Author: aramIS

From across the park, a low-pitched, adolescent chant starts up: “Jess-EE! Jesse-Eisen-BERG!”

“Ooh, no,” Jesse Eisenberg says, dipping his head. The 32-year-old actor, a New Yorker most of his life, is living in London at the moment while he appears in a West End show. On a thickly warm afternoon, we wander into a park in east London that seems ideally deserted until a local school clears out for the day, sending a dozen teenagers our way. Quickly they recognise Eisenberg, from the spring blockbuster Batman v Superman, in which he played the villain Lex Luthor, as well as 2010’s The Social Network, in which he put in an Oscar-nominated performance as Facebook founder Mark Zuckerberg. They heckle with glee: “Jess-EE! Face-BOOK! Super-MAN!”

Eisenberg quickens his pace along a path heading towards a wooded area. “Maybe if we just keep walking?” he wonders. “Maybe if I don’t respond to my own name?” But the chanting gets louder and, glancing back, we see the kids have begun to follow. “Ooh, no.”

Eisenberg is also a writer. He has a book of short stories to his name, many of them first published in the New Yorker, and he has written and starred in a trio of plays, the latest of which, The Spoils, has brought him to London. Without wanting to malign either profession, Eisenberg is perhaps more obviously a writer, in terms of his manner and appearance, than an actor. He speaks rapidly, mutteringly, in great long paragraphs full of observation and introspection and drollery and doubt, generally frowning at the floor while he does so. He’s bony, hunched, handsome in an undernourished-looking way – inconsistently shaved, today, and wearing a faded T-shirt that he keeps skittishly tucking into his jeans, then tugging loose again.

Tuck. Untuck. I recognise the gesture, I tell Eisenberg, as we walk. He was doing it on stage last night in The Spoils, portraying the twitchy protagonist Ben, a wealthy, idle Manhattanite who slowly alienates his friends by being socially ungovernable. “Oh-oh-oh this?” Eisenberg says, tucking in the T-shirt again, then untucking it. “Oh! The shirt’s too long, maybe, I don’t know.”

As an actor, he has a Dustin Hoffman-like repertoire of tics (lip flutters, fingertip taps, muttered half-laughs) that he uses to hint at his characters’ internal disorder. At a screening of Eisenberg’s new film, Now You See Me 2, a sequel to the 2013 action-comedy about a gang of adventuring magicians, I spotted a new addition to the repertoire. Eisenberg, playing the gang’s token neurotic, kept convulsively squeezing his sides with his hands, like someone operating a bicycle pump. I’m surprised, I tell him, to see these gestures carry over into real life.

“I guess we all do… things,” Eisenberg says, lamely. Unsatisfied with this answer, he continues: “I’m in the spirit of The Spoils, I guess. I have one foot inside my character. This is an unusual day for me.” He means being outdoors, scurrying along a tree-lined path trying to evade a pack of junior stalkers. Curtain up on tonight’s performance is a few hours away. “So normally I’d be sitting at home right now,” he says. “Kind of doing nothing, but thinking about the show.”

Is that healthy? “It’s not. We’re only doing a short run of The Spoils for that reason. Because I find doing plays totally consuming, in ways that don’t feel sustainable. I worry about the show from the moment I wake up. The only calm I have in my day is after it’s over.”

When I ask how long that calm tends to last, Eisenberg calculates for a moment and says: “Maybe 10 minutes?”

Before we meet, I expect to feel a degree of affinity with Eisenberg. We’re both Jews, inveterate mumblers, the same age and, despite a difference in height, similar in appearance. (The first thing Eisenberg says, when we shake hands, is, “You’re like me. But stretched.”) As it turns out, it takes a half-hour of disorienting conversation before I can get any sort of handle on his strange rhythms of speech, his spiralling patterns of thought.

He has a tendency to subject his words to instant examination, sometimes offering an overlaying commentary on statements just made. On worrying about his play: “I probably do this, unconsciously, in an attempt to create meaning in a show I’ve already done 100 times.” And on worrying about things such as this: “I don’t think I gain much from being able to describe my own unconscious needs manifesting consciously – that’s probably not necessary. I don’t think humans were doing that when they were hunting.” He calls all this “articulating my meta-experience”.

It isn’t always clear when Eisenberg is teasing and when he’s not. If his mannerisms are evocative of Hoffman, his chat is more Woody Allen, a wry, tireless patter, the world a quarter amusing and three-quarters appalling. His jokes rely as much on tone and context as content, and as such are easily missed. When the warmth of the summer afternoon suddenly breaks, for instance, and an absurdly heavy rainstorm soaks him through, Eisenberg gasps: “What’s going to happen to us?” When we make for the nearest tree, sheltering under it, the actor looks at me and says, “If this was a movie, we would kiss.” When the teenagers who have been patiently trailing us take cover under a tree of their own, he eyes them and mutters: “I feel like we’re going to be accosted. I feel like we’re going to be attacked.”

I ask what he was like, at their age. He frowns. “The best moment of my childhood was when my friend told me I was ‘as funny as Steve Urkel’. [Urkel was a character in the US sitcom Family Matters.] I’m serious. Because until then I never thought of myself as funny. I thought of my older sister as funny. It was, like, the first time anybody validated that for me.”

His father is a sociology professor, his mother teaches dance, and used to take bookings as a professional clown. Jesse, with older sister Kerri and younger sister Hallie Kate, grew up artsy, first in New York and then in New Jersey. Kerri acted from a young age in Broadway theatre, and Jesse did, too. For a while, he was an understudy in A Christmas Carol and later had a small part in a Tennessee Williams play. “And I was not good in any of it. I was just there because my sister was doing it, and I wanted to be with her.”

He wasn’t doing so well in mainstream education at the time. Eisenberg never fitted in at junior school, he once told an interviewer at the New Yorker, and for a period refused to go. He later told GQ magazine that, as a seven-year-old boy, he “cried every day” in class. Things got better when he transferred to a school in Manhattan that specialised in the performing arts. “Acting school was a safe environment,” he says now.

Though he does not name any condition more specific than “anxiety” in conversation with me, Eisenberg has in the past spoken about his treatment for obsessive compulsive disorder. (“I’m on a strong regimen of pills,” he said in 2009.) His better short stories play around with characters in therapy, or in therapy-like situations. In one story, an uncle is pushed to greater self-understanding by a young nephew who asks one question: “Why?” In another, a patient visits a therapist who talks only in sports cliches. Eisenberg once suggested that he gravitated towards playing anxious characters because he couldn’t be sure he’d come over any other way on set. “I need to stay busy,” he tells me. “Otherwise I go a little nutty.”

Happily, he has been in work since he was 16 and cast in TV sitcom Get Real. At 18, he sold his first screenplay to a Hollywood studio. (The movie, “a shallow but well-crafted commercial comedy”, as Eisenberg describes it, was never made.) That year, 2002, he appeared in an indie film called Roger Dodger, in which he impressed as a naive, virginal youth who was tutored in the ways of picking up women by an older lothario. In 2005, when Eisenberg was in his early 20s, he came to wider attention as the excruciatingly precocious Walt, teenage son of divorcing parents in Noah Baumbach’s muted comedy-drama The Squid And The Whale. Both these characters, force-marched into maturity by the reckless adults in their lives, were pitiable, but Eisenberg made room to explore their callowness and unpleasantness, too.

When was the first time he thinks he got it right, I ask – really nailed it as an actor? “Uh. Uh. Uh.” Eisenberg stamps his feet, considering carefully. “Well, I did this movie once, called Holy Rollers. It was about a Hassidic Jewish kid who becomes a drug dealer…”

Holy Rollers was released in 2010, so Eisenberg has briskly written off about a decade of screen work: not only Roger Dodger and The Squid And The Whale, but Adventureland (2009), a strange and brilliant indie in which he played a young amusement park employee. Eisenberg explains: “Holy Rollers was the first time I felt like I was acting for myself. Not the people that hired me.” He isn’t sure he did anything really special as an actor again (“working at my creative best”) until he was in Richard Ayoade’s drama The Double, in 2013, cast in a double role as identical-seeming office workers, Simon and James, who chase the same woman, played by Mia Wasikowska.

What about The Social Network? His performance as Zuckerberg was so persuasive, I thought, that it’s now hard to think of the reclusive Facebook founder without elements of Eisenberg’s fictional portrait coming to mind: the constant, robotic misunderstandings with friends and colleagues; the moment when his glassy-eyed belligerence finally gives way to fear as he’s violently confronted by a co-founder. I agree with the New Yorker’s critical take: “an indelible performance”; but not so special to Eisenberg?

“The Social Network was just a bigger movie,” he says, “with more specific expectations. And so, as an actor, you’re more conscious of those expectations, and it necessarily feels less personal. Even if it’s of a high quality, which of course that was, you just feel like it’s impossible to have that real connection.”

When he was cast as the sinister technologist Lex Luthor in the new Superman movie, an announcement made back in 2014, fans might have had his stellar work as a sinister technologist in The Social Network in mind. They responded warmly to the appointment. Expectations ran high for months, but when Batman v Superman was released this March, it proved a distressing mess: overlong, charmless, with Eisenberg’s role not much more glorifying than anyone else’s. Something had gone wrong in his performance, I thought. Where his Zuckerberg was brilliantly shifty, his Luthor seemed only smarmy, annoying instead of dramatically aggravating. Though Batman v Superman wound up making a lot of money, critics absolutely hated it.

Eisenberg tells me he didn’t read the reviews or the surrounding commentary. But he must have been vaguely aware of the kicking the film took?

“Uh, that film, I succeeded and failed in that film years before it came out.” Eisenberg means during production, when he was shooting his scenes. “At the end of the day, if I felt like I accomplished what I wanted to accomplish with that character, then it’s a success.” One of his co-stars, Jeremy Irons, recently acknowledged Batman v Superman wasn’t up to much. Whether from a greater sense of diplomacy, or an acknowledged tendency to be self-absorbed, Eisenberg takes a more personalised view. “Why would I worry,” he wonders, “about the specific gripes people have with something I do that is for myself?” He says that the only critic he cares to listen to is himself. “What other person looks to a consensus for how to do their job?”

I say a lot of people do. “Well, that’s unfortunate.”

Eisenberg agrees there’s a measure of self-protection in his way of thinking. Some years ago, he was in an independent movie called The Living Wake. It had a perfect script; filming was thrilling and satisfying; then he saw himself in the trailer and thought, “Oh, shit, I’ve ruined it.” Eisenberg didn’t watch the final version on its release in 2007 and hasn’t watched any finished movie he’s been in since. “I realised I didn’t have to. That it was a totally unnecessary part of the experience.”

Is he really not curious? “The curiosity,” Eisenberg says, “is outweighed by my terror.”

Still trapped under the tree, with the rain not letting up yet, we discuss other matters. Brexit (he’s intrigued, particularly by the immigration debate, the flavour of which he recognises from home). American basketball (he’s devoted). At one point, he idly wonders why the kids who have been following us all afternoon are “wearing little suits” – in New York that would usually indicate they go to a private school, which they don’t – and then he describes how his parents drilled into him and his siblings the outsize importance of social causes. “It was totally understood, growing up, that we should support people who are struggling. This was not debatable – in my family, no one talked about, you know, the value of lower taxes. We talked about the value of education, of social security, of universal healthcare.”

Was it a strange choice, in that case, to pursue a career in entertainment, rather than something more tangibly useful? Eisenberg points out that, just before coming to the West End, he spent four months volunteering at a domestic violence shelter in Bloomington, Indiana. While there, he collaborated on a fundraising campaign with the University of Indiana and raised $500,000, enough to pay off the shelter’s mortgage. “I would say this is a very clear example of using entertainment, or at least using a by-product of entertainment, in this case public notoriety, for something that’s more directly related to social justice.”

Why that particular shelter? Why Bloomington? “I was there for, like, personal reasons. For reasons I don’t want to bring up in an interview.”

This statement, of course, proves too enigmatic to ignore, so afterwards I do a bit of investigative Googling. When the Indiana Daily Student wrote about Eisenberg’s work at the shelter in April, it described charity worker Anna Strout, whose mother is executive director of the shelter, as Eisenberg’s girlfriend. The two were a couple in their 20s; in 2011, Eisenberg told an American magazine that Strout was the only woman he’d ever been on a date with. In 2013, they appeared to have separated, and Eisenberg was pictured on dates with his The Double co-star, Mia Wasikowska. For a couple of years, the two were photographed every so often in cafes and airports, but neither actor ever confirmed or denied the relationship.

I ask what it was like, as a socially uneasy individual at the best of times, to be subjected to paparazzi attention during that period. Eisenberg grimaces, shrugs. He compares it to the fact his dad teaches at a college campus that’s five hours from the family home. “Jarring, but it means he gets to do this thing he loves. The moment I complain about the totally disproportionate relationship between the wonderful perks I get [as a public figure] and the minor inconveniences that I’m tasked with encountering, is the moment I hope somebody slaps me in the face.”

Take being interviewed, Eisenberg says. “The whole context of what we’re doing right now is vain for me. But all of our lives have unusual circumstances. And you learn to live with those circumstances.”

Without warning, he twists his head in my direction and tumbles out a long, messy question of his own. “When I’m talking to you, and I can sometimes see your reactions, and I’m trying to gauge your reactions, do you look at me and think, ‘God! What an indulgent prick’? Or do you look at me and think, ‘This guy is smart and he thinks about what he does’? I ask because I wonder how I sound. Because nobody ever tells me to shut up.”

I say I think it must be tiring, being him.

He sniffs a laugh. “I know my circumstances are the luckiest circumstances that have existed since, y’know, the dawn of civilisation. I recognise that in an intellectual way. I just still put a lot of pressure on myself. When I think about the kind of luck I have, of not only being born in America, but being able to do the things that I want to do, it feels pretty stupid to feel anxiety.” He tugs at his T-shirt.

The heavy rain has started to ease. The schoolkids, inching closer, dashing from tree to tree, now step into the drizzle for a bolder approach. “So the kids are coming,” Eisenberg says. He reminds himself, at the last minute, to be nice (“I should be nice”). Then he turns to face them. The scene that follows is a little strange at first and, in the end, rather lovely.

“Oh, hi, hi, hi,” he says, bombarding the arriving group with questions before they can say anything. “You made it over here? You literally followed me? Don’t you have things to do? What are your lives like? Do you want to come underneath here? You go to school here? Were you walking home? Where does everybody live? Around here? Do you like it?”

For a moment, the kids are silent, dumbstruck. What are our lives like? Then, all at once, they respond with giant smiles and cries of, “Oh my days!” and they surround Eisenberg to shout brassy questions of their own. For 10 minutes, under dripping shrubbery, the kids and the movie star interrogate each other. What are you doing in London not Hollywood? (“I don’t know!”) Why are you all wearing funny little suits? (“We don’t know!”) Can you really get out of handcuffs like the magician in Now You See Me? (“Yes! Don’t try it.”) Who’s the best at drama? (“Me! Me! Me!”) They discuss Brecht, whom the kids have been studying. They discuss Hitler, same. One of the boys, hovering near the back with a basketball in hand, says to Eisenberg, “Sorry for following you around. Sorry if we made you feel weird.”

He replies, simply: “I always feel weird. This is no different.”

• Now You See Me 2 is released on 4 July. The Spoils runs at Trafalgar Studios, London SW1, until 13 August. Buy tickets from theguardianboxoffice.com or call on 0330 333 6906.

Barriers to services and a lack of voice in decisions are among parents’ complaints about special education in Iowa City schools.

Heidi Pierce and Megan Schwalm said parents, including themselves, have faced barriers in recent years to accessing needed services for their children. They said parents are not consistently included in meetings to talk about those services — an area the Iowa Department of Education recently investigated in the Iowa City Community School District.

Both mothers said they have concerns with district leaders’ approach to special education.

Schwalm said she faced a number of concerns while coordinating an education plan for her 5-year-old son, Maddox.

She said her family suffered financial burdens trying to access recommended services and said Maddox’s negative behaviors increased.

“He’s not getting the services that he needs,” Schwalm said.

As part of its investigation, the department of education cited the district’s special education program for noncompliance with the Individuals with Disabilities Education Act. The citations dealt with education plans, called individualized education programs or IEPs, that are unique to each student in special education.

Federal law requires schools and area education agencies to include parents in decision-making meetings about IEPs.

Officials during their investigation found issues in more than 150 IEPs before and during an on-site visit in May.

The visit revealed that parents were excluded from education plan meetings and raised concerns about decisions — which services children receive, how long they last and where they take place — being predetermined.

District to address citations 

Special Services Director Carmen Dixon said in an email that the district will follow all recommendations and mandates that resulted from the investigation, noting that the process is already underway.

The department is requiring the district to take corrective actions, including professional development and procedural changes for all levels of staff. A state-assigned adviser will work with the district on correcting noncompliant areas.

Dixon said she is committed to partnering with families and making sure students have access to a free, appropriate public education.

“The district appreciates the Department of Education’s support and guidance,” Dixon said.

Staci Hupp, a spokeswoman for the department, said in an email that actions the district were cited for had the potential to leave special-education students’ needs unmet, although the department did not find examples of unmet needs during its investigation.

However, she said the citations were substantial.

The concerns included education plans missing functional behavioral assessments, which provide steps for students to reduce negative behaviors and avoid restrictive procedures, such as placement in time-out rooms.

Hupp said such omissions could lead to more frequent usage of time-out rooms, although evidence of this was not apparent during the investigation.

“The nature of the citations observed were, without a doubt, impacting family participating in decision-making and student service delivery,” she said.

During a recent school board meeting, ICCSD Superintendent Stephen Murley said special education is “a very complicated, technical and compliance-based process,” and said rules concerning education plans recently became more complex.

“Our staff are working hard to make sure that they’re following the mandates that are included in both federal and state law to ensure that that paperwork is done properly,” he said.

Advocating for families

Pierce, a psychology professor, began advocating a few years ago for Iowa City families seeking help with special education.

She said she helped roughly 20 families, many low-income or new to special education, in part by sitting in on meetings for their children’s special education plans.

“I started out just with some friends that I knew. I go to a parents’ support group for parents of children with special needs, and I met some people there who were having trouble getting IEPs and appropriate IEPs,” Pierce said. “I started going to the meetings and noting when it seemed like the parent was not being heard and their information was not being considered.”

Pierce also provides behavioral health intervention services to families. She is a children’s mental health care consultant who is involved with autism and mental health groups.

Pierce said some families have not been notified about meetings to discuss their children’s services and faced last-minute meeting cancellations.

She said some families also had trouble accessing therapies, including occupational and music therapy, and one family had concerns about an unaddressed goal in their child’s special education plan.

She noted parents also had concerns with the Grant Wood Area Education Agency, which oversees the district’s special education program.

Dixon said teachers are working hard to provide timely meeting notices to parents. She said staff sometimes called or emailed parents about meetings but forgot to complete a meeting notice form on time. The district reviewed these plans to verify that the parents did, in fact, participate in the meetings, she said.

“If concerns had been brought to the district by parents about participation, we would have addressed them immediately. I do believe we involve all our families in special education decisions; everyone is considered an important member of the IEP team,” she said.

Pierce said she thinks district teachers are devoted to helping special-education students.

However, she said she wants to see “top down” changes to the special education program and a system put in place for parents to provide anonymous input on their experiences with special education.

“It shouldn’t have to be hard. It shouldn’t have to be stressful. We should go in and feel like we’re a team,” she said.

Seeking services for Maddox

Schwalm said when she sought an extra year of preschool for Maddox, a compassionate boy who loves trucks, the option was never on the table.

She said a therapist recommended the accommodation for him because of his diagnoses: autism, obsessive-compulsive disorder, anxiety, attention-deficit and hyperactivity disorder, and disruptive behavior disorder.

However, she said district officials would not consider the option during Maddox’s IEP meetings.

Dixon said she cannot comment on individual student situations because their records are confidential.

Schwalm said her struggles seem to align with the recent citations.

“It was very clear to me, and the folks that I brought to meetings with me, that when we got in there, decisions had already been made about what services we were going to be allowed to access for my child,” she said.

Schwalm said her son’s special-education team has also met without her.

She said during one meeting, district officials halted the discussion and reconvened in another room without her. When the team returned, they offered a decision about her son’s services, she said.

Schwalm said parents of children with special needs often fight exhausting battles for services, which can impact their financial situations and parents’ work schedules.

“For me, the entire year last year went like that,” Schwalm said.

Seeking help for gifted children with disabilities

Pierce also sought special education for her own children, who are intellectually gifted and have disabilities.

Ela, 9, an aspiring teacher, was diagnosed with autism, generalized anxiety disorder, and attention deficit and hyperactivity disorder.

Ben, 7, who loves chess, was diagnosed with generalized anxiety disorder and attention deficit and hyperactivity disorder.

Both children attend Shimek Elementary.

Pierce said despite letters from various doctors recommending special education for Ben and Ela, district and Grant Wood Area Education Agency officials repeatedly told her they were ineligible. She said officials told her they could not provide the recommended services to address their disorders and talents.

“I was just told there was no way we could ever do all of this, instead of ‘let’s figure out how this can happen,’ “she said.

Dixon said eligibility for special education is determined based on students’ disabilities and state criteria. She said the Grant Wood Area Education Agency is responsible for carrying out initial eligibility procedures, and the district works with the agency after a child is identified as a possible candidate.

Pierce said Ela now attends therapy seven days a week, although she could be accessing some services during the school day. She said this solution has helped, but is expensive and taxing for both Ela and Ben, who often sits in the waiting room.

Pierce said other families with limited access to transportation could not easily find a workaround the way her family did.

“There are families who don’t have a car. … How are they going to drive their kids back and forth to therapy? It is really a human rights issue,” she said.

Reach Holly Hines at hhines2@press-citizen.com or at 319-887-5414 and follow her on Twitter: @HollyJHines.

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When pharmaceutical companies create a new drug, they are always looking for compounds that treat specific profitable disorders, especially if they have the potential for blockbuster status. Patent life is 20 years after the drug has been identified as viable in clinical trials – this means that no one else can make or sell the medication during that time.¹

For this reason, pharmaceutical companies prep the marketplace for years prior for a successful launch with maximum impact and profit.

By the time a drug launches, doctors are ready to write prescriptions for that drug, and patients are primed to ask their doctors for it. Because it’s a name brand drug, the price is high, and pharma will want to keep that price point by protecting and extending their patent exclusivity as long as possible.

Pharma protects their patents in a number of ways. One option is to negotiate with generic drug manufacturers, asking them not to release their own versions for a set amount of time and money. Another way is to extend a patent by finding a new indication for it, thereby buying it another lifecycle as a brand name drug that sells at full premium price. In order to find this new indication, pharmaceutical companies have to get creative.

Pharma has found it profitable to create new illnesses to treat with successful existing drugs. An example of this phenomenon is Eli Lilly’s selective serotonin reuptake inhibitor (SSRI), Prozac. Prozac was originally launched and achieved blockbuster status with an indication for depression. The target market was doctors who specialized in central nervous system (CNS) disorders, Family Practitioners, and on the patient side, anyone who suffered from depression. As the first SSRI on the market, Prozac was hugely successful and widely prescribed for mild, moderate, and severe depression. In the USA, annual sales were $350 million in the first year alone and peaked at $2.6 billion a year.²

Doctors were also encouraged by Lilly’s pharmaceutical sales reps to prescribe Prozac for other “off label” uses. Off label uses are any symptoms that the drug is not indicated for and that haven’t been tested in clinical trials. Examples of off label use of an anti-depressant would be obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), social anxiety disorder, and panic disorder. It is interesting that prior to Prozac, there was no such “disease” as PMDD. Prozac was also recommended to be prescribed for shyness, fear of public speaking, and other non-medical conditions. And, patients were encouraged to ask for Prozac for these types of mild social phobias, making the drug very successful and profitable.

Because Prozac impedes sexual function, it is also recommended for premature ejaculation. Now that Prozac (fluoxetine) has gone generic, it is also prescribed off label for bulimia, post-partum depression, premenstrual syndrome, fibromyalgia, body dysmorphic disorder, pathological laughter or crying, narcolepsy, agoraphobia, trichotillomania (hair pulling disorder), seasonal affective disorder (SAD), and many other ills that plague the “worried well.”

“Nothing is as lucrative as a product that someone is desperately dependent on. And, nothing is better than getting those on board who aren’t even ill.”

– John Virapen, in his whistleblower book, “Side Effects: Death Confessions of a Pharma Insider” 

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Merck developed a drug treatment for benign prostatic hyperplasia (enlarged prostate, commonly referred to as BPH) named Proscar. Interestingly, Proscar was found to grow hair, and was launched as a brand new drug called Propecia for male pattern baldness which was now being positioned as a treatable “disease.” In reality, male pattern baldness is not a disease, it’s a common genetic condition. Gradual hair loss is a normal part of the aging process for many men. But, if repositioned as a disease that can be cured, it presents a huge market to be exploited for Merck.

Unfortunately, growing hair with the use of medication carries risks. In clinical trials, Propecia was found to cause sexual side effects such as decreased libido, erectile dysfunction, and ejaculation disorder. The drug launched anyway to a prepared eager-to-grow-hair target market. What the manufacturer failed to disclose in the prescribing information (PI) was that those adverse events often lingered even after patients discontinued use of the drug. At least 700 lawsuits are pending in New York State with more to come in New Jersey. The issue is that Merck knew that the adverse events would persist after patients ceased use of the drug, and they hid that information from the public.³

Pharmacia (now Pfizer) created a compound that would later be marketed as Genotropin. This drug is a human growth hormone that is targeted at “slow growing” children.⁴ The brand team primed the marketplace for the drug by appealing to parents of small children, essentially insinuating that being short was, in fact, a disease. Stats were gathered and a case was built that taller adults have more confidence, enjoy more advantages like promotions and raises, and generally earn more money than their shorter coworkers. What parent would want their child to miss out on those advantages? What the manufacturer failed to disclose is that there are serious side effects that come along with the use of growth hormone in a child’s developing body.

The off-label use of Genotropin was supposed to be the real cash cow. The goal of the Product Managers was to tap into the beauty market by promoting human growth hormone as an anti-aging breakthrough, attempting to relabel the entire process of aging as a disease process in need of pharmaceutical treatment. Researchers had hopes that clinical trials would demonstrate the compound stimulated the growth of muscle mass and decreased fat. Those trials never bore fruit, and Pfizer was unable to push that off label use. But it doesn’t mind promoting Genotropin to orthopedists to inject into the joints of injured athletes who are looking to recover quickly from sports injuries. Using human growth hormone may cause such side effects as pain in joints and muscles, arm and leg swelling, carpal tunnel syndrome, and gynecomastia in men (breast enlargement), and may also lead to heart disease and diabetes.⁵ These side effects were seen in older people rather than younger, but isn’t it older people who are more likely to take the bait of aging as a disease?

The trouble with prescribing any drug for off label use to treat a newly created disease, such as aging, is the potential for adverse events and even death. This is especially risky if that drug is prescribed by a General Practitioner who isn’t monitoring the patient for a specific disease the way a specialist would. Creating pseudo-diseases to increase profits isn’t about patient health. It’s about pharma wealth.

SOURCES

¹ http://www.drugsdb.com/blog/how-long-is-a-drug-patent-good-for.html

² http://archive.fortune.com/magazines/fortune/fortune_archive/2001/08/13/308077/index.htm

³ https://www.drugwatch.com/propecia/

⁴ http://www.genotropin.com/

⁵ http://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/growth-hormone/art-20045735

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There are many different forms of anxiety. Some of them include generalized anxiety, phobias, social anxiety, obsessive-compulsive disorder and post-traumatic stress disorder.

Courtesy of William Doan

“Why are there always so many damn socks in the laundry?”

William Doan’s wife asked him that question 10 years after they
got married. He laughs when he remembers it. There were, and
remain, so many damn socks in their laundry because when William
Doan wakes up in the morning he puts on two pairs.

“I had to sort of fess up at this point,” he said, “and she was
like, ‘really?'”

Doan, at 57, has lived much of his life with a diagnosis of
obsessive-compulsive disorder, or OCD, as well as an anxiety
disorder. He’s an artist and professor of theater at Penn State
University.

In pop culture, OCD is often used as a kind of shorthand for
fastidiousness. Every source I spoke with for this story quoted
the casual diss Oh, you’re so OCD! that sometimes gets
lobbed at neat freaks (or that neat freaks self-deprecatingly aim
at themselves.)

But real-life OCD has a specific, straightforward meaning. People
who have it experience obsessions and compulsions that feed each
other in recursive, hard-to-escape loops.

Wayne Goodman, chair of the department of psychiatry at the Icahn
School of Medicine at Mt. Sinai hospital in New York City,
explained what obsessions and compulsions are.

“Obsessions are always unpleasant thoughts, or unwanted images,
or unwanted impulses. They’re not in any way pleasurable.”

A child might imagine again and again their parents killed in a
plane crash. A religious person might feel bombarded with
blasphemous urges. Someone else might fear toxins or pathogens
that could invade their body.

So they develop compulsions, rituals they act out that offer
temporary relief from the obsessions. The connection between the
obsessions and compulsions may be difficult for people who
haven’t experienced them to understand.

“There are things like hand washing, doing things over and over
again, checking and checking,” he said. “But sometimes they can
be much more covert. They can be things you do in your head, that
nobody else is aware of, to try to neutralize a disturbing
thought or unwanted impulse.”

(Interestingly, it’s not actually clear that obsessions arise
first and lead to compulsions. There’s a body of research that
suggests the reverse. Young children with OCD tend to display
compulsions before they can articulate obsessions.)

That said, OCD isn’t about delusion or psychosis, where people
can’t distinguish reality from their illness. Goodman said,
“Patients with OCD in general have very good insight. They
recognize that the thoughts they’re experiencing, although
intrusive, are from their own brain.”

Goodman’s description tracks with Doan’s experience. “It’s
completely irrational,” he said. “I don’t even reflect on it or
try to figure it out anymore. I just know when I get dressed in
the morning I’ve got to put on two pairs of socks. It’s part of
how I have to begin my day. I have been traveling where I have
gone and bought clean socks because I miscalculate the number of
socks I’m going to need.”

It would be a mistake though to imagine OCD as a set of odd, if
somewhat difficult to manage, quirks. For people who live with
it, OCD becomes part of the texture of their hours and days. When
Doan walks, indoors, outdoors, or on the treadmill, he counts his
steps: 1 … 2 … 3 … 4 … 1 …. 2 …. 3 …. 4

Other people with OCD may perform small rituals – in their heads
or with their bodies – all day. These can be relatively trivial
and difficult to notice. I watched a friend throw salt over her
shoulder three times before she cooked for more than a year. But
before she told me the ritual related to her OCD, I assumed she
was just superstitious.

But the compulsions can also be debilitating. Goodman describes
patients who end up housebound, unshowered, and with uncut
fingernails because they’re avoiding germs in the water and
outdoors.

For many people with OCD, the symptoms ebb and flow over the
course of their lifetime.

Willian
Doan

“I can tell when im going to have some insomnia,” Doan said. “Or
suddenly I know that because I’ve been rehearsing arguments with
people over and over and over again in my head that its like
‘Whoa, you’re letting this get the best of you.'”

Doan said that he feels OCD, along with anxiety, in his body
before it translates into a mental experience.

The sensation begins in his chest, where the diaphragm sits and
the bones of the rib cage join together. He feels vibrations, and
a tightening feeling, and his breathing getting more shallow.

“If I could hear it I feel like it would be like humming. It’s
vibratory, that’s the best word I have for it,” he said.

Those vibrations the signs of either a panic attack coming on or
a period of heightened symptoms that can last for days.

When that happens, he has a series of coping mechanisms he can
engage. He meditates. He goes for long walks. He makes art – some
of it is illustrating this article – to express the wordless
sensation of the illness.

Sometimes Doan’s wife will notice his symptoms before he does.

“We’ve been married for 33 years. And while she only figured out
the socks 10 or so years in, she also just knows my personality.
And she is really sensitive to when I might be moving into a
phase of heightened anxiety.”

She’ll suggest he go somewhere quiet for a couple days to cope,
or go for a long drive, or close himself in his art studio.

“She’s become a wonderful partner in that sense, in that she also
senses what might be happening, and she knows what my good coping
mechanisms are and she helps to facilitate those.”

Similarly, he said his close collaborators in his theatrical work
have a habit of using humor to help break him out of
obessive-compulsive loops.

While Doan’s experience may be fairly typical as far as OCD goes,
the illness has no single common form. Blair Simpson, a
clinician, researcher and professor at the Columbia University
Medical Center, said that while OCD may be easy to define, in
practice it can be hard to recognize and diagnose. That’s because
the symptoms follow certain stereotyped patterns. But
any two people with OCD will likely have very different
experiences.

Broadly speaking, OCD divides into five categories or “symptom
dimensions.”

Some people live with fears of contamination (1) or harm (2).
They might worry that something will damage or contaminate their
bodies. Or they might fear hurting or infecting their loved ones.
These forms of OCD tend to associate with cleansing and checking
rituals.

Other people feel compelled to do things “just so” (3). I spoke
to one person who feels paralyzed when he can’t figure out which
parking spot lies closer to his door at work. Another walks into
stores to clutch every garment on her favorite rack until the
ritual abates.

Then there are people who struggle with “kept thoughts” (4).
These are “immoral” thoughts or urges that contradict the deeply
held beliefs of people who live with them, like a religious Jew
constantly imagining eating a pig.

And a final group struggles with hoarding (5), although
researchers now consider that a somewhat separate disorder.

But even within those categories, no two patients have the exact
same experience.

“I’ve seen thousands of patients, but I don’t think I’ve seen the
same symptoms replicated more than once,” Simpson said. “You have
no idea the range of thoughts or impulses patients have. We have
patients who think California is contaminated.”

William Doan

For that reason, she said many researchers avoid focusing too
heavily on the specific ways OCD can manifest. Those vibrations
Doan feels are too particular to him to draw any broad
conclusions from – though they may represent a type of
sensation to which other people with OCD can relate.

Right now, Goodman and Simpson say there are only two proven
treatments for OCD.

Medicine can help – specifically “serotonin reuptake
inhibitors” (SRIs and SSRIs) like Zoloft, which are also used to
treat depression and anxiety.

Psychiatrists don’t actually know exactly why SRIs work
for OCD, Goodman said. And for a long time serotonin acted as a
kind of red herring. Researchers ran down a blind alley looking
for a cause of OCD in the brain’s seratonin system. But they
found no answers there.

The other
proven treatment for OCD? Exposure therapy,
which is a specific type of what psychiatrists call cognitive
behavior therapy or CBT.

When Simpson has a patient, she’ll work with them to list the
things they fear: their obsessions. Then she’ll work through the
list with them, from mildest to most severe. She guides them to
encounter their obsessions without letting their rituals kick in.

It’s not easy.

“Initially they get more anxious,” Goodman said of his own
patients.

People with OCD work hard to avoid their triggers. One person I
spoke with compared them to allergies. The mild ones may resemble
a light cat allergy. They might make you uncomfortable if you
enter the wrong house. Severe ones can be closer to a bad peanut
allergy. You might feel like you’re dying if you bite into the
wrong sandwich.

And for CBT to work, Simpson said, the course of treatment should
be fast – just a few weeks. That’s a lot of stress in a short
period of time.

But even with the best medicine and CBT from an expert
psychiatrist, Simpson said, she can only expect to reduce
symptoms in most patients. There’s
no true cure.

“We see on average about a 40% decrease in severity,” she said.
Some patients go into near-total remission, while other may see
little to no impact at all.

William Doan

The researchers I spoke with want treatments for their patients.
They hope those methods will emerge from better knowledge of the
disease. Right now, they suspect the cause or causes of OCD lie
in the big-picture ways different parts of the brain connect with
one another. And there are already suspect circuits. But the
details remain a mystery.

When they figure out the details, Goodman hopes it will transform
her job.

“Ideally, I would have battery of noninvasive tests that look at
the brain,” she said, “And I could tailor treatments exactly to
what I saw, and then monitor the outcomes to see not only if my
patients are feeling better but if the circuit is performing
better.”

I asked her how far she thinks we are from that kind of
treatment, and she paused for several seconds.

“Further than I would hope. I hope I get there in my lifetime.
And if we don’t I hope we get there soon.”

In the meantime, most people with OCD can learn to manage their
symptoms.

“I think it’s a significant experience in my life, but not a
dominant one,” Doan said. “There are times where it has felt like
a dominant one, and that’s when reaching out to a counselor or
using my coping mechanisms can help. But you know, I don’t wake
up every day frustrated or anxious about these things anymore.”

I asked him if he would flip a switch to turn off his OCD if he
could.

“Ten years ago I would have said yes,” he said. “I want to do
away with my OCD.”

“But I think the time I’ve spent trying to figure out what to do
with it, how to cope with it, how to manage it, how to embrace
it, how to laugh about it, and how to let it be part of who I am
has brought me to a point where I think a lot of my creative
energy comes from that place. I’m not saying if I didn’t have OCD
I wouldn’t be able to function as an artist, but I do think a
good symbiotic relationship has emerged between my obsessive
energy and my drive to make work.”

Some workaholics may be prone to mental health disorders, compared to folks with greater work-life balance, new research suggests.

These disorders may include anxiety, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and depression, the study authors said.

The findings, based on a review of more than 15,000 Norwegians, suggest that “taking work to the extreme may be a sign of deeper psychiatric issues,” said study lead author Cecilie Schou Andreassen.

“Physicians should not take for granted that a seemingly successful workaholic doesn’t have these disorders,” said Schou Andreassen, a clinical psychologist with the University of Bergen, in Norway.

The research doesn’t delve into cause and effect, so it’s not clear how mental health issues and overwork might be linked. Nor should hard workers be labeled as workaholics, although experts say the distinctions between the two can be confusing.

“It is arguable that the term workaholism is misused, and that in the majority of cases, it is only normal working behavior,” Schou Andreassen said.

For this study, researchers surveyed nearly 16,500 working adults, average age 37. About 6,000 were men and almost 10,500 were women.

The study found that 8 percent qualified as workaholics based on their answers to questions such as:

• You think of how you can free up more time to work.
• You become stressed if you are prohibited from working.
• You have been told by others to cut down on work without listening to them.
• You work so much that it has negatively influenced your health.

Of those overzealous workers, testing revealed that one-third appeared to have ADHD, compared to 13 percent among the non-workaholics. And, 26 percent showed signs of obsessive compulsive disorder versus 9 percent of those with better work-life balance.

Also, nearly three times as many workaholics were deemed to have an anxiety disorder — 34 percent versus 12 percent. And the researchers said they found that the rate of depression was tripled — 9 percent compared to 3 percent — in the workaholic group.

Genes may explain the link between workaholism and mental illness in some people, Schou Andreassen said. It’s also possible that workaholism may contribute to mental illness, or the other way around. The study doesn’t provide any answers on this front.

Steve Sussman is a professor of preventive medicine, psychology and social work at the University of Southern California. He said that “work as an addiction is not well-understood by many people.” Some specialists question whether workaholism actually exists as an addiction, he added.

He said “ambiguity” exists regarding workaholic habits that might be considered an addiction and mental illnesses such as obsessive compulsive disorder.

Previous research has linked workaholism to compulsive traits and anxiety, said Sussman.

Another expert agreed that the subject isn’t well-understood.

“Many mental health professionals may not know about workaholism or have treatment plans for it,” said Malissa Clark, an assistant professor of industrial/organizational psychology at the University of Georgia.

Still, therapists can help patients “manage their workaholic tendencies, like developing strategies to help them ‘turn off’ work while they are at home or deal with poor marital quality and strained relationships with children,” Clark said.

“Another thing workaholics can do to help themselves is to communicate with their supervisor about when they will — and when they won’t — be available when they are off the clock,” she added.

The study findings were published recently in the journal PLoS One.

Are feeling anxious? Stressed-out? Maybe a little bit like there is no way you will ever do all the things you are supposed to do and even if you do do those things, you’ll probably mess them all up? Well, congratulations! You may be a woman!

According to a study from the University of Cambridge, women are nearly twice as likely to suffer from anxiety disorders as men, with a ratio of 1.9 women to every 1 man affected.

The study was a “systematic review of reviews,” looking at 48 studies to discover what social and cultural factors may play a role in a variety of anxiety disorders including generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, panic disorder and a host of different phobias.

The results show that women, people under the age of 35 and people from “Euro/Anglo cultures” are most likely to suffer from anxiety. 

In the United States, the study estimates that 18 percent of the population suffers from anxiety disorders. So, if you’re like me–that is an American woman under the age of 35–I’m sorry and you aren’t alone. Take a deep breath. Meditate. And maybe go get some counseling.

— Lizzy Acker

503-221-8052
lacker@oregonian.com, @lizzzyacker

While the young are indeed blessed with energy and strength, the state of their mental health is being ignored. (Source: Thinkstock Images)

Women as well as young adults are twice as likely to experience anxiety as men, a new study says.

Anxiety disorder — the most common mental health problem — is often manifest as excessive worry, fear and a tendency to avoid potentially stressful situations, including social gatherings.

“Anxiety disorders can make life extremely difficult for some people and it is important for our health services to understand how common they are and which groups of people are at greatest risk,” said lead author Olivia Remes at the University of Cambridge.

The findings showed that nearly one in ten adults (10.9 per cent) with heart disease were affected by Generalised Anxiety Disorder (GAD), but women were almost twice as likely to be affected as men. Also, women affected with heart diseases, cancer and even pregnancy showed a higher level of anxiety than men. Obsessive Compulsive Disorder (OCD) — an anxiety disorder characterised by obsessions and compulsions — was in general, found only one in a hundred, but the proportion with the disorder was double in pregnant women and slightly higher in the period immediately after birth.

“Anxiety disorders can also lead to impairment, disability and the risk of suicide,” added Louise Lafortune, research associate at the University of Cambridge.

Further, the level of anxiety among young individuals — both male and female — under 35 years of age were found to be disproportionate. In addition, people from Western Europe and North America were found more likely to suffer from anxiety than people from other cultures. “By clubbing all this data together, we see that these disorders are common across all groups, but women and young people are disproportionately affected. Also, people who have a chronic health condition are at a particular risk, adding a double burden on their lives,” Remes noted.

For the study — published in the journal Brain and Behavior — the team studied 48 scientific reviews that showed data between 1990 and 2010. The overall proportion of people affected remained largely unchanged, with around four out of every 100 experiencing anxiety.

Anxiety disorders like social anxiety disorder, obsessive compulsive disorder, agoraphobia, panic disorder and general anxiety are the most common forms of mental illness in the U.S. An estimated 18 percent of all American adults have an anxiety disorder, costing more than $42 billion a year. 

America is unique in this regard, according to the largest ever global analysis. Some regions of the world, including the U.S. but also Western Europe, have higher rates of anxiety disorders in general. What’s more, some groups within the U.S. have a higher risk of anxiety disorder diagnosis than others.

Olivia Remes, lead author of the analysis and an anxiety researcher at the University of Cambridge, reviewed 48 of the best or most comprehensive studies on anxiety prevalence around the world and was able to pinpoint which cultures, genders and age groups are most likely to be affected. The results also revealed where there are gaps in understanding among some groups.

“Much more research needs to be done on people identifying as lesbian, gay, and bisexual (LGB), because anxiety is an important issue in this group,” Remes said. “Also, Aboriginal people living in Canada, the U.S., New Zealand, and other parts of the world are at a significantly increased risk for poor health, yet we know so little about their mental health.”

Why anxiety disorders matter

Despite how common they are, anxiety disorders continue to be belittled as mere worrying instead of debilitating, disabling conditions that require treatment.

While a little bit of anxiety can be beneficial by helping us keep safe, people with untreated anxiety disorders experience overwhelming, uncontrollable feelings of dread or fear that can interfere with daily life and prevent them from doing the things they want to do. Learning more about these conditions is one way to help combat mental health stigma and get help to the people who need it. 

“[Anxiety disorders] can increase the risk for suicide, disability, and poor quality of life,” Remes said. “If we don’t know who is most affected by anxiety, we cannot do anything to decrease the human and economic burden associated with these disorders.”

Here are 10 takeaways from this landmark global study of anxiety: 

1. Women are twice as likely to be affected by anxiety disorders as men.

Women were more likely to be affected by anxiety disorders than men by a ratio of 1.9 to 1, and these difference persisted across time and in both developing and developed countries.

2. Young people are more likely to have anxiety disorder.

No matter what culture was studied, people under the age of 35 were more likely to have anxiety disorders than older people. This held true for all researched countries except for Pakistan, where middle aged people have the highest rates of anxiety disorders.

3. Opioid addiction is linked to an increase in the risk of anxiety.

Globally, the presence of anxiety symptoms in people who abuse opioids range from two percent to 67 percent, while actual diagnoses are about 29 percent. Among Americans who abuse opioids, that number is 16 percent.

4. People who suffer from gambling or internet addictions are more likely to also have anxiety disorder. 

In addition to opioid abuse, pathological gambling and internet addiction are two other risky behaviors that appear to be linked to an increase in anxiety diagnoses. Globally, 37 percent of pathological gamblers reported having anxiety disorders, while studies on internet addiction (mostly in Asian countries) find that anxiety prevalence is more than two times higher in people with internet addiction compared to control groups.

5. Anxiety often appears with other mental and neurological illnesses.

People with bipolar disorder, schizophrenia and multiple sclerosis are at greater risk of an anxiety disorder. In Europe, a range of 13 to 28 percent of people with bipolar disorder have anxiety too, while globally, 12 percent of people with schizophrenia have also been diagnosed with obsessive compulsive disorder. Finally, almost 32 percent of people with multiple sclerosis, which is a neurological condition, have an anxiety disorder, and over half of them have some anxiety symptoms.

6. Seemingly unrelated diseases are linked to heightened rates of anxiety.

People with cardiovascular disease, cancer, respiratory disease, diabetes and other chronic conditions are more likely to have anxiety disorder. For instance, symptoms of anxiety among people with congestive heart failure ranges from two to 49 percent. People with coronary artery disease have panic disorder at rates ranging from 10 to 50 percent.

Cancer patients, meanwhile, had anxiety rates between 15 to 23 percent. This heightened risk can extend even to cancer survivors and their spouses. Globally, people who had been diagnosed with cancer two years ago had higher anxiety rates than healthy controls (18 percent vs. 14 percent), and 40 percent of spouses of long-term cancer survivors developed anxiety.

7. Anxiety can be present in people with chronic, non-life threatening conditions.

People with diabetes are more likely to have either anxiety disorders or anxiety symptoms compared to healthy control groups, and this effect was stronger for women than men. For instance, women with diabetes had anxiety prevalence at almost two times the rate of men with diabetes, at 55 percent compared to 33 percent.  

8. A traumatic past could explain high rates of anxiety.

People who experience trauma can also have unusually high rates of anxiety. Studies of U.K. and U.S. veterans who had limbs amputated find that anxiety affects one-fourth to over one-half of these groups. Globally, people with a history of sexual abuse report anxiety rates that range from two percent to 82 percent.  

9. Anxiety is something to watch for during pregnancy.

Globally, pregnant and postpartum women have higher rates of obsessive compulsive disorder than the general population. That’s two percent and 2.4 percent, respectively, compared to 1 percent of the general population.

Ethiopian and Nigerian studies showed that anxiety was high in women during the pre- and post-natal period (15 percent and 14 percent, respectively), and that this effect was especially pronounced in younger women.

10. Vulnerable subgroups are more prone to anxiety.

Lesbian, gay or bisexual people living in Western countries have higher than normal rates of anxiety, and this effect is strongest for women. An estimated three to 20 percent of men face anxiety, while the estimate for women ranges from three to 39 percent.

Anxiety symptoms are also most common in old age, especially among those who have cognitive dysfunction, such as memory problems. Among seniors with mild cognitive impairment, an estimated 11 to 75 percent face an anxiety disorder. This extends even to their caregivers, who report anxiety in the range of four to 77 percent.

Remes hopes that her research highlights populations who are most affected by anxiety, so governments and health care systems can direct mental health resources, interventions and screening efforts toward these high-risk groups.

“Hopefully our study will raise awareness of anxiety as an important issue so that more research can be conducted on this, and those affected can seek help and receive the necessary treatment,” Remes said. “Mental health is important for all and is a basic human right.”

CORRECTION: This article has been updated to address language that inaccurately characterized multiple sclerosis as a mental health issue.