Dear Shire Pharmaceuticals,

Today I saw something which made me shudder to my core. I saw something that encapsulated, within the space of 77 seconds, pretty much everything that's wrong with America. Ironically, it was a commercial from an Irish pharmaceutical company.

"A commercial with everything that's wrong with America?" you're probably retorting, furrowing your brow skeptically as your own pet issues flood to mind. "What about Donald Trump? What about the vanishing middle class? What about Apple Maps?"

Forget about that stuff for minute.

Watch this-

Now obviously this commercial is a veritable treasure trove of forbidden comedic delights.

Sure, we could laugh over a list of side-effects that includes addiction, sudden death, stroke, heart attack, becoming a drug dealer, new or worsening mental illness, unexplained wounds (WTF?!!), and finger tips that change color from pale to blue to red. I know it's a common stereotype that Americans are super patriotic, but you went overboard with the red, white, and blue fingers, Shire. Even Americans don't want that.

We could question the wisdom of rebranding an ADHD amphetamine and selling it as an appetite suppressor, especially to individuals who are probably already at higher risk of having exactly the kind of stress maladaptations and neurotic behavior that amphetamines as a category are known to induce. I'm not saying that Vyvanse is meth, but you know who else has zero problems with binge-eating? That jittery truck driver with the emaciated face covered in scabs who grinds his teeth all the time.

The studies that the FDA reviewed noted a mean weight loss with the group taking Vyvanse as opposed to a placebo, and there were signs of marked loss in appetite as well. The nearly impossible thing to untangle is whether the weight loss was a result of healthier habits due to cessation in bingeing because of chemical level changes in the body that stopped the impulse to binge when not hungry—or if it was just a trusty case of amphetamines doing their appetite-killing magic.

One could point out that throwing what may be a purely physiological appetite suppressor at a psychologically-rooted problem like binge-eating is a quintessential example of treating the symptoms while ignoring the root cause of the disease. Vyvanse is perhaps the culmination of America's lazy, pharmaceutical-fueled, short-cut riddled, non-holistic approach to treating disease, especially those of a psychological nature.

We might even be skeptical as to whether Binge Eating Disorder should be categorized as a disease at all, or at least wonder whether including Binge Eating Disorder in the DSM-5 back in 2013 was a good idea.
“I tried (and failed) to persuade the DSM 5 group that BED was a premature and dangerous idea precisely because I feared it would be a backdoor excuse for drug companies to promote stimulant diet pills,” [said] Dr. Frances Allen, a psychiatrist and frequent critic of the DSM-5...

The CDC reports that half of us on average will suffer from some sort of diagnosable mental illness during our lifetime, whether it be anxiety, depression, or something less ubiquitous. That proportion will assuredly climb closer and closer to 100% as more and more behaviors are added to the ever-growing list of formally recognized illnesses. And there will just as assuredly be a suite of new or repurposed medications marketed towards each of those new illness demographics.

Virtually non of us are perfectly functioning human beings, but will we be better off when everyone has five prescriptions in hand, all for the treatment of different conditions which previous generations would have considered normal? Would our lifetime prognoses be improved?

I compulsively stroke my beard. I can't stop, no matter how hard I try. Oh sure, I can cessate for as long as I'm actively thinking about resisting the impulse, but as soon as my mind begins to wander, so does my hand, right up to my beard for a mustache twirl or a goatee tug. The only solution to my problem is to shave the beard off, a treatment option I find unacceptable for obvious reasons. 

A man without a beard is like a lion without a mane, or a car without a bra- naked and unspeakably shameful. 

To the extent that I feel my freedom and autonomy impeded by my compulsive beard stroking, I am indeed suffering under a psychopathology. Is there a medication that could relieve my symptoms? I'm sure there is. Would my lifetime prognosis or even my immediate quality of life see an improvement by taking that medication? I suspect not.

Yes, there are many faults to find with this Vyvanse commercial, but the thing that most made me want to punch a hole through my laptop lid the was actually the very first sentence.

"Binge Eating Disorder, or BED, is something I have, not something I do."

Now I'm no English professor (I am an English professor), but the last time I looked, eating was a fucking verb, and verbs are done, not had (gerunds and infinitives aside, obviously). Not having control over your actions doesn't unverb them and magically convert them into sterile, clinically-diagnosed nouns. Someone with Tourette's isn't not screaming obscenities just because they have no control over that screaming, anymore than someone with BED isn't not stuffing pint after pint of ice cream into their mouth alone in a dark kitchen long after everyone else has gone to bed, just because they have no control over that eating. The entire BED illness, like most psychological illnesses, consists of a series of undesirable actions, performed by the afflicted.

But it's easy to see why Shire wouldn't want BED to be a verb. Verbs sound like something you could just sort of... stop doing. Verbing sounds like a pretty easy problem to solve. Uncontrolled verbing sounds like an addiction, and addictions are things we kick and then move on with our lives. But I doubt Shire wants Vyvanse to be the Chantix of binge eating. I doubt Shire wants you to use Vyvanse to kick your binge eating habit and then get on with your life. It's in Shire's best interest for you to believe that BED is a chronic, incurable illness which will require a lifetime of pharmaceutical management. After all, BED is something you have, not something you do. If BED isn't something you're choosing to do, then BED also isn't something you could ever choose not to do. No, I'm afraid you'll need Vyvanse for that.

But believe it or not, it wasn't even the personal-responsibility-dodging, disempowering, victim-culture-enabling sentiment of that first sentence that got me all wound up. Because from a certain perspective, I agree with Jamie R.'s profound statement,

"Binge Eating Disorder, or BED, is something I have, not something I do."

I suspect that we are all victims, and any good determinist would agree with me. 

Man the machine—man the impersonal engine. Whatsoever a man is, is due to his make, and to the influences brought to bear upon it by his heredities, his habitat, his associations. He is moved, directed, COMMANDED, by exterior influences—solely. He originates nothing, not even a thought. did not create the materials out of which [your opinion] is formed. They are odds and ends of thoughts, impressions, feelings, gathered unconsciously from a thousand books, a thousand conversations, and from streams of thought and feeling which have flowed down into your heart and brain out of the hearts and brains of centuries of ancestors. Personally you did not create even the smallest microscopic fragment of the materials out of which your opinion is made; and personally you cannot claim even the slender merit of putting the borrowed materials together. That was done automatically—by your mental machinery, in strict accordance with the law of that machinery's construction. And you not only did not make that machinery yourself, but you have not even any command over it. - Mark Twain, What is Man?, 1906

We don't select our genes. We don't select our parents. We don't select our environments or most of our early childhood experiences. After you account for nature and nurture, neither of which you control, how much room is really left over for free will? If we were able to swap out your genes and memories with someone else's, how much of "you" would be left over? 

If I had Jamie R.'s genes and Jamie R.'s experiences, I'm sure that I too would be stuffing my large, soft body with large, soft pastries at 3:00 A.M. and weeping like a perimenopausal John Boehner as I did so.

But I do wonder whether Jamie R. applies the principles of determinism to every aspect of her life, or whether she only uses them to distance herself from the actions she's not proud of. Because if your genes and environment absolve you of blame, they also deny you praise. Your achievements too are the result of random genetic accidents and environmental happenstance.

I wonder how Jamie R. introduces herself at parties.

"Master of Fine Arts, or MFA, is something I have, not something I did."

"Volunteering at the Local Soup Kitchen, or VLSK, is something I have, not something I do."

"My burgeoning acting career, or SUCCESS, is something I have, not something I do."

I hope that's how Jamie R. introduces herself at parties. Otherwise she's a giant fucking hypocrite.

I'll buy your determinism argument and hold you blameless for all your sins, but you have to accept the complete logical ramifications of that philosophy; not just apply it selectively when it's convenient and then come trotting out with your tail wagging, hunting for praise and demanding respect when those same genes & environment lead you to do something good.

But Americans love a winner. Our Dream and our folklore and our exceptionalism are based upon punishing the willfully evil and celebrating the deservedly successful. We hate affluenza teens and we love Michael Jordan.

Who could forget the story of Davy Crockett, who used nothing but grit, determination, and his own bootstraps to tame the wilderness, defeat the Nazis, go from homeless bum to Wallstreet stockbroker, beat Ivan Drago in the ring, win the Super Bowl, and finally invent the iPhone before donating all of his immense wealth to fund animal shelters, entrepreneurial classes for troubled teens, and a new research wing named after him at Boston Children's Hospital? What a guy he was. No one doubts for a second that he was anything other than personally responsible for his every success.

Well maybe we should doubt, because we can't have it both ways. We can't be a nation of victims and self-made men. We can't blame the accident of birth for all the bad stuff we do and still reap the rewards for all the good stuff we do. Or as Jamie R. would put it, 

"The Accident of Birth, or AoB, is something I have, not something I do."

Sebastian Braff


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