Monday, April 30, 2012

Off Label

When I go to Hot Docs, I hope that each movie will deliver a mix of information, new perspectives, inspiration, and perhaps along the way, a dollop of entertainment.  The best movies deliver a film maker's message in a way that provokes me to think differently - to question ossified assumptions, and to open up new possibilities.  For me, the key to a good documentary is a clear theme, which is expanded both through hard facts and stories.  And year after year, Hot Docs slakes that thirst.

Off Label was a sloppy, lazy movie that took a scatter shot approach to several loosely-related themes and delivered on none of them.  And it didn't come close to living up to my expectations of a good Hot Docs film. It frustrated me that these filmmakers missed the opportunity to make a really good movie on a fascinating and important topic.  And they blew it.  They didn't sort out their primary message, and then use the film to deliver that message clearly.  They needed adult supervision, or a better editor.

The movie could have focused on the use of human guinea pigs in pharmaceutical human trials.  We saw a couple of people who eked out a living as human guinea pigs.  Such people enter trials with a cocktail of drugs from previous trials in their system, (which they fail to declare so they won't be rejected).   Could some scientist explain the risk of tainted trials from using such participants?  How much can a person earn this way and how many people do it?   From the Q&A with the directors, it emerged that this was the original idea for the movie; they should have stuck to this one message and nailed it. 

One human guinea pig we met had been induced to participate in human drug trials while a prisoner and suffers very poor health, allegedly because of these trials.  I try not to be swayed by correlation; I like to see cause and effect laid out clearly. There was no solid indication of his medical issues arising from these unethical trials on prisoners.  The movie could have focused on this theme alone and delivered a powerful movie.

A former pharmaceutical sales rep relates how he could skirt the letter of the law and yet encourage GPs to prescribe ever more drugs for off label (i.e. unapproved) use.  The movie could have explored this theme in depth, but the filmmakers chose to introduce it solely through the anecdotes of this one sales rep.  Focusing on this theme would actually have lined up the movie with the title!

It could have explored the trend toward overmedication in the US.  The most interesting character of all in the movie was a bipolar woman, living in a Sasquatch museum, and dosing herself with over 20 different anti-psychotic drugs a day.  How common is that?  How did she manage to get all those pills?  Did she get them all from one highly unprincipled doctor?  Did she visit many doctors, each of whom prescribed one or two?  Did she lie to get the pills, or did they not even ask her what else she was on?  Would personal electronic medical records eliminate such malpractice?

One segment portrayed the heart-wrenching struggles of a young man who volunteered as a medic for Iraq and was ordered to perform inhumane treatments at Abu Ghraib.  He told of cavalier treatment by the VA, who simply threw a variety drugs at him sequentially, in the hope that one would work, without any accompanying therapy.  This segment could have explored this in depth; however, the segment felt like a completely tangential thread that was never developed and detracted from the main movie.

American journalism has been tending toward the presentation of human interest stories as the foundation of the news.  There's no question that a human story can help to pique interest in a topic and draw you into an important subject.  But it is dangerous to extrapolate from a single human story to concluding that there is a systemic problem around an issue - decisions, and public opinion, should be based on evidence.  This was a movie without a shred of evidence or fact.  There could be only one drug rep in the US facilitating off label drug use, there could be only two people making a living as a human trial participant, but these kinds of human interest stories can create a ground swell of response to special cases.

I seem to have written an awful lot about a movie I didn't like.  I guess I was just so frustrated because it could have been so good.  The next post will describe a movie I LOVED!

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