People die everywhere, but they definitely make money off if it here.
— Jordan Rieke
“It was obvious he was deteriorating by his demeanor, he was losing a lot of weight and he was gaunt. And he felt he was being plagued by devils. He was psychotic.” As Mary Weiss remembers her son Dan Markingson, 26 years old when he was put into a clinical trial at the University of Minnesota in November 2003, you see photos of Dan as a child. He squints in the sun or wears a football helmet, he purses his lips to whistle or stands on the beach in a white hoodie, his smile assured and his sandy hair windswept.
As a boy, Dan was beautiful. As a young man, his mother remembers, he was tormented. He was also, you come to see in Off Label, exploited by his attending physician at Fairview Riverside Hospital, Dr. Stephen Olson, also the principal investigator in a clinical study at the University, making for what Mary notes is “a clear conflict of interest.” She appears in close-up, her hair white and short, her face so like that of that of the young adult Dan, visible in framed photos in her home, the camera zooming close, as if to seek what might have gone wrong. Mary asked his doctors to release him from the trial, telling them, “I see this inner rage, please don’t let it come boiling out, which it did.”
Dan killed himself in 2004. The sunlight coming through the window behind Mary now is bright white, and her own skin is pale and pink. As she remembers being informed by a local cleric, “Your son passed away,” her eyes grow wet. “I remembering thinking,” she says, “How ridiculous. He didn’t pass away. He was killed. He didn’t pass away. They let him die. And they need to be held accountable.”
Mary’s story is one of several revealed in Off Label, premiering at Tribeca Film Festival on 19 April. As it considers the many ways that pharmaceuticals shape everyday lives, this superb documentary looks at specific experiences, each poignant and hopeful and painful in its own way. Strikingly, and recalling Michael Palmieri and Donal Mosher’s previous film, October Country, the stories are rendered so as to emphasize their poetry and context, and to suggest how they are connected.
This connection has to do with big pharma, that is, the expansion of prescription medications. Such expansion is about money, of course, but how much money and what’s at stake for whom is a complicated business. For Michael Oldani, a former drug rep, the focus was sales. He pitched his product to doctors, and maybe, once, believed what he told them. “It’s easy to say we’re a world on drugs,” he says, following his introduction into the film as he pops a plastic gorilla out of a Mold-A-Rama machine (“And there we go! See?” he sort of smiles, holding the gorilla up for the camera). But the means to that end remains complicated and corrupt, as doctors prescribe drugs according to company contracts, and contracts are functions of marketing, and patients are incidental. “There’s a religiosity to being a drug rep,” Michael says, “In terms of believing that you are doing good work.” It wasn’t “until I was almost done,” he says, “That I realized what we’re doing here is really kind of shady.”
Kind of. The same description might be applied to a range of other legal activities within the industry, the testing of Dan Markingson included. He was given a choice, Mary says, to enroll in the trial or go to a mental hospital. Once enrolled, he was prescribed drugs that included Seroquel, made by the trial’s sponsor, AstraZeneca, and known, along with other antidepressants, to increase risk of “suicidal thinking.” The film also features interviews with several living drug testers, people paid to participate in studies, like the self-described “human guinea pigs” Paul Clough (“A lot of people who do studies seem to like to gamble,” he says while the camera follows him through a casino, “Playing for the one chance that I might hit it big”) and Robert Helms, who says, “It’s a take-take relationship between me and the pharmaceutical companies: they need bodies to do the testing and I need money.”
Such need once led Robert to appear on To Tell the Truth, an exceptionally creepy convergence of entertainment and exploitation included in Off Label underscores that he lies to doctors to enroll in trials, about his medical history and his age, for instance, otherwise he would not be selected. The doctors know he’s lying, he says, but he lies for “pennies,” whereas the drug companies are lying “to make billions of dollars over the many, years they have a patent on the drug. They have an agenda to prescribe these drugs to as many people as possible.” And yes, that agenda targets bodies.
As Mary’s experience indicates, these bodies aren’t always informed or precisely voluntary. The man whose story opens Off Label show, Jusef Anthony, was tested when he was in Holmesburg Prison. “God has a prescription,” he says, “And inside man, locked up in his spine, is 10,000 deadly diseases, locked up in cells. And every time you go outside of the boundaries of the prescription that life is supposed to be about, God releases one of those deadly diseases or germs into the your system as a warning that something is wrong and needs to be corrected. You see what I mean?”
For Jusef, something went wrong at Holmesburg. “You’re doing time in there,” he says, “That’s part of your life missing, that’s punishment enough.” Now he sits in a booth at a diner, awaiting the delivery of his lunch, a salad made of iceberg lettuce, tomatoes, and anchovies. “Yeah man, this looks tasty!” he enthuses, as the camera hovers over his plate. Jusef (born Edward) has been diagnosed with prostate cancer and rheumatoid arthritis, conditions he traces back to his time in prison, where he was told by a Dr. Albert Kligman that he would be testing bubble bath: his skin itches to this day, he says, over a close shot of his yellow, crusty fingers.
The lies told to Jusef suggest the many violations of trust and truth that structure the drug industry, at multiple levels. Along with Jusef, Michael, and other interviewees recall that such violations are at once mutual (the perpetual hope that payment will offset the cost of the lie, that doctors couldn’t or shouldn’t lie) and deeply disappointing. Doctors and reps, testers and patients, all tell one another and themselves lies. Jusef has found his own way through his particular pains and betrayals through his turn to Islam, and he demonstrates for the filmmakers how praying can make a difference. Paula Yarr finds solace in the Boulder Creek Community Church, near her home in Santa Cruz, California. Severely bipolar, she describes her effort to maintain faith — and vigilance — with regard to her prescriptions. She’s been hospitalized for poly-pharmacy, she says as a young woman who might be her daughter sits quietly on a couch in the background, her own daughter on her lap, a handmade paper mask on her face. Paula’s neighbor Michael runs a Big Foot Museum, and while he extols his own faith in the creature’s existence — or maybe it’s the faith he pitches to solicit business — Paula sorts through the many bottles of pills she confronts every day.
The effects of drugs on generations of users find a kind of perfect storm in Andy Duffy, former Army medic in Ira. Assigned to the prison at Abu Ghraib, he was instructed to treat prisoners by using a 14-gauge needle. “I know that’s purely to inflict pain,” he says, the camera tight on a monster hypodermic. Once he had faith that he would be able to “do good” as a medic, now Andy’s haunted by what he did do, and what he saw. The film offers wartime footage and photos as he describes his memories. The VA, he says, prescribes pills without therapy, long lists of medications that don’t necessarily address veterans’ specific issues, but are instead the products available due to “contracts with certain pharmaceutical companies.” Andy sighs, his faith just about run out. “I don’t need medication, I need help.”
Off Label brilliantly exposes how the many routes from faith and trust to desperation and despair are varied and sometimes hard to trace. It’s a fitting juxtaposition that the film conveys such intimate and difficult stories in images that are at once gorgeous and fleeting: trees dappled by sunlight, snowflakes whirling around gravestones, revolving doors reflecting hurrying forms and library microfiche machines whirring. Another set of machines — shiny and huge — pump and churn out hundreds of pills at a time, these nearly abstract images set alongside DEA agents dumping plastic sacks of medication into bins. As pills spill onto the camera like so many pink-and-yellow-and-blue promises, you see how this fiction of faith persists.