1 Boring Old Man

At the North Pole, the magnetic compass apparently spins at random, not knowing where to point. Is it because there’s no North? or is North everywhere? That’s the way I feel about this Atypical Antipsychotic story I’ve been preoccupied with for a couple of months. It’s like everyone’s walking around with a compass that doesn’t work any more. The Pharmaceutical Companies involved have forgotten what their products are used for. Many doctors seem to have forgotten why they became doctors. Whole industries have sprung up [Clinical Research Organizations, Clinical Research Centers, Medical Writing companies, etc] without being clear about what they’re even involved in. One has to move away from it all to avoid getting caught up in the confusion and becoming as blind as the other players. Once you get far enough away, it’s tempting to forget that it’s even there, that place where the compasses don’t work anymore. I guess I did that in my own career, like I said in my last next post [rip van winkle…] – I went to sleep. There’s a line from the narrative in that post that brought back some memories:

Left to my own devices, I’d blame anything and everything that ever happened bad on the Reagan years and the course change we took then. I can’t trust that feeling because I feel it about everything. The part I do trust is that our government seemed to lose its moral compass back then [if a government can have such a thing]. I still think that the idea that we could ‘privatize’ the care of the mentally ill or medical research was doomed from the start. It’s never been the same since. That’s my own bias. All of this was predictable back then. Even I knew it – as an early forty·something…

But all such thoughts do is make me want to go back to sleep, and that’s not the right thing to do right now. No matter what one thinks of the current Healthcare Bill, or Medicade, or Medicare, pushing our medical system to the front burner has to be a good idea. The businification of medicine has been a disaster, and will remain a disaster until something changes its course. Managed Care came into being to bring down costs and make medical care more available. All it did was the opposite on both axes. We changed things around with pharmaceutical patents to make generics more available, and in the process, we created pharmaceutical companies that act like Lilly and Astrazeneca to optimize their profits during a drug’s life cycle – no matter what the result. We’re picking at the edges of the problem without acknowledging its center.

As for the moment, there’s the problem of Psychopharmacology and Psychiatry. That compass is spinning wildly, maybe more erratically than any other in medicine right now. I know I have some thoughts about that topic, but they’re spinning too. I’m too tangled up right now in the deceit of the Eli Lillys and my personal experience of living through the Nemeroff years in Atlanta to find any clarity worth writing down at the moment. I’ve noticed that my recent blog posts look like a cheesy modern painting – everything in bold or italics, too many underlines. They look like something somebody who needs to emphasize everything might write – someone who has lost faith in ordinary communication. I know when it happened – my agita. It was when I decided to take a look at Zyprexa – so long as I was in the neighborhood. It’s not a medication I know or have ever used. It doesn’t come up in the charity clinics where I work. Risperdal is the only Atypical I personally use. Sometimes people show up on Seroquel from somewhere else, but I’ve only heard Zyprexa mentioned once in my whole experience there. It’s worth mentioning. He was a young adult on stimulants for ADD [which he seemed to actually have], and Zyprexa [for reasons unknown]. He’d lost his job with insurance and showed up in our clinic a month or so after he ran out of medicine. He said, "I really need the Adderall, but I’m staying off that Zyprexa." He described a few weeks of feeling terrible when he stopped, then said, "That s–t would cost me $450 a month if I stay on it! Does it help ADD? What’s it for?" That’s the extent of my own personal experience with the drug, and I knew nothing of its story before I started reading about it. I didn’t, however, have any problems answering his question. So I’m claiming scrambled mind syndrome after a week or so in the Lilly/Zyprexa orbit, temporary insanity as they say in court.