It’s a well-known fact that the use of a book’s cover for the purposes of judgment is not always the best way to go about making decisions. Additionally, since the dawn of written literature in the West, authors have pointed out that those who accept large wooden horses left outside their gates with a less than critical eye will often come to wish they’d viewed the matter with a bit more skepticism. It’s with these thoughts in mind that I tender this rather dubious review of The Amphetamine Debate: The Use of Adderall, Ritalin and Related Drugs for Behavior Modification, Neuroenhancement and Anti-Aging Purposes (2011) by Elaine Moore, a book whose cover, or at least whose title, could be called “inaccurate” at best and “grossly misleading” at worst, seeing as it involves use of the word “debate”, a term traditionally referring to a situation where two sides argue over an issue. And while it is normal in the course of a real debate for one voice in the argument to be stronger, better researched, or more convincing than the other, when one of the two sides doesn’t even show up, the use of the term “debate” is itself, well, debatable. As for the inadvisability of cover-based judgments, it is notable that the back cover of The Amphetamine Debate states: “This book covers both sides of the debate over amphetamine prescription and use.” Having read the thing cover-to-cover now at least twice, this claim leaves me with little else to do than scratch my head.
If the aim of Moore’s book is to “cover both sides of the debate over amphetamine prescription and use” then her work is, to put it mildly, an embarrassing failure. The book is unabashedly in favor of stimulant drug use, going so far as to dismiss the better part of those problems associated with said stimulants as being largely the result of insufficient legal access to speed, owing to pesky government restrictions. Throughout the text the dangers, complications, and concerns regarding psychostimulant medication are downplayed or dismissed, often by use of a “most studies show…” line of argument presented without references or citations.
If, however, the goal of The Amphetamine Debate is to provide aid, comfort, and what is essentially a resource guide for anyone wishing for greater legal access to stimulant medications––a resource guide camouflaged in a stupefyingly shallow way as a seriously researched impartial exploration of a difficult issue––than, for what’s it’s worth, I suppose the book is probably a success. However, woe betide anyone looking for a genuine engagement with the debate alluded to on the book’s cover.
It’s hard not to see The Amphetamine Debate as being anything other than an extended advertisement for amphetamine and its chemical allies. There’s a little bit of something in The Amphetamine Debate for everyone. For ambitious college students there are extensive descriptions of exactly what symptoms need to be reported in order to get access to drugs such as Adderall. It’s got everything a concerned parent would need to make a convincing argument to a pediatrician that their child needs pills. It’s got everything a physician would need to pitch psychostimulant medications to a concerned parent. It’s got a wealth of information for anyone seeking to make an argument that in all fairness, cognitive enhancement drugs should be broadly available for any adult wishing to partake of them under a doctor’s supervision. (Note: There may very well be a fair argument here; however, the sneaky and dishonest way in which that argument is slipped in without any benefit of a cross-examination serves only to endanger such a viewpoint’s legitimacy.) In this context, the chapter sketching out a vague outline of the current U.S. methamphetamine crises seems somewhat incongruous; but perhaps its function can be seen as a magnet to draw criticism of the social dangers of amphetamines and their ilk onto their country cousin, meth, whose epidemic abuse status, The Amphetamine Debate would like to imply, is owing almost entirely to a lack of access to legal speed due to “government restrictions.”
There are two main problems with The Amphetamine Debate as a book. The first—the disingenuousness of its title—could easily be cleared up by renaming it The Debate is Over: Why Everyone Should Have Legal Access to Speed. The second is the fact that the book reads like it was written by a number of different, and often mutually conflicting, authors. Simply put, the book is a mess, totally lacking in arc, argument, and organization. Facts, concepts, and anecdotes are repeated throughout, often presented as if they were being mentioned for the first time, despite having already been covered in previous chapters. Spelling and grammar errors indicate insufficient copyediting (not that I can talk, but the book even misspells the name of its own publisher in the “also by” section of the copyright page). Early chapters assume readers to be comfortable with professional medical vocabulary, while later chapters repeat much of the same material recast in more of an “our friend the neurotransmitter” style approach. Internal inconsistency abounds. While the first chapter repeatedly stresses that concerns surrounding psychostimulant medication are largely a matter of “...highly publicized accounts of amphetamine misuse and abuse by a small number of individuals…”, the second chapter already alludes to the fact that by 1966 Benzedrine inhaler abuse had gotten bad enough to require legislative intervention. By chapter seven, grudging admissions are made as to the seriousness of widespread speed usage, especially in the form of methamphetamine. The chapters dealing with ADHD diagnosis and medication particularly stand in sharp contrast to any debate-ish interpretative pretense found elsewhere, with long stretches of the text reading as if they had been copied directly off the bottle of certain medications, listing indications, contraindications, and even directions for usage: “The XR formulation must be swallowed whole or sprinkled on food; it should not be crushed, chewed or divided.” Sections of such text are repeated practically verbatim elsewhere.
The striking contrast between sections really cannot be emphasized enough. On the one hand, it could all be put down to bad editing. By which I mean really, really bad editing. On the other hand, several other explanations might account for the stylistically fractured nature of the text. One would be that individual chapters had been prepared for publication separately and then simply not reworked into the flow of the entire book when compiled. A slightly more cynical explanation might be that the individual sections were never really meant to be read as a whole, but are instead presented with the assumption that readers will be cherry-picking which topics to read about according to their interests. The most cynical explanation, and one that I understand constitutes a very serious accusation, is that several of the chapters of the book restate information because they are essentially cribbed, transcribed or re-worded from other works. It’s no small matter to publicly suspect that a book may either engage in or at least flirt dangerously with plagiarism. It is most certainly not an accusation I would make without evidence, but unfortunately I was able to identify a number of passages in The Amphetamine Debate that I recognized, and then confirmed, as coming word-for-word from the 2008 book On Speed by Nicolas Rasmussen. Moore cites Rasmussen more than any other single source I could find, and does go out of her way to include special thanks to him in her acknowledgements. However, she also works portions of Rasmussen’s text verbatim into her own without use of quotation marks. At worst this is highly dubious behavior, ethically and professionally. A best it merely reflects an extremely sloppy approach to the appropriation and citation of other people’s work. In either case, having located at least one instance of this (compare The Amphetamine Debate pg. 21 with On Speed pg. 16) it’s hard not to wonder where else the same thing might be happening.
Speaking of Rasmussen, having already read On Speed put me in a position to feel especially critical of The Amphetamine Debate. One of the most disturbing aspects of Moore’s work is how entirely uncritical it is about the possibility of collusion between corporate interests and medical professionalism to profit from issues of psychiatric health––a practice documented at some length in Rasmussen’s book. Indeed, throughout The Amphetamine Debate there is a marked lack of inquiry into the profit motive of those in the mental health field, with breezy sentences being tossed out like: “Such early research [...] initiated a novel working collaboration between universities and pharmaceutical companies that has proven mutually beneficial through the years.” Furthermore, issues such as the first reported deaths, circa 1939, from amphetamine abuse are presented exclusively in terms of having posed a “marketing problem” for early pharmaceutical interests. If I had not also read (and reviewed) On Speed it might be possible to chalk Moore’s total lack of engagement with the issues surrounding the medicalization of mental health to simple naiveté. However, considering how thoughtfully and thoroughly Rasmussen tackled these issues, indeed making them a primary focus of On Speed, and considering how heavily Moore leans on (if not directly appropriates) large sections of his book, the fact that she totally ignores one of On Speed’s central themes leaves me with a bad taste in my mouth. She read all of that. She was exposed to the entirety of that argument. She encountered a very thorough examination of a culture-wide problem of growing significance—the reliance on prescription drugs to conform to increasingly destructive social expectations—and in response chose to utterly ignore it and go on pimping the meds. It’s a critical lapse that throws an ugly light on her entire effort.
It is notable for instance, that in a book purporting to explore the full range of fact and opinion surrounding the use of prescription amphetamine, particularly with regard to issues such as ADHD diagnosis and medication, the total amount of text I could find voicing even the possibility of irresponsible overmedication of American schoolchildren (a possibility taken quite seriously by Rasmussen) numbered 140 words. Moreover, the paltry paragraph in question doesn’t even tackle the issue seriously, but instead makes anecdotal reference to a journalist who, while setting out to write a book exploring the issue of overmedication “expected to find pushy parents demanding psychostimulant drugs and doctors more than willing to comply with parental requests,” but who however “soon learned that this wasn’t the case.” The journalist’s book is not even mentioned by name (a little digging revealed it to be Judith Warner’s 2010 release, We’ve Got Issues: Children and Parents in the Age of Medication) and reference is only made to a New York Times review of the same (apparently Moore didn’t bother to actually read the book whose conclusions she summarizes). That out of all available literature on the topic of medicating children the author cited only a book review of a relevant text is indicative of the depth of The Amphetamine Debate’s overall approach to a sticky subject.
One of the most stunning examples of the book’s final position is the embarrassingly titled “summery” found tacked on to the end the last chapter, a chapter otherwise entirely concerned with haphazardly listing off a broad spread of topics in neurology (where, once again, basic topics about the biology of the nervous system are restated as if for the first time), neuroethics (defined here as a branch of ethics dealing with “fairness and the availability of stimulants”), and a bevy of theories, practices, and products concerning smart drugs and cognitive enhancement. Of all the chapters, the last one best exemplifies the patchy, buckshot feeling of the entire book, standing as a prime example of the laziness and incoherence that plague it throughout. The “summery”, appearing almost as an afterthought. encapsulates the actual position of the author. Had it been put on the back cover, prospective readers would have been far better prepared for what to expect to find within:
Experts agree that because of their value, amphetamines are not going to go away. [...] Today’s laws mandating that prescriptions for amphetamines be hand-delivered to pharmacies each month act as deterrents for many parents whose children would benefit from amphetamine use. Many of amphetamine’s medical uses, particularly in neuroenhancement, are not being fully realized because of current restrictions. These restrictions also lead to people finding illicit drug sources.
The overwhelming slant that The Amphetamine Debate gives toward supporting widespread stimulant use begs the question of what exactly the author’s motivation was in putting it together. The most extravagant and paranoid hypothesis would involve money changing hands off-stage, sufficient to produce an ostensibly objective book by an independent researcher all too sympathetic to the interests of certain drug companies—a hypothesis made more credible by the fact that throughout the early history of amphetamine use in America this is exactly what took place, and rather aggressively too, with drug companies heavily funding any researcher willing to scientifically endorse their product. However, there is absolutely no evidence of anything of the sort going on here. My own best guess would be that nothing more sinister took place than an author perceptively taking note of the fact that stimulant drug use, in particular among American children, is on the rise and that a growing market exists for books like this one, aimed at explaining amphetamine for the benefit of that market––thus making this book not dissimilar to those ocean dwelling scavenger fish who attach themselves to shark bellies and nip timidly at spare morsels that fall from the enormous gaping maw of their predatory hosts.
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