In a running time of little more than an hour, Off Label attempts to take a panoramic view of Americans wounded by the avarice of the medical-industrial complex, but its narrative suffers from a documentarian form of A.D.D. Using segments of five or fewer minutes, co-directors Michael Palmieri and Donal Mosher introduce, among others, a pair of human guinea pigs who have years of experience as subjects in clinical drug studies for pay; a bipolar woman in late middle age overwhelmed by a daily pharmacopeia of 20 pills, and as many side effects; an ex-con victimized by ghoulish experiments performed on prisoners in the 1960s, who, though subsequently afflicted with prostate cancer and hepatitis, maintains a godly attitude of forgiveness based on his Muslim faith; and a Minneapolis woman who’s become a reform activist after her mentally ill son’s suicide was seemingly prompted by his participation in a drug-marketing study (“He didn’t pass away, he was killed”).
Serving as a mildly eccentric “authoritative” voice laying a backdrop to these experiences is Michael Oldani, a former Pfizer drug rep from the boom era of anti-depressants (Paxil, Zoloft) who compares psychiatric patients’ fate unfavorably with treatment of distressed zoo primates (“not a lot of care; a lot of pharmaceuticals” for the humans). Oldani laments how the once unheard-of practice of primary-care physicians prescribing psychotropic drugs has evolved into a knee-jerk reflex, often leading to toxic effects, and demonstrates how pharma salespeople aren’t above shuffling boxes on the sample shelves of medical offices to out-hustle their competitors.
But these disparate stories, some tragic and others dubiously pop-anthropological (a young crusty-punk couple planning their wedding funded by the drug-subject earnings of the groom, in the shadow of the Mayo Clinic), never coalesce into a consistent or coherent vision of the crisis in polypharmacy and over-prescription. The most wrenching sequences carry a willingness to confront horrific detail, as in the crusading mom’s recounting of her child’s grisly self-mutilation, and a young PTSD-diagnosed vet of the Iraq war recalling his post at Abu Ghraib, punctuated by graphic photos of blown-off body parts taken in the aftermath of attacks he survived. (Now suffering frequent nightmares, he mutters over his score of pill bottles, “I don’t know what’s working.”)
Palmieri and Mosher’s anger and sincerity come through, but their wandering approach and compression of material that would seem better treated at twice the length is something of a dead end. One of the habitual clinical subjects, now over the studies’ age limit and independently researching the pharma world with the assistance of Adderall, can be seen as a hero or a quixotic fool in different scenes; we know too little of him to make a judgment. And the filmmakers’ compassion doesn’t extend to one unlucky drug rep who’s trailed by their camera (face blurred) for the sin of not talking for attribution. Off Label would have profited from selecting its parameters and villains with greater care and precision.