Psychostimulants (such as Ritalin) are drugs that physicians prescribe to children with Attention Deficit Hyperactivity Disorder (ADHD). Following their introduction in the United States, the use of psychostimulants grew rapidly. However, this has not been the case everywhere, for the US represents 80-85% of the world’s psychostimulant consumption. Moreover, some countries, such as France, recognize ADHD as a medical condition but rarely treat it with medications. The aim of this article is to shed light on the American case. Towards that end, I compare the diagnostic systems used by American and French clinicians, an analysis that yields two important findings. First, the American diagnostic system has a much more liberal definition of ADHD, which leads to higher diagnoses and greater psychostimulant consumption. Second, where the American diagnostic system favors a biological understanding of ADHD and the use of medications to treat it, the French system emphasizes a psycho-social understanding and emphasizes psycho-social treatments (such as psychotherapy, family counseling, etc.). Beyond accounting for American medecine’s predilection for prescribing psychostimulants, this analysis contributes to a sociology of pharmaceuticals by revealing the synergistic relationship between disease classifications, the diagnosis of disease, and the use of pharmaceutical medications.

Prior to 1989 prescription drug manufacturers rarely used consumer advertising, spending less than $5 million between 1985 and 1988. The manufacturers’ reluctance was largely due to physicians, which bitterly opposed their use of consumer advertising. However, by 1996, a mere seven years later, the situation had reversed itself, as drug manufacturers spent over $790 million on the marketing, despite continued physician opposition. Over the course of those seven years physicians lost their influence vis-à-vis consumer advertising, and explaining why is the central goal of this paper. Towards that end I address four questions: (1) Why were physicians opposed to consumer advertising?; (2) Why did this opposition influence drug manufacturers prior to 1989?; (3) Why did the opposition cease to deter the drug manufacturers in the 1990’s?; (4) How did drug manufacturers work to overcome physician opposition? In the end I will argue that physician influence was diminished by two factors: 1) the Managed Care revolution circumscribed physician prescribing authority, which, in turn, weakened their influence over the drug industry, and 2) drug manufacturers studied physician opposition, which enabled them to deploy the ads in a way that was less likely to provoke physicians. Moreover, this work will contribute to the market sociology literature.