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A recent study found a brief delay in peak growth spurt among boys who took ADHD stimulants for at least three years, but no significant effect on their ultimate height. (iStockphoto)

More Evidence That ADHD Drugs Don't Curb Ultimate Height

by Katherine Hobson
Sep 1, 2014

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More and more kids are being diagnosed with attention deficit hyperactivity disorder, and many are medicated — often with stimulant drugs like Ritalin or Adderall.

With so many children taking these drugs, plenty of parents and doctors are concerned about potential side effects, including the possibility of curbed growth. Some studies have suggested that the drugs can cause growth to slow a bit, while others haven't found a link. Few studies have followed these kids beyond their youth to track their final heights. Now there's some reassuring news on that front: Research published online in Pediatrics on Monday found that children who took ADHD medicine didn't have height deficits in adulthood.

Researchers looked at medical records from people born in Rochester, Minn., from 1976 to 1982. They identified 340 children diagnosed with ADHD, and tracked them into adulthood. Each person's medical record was then compared with those of two other people, matched for age and gender but otherwise randomly selected, who didn't have ADHD. (All were participants in the Rochester Epidemiology Project, a long-term data collection and research collaboration.) The 171 children who took stimulants for ADHD started at an average of about 10 years of age, and took the drugs for about 4 1/2 years. (The study didn't look at newer, nonstimulant drugs like Strattera, which wasn't approved until 2002.)

Neither an ADHD diagnosis itself nor treatment with stimulant drugs was linked to a significant difference in growth or final height, compared to the average for that age and gender, says Dr. William Barbaresi, lead author of the study and a developmental-behavioral pediatrician at Boston Children's Hospital. The only significant effect was that, for boys treated with the drugs for at least three years, the medicines were associated with about a six-month delay in the peak growth spurt. But there was no significant effect on the ultimate height of those young men, says Barbaresi.

Still, it's crucial that doctors continue to monitor the growth of children taking these drugs, Barbaresi says. It's possible that some in the study were taken off their meds if their growth rate raised concerns. And because of where the research was conducted, the population was mostly white, which might also limit the findings.

But the research suggests that "in the real world, with clinicians making decisions, there's no long-term impact" on height, Barbaresi says. His study showed no relationship between dose or duration of treatment and adult height.

The research adds to the evidence suggesting that "this is not an issue that people have to worry about," says Stephen Faraone, a psychologist at SUNY Upstate Medical University who researches ADHD.

"It's a terrific study," says James Swanson, a pediatric psychologist at the University of California, Irvine who also studies ADHD. He's on a team looking into the effects of higher doses of stimulant drugs, taken over a longer period of time. Long-term data on growth from that study, he says, have not yet been published.

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Charles Cumming's latest book is A Colder War. (Jonathan Ring)

Author Charles Cumming Ponders The Seductions — And The Sins — Of Spying

Sep 1, 2014

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If you were making a movie about the world of British espionage, you'd want to cast someone like Charles Cumming as your undercover agent. He's tall and handsome and self-assured and utterly charming in that self-deprecating British way. You can imagine him effortlessly gliding through the small talk of embassy parties or sweeping a gullible female officer off her feet — in service of Queen and country, of course. In other words, it's easy to be seduced by him.

And seduction is what it's all about, according to Cumming — who is, in fact, a best-selling author of spy novels. "Spying is about relationships, and spying is about persuading people to do what you want them to do — and that is not so far removed from a romantic relationship."

Cumming was actually approached to join the British intelligence services after he graduated from university. A friend of the family suggested he might want to explore joining the "diplomatic" service, a delicate euphemism for the Secret Intelligence Service, MI6. He went through the early stages of application — and that experience inspired A Spy By Nature, which follows young recruit Alec Milius as he learns that while deception is necessary in the complex world of espionage, self-deception is something else entirely.

Cumming's new novel, A Colder War, stars Thomas Kell, an unjustly-disgraced MI6 agent called in from the cold to investigate the death of a seasoned officer in an apparent accident. It's got the requisite action scenes, exotic locales, and intricate spycraft, but it's what you might call "thinky;" light on the kind of derring-do found in a standard spy novel. "It's derring-don't," he laughs.

And in a way, he's right. Cumming is more concerned with the moral quandaries inherent in espionage. "I don't think spies think of themselves as liars. I think they think of themselves as patriots, and as a necessary evil, if you like, because by lying it's a means to an end — they are trying to save lives or protect people or gather intelligence."

Cumming has been hailed as a worthy successor to John Le Carr, and it's clear the great British spy novelist has had quite an influence on his approach to his craft. "There is a demand that American readers have for spies to be heroic," Cumming says, "to not have all of the gray areas that we explore on this side of the Atlantic ... here, we're all sort of George Smiley and self-doubt, and self-pity, even." George Smiley, being, of course, the mild-mannered and morally conflicted hero of many Le Carr books.

Kell is no George Smiley, but he's a sympathetic character, someone the average reader can identify with even if the average reader is not, in fact, a spy. He's middle-aged, with a failed marriage under his belt and a thoroughly stalled career. Despite that, Cumming also knows that the average parts of a spy's life can make for tedious reading "If I was true to the operational day-to-day teamwork of tracking some brainwashed mad mullah in Derbyshire, the reader would get very bored very quickly, because as Le Carr pointed out — and Tom Kell is fond of quoting, spying is waiting."

So Cumming includes the thrills — because an espionage thriller must thrill — but what really appeals to him is making room for depth and development of characters. "I don't really think of myself as a spy novelist," he says. "I just think of myself as a novelist who writes about spies, because by writing about spies I can get into all sorts of things about human behavior and relationships and ambition and frailty that the genre affords."

Madhulika Sikka is Executive Editor of NPR News, and an unabashed fan of espionage thrillers.

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During the rainy season, a canoe is a handy vehicle to have in the waterlogged Peruvian neighborhood of Belen. (Courtesy of Dave Ohlson)

Volunteer Docs In Peru Take A Shopping Trip To Look For Patients

by Dave Ohlson
Sep 1, 2014

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Medical student Dave Ohlson and Leovina, a local counselor, talk with potential patients in Belen, a neighborhood in Iquitos, Peru.

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After a couple days operating on people in Iquitos, Peru we realize we're going to need some more patients.

We started with about 50 candidates, with hernias, tumors or unidentified pains. But most were excluded for a variety of reasons. Some were too old or weak, and we feared complications with their hearts. Some never returned with the x-rays (relatively affordable at government clinics) we would need before operating. Yet others had conditions we were not equipped to operate on, like tumors of the ovaries or uterus.

A couple of us medical students headed out into the neighborhoods to find more patients.

Iquitos is divided into four districts, each with its own mayor and demographics. Belen is the poorest, situated on the edge of town. It literally extends into the Itaya River, a huge tributary of the Amazon. The houses are built on stilts or just float, tied to posts to prevent them from drifting away. The further out on the river, the more questionable the construction gets: homes cobbled together with scrap wood and plastic. If you are truly poor, this is where you stake your claim.

We begin in the market, the largest in the city, and walk gradually downhill past stalls offering chicken, fish and monkey meat. There are clothes and shoes as well, but it's the meat that catches your eye, laid out on wooden tables and of questionable freshness.

Tarps strung over the street between the stalls lend red, green or blue hues to the scene. Through the open areas between these tarps, vultures descend to the street to squabble with stray dogs over scraps.

We're with Leovina Perez, a Peruvian counselor who works with the residents of Belen. We get a lot of attention from the vendors as we're still dressed in our scrubs from the clinic. As we walk between stalls a woman asks us what we're doing. When we explain that we are looking for people who might need surgery she asks us to examine her abdomen.

We step off the street through a door and into a concrete storeroom. She shows me her stomach while explaining the pain she has. Unfortunately, it is not a hernia, something we can easily fix in the operating room. It's likely a benign tumor of the uterus. Also known as fibroids, these growths can cause pain, especially during menstruation. We aren't equipped to perform gynecological surgeries during this visit but take her information so that Leovina can contact her if another surgical team comes through.

We turn and walk down stairs until we come to the edge of the water. It is the beginning of the dry season, and the water has receded a bit. The houses stand on their stilts about half a story above the waterline. From here you can get in a canoe or use makeshift walkways suspended above the fetid waters. Garbage is strewn about, collecting against the homes in the water. You can smell the human waste that gets deposited straight into the river. There is no sewer system or garbage collection. The current just carries it away — or so one hopes.

As I struggle to keep my balance on the narrow wooden planks I think about how much I do not want to fall in this water. Then I come across a group of children swimming, laughing and splashing each other. It's not exactly shocking. The reality is that more people live in similar makeshift communities around the world than live in American-style neighborhoods. Still, the water makes it seem especially unsanitary.

Leovina knows of a potential patient, so we follow her along the catwalk by rows of wooden houses. Eventually we come to the individual's home, where he waits with another man interested in surgery. Inside, a television is on next to a stereo with rather large speakers. It's one of the classic paradoxes of our times that we're here in the poorest area of Iquitos, yet some homes have satellite TV and we follow up with these patients via cellphone.

The home consists of a main room with two smaller rooms attached. Plastic sheeting lets light in through the ceiling. I can see the water through gaps in the wooden-plank floor.

After interviewing the patients I take them one at a time into a bedroom to examine them. One is suffering from quite a large hernia that he's had for 15 years. It hurts, he says and keeps him from working. He's in his 70s and I worry that his age increases the risk for surgery, but I tell him to come to the clinic for a final determination. The other man is younger, maybe 50, and has a smaller hernia that should be easy to repair.

We walk back via a different route finding more patients along the way. The walkways bring us to concrete streets, a recent improvement to the neighborhood. The receding waters have left behind large piles of wet garbage, which we pick our way around. The houses here are mostly concrete and brick. Various shops occupy their lower levels, but in the rainy season the water sits just below the second story. I am told that in very wet years the water can reach even higher.

It's tempting to call Belen a slum, but really it is a neighborhood like any other. Though the people are poor there are a range of incomes. Some people work in the market; others have jobs in the city. To call it a slum seems insulting to the dignity of the people who live here. They do the best they can with the little they have.

Leovina herself grew up here. People of Peru, the NGO she now works for, became part of her life when she was barely a teenager. Through this group she was provided with the opportunity to go to college. Today she counsels orphans and women in crisis centers run by the organization. Her story is a great example of how a helping hand can turn someone's life around — and that's basically what we're trying to do when we go out looking for patients.

The patients we found came to the clinic and most had successful operations. The reality, though, is that we couldn't get to everyone we wanted to help.

On our last day of clinic I had to go and speak with one of our patients from Belen to tell him we were not going to be operating on him. It was the older of the two gentlemen I had examined in the home above the water. We were leaving the next day and knew we'd already be operating into the night. As a medical student I know it will someday be my job to deliver bad news, but that doesn't mean it will ever be easy.

I felt personally invested in this patient. We had walked out into the neighborhood and found him, offered him hope, and now we were going to just leave? It seemed unfair, but the hard truth is that there has to be a limit. There are a finite amount of resources, and there are physical limits to how much work people can do. Someone has to be the last patient. We operated on the younger man because he had a lower chance of complications. It was a triage decision that underscores the fact that there is a lot more work to be done here.

I talked with Paul Opp, the director of People for Peru, about this. His organization gave logistical support to our trip and they host many other types of groups throughout the year.

Sometimes he'll hold a dinner for new volunteers and give each of them a coupon redeemable for a meal at a local restaurant. And the volunteer is told to give the coupon to a deserving resident of Iquitos.

It sounds simple enough, but the area of downtown Iquitos that runs along the Amazon River has many needy children begging and they recognize these coupons. It's easy to give away a voucher for a free meal. What's not easy is a situation with ten hungry children begging you to feed them — and you can only help one.

Paul hopes this coupon experience will point up the enormity and difficulties of the task here. A city can't be changed overnight. But with groups coming in to help, at least some residents will get the help they need.

As for me, I can't wait to return.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

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During the rainy season, a canoe is a handy vehicle to have in the waterlogged Peruvian neighborhood of Belen. (Courtesy of Dave Ohlson)

Japanese Baseball Games Goes 50 Innings

Sep 1, 2014 (Morning Edition)

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Medical student Dave Ohlson and Leovina, a local counselor, talk with potential patients in Belen, a neighborhood in Iquitos, Peru.

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During the rainy season, a canoe is a handy vehicle to have in the waterlogged Peruvian neighborhood of Belen. (Courtesy of Dave Ohlson)

Archaeologists Find Brewery Remains At Virginia Campus

Sep 1, 2014 (Morning Edition)

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Medical student Dave Ohlson and Leovina, a local counselor, talk with potential patients in Belen, a neighborhood in Iquitos, Peru.

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Archaeologists digging up the grounds of the College of William & Mary in Williamsburg found the remnants of a campus brewery from the 1700s. It's already known that salves sold the school hops.

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