4/30/2000 – Gumble’s Interview with MI Medical Examiner re: Ritalin

From Ann Blake-Tracy….

We sent you the news last week that Oakland County Medical
Examiner Dr. Ljubisa Dragovic in Pontiac, MI attributed a ten year
span of Ritalin use to the heart failure death of 14 year old
Matthew Smith.

Apparently for years the school had threatened to turn the family
in for neglect if the boy was not kept on Ritalin – a problem facing
far too many families today in a country that has been given
warnings by the United Nations because the United States uses
90% of the world’s Ritalin supply. This is going on in schools
that deceive us all by posting signs that read “Drug Free Zone.”
It would be far more appropriate to post signs that read “Drug
Zone.” I have always said it is so ironic that the police could
probably confiscate more “meth” raiding a school for
methylphenidate (Ritalin) than they would in shutting down a
meth lab.

Matthew’s chest pains and racing heart had been ignored as
warning signs that the small blood vessels that supply the heart
were being shut off by the Ritalin because, “You just don’t see
this in the younger population.”

On April 17, 2000 Bryant Gumbel interviewed Dr. Dragovic and a
psychiatrist who was attempting to defend psychiatry’s use of
Ritalin. Some very interesting points were made by Dr. Dragovic
in the interview that we would like to share with you. Some of the
most important points I have highlighted.

Ann Blake-Tracy

GUMBEL: Matthew’s cause of death was officially listed as heart
attack. Why do you blame Ritalin?

Dr. DRAGOVIC: Well, because we found, at autopsy, changes
that were of significance, and these changes were particularly in
small blood vessels that supply the heart muscle. These
chronic changes, these are the changes that result from
long-term type of exposure to a stimulant like this.

GUMBEL: Could–could there possibly be no other cause for a
heart attack in a 14-year-old? No family history of heart trouble,
no–no possibility of drug use?

Dr. DRAGOVIC: Well, we did all the toxicological workup. The
only medication he was on was actually Ritalin, which is
methylphenidate. We certainly excluded all other disease
processes in his body. There was nothing wrong with the
14-year-old, other than the fact that he had some significant
changes, long-term changes in the small vessels that supply
his heart muscle. And I’m not talking about large coronary
arteries. I’m talking about arterioles. These are the smaller
vessels that, over a period of time, get really primed up by-by the
effect of this type of medication.

GUMBEL: I want to bring in our guest here. Psychiatrist Bill Koch
has prescribed Ritalin to thousands of patients. You’ve
characterized Dr. Dragovic’s views on Matthew Smith’s death as
a wild claim. How come?

Dr. KOCH: Unfortunately, with all due respect to the doctor, there
is absolutely no evidence that Ritalin causes vascular disease.
This medication has been around for almost 50 years. It’s been
used in millions of children, and there’s no evidence that it
causes heart disease. In fact, it has been cleared by the
American Heart Association as being very safe. They don’t
require even any monitoring, unless there is somebody who
already has heart disease. Among the patients that I see, I even
give it to people who have heart disease. I mean, obviously, if
they have heart disease pre-existing, they’re very carefully
monitored. But there is no evidence. In fact, one of the nice
things about Ritalin is that it has very little effect on the heart,
do some of the other stimulant medications.

GUMBEL: …Dr. Dragovic is there something you’re not looking

Dr. DRAGOVIC: Well, I would like to remind my esteemed
colleague over there that in pathology, and particularly in forensic
pathology, we don’t come to a conclusion through a democratic
process of arguing the points. It’s the findings that dictate the
diagnosis, and they are there. We didn’t put them there. If there
is a better explanation I will certainly take it. To exclude the
possibility of effect on the heart of a known adrenergic agonist is
really a far-fetched type of expression. Unfortunately, we learn
through our mistakes, and the analogy can be found in Seldane,
or the cases of which I have deaths related to Seldane I have
investigated, cases of deaths of Parlodel, Bromocriptine and
things like that–we are just learning through the unfortunate
experiences, and…

GUMBEL: Let me ask you something. Where Ritalin is
concerned, will you have any pause about prescribing it from
here on?

Dr. KOCH: Absolutely not.

GUMBEL: And Dr. Dragovic?

Dr. DRAGOVIC: I’m not a psychiatrist. I’m a forensic pathologist
and a unipathologist. I’m a basic scientist. I have seven children.
I would never suggest or allow my kids to take it or anyone who I
know would I advise to take it.

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