Diagnosing my perspective

As I sit here in Malawi reading this article in the NYtimes, I feel lucky to have no other health, financial or family issues. I'm lucky enough to leisurely read about the urgency of an objective test to evaluate ADHD.

Most mainstream researchers consider A.D.H.D. to be an authentic neurological deficit that, left untreated, can ruin not only school report cards, but lives. Nonetheless the quest for objective evidence has gained new urgency in recent years.

Many critics say the disorder is being rampantly overdiagnosed by pill-pushing doctors in league with the drug industry, abetted by a culture of overanxious parents and compliant educators."

Having just wandered through the wards at KCH and Bwaila for the first time, which were teeming with broken, ill and tired people...waiting for hours, the language used in this article appeared to be unnecessarily sensational at first. How can they be concerned about over-diagnosing ADHD in the US when there are so many people in need HERE!

Then I thought about it a bit more. It's a big issue in the US. As far as troubles go for what we're used to dealing with in a developing world, it's something that needs to be examined and made right. Who am I to assign worth to a condition that affects many people in the US and is a complicating factor for education and health resources. It's a burden to our healthcare system and that makes it important.

In fact, the underlying problem--establishing an objective diagnostic method for a difficult to diagnose disease to avoid over treatment--is a major issue in resource-limited settings as well.

In the US, over-medicating kids for ADHD is an imprecise solution to a difficult to characterize problem. In Malawi and other resource-limited countries, TB is difficult to define and diagnose so presumptive treatment is often the solution. Even with an accepted threshold of CD4 counts precisely measuring values is difficult here, which in turn makes the decision to initiate HIV treatment fuzzy.

Since healthcare provision is lacking in different ways in both countries, it's easy to compare and get frustrated with the US prioritization of resources. The diseases are more severe in Malawi, the life expectancy much shorter and the remedies are known and proven in other places (provided resources are available). It's frustrating and really easy to question the ridiculous diagnostics ordered to resolve noncritical health problems in the US. But, I have to keep it in perspective.

While the target may be different, the problem is similar.