All posts by mross109

A Theory of Addiction

By Dr David Laing Dawson

My new theory about addictions, at least about the explosive increase in serious opioid addictions in the last few years:

I am well aware of the culpability of Purdue Pharma promoting Oxycodone, Oxycontin as “non-addictive”, coupled with an “academic” push to have doctors pay more attention to chronic pain, and then some sloppy prescription practices after acute injuries. And I am well aware that some addictions begin as self-medicating, usually self-medicating a mood or anxiety disorder.

I understand how hooked they are. How, once addicted, consciousness is reduced to getting that fix. Empathy is lost along with any ability to think beyond the fix and the avoidance of withdrawal. By that point there are brain changes and it is a disease.

And pockets of addiction can be found alongside unemployment, poverty and despair.

But this is 2018. Not 1932. There really is no shortage of easily acquired food, and despite the cries for more affordable housing for families, there really is no shortage of basic shelter for single men.

So why now are so many men sleeping on benches and on the hustle for drugs around the Sally Ann in my neighbourhood? And why is the otherwise fit looking man with his German Shepard dog willing to stand for hours in a cold drizzle at a busy intersection collecting coins from every tenth car that stops? And why on earth does anyone ever inject a substance into his vein that has a ?10, ?20 percent chance of killing him?

I have also had many clinical experiences of addicts, vague, unhappy, scattered in thought, pathetic in actions, but laser focused and energetic when it comes down to the moment of trying to persuade me to write a prescription. Tenacious, persistent, with far more stamina than I.

And here are two more seemingly unrelated bits of information: When we go on holiday our sense of well being peaks on day 8. It is downhill after that. Time to go back to work, we say, by day 12. And some zoos have learned that making the carnivorous animals hunt for their food, rather than just giving it to them, makes them happier and healthier. And the retired couple, free now of children, mortgage and job, free to roam in an RV. What do they always do? They get a dog, or two dogs to fuss over, look after.

We humans were not made for leisure. Our DNA tells us we need to hustle. We need to hunt for food, check the barricades, repair the roof, fashion the spear, dig the trenches, work for ten hours in the mine, or kitchen. We are programmed to be busy. And our busy-ness rewards us with food, safety, or some small achievement. (I am quite amazed how delighted I am when I manage to complete a New York Times Crossword puzzle and then cast it aside to look for a new one.)

Challenge, occupation, risk, reward, repeat. (note that this is the same sequence video games provide)

Our focus has been on the reward, the drug, swallowed, snorted or injected. We can make that safer with safe injection sites. We can eliminate the need for the hustle if we provide the drug. But what of the challenge, the occupation, the risk and the repeat? What of the need for the hustle?

My new theory is that these last few decades have removed the natural life challenges and occupations for more and more men, and that drug addiction provides just that. That is, it provides not just the reward (the drug) but also the challenge and occupation, the risk and repeat.

As do video games for the young man in his parents’ basement.

We can “treat” addiction, try to eliminate drugs, or provide the drugs legally, but how do we replace challenge, occupation, risk, reward, repeat as the robots take over all the work?

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The Art of Psychiatry

By Dr David Laing Dawson

The Eyes, ahh, the Eyes.

Some years ago a psychiatrist asked me to see one of his patients on the ward of the mental hospital. She had been admitted in a state of psychosis; he had prescribed appropriate medication, and then later increased that medication, and now she sat alone all day, communicating with no one. Was the dose too high? Had he made her toxic? Should he stop the medication?

In her room the woman sat fully clothed on the side of her bed staring straight ahead. I introduced myself and talked with her. I sat beside her on the bed and talked to her. I received no answer, verbal or non-verbal. I looked closely at her eyes.

I left her room and talked with her doctor. Increase her medication I told him. He raised his eyebrows. No, I said, I’m sure.

He did so and the patient recovered, first in small ways, acknowledging the presence of others, and then talking, engaging, and plans for discharge were made.

Her eyes told me she was in a state of high arousal, not drugged at all, but rather in turmoil, flooded by fears and anxieties to the point of immobility. Her eyes were alive but focused internally.

It is easier to be a poet than a scientist when it comes to eyes. A nurse might say to me about a patient, “The lights are on but nobody’s home.” It is an apt phrase, so accurately describing a state of dementia. In early dementia the right image, phrase or music might bring that person back home for a while, but then she will leave home again, and, eventually, not return.

And then there is the stare of the true believer, aroused and focused, all knowing, all seeing. They are the same eyes one sees in delusional states. Perhaps they are daring one to challenge them. They send no signal of welcome, no invitation for discourse, no flicker of doubt. They are the easiest to imitate.

Boys on the ASD spectrum avoid eye contact, and when they are coaxed into making such “contact”, the eyes quickly touch and then slip away, as we do when we glance at the sun.

The girls, the ASD girls sometimes stare fixedly, unblinking. They make “good” eye contact we notice, but the dance is wrong, the movement static, the intent unreadable; my smile goes unanswered by her eyes.

The eyes of the man with schizophrenia are similar, but often flit from certainty to perplexity and back again, as if they are trying to decipher a very difficult passage in an ancient text.

Depression is always present in the eyes. The light is dimmed, the person home, but slow to answer the door. Sometimes they are hooded and dull, but other times, in agitated depression, fearful and searching.

And then mania. If it is an angry mania I sit low in my chair and make only fleeting eye contact, for fear of adding fuel to the blazing fire within my patient’s eyes. If it is a grandiose mania, I watch the eyes of delusion and true belief and wait for a moment of doubt, a shadow to cross those eyes, before I offer a comforting smile and some medication.

Smart Phones and Mental Health

By Marvin Ross

Can your smartphone usage predict your mental health? Silicon Valley seems to think so and millions are pouring into a start up called Mindstrong. The concept is that its “app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage — how quickly they type or scroll, for instance.”

The app has generated tens of millions of dollars in investments from people like Jeff Bezos of Amazon and one of the company’s executives in Dr Tom Insell the former head of the National Institute on Mental Health. He acknowledged that the app isn’t perfect but the CEO told STAT that it “could provide unprecedented insight into conditions like depression”. They also told STAT that it “can even predict how a person will feel next week, or at least how a person will perform on the Hamilton Rating Scale for depression — kind of like a weather app for your mood.”

There is one little problem with the hype for this company. The program has never been validated by independent scientists and none of the results from 5 clinical trials have been released. They did publish a pilot study of 27 subjects and presented a poster of that which states that this is feasible.

This project came to my attention while I was reading Bad Blood Secrets and Lies in a Silicon Valley Startup by John Carreyrou of the Wall Street Journal. The book deals with a long standing health startup begun by a 19 year old Stanford dropout. Elizabeth Holmes was afraid of needles and decided that it would be possible to perform all blood testing with just a small finger stick as is done with blood sugar levels. Her idea was that the testing could be done instantaneously and people could even have these units in their homes.

She patented the idea, set up a company and managed to raise sufficient funds to value her company at $9 billion. Members of her board included former US Secretaries of State George Schultz and Henry Kissinger as well as General Mad Dog Mattis who went on to become Secretary of Defence under the Trumpster and Rupert Murdoch. Along the way, she managed to get testing done with the US Military and two pharmaceutical companies but those efforts failed. She also had arrangements with Safeway and Walgreens Pharmacy chain.

Investors have lost over $600 million in the venture including over $100 million by US Secretary of Education, Betsy Devos, and the heirs to the Walmart fortune. The founder was recently charged with criminal fraud.

So, if I’m a tad skeptical about using smartphones to measure mental illness, there is a reason. First, let’s have the data subjected to peer review in reputable journals.

Conrad Black and Donald Trump

By David Laing Dawson

I made the mistake of reading an article by Conrad Black. I usually avoid reading Lord Black of Crossharbour (“on leave”) for I find his over-use of penultimate, supercilious, pretentious, swank, grandiloquent, Miltonian, show-offy adjectives very annoying.

But I did read his paean to Donald Trump, and then went for a bicycle ride to clear my head. But what should one expect from a man who gave up his Canadian citizenship for a Peerage in the UK, and once flew across the Atlantic to attend a costume party dressed as Cardinal Richelieu?

He refers to all immigrants entering the US through the border with Mexico as illiterate peasants and he thinks Donald Trump is the leader America needs. He does find Trump “grating” and that he takes “liberties with the truth”, but he thinks that Trump can make America Great Again, and by that I think he is referring to a degree of respect we all must show for the man holding the true weapons of mass destruction in his hand. And by “respect” I think he means fear. Donald does seem to be on track for making America a country we soon will all fear.

Of course, Conrad Black, as a man barred from entering the United States, may simply be, like so many others, currying favour with the one man who could and might pardon him.

And then I read another by Lord Black along the same lines but more of a dissection of the geopolitical game afoot. And I was reminded of an experience from 1964. Bear with me for a moment.

Our first year medical school class went on a weekend retreat with faculty. This entailed a 90 minute bus ride to a resort north of Vancouver. By chance I sat next to our Professor of Physiology. The Vietnam war raged and was about to expand. My companion on that trip had fled McCarthy era USA rather than testify against his colleagues, who might or might not have attended a communist party meeting. So we talked Vietnam.

I was 24 at the time, but worldly and cynical. I argued geopolitics along the lines that it was better for the two major superpowers, the two competing ideologies, to be squaring off in the jungles of Vietnam rather than in the skies over Moscow and New York. He disagreed. It was simpler than that for my professor, who must have been in his 40’s or 50’s at the time. For him it was simply immoral. It was immoral for Americans to take their guns, their napalm, their warships and their helicopters to Vietnam and kill people. It was simply wrong.

By the end of that trip I had concluded that if he could remain idealistic in his 50’s, surely cynicism in my 20’s was, at least, premature. It wasn’t long after that I found myself in a placard carrying crowd in front of the American Consulate chanting: “Hey, Hey, LBJ, how many kids did you kill today?”

But why I was reminded of this was because Conrad Black was writing with his usual elegance and erudition about the geopolitics of recent years, the new balance of power, the symbolic chess game played by nation states, and prognosticating about the geopolitics of the future. And it is this examination of geopolitics that I can hear from other politicians, commentators, advisors, other writers. And it reminds me of my self, age 24, arguing, albeit more naively, about these world events and shifts and movements and power struggles as if they are being played on large chessboards by giants, with the pawns and rooks representing a few million to a billion people. And talking about it and playing the game as if they experience, think about, Joseph Stalin’s famous observation as advice, rather than the cynical observation of a sociopath. “One man’s death is a tragedy; the death of millions is a statistic”.

My medical school professor could see beyond the geopolitics and the million death statistic to the terrified little girl fleeing the sticky horror of napalm.

The Bannons, Boltons, Millers, Trumps and Conrad Blacks of this world do not, cannot.

I do not want them to have any influence over myself or the lives of my children and grandchildren. We need to stop listening to them and focus instead on the little girl fleeing the napalm and the kid from Honduras locked in an American cage.

Trump, Dr Ford, and A Warning to Americans

By Dr David Laing Dawson

I wrote a blog before the 2016 election of Donald Trump titled “the mental and emotional age of Donald Trump”. I looked at a range of his behaviours and his speech patterns and considered the age at which such a behaviour would be typical for a boy or man, though not exemplary, not necessarily good, maybe even requiring some parental admonition, just typical. I arrived at an average of 14. Though some Trump statements required a pre-teen brain and some rose at least to 18 year-old jock talk.

A comment someone left on that blog was that I was being generous; it would have to be a particularly entitled and narcissistic 14 year-old.

More recently I listened to Trump mock the testimony of Dr. Ford and then go on about the threat the #MeToo movement poses for fine young men. He took on the voice of a boy talking to his mother about all the hard work he’s done, about being offered a great job, but all this is over because some woman he’s never even met is accusing him of things he’s never done. How terrible this is for men and boys.

I might run across a small group of 14 year old boys with one of them going on in this vein, and two might be laughing, though more at the outrageous display of disregard for propriety than the content itself; another two would be cringing, but unable to break the code of teenage boys to never be a “pussy”.

So the comment was fair. Only a nasty, narcissistic, and probably guilty 14 year-old could talk the way Trump so often talks.

Donald may be but a symptom of some other struggle in your country, my American friends, and I know you have some wide divides that need major bridgework, but he is doing damage to your country, more and more damage each day he has a voice.

They were laughing at him at the U.N. Much of the world is appalled by him and all he represents. He throws oil on your fires; he cozies up to nasty dictators; he is stripping the USA of any moral high ground it ever might have had; he is creating fizzures in your country it may take decades to repair. He has reduced political discourse to a schoolyard brawl and international relations to flea market bartering.

He represents you, my friends, and how we see him we will begin to view you. We don’t care how you see us, you may say, we are better than that. But there is a bit of psychology here you might not like. For gradually, whatever traits we assign to you, you will absorb, you will become.

This midterm you can show the world you are not all Trumpets; you can clip his wings and put him in a tail spin. Please do so.

Anti-Psychiatry

By Dr David Laing Dawson

As a personal addendum to Marvin’s piece:

In the years before I studied medicine and then entered psychiatry, the mental hospitals, the Asylums, were full. I believe the largest in North America housed about 13,000 patients. There were no effective treatments (with the exception of ECT) though many things were tried, from field work and prayer to cold baths, spinning chairs, and insulin coma. These Asylums themselves grew from an increasing social awareness, acceptance of social responsibility, and recognition of the need for the state to look after the intellectually, cognitively, emotionally, and socially disabled among us. (roughly 1850 to 1990)

The doctors, the Alienists, and then the psychiatrists were given wide latitude to hold, to keep, and to treat.

Curiously I do not recall any active anti-psychiatry movement then or through the years 1960 to 2000 (with the exception of Scientology). And it was through those years that actually effective treatments were developed. And by effective I mean scientifically proven to be effective.

I can now prescribe something that quells mania in a few days, that pulls someone from a stuporous depression in two weeks, that reduces panic attacks, that eliminates the excruciating pain of agitated depression, that tempers debilitating obsessions and compulsions and that gradually returns the insane to a state of sanity – if my patient will let me.

And it is now, again curiously, at a time when psychiatrists do have effective tools to treat mental illness and when they are very restricted in any use of these treatments without explicit consent and when those Asylums have been reduced to a tenth the capacity they once had, that an anti-psychiatry movement has developed.

I have to conclude that the motivation for this anti-psychiatry movement is not the welfare of others but of professional rivalry and fear. And like some other attitudes today (anti-vaccination, anti-global alliances, pro-alternative medicine, anti-fluoridation), it has to be based on memory loss – that is, a profound memory loss of childhood death from diphtheria, WWI & II, the crippling polio epidemics of the 1950’s, the rotten teeth of the average kid in 1930, and the wards of catatonic or raving and tormented souls in the lunatic Asylums, and, before that, in the jails and stockades, tied to poles, or expelled from villages.

Of course there is much to discuss in the liberal arts and social sciences about how societies have defined normal and abnormal, and all the forces at play in each Era, and about the uses and abuses of power, and about the benefits of capitalism (all effective modern medicines have been developed within capitalist systems) and the horrors of unregulated capitalism.

And these (along with the philosophy of science and the successes and limitations of the disease model of human ailments) can all be discussed and investigated within schools of social work and medicine in an academic fashion without prejudice. In fact, a really good academic question to ask would be: Why is there now a strong anti-psychiatry, anti-vaccination movement? Is it related to the anti-science zeitgeist of Trump world? Is it a failure to teach real history? Is it fear of a loss of the sense of a perfect God-made homunculous within each of us? Is it the fault of the internet? Have our entertainments (think Dr. House, Hannibal Lecter, and Jack Nicholson receiving ECT) overwhelmed our perception of reality?

Or is it just some social workers and psychologists wanting more power and status?

 

The Good, the Bad and the Ugly of Social Work

By Marvin Ross

Social workers can and do play a significant role in helping the mentally ill to recover when they work with psychiatrists, nurses and occupational therapists. In my personal life, I’ve just witnessed how a knowledgeable and caring social worker can impact recovery from psychosis in an inpatient setting.

Sadly, the training that many social work students (and others like psychologists and counsellors) receive from some institutions does not aid in that role. Susan Inman, the author of After Her Brain Broke, Helping My Daughter Recover Her Sanity, has long complained about the lack of science and medical training for many of these professionals. She said:

Many credentialed mental health clinicians have never received science-based curriculum on severe mental illnesses. Too many are still being trained in the parent blaming theories which contemporary psychiatric approaches to schizophrenia have long since left behind.”

For a number of reasons, I had occasion to look at the mental illness course being taught at McMaster University in Hamilton Ontario and it confirms all that Susan had to say. The course is called “Critical Issues in Mental Health & Addiction: Mad & Critical Disability Studies Perspectives for SW”. Part of the course objective is to:

“explore contributions from critical disability studies, mad studies and the historical influences of sanism and eugenics on contemporary mental health practice. Addiction will also be briefly explored within these contexts.”

Then, this is added

“Throughout the course guest speakers may be invited to share experiences and analyses on course themes from ex-patient, survivor, consumer, service-user, and mad perspectives.”

Nowhere do I see anyone coming who can provide the medical perspective which would include the physiology and treatment of mental illness. Given that McMaster has a world-class medical school and one if its teaching hospitals is a psychiatric facility, this is very troubling. It would be so easy to find a psychiatrist to talk to the class or to take a field trip to the local psychiatric hospital.

One of the readings in the first week is Geppert, C. (2004). The Anti-Psychiatry Movement Is Alive and Well. Psychiatric Times 21(3), 21. Retrieved December 4, 2009”. This article is no longer on the Psychiatric Times website that I could find and the professor referenced it in 2009. It would be nice if the professor asked his students to read something like Psychiatry and Anti-Psychiatry by Dr Allen Frances. There are many comparisons of these two approaches in that article and students should have an opportunity to see both sides.

Another set of readings for this course is by Geoffrey Reaume who is a professor of disability studies at York University in Toronto. His view of Mad Studies can be summed up by a quote he gave to an article on Mad Studies in University Affairs in 2015. He stated that “People with PhDs had oppressed mad people throughout history. I wanted to help liberate this history from the shackles of the medical model.”

Dr Frances had this to say in the article I cited above (for psychologist also read social worker):

Psychiatry is far from perfect, but it remains the most patient-centered and humanistic of all medical specialties and has the lowest rate of malpractice among all specialties.

Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction—espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick.”

And he added:

For people with severe mental illness (eg, chronic schizophrenia or bipolar disorder), a broad biopsychosocial model is necessary to understand etiology—and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.”

Another author used quite a bit in this course is Bonnie Burstow of the Ontario Institute for Studies in Education (OISE) at the University of Toronto. Dr Burstow is the creator of a scholarship in Anti-Psychiatry Studies. I’ve done two Huffington Post blogs about Dr Burstow. The first was entitled The Truth Behind U Of T’s Anti-Psychiatry Scholarship and the second was Time For U Of T To Rein In Its Anti-Psychiatry Activist It is worth noting that OISE is a post graduate school on teaching, learning and research. Nothing to do with science or medicine.

In my second Huffington Post blog, I had this to say about Dr Burstow:

Burstow does not believe that the brain is capable of becoming ill, and that therefore mental illness cannot exist. Her doctoral thesis, according to the media spokesperson at her institution, was entitled “Authentic Human Existence: Its Nature, Its Opposite, Its Meaning for Therapy: A Rendering of and a Response to the Position of Jean-Paul Sartre” in 1982 at the University of Toronto.

Dr Burstow is the author of a book called Psychiatry and the Business of Madness which is not one of the readings for this course but exemplifies her position. Blogger, Mark Roseman wrote a very lengthy and detailed critique of this book which is well worth reading.

Roseman defines anti-psychiatry as:

a position that psychiatry is 100% flawed, has no redeeming features, is built on a stack of lies, necessarily does harm to all who encounter it, and must be abolished in its entirety. Moreover, the real proponents of antipsychiatry do not want to seriously engage in discussion with the broader community. They are not interested in critique, or divergent opinions, but only discouraging those seeking treatment, and attracting new followers to their movement.

The course does discuss medication but this is the description of that:

The Biological Mind: What are some of the critiques of the role of medication and the psychopharmaceutical industrial complex? How does neoliberalism matter in mental health? How do we think critically about suicide and self-harm?”

Here is the recommended reading:

Cohen, D. (2009). Needed: Critical thinking about psychiatric medications. Social Work in Mental Health, 7(1-3), 42-61.

Medawar, C. & Hardon, A. (2004). Sedative hell. In Medicines Out of Control? Antidepressants and the Conspiracy of Goodwill (pp. 11-27). N.P., Netherlands: Aksant.

Whitaker, R. (2001). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, Massachusetts: Perseus-p.3-19.

White, J., Marsh, I., Kral, M. J., & Morris, J. (Eds.). (2015). Critical Suicidology: Transforming Suicide Research and Prevention for the 21st Century. UBC Press. – Introduction

The titles give it all away. Whitaker, of course is an infamous anti-medication proponent and I have critiqued his views a number of times as have others more qualified that I am as in the debate between Whitaker and Dr Allen. The teaching of anti-psychiatry did not include anything pro-psychiatry and the discussion of medication contained no information on the benefits of medication. Should students not be given an opportunity to see the other side? McMaster and its teaching hospital has many first rate psychiatrists well versed in their specialties. I’ve observed the near miraculous results that properly prescribed medications can have on severe psychosis. Neoliberalism did not come up once.

The bottom line is that no one who graduates from this course will be capable of working in a psychiatric setting with patients. Hopefully, none of them will. The effective social worker I cited at the outset is a graduate of another university.

 

Reflections from Vienna Monuments to Statues to Sir John A and Residential Schools

By Dr David Laing Dawson

I have just visited memorials commemorating the successful defense of Vienna in 1638. The Turks were at the city gate and undermining the wall. They were just a few days away from plundering the city when the cavalry arrived, contingents from Poland, Cossacks from the Ukraine among many others, warriors from the Christian nations assembled by the emperor of Poland.

And it reminded me that all the tribes of humans have been conquering, pillaging and plundering each other for thousands of years. And that includes the tribes of the First Nations, the Ojibway, the Mohawk, the Sioux and all the others. And conquering meant, beside pillaging and plundering, killing or enslaving the men and boys and raping and/or assuming ownership of the girls and women.

It had been the way of mankind for centuries, and, here and there it seems, it still is.

During John A. McDonald’s lifetime the Americans to the south were still sending out the cavalry to kill as many Indians as they could. (the official policy was “removal” but that usually meant massacre)

In Canada the conquering had taken place by the British and French, with some killing and plundering but also with a number of treaties. Now what to do with the conquered, the many scattered tribes, the people we now refer to as First Nations?

If history were to guide it would tell us the conquering should continue, killing and enslavement of the males, the rape and enslavement of the females.

But John A. and others in the newly formed Canada decided on a different plan. They would round up all the Indian children and send them to boarding schools while leaving the adults to hunt and gather, fish and farm, on land set aside for them. The plan may have been to “take the Indian out of the child” along with learning English or French and a bit of arithmetic, and it proved to be not so great an idea, especially letting the church run the program, but all in all, considering historic precedent, including the way a conquering aboriginal tribe treated a conquered aboriginal tribe, was not this idea really a quantum leap forward? I mean compared to all we know of the ways of human tribes throughout history?

I am not suggesting we raise new statues of John A. McDonald, but those we have deserve to remain. We now view residential schools as a destructive force, destructive to family and culture, but for John McDonald, it was not just a reasonable decision for the time, but a big step forward.

Some Reflections on US Healthcare From the Great White North

By Marvin Ross

Like many outside the US, I am perplexed by their health care system, the amount that is spent, and the poor results for citizens that it creates. Last year, I wrote in the Huffington Post about what I call my near death experience and contrasted by care and costs to that of the US. My key comment was that there should be no profit motive in health care.

I’ve just finished reading a book called Tailspin: The People and Forces Behind America’s Fifty-Year Fall – and Those Fighting to Reverse It by Steven Bell. This is a fascinating and well documented read on the state of American politics, the economy and the law. I am just going to focus on his revelations about health care and the pharmaceutical industry.

To begin with, a 2003 law which is still in effect forbids Medicare from negotiating drug prices with big pharma in order to get a volume discount. Everyone must pay the inflated prices set by the companies and the industry has managed to fight off all attempts at price control that are common everywhere else in the world.

Between 1970 and 2010, per capita spending on health care increased in inflation adjusted 2013 dollars by nearly 420%. Costs went from $1742 to $8400. Company profits and executive salaries showed similar growths. Between 1980 and 2016, personal out of pocket spending on health care grew by 460%.

I have always been confused about how Obamacare actually works given the complexity of the US system of multiple insurance companies all making profits compared to the single payer system we have in Canada. According to Brill, all Obamacare did was to subsidize people who did not have health insurance through an employer and who could not afford it to be able to buy insurance. More people were able to sign up with insurance companies so the insurance companies were able to enjoy even larger profits. A pretty pathetic system in my opinion and still the Republicans want to end that.

One tactic that big pharma uses to increase profits is to promote their drugs off label. Drugs are approved by the FDA for certain conditions and companies cannot market them for uses that they have not been approved for. However, in 2016 8 of 9 big pharma companies paid billions in fines for violating the criminal statute against that marketing. However, they still made money.

Risperdal, an anti-psychotic manufactured by Johnson and Johnson (J & J), was promoted for use in children and the elderly. In children, it caused young boys to grow large breasts and in the elderly it caused stroke, diabetes and other negative effects. J & J earned $18 billion on Risperdal sales with an estimated $9 Billion of that coming from off label sales. They paid out $6 Billion in settlements so netted $3 Billion for their illegal activity.

The day before a $2.2 Billion settlement, their stock traded at $93.37 a share. A year later, the stock traded at $108.62 a share. Alex Gorsky who was the sales manager for Risperdal and then the head of that division, was given a 48% raise in salary and bonus to $25 million. Who says crime doesn’t pay.

J & J’s tactic was one recommended by a consultant called Michael Pearson – a Canadian educated at Duke working at a consulting company in New Jersey. His advice was to raise prices aggressively when they still had patent protection and boost sales by targetting off label use. He also told them to cut back on research and development and, instead, buy up small companies developing new agents that did not have the funds to get FDA approval.

In 2008, Pearson struck out on his own and bought a small California drug maker. He borrowed enough by 2010 to merge with a larger Canadian company and move his headquarters to Montreal. The company became Valeant. He began borrowing more money, issuing new stock, buy a company, raise prices, expand markets, and cut back on R and D. At one point, he tried to take over Allergan and the plan was to strip 90% of its R & D budget. His takeover failed but he went on to doing more than a hundred deals. None of them had anything to do with producing new medicines but rather to increase stock prices and that went up over 4000%. Fortunately, his house of cards collapsed by 2016 but they had raised prices on crucial drugs by a good 200 to 300%.

Given the emphasis on profit, is it any wonder that the US ranks 29th out of 35 on infant mortality; 26th on life expectancy. In terms of health care performance, the US ranked worst of 11 other developed countries