The Price of a Life

The Pioneer Press published a three-part series May 18-20, 2008 regarding the death of a person with mental illness which raised allegations of unethical practices by a U of MN (U) psychiatrist in connection with drug company-sponsored research . It brings me to wonder how we value the life of a person with schizophrenia. Is their life worth the same as anyone else’s?

THE FACTS (as reported by the PP, I have not verified them):
- Dr. Stephen Olson, the U psychiatrist in question, has attracted and conducted several studies sponsored by AstraZeneca, manufacturer of the anti-psychotic drug Seroquel.
- One of the studies focused on people newly diagnosed with/treated for schizophrenia, comparing the effectiveness of Seroquel to two competing drugs.
- Dan Markingson was a participant in this study. Markingson’s mother felt his treatment wasn’t working and asked Olson to drop her son from the study, but to no avail.
- Markingson eventually committed suicide in the bathroom of a St. Paul group home.
- An autopsy revealed no sign of Seroquel or any other anti-psychotic drug in Markinsin’s body.
- Mom sued Olson ,the U and AstraZeneca for causing her son’s death, but the University and AstraZeneca were found to have no responsibility. Mom won a judgment of $75,000 against Olson, reportedly just enough to cover her legal expenses.
- In the end, the study found little difference between the three drugs.
- One in four Minnesota psychiatrists receives “research” money from drug manufacturers.
- According to 2007 figures, 167 Minnesota doctors accepted at least $100,000 from drug companies since 2002.

THE ALLEGATIONS (implied in the PP articles) and TREPP’S TAKES:
But first, a few disclosures:
- As far as I know, I never met Markingson; he has never been served by Tasks Unlimited.
- I have met both Olson and Schulz. Dr Schulz, Director of Psychiatry at the U of MN, is a donor of Tasks Unlimited.
- I am a former Gopher.
- In 2002, my wife received an experimental bone-marrow transplant at the U of MN hospital, which saved her life.
- I wrote the first draft of this blog using a drug company’s ball-point pen.
- Tasks clients have participated in research conducted by Drs. Olson and/or Schulz – but actually very few, because their studies of schizophrenia presume that patients will be motivated to participate by token compensation ($10- 20/visit). Unfortunately, they’re right, because, except at Tasks, schizophrenia renders its victims destitute. [I am intrigued, by the way, that the PP article never refers to the compensation paid directly to Markingson for his participation in the study.]

Allegation: AstraZeneca uses selective information to promote Seroquel.
TT: Duh! That’s what advertising is – every advertisement for a product, service or political candidate that ever appeared in the Pioneer Press uses selective information to promote.

Allegation: Drug companies shouldn’t be allowed to sponsor research on their own products, and it was unethical for the U or Olson to accept money from drug companies, in part because then Olson became financially dependent on AstraZeneca.
TT: Drug manufacturers are the only source of funding for research on the treatment of schizophrenia. The government doesn’t sponsor any Bill Gates doesn’t, that I know of. Is drug company-sponsored research a bargain with the devil? Maybe. But without it, there would be no research at all! And, of course Olson’s salary comes from research money; that’s what sponsorship means. Do you think Pawlenty wants to pay for it? Should they take it out of tuition?

Allegation: Olson (and maybe Dr. Charles Schulz) were recruited by the U for his/their ability to attract research dollars.
TT: No kidding? Next the Pioneer Press is going to reveal that Tubby Smith was recruited to win basketball games.

Allegation: The U’s Institutional Review Board (IRB) is suppose to protect people like Markingson from unscrupulous researchers, and its guidelines specifically prohibit “power-based” coercion, but it doesn’t actually work. Markingson was not competent to consent to participate in the study.
TT: IRB’s are probably a joke, in general, but when it comes to research involving people with schizophrenia, they are a cruel joke, adding time and expense to every research project, but no actual value. IRBs focus on informed consent and full disclosure; neither of which is remotely possible when working with people experiencing psychosis. Of course Markingson wasn’t competent to understand what he was consenting to – the target population for the study was actively psychotic patients. If we really want to insist on informed consent of the subject, there would be no research involving psychosis.

In fact, Olson once told me that the IRB wouldn’t allow him to pay Tasks’ clients more than $20 per visit because adequately compensating them for their time would be coercive. Kind of a Catch 22, don’t you think? You can only participate in this research if you fully understand that it might cause you to commit suicide, and only if you consider $20 adequate compensation for that risk.

Allegation: Olson’s dual/triple role as treating physician, researcher, and witness in involuntary commitment proceedings against Markingson, was improper.
TT: This is not merely common; it’s the norm. Three psychiatrists involved with one patient doesn’t provide better care; it creates chaos. Plus, there is a shortage of psychiatrists in the Twin Cities; and a critical shortage of psychiatrists willing to treat schizophrenics. Quite frankly, it’s not very rewarding, financially or otherwise (unless you work for Tasks, where patients actually recover) – and they get sued a lot.

Allegation: Now the U is suing mom for their legal expenses.
TT: Classy move; makes me proud of that big Maroon M

But ultimately, it’s the facts of this case that are more revealing than the allegations:
- It seems likely (obviously, this is just speculation based on limited data) that the real cause of Markingson’s suicide was untreated schizophrenia. It doesn’t seem to matter whether Markingson was in a research study, whether Olson and the U were profiting from the study, or what medication Olson or anyone else might have prescribed because MARKINGSON WASN’T TAKING IT ANYWAY! [I don’t exactly understand the point of a study comparing patients not taking one drug to other patients not taking something else.]

- Schizophrenia doesn’t respond to psycho-therapy. Effective treatment requires (among other things) the prescribing and taking of medication. The psychiatrist’s role is to prescribe the right medication, but that’s only half the battle. The Tasks program and staff happen to be very good at motivating our clients to take their meds as prescribed. Tragically, only a small percentage of Minnesotans with schizophrenia receive comparable support for this, and Markingson wasn’t one of them.

- The $75,000 Markingson’s mom recovered from Olson seems low. Unless you consider that our legal system routinely assesses the value of a schizophrenics life at less than $75,000. Which also doesn’t seem fair.

On the other hand, if we don’t value these individuals, while they are alive, enough to publicly fund research into their illness, if we don’t care enough to create a system that actually guarantees they will take the medication and get the other services we know will help them, why should we value them at death?

Veterans Can Lie?

Last week, the federal government announced a new policy related to security clearances for government jobs. They still ask applicants if they have consulted a health care professional in the past 7 years, but as of last week, it is no longer a federal crime to deny having sought mental health counseling IF “the condition was related to service in a combat zone.”

It’s Good News because even though over 4,064 American soldiers have been killed in Iraq, and 29,829 physically maimed, and tens of thousands psychologically damaged by an ill-conceived war, and even though the Veteran’s Administration seems horribly ill-prepared to provide appropriate mental health treatment for the returning hordes of traumatized soldiers, at least our heroic soldiers, many of whom have paid a terrible price in service to their country, won’t be prosecuted for lying on their job application.

But it’s Bad News because we all know that anyone who has ever sought counseling for any sort of emotional stress is forever after incapable productive activity, and thus this new policy will frustrate our burgeoning security-clearance industry’s efforts to ensure that no such persons are ever given an opportunity to earn a living.

The new policy is also bad in that it may provide access, for disabled people, into government-work environments which, as we know, are widely regarded as models of efficiency and productivity – what if one of these veterans landed a job at the post office, a place never previously exposed to mental instability?

But actually, it’s No News because the new policy applies to such a tiny fraction of the workforce – only those traumatized by service in Iraq, and only those applying for government jobs, and, worst of all, only those who have sought treatment. We need to realize that 20% of the population experiences some form of mental health problem during their lifetimes; we need to ensure that none of these damaged Americans ever gets a job.