Delusions, Illusions

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Reading lots, between my inter-library loaned crime novels — finished Tana French’s The Likeness last week, am reading PD James’ new Dalgleish novel, The Private Patient, now, and have Reginald Hill’s The Price of Butcher’s Meat to read afterwards — and the arrival of the Wall Street Journal through the door slot almost every day, a little 6-month perk for having completed about 200 online surveys in the last few years … I love the WSJ, its editorial board notwithstanding.

Here are a couple of recent gems from its pages:

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Destructive Delusions: How therapists and ‘victims’ seized on the idea of repressed memory, leveling false charges and ruining lives, by Theodore Dalrymple, a book review of Dr. Paul McHugh’s Try to Remember: Psychiatry’s Clash Over Meaning, Memory, and Mind. Best lines:

“One of the most extraordinary outbreaks of popular delusion in recent years was that which attached to the possibility of ‘recovered memory’ of sexual and satanic childhood abuse, and to an illness it supposedly caused, Multiple Personality Disorder. No medieval peasant praying to a household god for the recovery of his pig could have been more credulous than scores of psychiatrists, hosts of therapists and thousands of willing victims.”

“In Try to Remember, Dr. McHugh hints at the cultural context in which preposterous and vicious accusations against parents and others could be so easily believed by seemingly intelligent people, including courtroom judges. … Freudianism alone could not have produced the necessary atmosphere; there must have been other forces at work as well. The sanctification of victims and victimhood comes to mind.

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Japan’s Latest Fashion Has Women Playing Princess for a Day

Japanese women in their 20s and 30s are dressing up as doe-eyed princesses, aiming “to look like sugarcoated, 21st-century versions of old-style European royalty. They idolize Marie Antoinette and Paris Hilton, for her baby-doll looks and princess lifestyle.” They buy $1000-outfits (frilly dress, parasol, handbag, shoes) and work their straight hair so that it’s curly with ‘super-volume” to assuage a “longing for a happy-ending fairy tale,” if you accept that bit of sociological analysis.

The women (aka ‘girls’) particularly idolise 24-yr-old Keiko Mizoe, sales clerk at one of the stores that sells the gowns, who calls those who sport the look “perfect, gorgeous and feminine.”

A 16-yr-old who’s buying the clothes online because the store seems too intimidating says:

Their cuteness is beyond human. I’d like to be like them.”

A 36-yr-old housewife felt “shy about her plump figure” so she lost 33 pounds and can now wear the tight-waisted dresses, on which she spends $2,000 or $3,000 a month. Her parents “send the couple food so they have more money for Ms. Yamamoto’s shopping sprees.

‘I figure it’s OK as long as what I’m buying is pretty,’ she says.”

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How a Drug Maker Tries to Outwit Generics describes how pharmaceutical company Cephalon, Inc. maximises profits on its drugs, in particular, its narcolepsy drugs Provigil and Nuvigil, and entices customers away from cheaper generics. The company, using an apparently common tactic of pharmaceutical companies, has been recently increasing the price of Provigil — now $8.71 per tablet, 24% more than 8 months ago and 74% more than 4 years ago — so that patients will have an economic incentive to switch over to Cephalon’s new and longer-lasting narcolepsy drug, Nuvigil, which will be available next year at a lower cost — and, critically, which won’t be off patent until 11 years after Provigil will be:

“It works like this: Knowing that Provigil will face generic competition in 2012 as its patent nears expiration, Cephalon is planning to launch a longer-acting version of the drug called Nuvigil next year. To convert patients from Provigil or Nuvigil, Cephalon has suggested in investor presentations that it will price Nuvigil lower than the sharply increased price of Provigil. By the time the copycat versions of Provigil hit the market the company is banking that most Provigil users will have switched to the less-expensive Nuvigil, which is patent-protected until 2023.”

One woman who takes Provigil off-label for Parkinson’s stopped taking the drug when her cost went to $565 per month. Her insurer, like most, won’t cover payment of an off-label use (a use not approved by the FDA).

The article later notes that “fully preventing tactics like Cephalon’s would be difficult short of outright regulation of drug prices. Most other countries in the world control drug prices, but most U.S. regulators and legislators have opposed such moves.”

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In further drug-related news: Power of Suggestion: When Drug Labels Make You Sick by Melinda Beck looks at the effect of nocebos, which are the opposite of placebos: the power of suggestion that brings on illness:

Research deliberately causing nocebos has been limited (after all, it’s kind of cruel). But in one 1960s test, when hospital patients were given sugar water and told it would make them vomit, 80% of them did.  Studies have also shown that patients forewarned about possible side effects are more likely to encounter them.”

Interestingly,

“the rare, serious side effects listed on drug package inserts — say, toxic epidermal necrolysis, in which one’s skin falls off in large sheets — are less subject to nocebo effects.”

It’s harder to “suggest” one’s skin to slough off than to evoke headache and fatigue by suggestion, and anyway, as is noted in the article, large percentages of the general population experience these vague symptoms regularly; in a 1968 study of healthy subjects not on medications, only 19% said they had no symptoms (such as headache, fatigue, dizziness) in the past 3 days. Also noted, that anxiety about illness can bring about common side-effect symptoms like nausea, diarrhea, dry mouth and rapid heart beat.

** Hours after I read this, I learned that the dear friend of a friend of mine is suffering from exactly this “rare, serious side effect” of toxic epidermal necrolysis, likely from anti-inflammatories she had been taking for a while.

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