Choose your placebo wisely

candyI’m giving the Smashwords.com version y1 a light dusting while I wait to get d4 back from my editor, and I came across the article from Newsweek science writer Sharon Begley that inspired a fair amount of my plot. Begley took a hard look at multiple studies and concluded that for those with mild to moderate depression, anitdepressants were just expensive candy. In fairness her full report is considerably more nuanced, and well worth reading. It raised her to hero status in my mind. Those who make a living writing for publications that rely on advertising will seldom be found telling uncomfortable truths about products sold in the same pages.

magic wandAs I reread her work today, a whole different aspect of her article struck me as odd. Placebos. What an odd concept. If you were doing a clinical study on the effectiveness of any medication, why not simply give half the people in the trial the medicine and tell the other half that they are not getting it. We all know why. People who think they are getting medicine sometimes get better based on belief alone. Real measurable illnesses can be cured by the power of belief, albeit not predictably or reliably. Of course that outcome needs to be removed from any study.

Doesn’t this strike anyone else as incredibly strange? The entire medical community and bulk of society accepts that a placebo can cure a physical illness. You’d think somebody out there might be working to develop better and more effective placebos.

wiineAs this line of reasoning wound its way through my brain, I realized that I already use  a lot of placebos to stay healthy. I just don’t call them that. I call them vitamins, which I continue to take in spite of reading that they are a waste of money and the average person gets all the vitamins they need from their diet. I call them immunity boosters, the things I take to fight off a cold even though evidence of their effectiveness is dubious as well.

Now that I think of it, my favorite placebo is a nice glass of red wine. Some might refer to this as self-medicating, but as far as I am concerned the wine is taken each evening to stave off heart problems. There is also the green tea I drink every day to ward off cancer (and because I like it) and the bit of dark chocolate I allow myself and oh yes the Greek yogurt that I love that does something, I forget what.  Maybe calcium for my bones? I think I need to be taking something to improve my memory. Does anything involving caramel and salt improve brain function?

Seriously, none of these things in moderation are hurting me a bit and I’m willing to bet they are helping my general health a little, just maybe not to the degree I think they are. It doesn’t matter. I’m healthy as can be and have been so photofor decades, and my firm belief that my indulgences and choices make me stronger is no doubt playing a part. The placebo effect is everywhere, not just in clinical trials. If used right, it’s a very good thing.

Lately I’ve found myself thirsty at night and I’ve started keeping a glass of water on my nightstand. I’m also not sleeping as well as I used to (getting older does that) and I’ve convinced myself that better hydration is the solution. Wake up at 3 a.m.? Don’t think about the project at work or trying to sell the house or worry about the kids. Take a big drink of water and go back to sleep. Water does put you to sleep, you know. At least I think it does. Apparently, that is what matters.

Embracing your inner opportunist

Patricia 1How far over the speed limit do you drive? Come on. No one drives it exactly. One mph? Two? Me, I allow myself up to about nine under normal circumstances.

How fast does someone else have to drive before you’re happy to see them get a ticket? If they’re going much more then ten mph over, I feel like public safety is being preserved. Less, and I rant about how we live in police state. Let’s face it. We all push the rules, and we all have our own particular definition of when enough is enough.

In my novels x0 and c3, I crafted villains who were clearly evil. In y1, I opted for someone easier for me to understand. He’s a man who pushes the rules, just like we all do, and a man who knows how to profit well from the little opportunities that his rule bending provides.

I put him in charge of marketing at a pharmaceutical company, not because I dislike prescription drugs or the companies that make them. I have had plenty of reasons to be grateful for modern medicine. But I do know that there is a lot of grey area in selling medication, regarding both the doctors who write the prescriptions and the eager public who watches the ads on television. Just like everywhere else, rules can be bent.

Doctors can be encouraged to write frequent off label prescriptions, something intended by law to be rare. They can feel slightly obligated to preferentially prescribe a new drug in spite of its not fully understood side-effects, and they can be encouraged to do both of these and more with travel, food, honorariums, and gifts. Most people in the medical profession are at the very least decent and well meaning, and they will truthfully insist that they cannot be bought for the price of a lunch.  I am sure that they can’t, and I made the same argument when potential suppliers took me out to lunch in my profession.

raising 3So how many lunches for how many people in the office does it take to have an impact? The folks in marketing are trying to find out. How lavish do the gifts have to be? Should we be ignoring the fact that the product itself has a unique capability to effect the health and happiness of others in a way that only medication, with all its side effects, can?

My villain in y1 is a very fine opportunist, happy to push those boundaries further each day, and glad to pay the nuisance fines slapped against his firm when he goes a little too far. Just the cost of doing business he tells his staff, ignoring the dangers of the products he makes and sells.

I got far enough inside this guys head to make myself squirm, before I let him spiral out of control and engage in the equivalent of doing 70 mph in a school zone. That way I knew that my readers would all be happy to see him caught and punished in the devious way I had intended all along. Before he turned ultra bad, however, I hoped that my reader would squirm a bit as well, and think about the fuzzy boundaries between playing the game well and doing harm.

(Please like writer Patricia Polacco’s Facebook page and the page for Raising Ecstasy, the sources of these two clever images. Please see my x0 blog for a post about crafting villains that are unambiguously evil from the start, and see my z2 blog for an upcoming post about my tale of researching racist groups in America.)

A good choice

Some readers of y1 have praised the story’s criticisms of the zealous marketing of prescriptions drugs in American, particularly mental health drugs to children and young adults. A couple of readers have taken issue with it.  For me as a writer, the subject was representative of the larger issue of putting profit ahead of the well-being of our children. It was a vehicle to make a bigger point.

tearsBut as a mother, the idea of routinely prescribing drugs with serious side-effects and unknown long term consequences to children as young as two years old hits home with an emotional wallop of its own. Every once in awhile I come across an article that reminds me why I thought that  pharmaceutical marketing targeting children would provide a good villain for my story.

Gwen Olsen, who worked for fifteen years as a drug rep for Johnson & Johnson and Bristol-Myers Squibb, was recently quoted on Alternet as saying: “Children are known to be compliant patients and that makes them a highly desirable market for drugs, especially when it pertains to large profit-margin psychiatric drugs, which can be wrought with noncompliance because of their horrendous side-effect profiles.”

Great. Adults are allowed to follow their best instincts and listen to their own bodies, and therefore frequently stop taking drugs they find more harmful than helpful. Children can be ordered to take their medicine, and their parents can be scared into making them do so.

It is enough to make a healthy adult want to cry.

How things change: the eye of the beholder

Visit psychsearch.net

Visit psychsearch.net

When I graduated from high school, apparently  homosexuality was listed as a mental disorder in the Diagnostic and Statistical Manual used by psychiatrists to diagnose mental conditions. I didn’t know it at the time, of course, because to the best of my knowledge there weren’t any homosexuals in my home town and there possibly weren’t even any in the whole state of Kansas.  It was a rare condition, my mother assured me.

Unbeknownst to me, there were also gay activists in 1974, and they pushed the American Psychiatric Association to remove it from the DSM. It was removed, and since then a lot a of new illnesses have been added. As edition five came out this spring, psychiatrists took a lot of grief for classing so many types of behavior as “illnesses.” For example, disruptive mood dysregulation disorder threatens to turn children with too many temper tantrums into those with a mental disorder and binge eating (defined as excessive eating 12 times in 3 months and I wonder if my ice cream habit puts me over the top here) is now an official mental illness.

On the one hand, classification as an illness does allow those who want help to get their insurance to pay for it, if they have insurance 🙂 . On the other hand, having your idiosyncrasies or your own areas for personal growth classed as a mental disorder could be life altering in negative ways as well.

So what of homosexuality as a form of mental illness? Well, a few months ago Saul Levin, an openly gay man, was named the  new American Psychiatric Association chief executive officer and medical director.

Things do change with time. In the case of Dr. Levin, I’m glad that they have and I wish him the best. In the case of the new mental illness referred to as “hoarding disorder” …… well, I prefer to still consider it one my more charming little eccentricities.

For more on how things change with time, visit my z2 blog here for thoughts on human trafficking and Broadway musicals. Also visit my x0 blog here for thoughts on veggie burgers, humor and empathy.

Side effects of a quick fix

“We live in a world where everybody wants a quick fix for their problems,” said Dr. Sasha Bardey, a psychiatrist who is a  co-producer of “Side Effects.” an upcoming film staring  Jude Law and Catherine Zeta-Jones. This new thriller, due out Feb 8, mixes murder and psychiatric medicine and you can read about it in the New York Times here.

It interests me because this is a combination I explored in the novel y1.  The shape-altering young hero of my book finds himself entangled in a murder devised to hide some of the unsavory secrets of a unscrupulous fictitious pharmaceutical company. Director Steven Soderbergh, on the other hand, will be telling the tale of murder committed as a side effect of prescription drugs intended to treat depression.

Check out the trailer for the movie here.

 

How happy is your brain?

From Crystalinks.com

From Crystalinks.com

My other blog includes occasional posts about telepathy because the hero of my other novel, x0,  is a budding telepath.  Last night I made an attempt to understand how telepathy might be possible without requiring magic that defies the laws of the known universe. (Please understand that I have no objection to law-defying magic.) I realized that much of my arguement came from my research for y1 into the workings of the human brain. Zane, the hero of y1, is a student of neuroscience because he desperately wants to understand how he can alter his appearance. Once he begins working for a pharmaceutical company dedicated to mental health issues, however, other aspects of the brain begin to intrigue him.  Like, what happens in your brain when you are happy?

A brain works by chemistry and by electrical impulse, and it directs hundreds of chemical substances called neurotransmitters that travel in-between the brain’s cells, delivering messages about thoughts and feelings. I share Zane’s amazement that such a system even works, much less with the precision that it does.

We do know that different substances deliver certain kinds of messages, like a FedEx that only does books or a UPS that exclusively delivers clothing. One of these messengers, serotonin, generally likes to blab to the nearest neuron about anxiety, mood, sexuality, and appetite. Another, norepinephrine, appears to focus on delivering messages about fatigue, alertness, and stress. Dopamine likes to communicate about motivation and reward. The theory behind antidepressants is that the neurotransmitters that like to communicate about feelings should be linked to a person’s happiness. So when people are depressed perhaps it is because they do not have enough of these particular messengers running around to spread the joy.

medicineThe very first antidepressants created in the ‘50s tried to raise the brain’s levels of serotonin and norepinephrine, to play with this mental message system. A second class of anti-depressants was based on inhibiting the enzyme that breaks down these guys in order to leave more of the good stuff in the brain. Basically the same idea. Next came the less side-effect-plagued successor, known as selective serotonin re-uptake inhibitors (SSRI), the most frequently prescribed antidepressants today. First developed in the ‘70s, and continuously improved upon by different pharmaceutical companies, SSRI’s work by stopping the process of reuptake, a fancy name for when a responsible neuron absorbs the neurotransmitter it has sent out, to take the messenger back off the streets once the message has been sent. The theory here is that by keeping the sending neuron from doing its re-absorbing, more of this “happy” chemical stays running around the brain. Again, the same idea.

From Wired.com

From Wired.com

While it sounds great to say that taking this medication is “fixing chemical imbalances in the brain,” the problem is that no one gets to do experiments on a live human brain. Thankfully. And dead human brains don’t send chemical messages and can’t be depressed. Neither really can animals, at least those generally accepted for grisly lab experiments. So no one actually knows whether depressed people have less serotonin in their brains. Or whether they reabsorb it too fast without medication. In fact, no one knows how much serotonin a generally joyful person has. Can one really have too little? Or too much? Because a few antidepressants lower serotonin levels, and they appear to work too.

Trying to figure out what makes for a happy brain is complicated even more because there is no way to tell how much these medications change a person’s serotonin levels, because there is no way to measure those levels in a live human. Which means that, in the end, the only evidence we have that serotonin levels might be related to human depression at all is that in more cases than not, the medication works.

Is it working because it is based on an accurate analysis of how chemicasl in our brains keep us happy? Or not?  That will be subject of another post.

Depressed Toddlers? Really?

One of the villains in y1 is the zealous CFO of a pharmaceutical company who is anxious to reap the profits from over-medicating his new target demographic, children.  I did a fair amount of research on this subject because I wanted to make sure his tactics were believable, and also because I wanted to be careful not to malign the use of medicine when it was genuinely needed and beneficial.

It is true that by the time I finished writing y1, I personally found the vastly increased use of medication to control behavior and emotional issues in children to be disturbing. Every once in awhile, I still run across an article that makes me shudder. A friend recently sent me this article from Science Daily published in 2010. In a nutshell it discusses the idea that even toddlers can be depressed and it talks about the difficulty of the diagnosis because depressed preschoolers often act normal and may not even appear particularly sad.  However, researchers assure us, methods are being developed to ferret out those difficult to locate symptoms. Are you shuddering yet?