Off Label

Off Label

Off Label (Directors: Michael Palmieri and Donal Mosher): The most chal­len­ging film at this year’s Hot Docs was not a sur­prise to me. I’d seen the dir­ect­ors’ pre­vi­ous film October Country (review) at a Doc Soup screen­ing back in 2010, and I was very curi­ous how their very intim­ate, very per­sonal approach could be brought to bear on the weighty sub­ject of this film, the off label use (and abuse) of pre­scrip­tion drugs. Purely from an issue stand­point, this is an enorm­ous and still grow­ing prob­lem in the US and likely else­where in the developed world as drug com­pan­ies, in a quest for greater and greater sales num­bers, begin relax­ing the bound­ar­ies around drugs’ indic­ated uses. For patients, this can help alle­vi­ate symp­toms of chronic con­di­tions, but more often than not it leads to bizarre side effects or even addic­tion. And the real issue is becom­ing a health care sys­tem in which primary care pro­viders (who used to be called fam­ily doc­tors) are too busy to talk to their patients, espe­cially when it’s so much easier (and in many cases, luc­rat­ive) for them to pre­scribe more and more drug treat­ments.

All of which has made the film very dif­fi­cult to write about for me. I knew Mosher and Palmieri wouldn’t be mak­ing a typ­ical “issue doc” but what we get is so much more vis­ceral. We meet a group of char­ac­ters, all of whom have had their lives changed by “off label” drug use. From the syn­op­sis:

Welcome to the strange phar­macy that is America. In Iowa City a 22-year-old army medic last sta­tioned at Abu Ghraib prison struggles with the VA to find treat­ment to cope with PTSD. In Minneapolis a woman fights for reform after her son com­mits grisly sui­cide in an anti-depress­ant mar­ket­ing study. In Rochester, Minn., a young vag­a­bond couple pay for their wed­ding by doing drug tri­als for money. In Santa Cruz a woman takes 18 dif­fer­ent pre­scrip­tions and lives in a road­side Bigfoot Museum. In Philadelphia an aging African-American Muslim recounts the hor­rific exper­i­ments con­duc­ted upon him while he was imprisoned and for­gives those who des­troyed his phys­ical health. In Milwaukee an eccent­ric med­ical anthro­po­lo­gist tracks the course and influ­ence of the drug mar­ket he once helped shape as a former drug rep for Pfizer. These are some of the stor­ies col­lec­ted in OFF LABEL — a look at life in the twi­light zone of phar­ma­ceut­ical drug con­sump­tion and American health care.

My first reac­tion upon see­ing the film was bewil­der­ment. There was an over­whelm­ing sense of sad­ness in the film, but no real out­rage. It was as if the prob­lem was too big, the enemy too indefin­able, to focus any energy into chan­ging any­thing. And that made me angry. But upon a second view­ing, the film’s value as a cri de coeur was driven home to me as I saw the con­nec­tions between people and their stor­ies. Connections forged by the film’s edit­ing, but ones that seemed import­ant to bring to fruition in real life. So many people in the film seem lonely and their drug stor­ies seem like a way to get a handle on some of these feel­ings. For the ones who make money as drug test sub­jects, the film allows them to tell their stor­ies of feel­ing mar­gin­al­ized and with few other options. For the men­tally ill and their fam­il­ies, the film gives them a place to express their anger and grief at a health care sys­tem that has often failed them.

The film’s recur­ring musical cue is the Carter Family’s “No Depression in Heaven” which was recor­ded in 1936, dur­ing the Great Depression. The genius of using the song is that it ties together the cur­rent eco­nomic situ­ation of many Americans with their state of men­tal health. Off Label is unlike any other doc­u­ment­ary you’re likely to see deal­ing with issues of cor­por­ate influ­ence and the state of the health care sys­tem. It doesn’t pro­pose any easy answers. But this deeply humane film doc­u­ments the often-pain­ful stor­ies of just a few of the cas­u­al­ties of today’s pill-happy med­ical cul­ture, and it will leave a last­ing impres­sion, not unlike a scar.

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2 Responses to Off Label

  1. Drew Kerr says:

    This one was on my short list of picks for Hot Docs, but got edged out. Looks quite inter­est­ing.

  2. Pingback: Interview: Micheal Palmieri and Donal Mosher — Toronto Screen Shots

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