The Death Panels Among Us.

Unaccountable authority figures directing helpless patients into suboptimal care. Uncaring, unkind bureaucrats making life and death decisions based only on concern for the dollar. Life and death he said, which means people die based on edicts from the health care authorities. Like dead dead. Buried in the ground with worms picking your bones clean kinda dead. A future that I'll have to grant my teabagger friends, would be frightening if it ever came to pass.

And by "would be frightening" I mean "is frightening." Because that future is already here. Not in a socialistic Obamacare kinda way, but in a totally free market AstraZenecare kinda way.

Meet Dan Markingson, who is now dead.

Dan had issues, severe mental illness issues. Issues of the type that would lead him to write poems like this:

"I'm especially eager to attend this storm and SLAY those who deserve slaying.
I will choose victims immediately...
I HAVE NO EMOTIONAL ATTACHMENTS. I KILL FOR FUN!!"

Not surprisingly, Dan was committed and put on Risperdal in an attempt to make killing a little less fun for him. In Minnesota though, where Dan lived, a person can get a "stay of commitment," meaning that as long as they agree to follow their doctors orders, they will not be institutionalized.

So far, so good, right?

Six days after he was hospitalized, Dan's doctor asked the court for such a stay. The next day he recommended Dan enroll in an industry funded study of atypical antipsychotics.

Uh-oh. Most of you can probably sense where this is going. For those of you who need some clarification, I'll bring in the Bullshit Exposure Through Dramatization Players:

The scene, a large state mental hospital on a dark and stormy night. Three policemen burst through the front door carrying an obviously deranged and agitated individual.

Patient: Ah! The voices inside my head! They make me want to kill people! This sucks!

Policeman: We can't have you killing people son. You have to stay here now.

Patient: I don't want to stay here and I don't want to kill anyone, even though it would be great fun. Isn't there another way?

Doctor: Here. Take this.

Patient: Wow. I feel better now. Can I go?

Doctor: Absolutely. As long as you agree to follow my orders. Now sign this paper that will enroll you in a clinical study. I'm technically just recommending you take part, not ordering, but if you disobey my orders you stay here with a roommate who eats his own poo and thinks it's kinda fun to kill people too. So you really should sign.

Patient: What?

Doctor: Right by the X. I highly recommend it, and I have the power to have you committed.

The patient then signs.

The study that was highly recommended to Dan was designed to compare the effectiveness of Seroquel, Zyprexa and Risperdal, three newer "atypical" anti-psychotic medications that compete in the highly lucrative crazy market. Nothing wrong with that I guess. It's actually a good thing to have head to head effectiveness data in a country where all a med has to do is beat a placebo to be approved. This study was also designed and paid for by AstraZeneca, the maker of Seroquel.

Uh-oh. Here comes the list of entirely predictable facts.

- The study was too small to reliably detect any differences between the three meds. "In scientific terms this study is of very little value" said the editor of the British Journal of Psychiatry.

-It measured "effectiveness" by how many people stopped taking their drug. As long as you took your pill every day, it was effective. And if you stopped taking it, the reason why was not noted. "It does not make scientific sense to do a study and not measure one of the most important outcomes." said Dr. John Davis, professor of psychiatry at the University of Illinois-Chicago.

So why even bother to do a study that experts call out as junk science? Here's a clue.

In 1997, when Dr. Andrew Goudie, a psychopharmacologist at the University of Liverpool, asked AstraZeneca to fund a research study he was planning, a company official replied that "R&D is no longer responsible for Seroquel research—it is now the responsibility of Sales and Marketing." The official also noted that funding decisions would depend on whether the study was likely to show a "competitive advantage for Seroquel."

So....evidently some studies are to learn, and some are for show. So a sales rep can wave a shiny brochure under your nose that has a chart on it showing one bar dramatically different from the others.

So, after being stabilized on Risperdal, Dan Markingson was enrolled in a study in which he was randomly assigned to take one of  three subject medications. He was barred from being taken off his assigned drug, prohibited from being switched if the drug he was taking did not work. Other meds used to control depression, anxiety, or agitation were restricted. I'll let Mother Jones take it from here:

After Dan was enrolled, he stayed at Fairview for about two more weeks. By that point, Olson thought Dan's symptoms were under control, but (Dan's mother) Mary was still very worried by his erratic behavior. She recalls meeting with the doctor: "Olson came in and sat down and opened his file and said, 'Oh, Dan is doing so well.' And I said, 'No, Dr. Olson, Dan is not doing well.' I think he was taken aback." Even so, on December 8, 2003, Dan was transferred to Theo House, a halfway house in St. Paul. He was required to sign an agreement confirming that he understood he could be involuntarily committed if he didn't continue taking his medication and keeping his CAFE study appointments.
At the halfway house, Dan often stayed in his room for days. On March 26, 2004 nearly four months after his discharge from Fairview, his thoughts were still "delusional and grandiose," according to a social worker's note. An occupational-therapy report from April 30 detailed Dan's condition: "Personal appearance disheveled. Isolated and withdrawn. Poor insight and self-awareness." Entries in a personal journal that Dan kept during this period don't show any obvious changes, suggesting that he was improving little, if at all. Mary felt he was becoming angrier. "He was so tense, with this ready-to-explode quality."

About a week later.....

Dan had stabbed himself to death in the bathtub with a box cutter, ripping open his abdomen and nearly decapitating himself. His body was discovered in the early hours of the morning by a halfway-house worker, along with a note on the nightstand that said, "I left this experience smiling!" Later, when the blind on the study was broken, researchers found that Dan was being treated with Seroquel, the drug manufactured by the study sponsor, AstraZeneca.

Which would be sad enough if Dan had died in the pursuit of knowledge. Unfortunately, Dan Markingson died in the pursuit of a graph where one bar could be printed in color and be much bigger than the other two. A graph that then could then be waved under your nose for a few seconds in the hope you wouldn't look all that closely at it.

So perhaps, my teabagger friends, you need to worry less about the fictional and improbable death panels you fear under a future of Obamacare, and focus more on the AstraZenecare death panels of the present.

Just sayin'

Read the whole Mother Jones magazine article here. 
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The Death Panels Among Us.
The Death Panels Among Us.
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