Being sick is not nice. People who help us not be sick are generally regarded as pretty nice. One of JF's buddies put it very poetically when he said that hospitals work to "unfuck people up".
But not everything about the medical establishment is wonderfully unfucked. Take, for instance, drug marketing, advertising, and PR.
This commercial is absurd. There are four things going on - the visuals with cute girls and bright balloons; the fast catchy music; the words at the bottom; and the voiceover. Try and focus on "serious complications" and "side effects may include" when you're watching pretty colored balloons, reading the words on them/at the bottom of the screen, and humming along to the song. This commercial is almost a self-parody - admission of ridiculous amounts of risks, then desperate "but maybe you should still buy it anyway!" The extreme visual overload of text is representative of pharmaceutical marketing's three-ring circus of smokescreens, sparkles, and doublespeak masking lies and insatiable greed. In keeping with our theme of co-opted vulgarity, these commercials are what is commonly referred to as a "clusterfuck".
But wait! Not only does drug marketing employ showy, distracting sleight-of-hand, it also stigmatizes! Commercials for Abilify (a drug for bipolar disorder) show sufferers alone until they make the decision to take the drug, at which point they are walking and talking with other people. Because the mentally ill can't have meaningful, fulfilling, healthy relationships without Big Pharma helping them out. I can't find the commercials online, but their site contains this warning: Some medicines can increase suicidal thoughts and behaviors in children, teens, and young adults. Serious mental illnesses are themselves associated with an increase in the risk of suicide. When taking ABILIFY call your doctor right away if you have new or worsening mood symptoms, unusual changes in behavior, or thoughts of suicide. Patients and their caregivers should be especially observant for such symptoms within the first few months of treatment or after a change in dose.
So this could actually do the opposite of what it intends to do, but that's not their fault because these people are already messed up! Note how it says "patients and their caregivers" - not "patients or their caregivers" or "patients and their doctors" - implying that even medicated, bipolar people can't really be trusted to take care of themselves. To compare, the similar warnings on websites for Yaz and Celebrex say only "tell your doctor", with no third-person reference to "patients" or "caregivers", affording users more autonomy, responsibility and dignity. I also like the vague "some medicines" that distances the product from the warning. Soon we should be seeing food packaging saying "some food may contain nuts!" or laws like "some people shouldn't kill some other people."
Also, even with that stated risk, it does not say the drug should not be prescribed to teens/young adults, while both Yaz and Celebrex warn that "people with [condition] should not" take them. I'm not exactly sure what to make of this - is psychiatry not enough of a concrete science for these risks to be valid enough? Do we care less about taking risks with the health of young mentally ill people? Is mental illness seen as a "worse" or "more devastating" condition that makes the risk more worth it? What the fuck?
Pfizer also cares more about money than those silly crazy folk, defending their new lucrative anti-smoking drug Chantix and claiming it can still be prescribed to the mentally ill even though it has been linked to mania/depression. (Research credit Furious Seasons.) This mirrors the longer-running issue hinted at above - legal and medical cases established a link between SSRIs (anti-depression meds) and suicide in young people and yet the drug companies (including Pfizer, who makes Zoloft) didn't stop marketing them for adolescent use. All the FDA did was slap a black-box warning on them, allowing Big Pharma to effectively "fuck over" kids and their families for money.
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6 comments:
not to mention the name itself - 'abilify'. i often wonder why drug companies even advertise prescription drugs - patients can't just buy them; they have to be approved of and favored by the doctors, and it seems a lofty goal to advertise with the requirement to list all risks according to FDA (though obviously they've overcome this, unfortunately). i distinctly remember a time when prescription drugs were never advertised.
First off, you make some very valid points about a topic I feel pretty strongly about, that is prescription drugs (although my problem is more with deals between doctors and pharmaceutical companies, resulting in unnecessary prescription, which we have already discussed).
However, I thought I would offer the perspective of someone who has experience with bipolar disorder? I will try not to comment on any other mental illnesses or the other two drugs, because I do not know very much about them (and if I do make any blanket statements, ignore them, please).
Yes, Ablify could do the opposite of what it is intended to do. In fact, it probably will. Similarly, in our (my family’s) years of experience, nearly every medicine prescribed to treat the disorder has done the opposite of what it is intended to do, at some point. Part of the cause here is that bipolar disorder is just that. When using a medication to try and treat the depression, you risk the induction of mania, and vice versa (both of which are dangerous states of mind – something I will get to later). These risks are valid, but psychiatry is, indeed, not a concrete science, the administration of drugs for bipolar disorder is very much trial-and-error. What works for me almost certainly will not work for you, and at the same time, likely will not continue to work for me for very much longer. (Now, there is a reasonable chunk of the ‘manic-depressive population’ that has found a drug that works for them more permanently, but that is frequently not the case and has not been my experience).
I do not know how much you or your readers know about the illness and this is probably obvious, but I want to point out, exactly, what mania is (and no, it is not merely an elevated mood or a ‘high’ as I have heard it described by people who self-admit that they know very little about the disorder). It is, roughly, a heightened state of passion and creativity and brain activity, which includes happiness…and irritibility and anger and hallucination and homicidal behavior. In the case of my father, he lives in an entirely different version of the universe, which on the surface seems harmless, but when he roams Bell Road in the middle of the night (and I mean Bell Road, not the surrounding walkways), it becomes a significantly more dangerous situation. This is the stage during which people with the disorder commit homicide (not to say that everyone does and my dad has not, though it has taken self-control and faith in order to abstain, but the stages are frequently referred to as ‘suicidal’ and ‘homicidal’ as opposed to ‘mania’ and ‘depression’).
During times of lucidity, my father will be the first to admit that he needs someone to, literally, take care of him during the heights of mania and depression. My dad has a particularly severe form of the disorder, so what I say may not apply to every ‘sufferer,’ but some stages render him completely incapable of participating in, or even being fully aware of, his surroundings. Thus, decision-making truly becomes impossible because he is literally not aware of what is going on. He loses the capability to consider his options and consequential differences and, in any sense, make an informed decision. This is the reason why it truly and unfortunately is necessary for someone else to keep an eye on the symptoms. The average person on birth control has the ability to tell if they get a headache (I am sure that is not a relevant example, but that sort of thing). However, (coming up: real-life example!) mental illness is a different breed. My dad was suicidally depressed and his current medications were doing nothing, so his doctor switched his medication to pull him out of the depression. Because he was in such an ‘altered’ state of mind, he was not paying attention to side effects, or even to dosage. He took more than the recommended dosage (not a lethal amount, this was not a suicide attempt), and he rapid-cycled into hypomania (let me know if you need me to clarify this). At this point, he began hearing voices telling him to do things, was angry beyond my angriest and was, as earlier described, walking the streets. (It got way scarier than this, but I will leave that mostly out). My point is, at no point from suicidal depression to hypomania was he cogent. At no point was he able to think clearly enough to realize the danger in his behavior. He would never have been able to say ‘Wait, this hurts and it didn’t before. Maybe I should see a doctor.’ He would, as far as I can tell, have continued to take the higher dosage of the medication and continued to seriously threaten his personal safety, had my mother and grandmother not seriously and aggressively intervened. He needs someone to watch for him, because he frequently cannot watch for himself. Maybe that takes away some form of autonomy, dignity, and so on, but it is worth it to save him from the times he cannot fully function so that he is able to fully experience the times that he can. It is the disease, not the advertisement that fails to afford autonomy, responsibility, and dignity.
Manic depression, in my experience, is a far ‘worse’ and ‘more devastating’ condition than either fertility or arthritis. The risk is more ‘worth it’ than I can conceivably express in words. I think when you go through periods during which it is a crapshoot whether your dad is alive, you understand the devastation. Celebrex = arthritis or death by heart attack? I can look at that and choose another medication, if I suffer from the described conditions. When the question is, in the same order, Ablify = 95% chance of sucicide or 96%? Maybe it is worth the extra little risk for even the most minor chance that it will get better, that maybe one day, it will be zero chance of suicide. There are no other options. Every medication for bipolar disorder has a high chance of making things worse, but the illness is, indeed, that bad. It is not a matter of I feel extra happy or extra sad today. It is a life-altering condition. It is not a matter of how we define normal, it is a matter of life and death, not only for the ‘sufferer’ but for the people surrounding him.
None of this is to say that he is lesser of a person. Beautiful things come from times of mania (see Hemingway! Plath! Churchill! Mozart!) and my dad has an ability to empathize beyond anything I have seen from anyone else. (Fortunately, the illness gives him, but treatment does not eliminate the latter.)
I totally get so many of the points you are making and it is hard to talk about some of them from internet research, as opposed to first-hand knowledge, so I really do appreciate your inserting the issues into our conscious and our conversation. These are all issue s we need to be aware of and confronting. I think so much more could be done through bipolar support groups and non-chemical methods of approaching the disease, but I also think it is important to be aware of how significant the disease is when you actually have it, as opposed to hearing about it. Suffering from the symptoms is a wholly different experience than reading about them.
Unfortunately, psychiatrists and research scientists in the field have not pegged specifically what is the cause of the disorder, so they test different drugs they think might work. They frequently do not fully understand why they do or do not work, so it becomes nearly impossible to tailor the drug to the patient.
i'm treading on eggshells here but amanda, remember that lily's perspective (because she doesn't have the first-hand experience you do) is a more general one. i agree that hers dangerously leaves out instances like yours in which drugs are necessary in a huge way, but i think it's still dramatically relevant that she pointed out how big pharma in its ads dangerously leaves out instances not like yours (the kinds of cases of bipolar disorder that i am more familiar with) in which medication isn't necessary and in which patients are consistently lucid enough that the decision should be theirs. i think the important thing is that the public isn't ignorant of either ends of the spectrum - either lily's perspective that the mentally ill shouldn't be stigmatized, or amanda's that medication is often a life preserver.
Amanda - I understand the points you've raised and I'm not saying that bipolar disorder shouldn't be medicated or that the advertisement is completely wrong in existing. It's a serious condition that oftentimes requires serious intervention. But, you're right, most people don't have the firsthand knowledge that you do (and, while I can't claim the same experience as yours, I'm not basing this entirely on only internet research) and so when they see ads like that, they may not understand the nuances and complexities of what bipolarity is - meaning all they get out of the ad is the stigma I pointed out. Also, there are cases unlike your dad's that may be treated too aggressively or chemically, based on the medical opinions ads like that help spread. Drugs should definitely be an option, and there's no reason why they shouldn't be advertised - it was the language and implications I had an issue with.
I also must disagree with you in that I don't think risking making the condition worse is worth it if there's a chance it might help. I know it's terrifying for people with it and their families; but so is terminal illness, and I think people would have serious pause if their doctor propsed a treatment for terminal cancer that "might work but also has a good chance of killing them faster."
CI (Is this even still anonymous?)
The thing is, every medication has a risk of making it worse, so if you want any chance of making it better, you have to have the risk of making it worse. Fortunately, if you are watching your symptoms it is not hard to stop taking the medication is not working a switch to one that is. The difference is that bipolar doesn't have to be a terminal illness. It can be almost cured. It's hard to express, beyond mere scariness, that my dad does not engage in anything when he's in either mania or depression, whereas with the right medication, he can be restored to total normalcy. And I'm not doing a very good job. I also want to say that I'm glad you posted this, because I agree with you for the most part, so my intention was not to pick apart the arguement, but rather to give a more in-depth perspective, for your benefit, especially because of your other work for the anti-stigmatization of mental illness.
I totally and completely agree that bipolar and other disorders are frequently over-medicated, in part due to the relationship between prescribers and, as you say, Big Pharma. There is so much that can be done with the people surrounding someone who suffers and de-stigmatization is a HUGE, HUGE, HUGE part of that, because when people freak out, they cannot help. In conclusion (my lit teachers would be so [not] proud), good post and I completely and totally agree with the general points made.
Monica - I was going to reply seperately, but I pretty much covered what I want to say. Although it would help me for you to describe the kinds of bipolar disorder that you are more familiar with, because it's something I talk about a lot, and I'm pretty sure I sound ignorant most of the time.
Love you both.
Chantix is available in all licensed pharmacies in many countries of the world. It is also available online as many licensed sources sell it by providing professional services. This process may require you to do an online consultation that is a process similar to doing a face-to-face consultation with a doctor, but cannot replace it. http://www.chantixhome.com/
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