With at least four past investigations and one pending, the Dan Markingson case, involving the suicide of a patient during a University of Minnesota drug trial, goes on interminably. It involves the most remarkable, random piling-on I have ever seen — yet it has failed to achieve its apparent goals of disciplining the doctors who conducted the drug trial (they have been repeatedly cleared), while state legislation passed a few years ago already requires desired changes in research procedures. So what’s the point?
With respect to the alleged facts in the case: Just because two things coincide, that does not establish cause and effect. (If I enroll in a drug study, then have a car accident, did the study cause it or was I careless?) A certain number of patients with schizophrenia take their own lives, whether or not they are enrolled in a drug trial. But we will never be certain whether the drug itself played a role in this particular death. The possibility cannot be definitively ruled in or out, regardless of beliefs or innuendoes.
I have an awful hunch that some of those expounding on this case are under the misapprehension that schizophrenia equates with lower I.Q. — that these patients are more easily tricked and that, therefore, they need to be protected from the doctors running such a study. This is so wrong; schizophrenia patients on average have a slightly higher I.Q. than the general population, and most make decisions as wise as yours or mine when their symptoms are adequately addressed. They might be eager — maybe too eager — to find something that will relieve their symptoms, but what patient isn’t? Let’s not assume that these doctors pulled the wool over the subjects’ eyes and led them down the garden path.
In fact, patients with schizophrenia probably have been disappointed by more than one provider or one medication over the years of their illnesses, and because of that, they are more assertive and questioning than you or I might be. I am very grateful for the research that has gone before, and thank both the subjects and doctors who have participated; without them, we would have precious few medications for these devastating illnesses.
My son, now 37, has schizophrenia, and Dr. Olson, one of the doctors conducting the study being investigated, is my son’s psychiatrist. He has treated my son with the greatest respect; has asked probing questions, listening to the answers intently; has honored his intelligence; has explained exhaustively what he is recommending, and has generally bored me nearly to tears with his thoroughness (but I wouldn’t want it any other way). His care has helped immensely, and each time I sat in on a psychiatric appointment (with my son’s permission), maybe five or six times in 10 years, his deep caring was always evident.
Nothing of these doctors’ hard-earned reputations or grateful patients’ stories comes through in the media. What does appear resembles the drumbeat of a high-tech lynching (to employ a phrase from the 1990s). It may not be criminal guilt that is being determined, but it looks like guilt just the same, and it can destroy or badly cripple a professional career. It is unseemly for well-educated laypeople to be engaging in this. Some seem to have forgotten much of what they knew about critical thinking, and even about the concept of being “innocent until proven guilty.” We used to believe in allowing the authorities to do their investigating without outside interference, but now everybody’s an expert because they saw one on TV.
We shouldn’t take everything we hear as fact. Question, question, question. Ask: Does this make sense on the face of it? Ask whether the death might have had another cause, such as a bad experience, or this patient simply losing hope. Ask also: What were these doctors’ reputations before this trial in the press began? Had their methods or ethics ever been questioned before? Were they hard up for money, or were they already well-compensated? Would you, the reader, have sold your integrity for the fee these doctors were being paid? Had the young man attempted suicide before? How many times? And were those what the profession calls “serious attempts?” There are many more such questions.
In ordinary legal proceedings, only “one bite at the apple” is allowed, i.e., one trial. If you lose, that’s it. Why should this situation be so utterly different? Who shall define the end — our legislative auditor (the latest authority persuaded to step in)? The courts? Some other entity? We seem to be slogging along with no end in sight. And let us not forget that the doctors are human beings, also. The pattern of attacks on them is deeply troubling: Each time another investigation clears them of ethical wrongdoing, another investigation is demanded. To whomever is pushing this: How much is enough?
Fellow citizens, give it a rest, please, and let the real experts do their jobs. Then honor their expertise, and accept the results.
Mary McLeod, of St. Paul, is a retired attorney.