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Making a Killing, by Carl Elliott

Making a Killing, by Carl Elliott

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Published by Michael Cook

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Published by: Michael Cook on Sep 04, 2010
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07/15/2013

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54
mother jones |
september/october 2010
    a    r    t    c    r    e    d    i    t    t    k
making a killing
 
september/october 2010
| mother jones
55
it ’ s not easy to work up
a good eeling about the institution that destroyedyour lie, which may be why Mary Weiss initially seemed a little reluctant to meetme. “You can understand my hesitation to look other than with suspicion at anyoneassociated with the University o Minnesota,” Mary wrote to me in an email. In 2003,Mary’s 26-year-old son, Dan, was enrolled against her wishes in a psychiatric drugstudy at the University o Minnesota, where I teach medical ethics. Less than sixmonths later, Dan was dead. I’d learned about his death rom a deeply unsettlingnewspaper series by
St. Paul Pioneer Press
reporters Jeremy Olson and Paul Tosto thatsuggested he was coerced into a pharmaceutical-industry study rom which the uni-versity stood to prot, but which provided him with inadequate care. Over the nextew months, I talked to several university colleagues and administrators, trying tolearn what had happened. Many o them dismissed the story as slanted and incom-plete. Yet the more I examined the medical and court records, the more I becameconvinced that the problem was worse than the
Pioneer Press
had reported. The dan-ger lies not just in the particular circumstances that led to Dan’s death, but in a sys-tem o clinical research that has been thoroughly co-opted by market orces, so thatmany studies have become little more than covert instruments or promoting drugs.The study in which Dan died starkly illustrates the hazards o market-driven research
Clinical trials have become marketing exercises for Big Pharma –and cash-strapped universities are helping make the sale.
Too bad for Dan Markingson.
 MakingaKilling
by carl elliott 
illustrations by sam weber
 
56
mother jones |
september/october 2010
making a killing
medical treatment. Instead, he proposedthat Dan take part in an industry-undedstudy o antipsychotic drugs. The univer-sity’s study coordinator, Jean Kenney, hadDan sign a consent orm when Mary wasn’tpresent, and on November 21, he was en-rolled in the study.On the surace, the study appeared be-nign. Its purpose was to compare the eec-tiveness o three “atypical” antipsychoticdrugs, each o which had already been ap-proved by the
fda
: Seroquel (quetiapine),Zyprexa (olanzapine), and Risperdal (ris-peridone.) The study was designed andunded by AstraZeneca, the manuacturer o Seroquel, and it called or 400 subjectsexperiencing their rst psychotic episode totake one o the three drugs or a year. As-traZeneca called it the “
cafe
” study, whichstood or “Comparison o Atypicals in FirstEpisode.” The management o the
cafe
 
study had been outsourced to Quintiles, acontract research organization, which wasconducting it at 26 dierent sites, includingthe University o Minnesota. (For more on
cros
, see “Trial by Hire,” page 60.)Yet the
cafe
study was not without risks.It barred subjects rom being taken o their assigned drug; it didn’t allow them to beswitched to another drug i their assigneddrug was not working; and it restricted thenumber o additional drugs subjects couldbe given to manage side eects and symp-toms such as depression, anxiety, or agita-tion. Like many clinical trials, the study wasalso randomized and double-blinded: Sub- jects were assigned a drug randomly by acomputer, and neither the subjects nor theresearchers knew which drug it was. Theserestrictions meant that subjects in the
cafe
 study had ewer therapeutic options thanthey would have had outside the study.In act, the
cafe
study also contained aserious oversight that, i corrected, wouldhave prevented patients like Dan rombeing enrolled. Like other patients withschizophrenia, patients experiencing their rst psychotic episode are at higher risk o killing themselves or other people. For In another email, Dan wrote:
“I’m especially eager to attend this storm and SLAY those who deserve slaying.I will choose victims immediately…I HAVE NO EMOTIONAL ATTACHMENTS. I KILL FOR FUN!!” 
On November 12, Dan said he would killMary i called upon to do so. She called thepolice. Dan was taken to Regions Hospitalin St. Paul. But the hospital had no psy-chiatric beds available, so ater a ew hoursDan was transerred to Fairview UniversityMedical Center, a teaching hospital or theUniversity o Minnesota Academic HealthCenter. He was treated by Dr. Stephen C.Olson, an associate proessor in the univer-sity’s psychiatry department, who prescribedDan Risperdal (risperidone), an antipsy-chotic drug oten prescribed or patientswith schizophrenia or bipolar disorder.(In Minnesota, doctors are allowed to giveantipsychotic drugs to mentally incompe-tent patients without their consent or upto 14 days, but only to prevent serious,immediate physical harm to the patient or others.) Olson believed Dan was psychoticand dangerous, and lacked the ability tomake decisions regarding his treatment;on November 14 he signed a documentthat recommended Dan be committedinvoluntarily to a state mental institution,noting that he “lacks the capacity to makedecisions regarding such treatment.” Threedays later, a clinical psychologist also rec-ommended involuntary commitment, reit-erating that Dan had threatened to slit hismother’s throat.In Minnesota, patients who have beeninvoluntarily committed are given another option: a “stay o commitment.” Patientscan avoid being conned to a mental in-stitution as long as they agree to complywith the treatment program laid out bytheir psychiatrist. On November 20, Olsonasked or a stay o commitment. The courtgranted the stay or six months, stipulatingthat Dan had to ollow the recommenda-tions o his treatment team. Olson, how-ever, did not simply recommend standardand the inadequacy o our current over-sight system to detect them.Mary Weiss is a slight, white-haired wom-an in her late sixties who smiles rueully atany question, no matter how painul. Sheis the sort o Minnesota liberal who volun-teers or political campaigns and signs her email with fowers. When we rst met ata coee shop in St. Paul, she was wearingan Obama pin on her sweater. Mary raisedDan alone, working a job at the postal ser-vice. Old photographs show Dan growinginto his good looks; according to Mary, hewas also a gited student. In high school,Dan got a perect score on the verbal por-tion o his
sat
. He graduated rom the Uni-versity o Michigan in 2000 with an Englishdegree, and that all he moved to Los Ange-les, hoping to become a screenwriter or anactor. To support himsel, he got a job as acelebrity-tour bus driver.When Mary went out to Los Angeles or a visit in the summer o 2003, it was clear Dan had changed. He’d adopted a newlast name, Markingson. His behavior wasbizarre. “He said, ‘You haven’t told mewhen the event is going to be,’” Mary said.She had no idea what he was talking about.The next day, he took her to his apartment.He’d encircled his bed with wooden posts,salt, candles, and money, which he saidwould protect him rom evil spirits. Heshowed her a spot on the carpet that he saidthe aliens had burned.I asked Mary how she’d reacted to all o this. “I panicked. I called 911,” she replied.But when the police arrived, Dan was ableto convince them she had overreacted. “Hesaid, ‘Oh, my mother just drove rom Min-nesota and she’s very tired,’” she recalled.Worried that Dan was seriously ill, shetried to convince him to return to St. Paul.He visited her in August, returned briefyto Caliornia, and then came back to St.Paul in October.Dan grew convinced that the Illuminatiwere orchestrating an event in Duluth,Minnesota—a “storm” in which he wouldbe called upon to murder people, includ-ing Mary. Some o his emails rom lateSeptember 2003 suggest the extent o hisdelusions:
“I’m aware that people can cast spells that canhurt you at a distance.I’m aware that some people can read minds.I’m aware that some people might actuallybe ‘hybrids’ and not altogether human.” 
How much of a risk  to human subjectsis justied in a study whoseaim is to “generatecommercially attractive messages”

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