as, as they as they're aware of.

Dr Jeremy: And then 

Val: these people have ADHD. Yeah. And they expect them to follow the protocol. Yeah, please. Yeah. That's a good, it could be a break. That's a good,

Dr Jeremy: that's a good point. But it could also be that, someone who at some point they weren't taking the medication . But then at some point they decided to take it. Okay. They get checked off as well. So basically this tends to reduce the impact of selection bias. And so that combined with a a way of complicated statistical weighting, it means they, they tend to get two groups that are fairly equal which kind of mimics the randomization part.

Dr Jeremy: So I thought it was a clever way. It's not as good as a real randomized control trial, but it but it's probably better than just looking and naively just noticing that one thing followed another, therefore there's a cause. It's it's definitely an improvement. So I think that's just the way sort of population [00:34:00] level health research is done.

Val: Okay. I didn't understand it, but no, I didn't understand it. He's going to get pulled apart. 

Dr Jeremy: Yeah. I had to really wrap my head around this cause I'd never heard of it. 

Val: No, this isn't the kind of 

Dr Jeremy: research I've ever been trained in. So it took me quite a bit to try to understand what exactly are they doing here. It seems they've they've got an interesting finding, and probably the next thing that they b they want to do would be something more smaller. As you say try to do an actual randomized control trial measure these things. Fewer people, but probably more practical. And if you could actually control or see whether or not people are actually taking their medication it'd be expensive. But might be worth doing. 

Val: does it say when this study was done? 

Dr Jeremy: It came out on the 13th of August in the the British Medical Journal. So yeah, it's , pretty prestigious journal.

Val: So that's the end of the episode. Let's look at our labels and misconceptions are.

Val: You, as I said, the label is from what that [00:35:00] study says. People with ADHD commit a lot of crime. 

Dr Jeremy: Yeah, I think my label would be this ADHD, right?

Dr Jeremy: That's a diagnostic label. 

Val: Oh yeah, you did it. Did you do your Miss your misconceptions. 

Dr Jeremy: Yeah, the misconception, is just what we've been talking about this episode is that, we don't want to give the misconception that people with ADHD are more likely to suffer from these things. Necessarily or that they're especially likely to do things like, commit a crime, or get into a car accident, or kill themselves.

Dr Jeremy: They're not. Actually, the vast majority of people with ADHD are, at least over the two years, did not do any of those things. 

Dr Jeremy: As we've established, I seem to be long winded today. 

Val: Yeah, very long winded. Okay. Let's get into today's episode.

Val: Okay. That's a wrap. 

Dr Jeremy: Fantastic. I'm just 

Val: fantastic at this. Okay.