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May 13, 2007

Your Turn: What About Anya?

Anya
(click for full size)

Why is it that the pharmaceutical industry comes under so little scrutiny?

Could it have something to do with the fact the industry continues to finance the FDA's oversight function, or that the industry buys off the media with $4 billion a year (yes, billion) in direct-to-consumer advertising (an amount that has doubled since 2000), or that it's standard operating procedure to buy off  financially reward doctors?

The scarcity of mainstream coverage on this subject makes every write-up that much more important.  That's why I wanted to focus on Thursday's article in the NYT regarding the way the industry markets psychiatric medication to children.

The story is structured around the experience of 15-year-old Anya Bailey (shown above) who, three years ago, was put on an anti-psychotic for an eating disorder.  (Her psychiatrist at the time was being paid by the drug's manufacturer to give marketing lectures for the product.)  Anya's appetite returned, but the medication -- which was also heavily sedating -- led to a disabling nerve condition in her back.

It wasn't until last year that Anya went to the Mayo Clinic and was told to stop taking the drug.  With counseling, her weight normalized.  According to her mother, her back is also improving with the help of medication targeted specifically for that condition.

Because, as mentioned above, the behavior of the drug industry receives scant attention, the accompanying photo also becomes a signature one.  I've got a number of questions about it, though.

How much is this portrait illustrative of the problem?  And if it does speak to the problem, could it actually be doing so at Anya's expense?  For example, if she's psychologically sound, does the pose, the expression, the exact location, the general setting, and/or the 16-ounce coffee mug suggest that Anya's a healthy girl who has been taken advantage of by the system, or does the photo, itself, take advantage of her again?

I was also wondering if the image might also be making some cultural inference about community and/or suburbia as a factor in the medication (and over-medication) of children or consumer passivity in the face of medical and commercial exploitation.

(image: Fabrizio Costantini for The New York Times. May 2007. East Grand Forks, Minn. nytimes.com)

Comments

I saw this photo in the Times. I thought it was a pretty good depiction of the lack of community (and community/inter-personal support) in suburban America. I think I can see about 10 houses in this photo; where are the people? Do you think that this girl is acquainted with her neighbors? Does she have a sense of being part of a community? And yet, there is nothing in her environment that encourages a sense of self either. It is utterly faceless in so many ways; I really hate this scene. I think the big mug is a red herring; the real problem is the insanely bleek environment where she lives. Ugly.

Oh yes, I think the backdrop is clearly one of the keys to the picture. One can imagine the photographer, recognizing its striking semiotic potential, saying "let's go outside" to take this picture. It is a tableau of emptiness, with street tracing down to a vanishing point, and "nothing on the horizon." It is a particularly bleak variant of suburbia, a latch-key world of stupefying greyness, a place where anyone would hate to live. The girl may have been starving herself, but she is also being starved of life here. Minnesota in the Springtime is not necessarily a lush and vivid place, but this neighborhood seems cursed with a dying, Stepford ambience. Anya stands vulnerably in the street, and though is not likely to be mown down in the next moment, is in a place where people are "not supposed to be," a "subject" astray in the proper domain of powerful forces and dynamics that at 15, she is not yet old enough to control.

Short-shorts of adolescent sexuality thwarted by the cold and isolated world; hunched shoulders of a pained and reflexive self-protection; "travel mug" of coffee, rather than a cup, to be ready for escape.

The commentators above pretty much nailed it- the isolation of suburbia where your daily friends consist of your favorite mug and your faithful shadow, and the only signs of life, your orange (plastic) clogs.

Can't wait for Michael Moore's SICKO!

How much is this portrait illustrative of the problem? And if it does speak to the problem, could it actually be doing so at Anya's expense?

What is “the problem”? The photo doesn’t speak to the issue of doctors taking payments from drug companies. Is that the problem? Anya looks vulnerable and alone in the portrait. Or is that the problem?

Here’s a problem: The article is crap. It is poorly written (it’s vague, it’s badly structured, it makes assumptions, it draws conclusions that are unsupportable, it covers too many complicated issues too superficially) because the subject matter is poorly understood by the writers/editors. That might be at Anya’s expense. That the photographer could illustrate it at all is an accomplishment.

While waiting for my doctor I have seen the drug pushers enter the office and slither toward the receptionist in their skirt or suit of fine cut black cloth with the solemnity of undertakers. At this point I try to rework and murmur something about an old movie and snake oil salesmen to anyone who's not hiding behind a magazine.
The pharmaceutical companies are a prime example of excessive corporate influence, control and criminality. So much time and money wasted in manipulation, in that aspect I suppose the young girl in the wasteland is appropriate.
Those articles are too long and mostly gobblygook as well.

make a god of money
worship it with automobiles
too young yet to drive
so fill the emptiness inside
with whatever you parents give you
bide your time
you body is a shell that keeps you here
but you want to go

As a mother, my first reaction would have been "What?!?! A powerful antipsychotic to treat an eating disorder?" Maybe medical marijuana would have been more appropriate, and the side effects would be nowhere near as severe. As a clinical herbalist, I am constantly amazed at how little control people feel they have over the health and well-being of themselves and their children. People are so willing to hand over their most precious ones without even a forethought of the potential consequences. Vaccines are a whole different topic, but the premise is the same--"Parents, you must vaccinate your child according to this schedule, or your child will never be allowed into preschools, schools, churches, college..." etc. And these parents buy into it, unthinkingly.

I feel sorry for this child Anya because her mother was so ignorant and didn't do the proper research before agreeing to allowing her child to become a guinea pit, a guinea pig, that unfortunately will have no effect on the outcome of what doctors and the pharmaceutical giants continue to do. Isolated by being nothing more than another suburban teenager, at the mercy of Mother and Doctor. It is my hope that her need to express herself by the lovely orange crocs will help her to take possession of her own health as she gets older.

I was amazed at some of the things I read in that article. I hope they don't succeed in pushing that crap in the rest of the world; half the kids around here would be on Ritalin or whatever. And I also am interested to see Michael Moore's newest film.

half of the kids here ARE on ritalin. That's one of the things we're complaining about.

I think Ummabdullah's talking about the Gulf, where she lives. May I point out that in the Gulf states 97% of mental patients are women (In America a majority of mental patients are women, but the discrepancy is not anywhere near as great), eating disorders among girls like Anya are well documented, and Dubai is the world hub of sex slave trafficking. I have no idea how many of their kids are on Ritalin, nor do I think it matters. I'd rather be a young girl in "barren suburbia" America than a girl in a traditional gulf Arab family, any day. At least I would grow up with the idea that it's not a sin to control my own destiny. I wouldn't be married off at Anya's age, and told by my own parents that only a dead body of mine should leave my husband's house. Etc. etc. etc. Barren suburbia is bad but let's not make quality comparisons between bananas and raspberries or whatever the hell it is.

That said I do agree with the posters above; I just don't think pointing out the flaws in our own society is any call for gloating on the part of people who live in other societies. Gulf cities have plenty of alienation (the majority of their populations are immigrants from other places) and there are thousands of acres of soulless concrete blocks of apartment buildings that make this suburb look gorgeous, thank you very much.

Jeeez, America did not invent the concept of the disaffection of the young, you know.

The trouble here is that drug use in America is a cultural norm, with two classes of recreational or lifestyle drug users--those who can afford to give big pharma their cut and get doped on prescription medication, and those who get their drugs on the street and get life terms in prison for denying big pharma their percentage of the profits.

Of course to drag the kids into it, before they've really had a chance to decide if they'd like to be junkies or not, and pathologizing them in order to justify turning them into junkies, is horrible and criminal and all but what can you do, when people are not allowed to call things by their names. A junkie is a junkie in my book, and aren't we all depressed? Good grief.

A sense of community would undercut the consumer culture more or less completely--people would let their friends use their washing machines, and fewer washing machines would be sold as quickly. Joint families would buy one fridge, whereas when people live alone everybody needs their own fridge--so in bleak suburbia fridge sales are sustainable. Car sales are bad enough without people giving rides to their neighbors. The LAST thing the American economy can stand is a renewed sense of community and a true sense of family values, as opposed to the political talking points kind. So just get the idea completely out of your heads. With your loneliness and bleak suburbia you are doing your part to hold up Our Way of Life. Every isolating purchase of wide screen TV supports our troops.

Boy, and I bet you thought that whole rugged individualism and pull yourself up by your bootstraps thinking had something to do with America, didn't you? It's just the most American of marketing ploys.

I too am looking forward to Sicko. I hear the government is trying to quash it, though. Any updates?

Geez, Tina, calm down. (Need a Valium? Just kidding.) I wasn't talking about the state of American children, I was talking about the pharmaceutical companies and their salespeople. So far, I think it's only the U.S. and maybe the UK where they've convinced people that normal children have problems that require mind-altering drugs, but I'm sure they're looking to expand their markets, and I have seen news items here where the occasional visiting expert mentions ADD or ADHD, and I always wonder how long it will be before they're bringing in consultants to prescribe drugs. That's what I meant. (And I do realize that there probably are some children who do have severe problems; I'm not talking about them.)

(Just for the record, though, everything you said about the Gulf was BS.)

My dear, Valium is SO 1980s. Prozac is for baby boomers who got hooked a decade ago. To be trendy in the 'burbs, it's Zoloft, baby, all the way. At least for now.

I feel so left out. My kids aren't addicted to anything.

ummabdullah, Michael Moore has been throwing darts at corporations and politicos for years, but he didn't get into any trouble with the gov't till he started his film on the legal drug industry, supposedly for "going to Cuba." Yeah, like he's the only person to go to Cuba from the US in the past 50 years.

I think it was Bernie Sanders on the Thom Hartmann show last week that said the biggest donor to congress is big pharma. More than the NRA! Just in case anyone was wondering why the latest effort to allow discount drugs in the US for those on MedicareRx programs was voted down last week.

BTW, I once worked for a group of doctors who had been in practice since 1935. Their rule was not to prescribe any meds until it had been on the open market for at least a year. The senior doctor in the practice would occasionally agree to see a drug rep, but only if he wanted to argue with him/her. And it was usually her. The pharma's specifically send out beautiful young women to see the mostly male doctors. Can't imagine why....... Oh, and they were also subjected to an almost constant stream of lush dinners, er, seminars and frequently an 'honorarium' for attending. Pharma also targets doctors who prescribe certain meds (which info they get from the pharmacies). They then have reps call on them to show their 'appreciation.' Big Brother, indeed!

My son came home from kindergarten yesterday with a promotional packet for Pediasure (which I guess is like baby formula, only for ages 1-10), with a free sample. The brochures talk about kids who are picky eaters and aren't getting the nutrition they need... So some parents will probably worry and decide that their kids need Pediasure supplements.

When I had my children, they tried to give me big cans of formula (made by the same company, Abbott) in a gift bag when I left the hospital, and they were amazed when I left them there. I'd read for years that this was not allowed, but it's normal procedure here (and few women here breastfeed, although the number is growing slowly).

I know this isn't the same as Prozac, but it irritated me.

Deer in the headlights.

Me and my shadow.

Playing in traffic.

Erotic vulnerability.

Lolita is the victim.

Orange shoe diaries.

Just wanted to let you know that my daughter was drinking herbed tea that morning, as we walked to sit and to dialogue by the Red River. I specifically asked that are actual living place not get depicted by the wonderful photographer Fabrizio Constantini. I think he did an excellent job! I passed this story along in hopes that others could learn from our predicament. Unfortunately, I was forced to keep giving my daughter this harmful medication, by research physicians who complained that Anya was in need of Child Protective Services whenever I demanded to take her off Risperdal. I didn't know until this year that financial incentives had displaced their Hippocratic oaths. I did the best that I could at the time, but we were preyed upon.

Isabella Bailey, a personal thanks for your comments.

First I would like to say I was particularly troubled by one commentators specific personal attack on you and your daughter, it was totally unwarranted and vicious.

Now that you have mentioned that the photographer not use the home photos, I have located two from your living space and suggest, if either or both of these had been available, many of us would have observed the warmth and caring within your home and experienced in some small measure your personal anxiety

I sincerely hope things are improving for you and Anya.


actually, thats just because i live on the edge of town, east grand is bigger than just that, and yeah in a small town likw this you kinda have to know who your neighbors are, i mean i go to school with all their kids. And i do have a snese of self, im an artist, so how can i not? and i only have the mug because it was like, 7Am, too early, i was drinking coffee to wake up. but you should see the sunset on the river 3 blocks over from my house, its beautiful.

wow, your reding is way off, i grew up in the twin cities so i know "the powerful forces and dynamics that she cannot control" i didnt grow up here but i actually love it, i dont plan on leaving anytime soon despite the fact that im 18 in 2 months.

my daisy dukes are sortve my summer uniform as soon as it gets warm enough, it wasnt cold, jest windy. i was bracing against the wind because up here, my being so small i have been knocked down, and we were going for a walk at 7Am, i was trying to wake up, thats why the mug.

Hey! my crocs are not plastic! theyre styrofoam rubber and who the hell is Michael Moore?whats he got to say about anything and why?

They did a lot of research and we provided them with a lot of information too, they had it pretty right on actually.

actually he doctor threatened my mother with child protective services if she didnt put me on the med, she didnt know what to do, And im an artsist, so i express myself nicely, if you like i ll send you a painting.

actually in the burbs the thing is not zoloft, its painkillers...i have too many freinds who are addicted not to know

did he really mention orange shoes?or did you make that up?

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