Who’s Afraid of a Small Blue Pill?

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Foundation staff and trustees were the subject of one of the most surprising (some would say shocking) drug trials in recent memory, described in the May issue of the British medical journal Lancelot.

Over a seven-year period (1992-1999), 22 American and British charitable foundations took part in a double blind study of Ritalin to treat adult onset attention deficit hyperactivity disorder (ADHD) and improve the foundation’s ability to focus and stay on topic. The hallmark symptoms of ADHD—distractibility, impulsivity and high activity—are so commonly associated with philanthropy that the diagnosis is often not considered, until “Foundation Attention Deficit Hyperactivity Disorder” (FADHD) was proposed as a condition. Announcement of the Foundation Attention Project and its funding source immediately brought criticism from both mental health advocates and foundation organizations.

Nevertheless, participants in the study have been outspoken in their praise. “I would have been the last one to have thought this would work,” said Terry G_______, president of a major U.S. Foundation. “I still can’t believe the researchers talked us into this, let alone that it completely transformed our grantmaking.”

“When taken as prescribed, methyl-phenidate is a valuable medicine,” said Dr. Seymour Wallach, medical director of the Attention Institute and project manager for the study. “The mode of action in humans is not completely understood, but methylphenidate presumably activates the brain stem arousal system and cortex to produce its stimulant effect, and paradoxically allows the brain to relax and focus for long-term thinking.”

In the study, the program officers, managers and trustees of 11 foundations were prescribed drugs used to treat ADHD, primarily 10 mg doses of methylphenidate (the generic equivalent of Ritalin); 11 other foundations were given identical blue sugar pills. Within a few days of initiating the drug trial researchers documented substantial improvements in the subjects’ ability to stay on task, participate in extended conversations, keep appointments and develop long-term trusting relationships.

The most notable results appeared between 18 and 36 months into the study, where it reduced the frequency
of preference shifting, amendments to guidelines and sudden unexpected initiatives. While philanthropic institutions periodically adjust their focus (particularly after a management change or when a primary donor switches therapists), there is a tension between new and newsworthy contributions and deeper involvement and impact on an issue.

In the four-year outcomes evaluation phase of the research, a content and activity analysis of the subject foundations’ priorities, focus and productivity was conducted, supplemented with focus groups, in-depth interviews and public opinion polling. Particularly striking were responses from both investment companies hired by the foundations to manage their assets, as well as charitable organizations that receive contributions from the foundations, who independently observed
a striking increase in long-term goal-oriented behavior.In addition to lengthening span of attention, foundation evaluators documented increased payout, faster turnaround, quicker delivery of checks, reduced administrative overhead and operating expenses, sitting patiently and quietly in meetings in communities, reduced grandstanding and reports of greater humility.
Like any significant change, the Foundation Attention Project has been challenged by people who see a downside, from its underlying premise and use of behavior changing drugs to its financing by the drug’s manufacturer. “This is an outrageous abuse of stimulant pharmaceuticals in the workplace,” said Melissa Wilson-Stuart, Secretary General of PharmWatch, a London-based advocacy organization. “I have never heard of this so-called ‘Foundation Attention Deficit Hyperactivity Disorder’ (FADHD). Even if this new syndrome does exist, which I doubt, there are natural vegetable products that can have the same stimulant calming result without the Ritalin side effects of dry mouth, loss of appetite and weight loss, insomnia and itchy fingers.”

Foundation representatives were also critical, most notably Yusef Arak, President of the Association of Large Foundations, Washington, D.C. “I’m not convinced that these people knew what they were getting into, and the fact that they don’t disclose which foundations took part in the experiment throws the supposed results into question,” Arak said. “I can’t tell you how offensive it is to suggest that our flexibility, nimbleness on issues and willingness to dive into the cutting edge of society’s possibilities is somehow a problem.”

Every aspect of the Foundation Attention Project drug trial was unusual—its time span, industrial application and trans-Atlantic locus. Rumors about the existence of the project had been floating among nonprofit organizations and foundations for years, but surprisingly little information leaked to the public (other than at a Scientology Web site).

“I know there are people who think we’re crazy, but of course that’s what they said about Columbus, Harriet Tubman and John Forbes Nash, Jr. [the subject of the film A Beautiful Mind],” said Terry G_______, as she rubbed her ring finger. “There is no way we could have anticipated how revolutionary our outlook could be if we were able to stay in our chairs long enough to truly understand what is happening in communities and how nonprofits get work done. Frankly, before this started, we were easily bored, lost interest quickly and spent more time at foundation conferences than we did meeting with the public.”

Ms. G_______, whose trustees and staff received active methylphenidate, now urges other foundations to give it serious consideration: “This place has changed. Who would have thought that our trustees would approve 10-year grants? It’s as if a veil has been lifted from in front of our eyes. I’ll take a dry mouth for this any day. We can still think big thoughts, which I think is important, but now we are able to apply ourselves for the long run.”

“This is such a pile of piffle-poffle,” countered Mr. Arak, “Philanthropy is not a disease of the mind—this is a professional undertaking requiring sophistication and skill. If these people were really serious about improving grantmaking, they would form a grantmaker affinity group.”

Thus far “Foundation Attention Deficit Hyperactivity Disorder” has received limited acceptance in the medical and foundation establishments, but judging from the number of new foundation grants on both sides of the controversy, a great deal more is going to be heard about FADHD (at least for a while).

Phil Anthrop is a consultant to foundations in G-8 countries.