Off Label

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

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

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

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

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