For some, it is a promising new way to keep mentally ill patients on their medication. For others, it is coercion and mind control. Even the Food and Drug Administration does not know quite how to categorize it.
Though a surgical implant that can release medication to treat schizophrenia is still years from the market, it is already kicking up a storm of controversy.
Steven Siegel, a physician and psychiatry professor in the Medical School, is leading the development of surgically inserted implants that release steady doses of medication over the course of a year.
The implant, which could be available within two years, would "allow people to make a decision about future treatment," Siegel said. Like Norplant, a contraceptive implant, it precludes the possibility of forgetting to take a pill.
"When you start to take meds, after two or three weeks, you feel a lot better. And you say, 'I don't need to take these anymore,'" explained Paul Wolpe, a bioethics professor who was a speaker in a seminar that addressed the ethics of the new technology last Wednesday. "But you do."
Wolpe explained that much of the debate over the implant is because of the history of treating mental illnesses.
"Psychiatric populations aren't like any other populations," he said. "They see themselves as a population who has a history of being abused, coerced.... They've fought long and hard to get the right to control which drugs are used on them."
"It's very different than if you come out with an implantable for cardiac disease," he added.
The implant's duration, coupled with the legal right to medicate mentally ill patients against their will if they pose a threat to themselves or to others, raises the potential problem of forced implantation without the chance for reversal.
Wolpe said the implant could theoretically be used in prisons or mental institutions to control behavior.
There are also more subtle forms of coercion, he explained. Because the implant is cheaper than pills, health insurance companies could start paying for the implant but not for oral medication.
However, Siegel dismissed the idea of coercion by insurance companies.
"As a practicing physician, I've never had an insurance company say they'll only pay for medicine X and not Y," Siegel said.
In addition, according to Wolpe, the criminal justice system could threaten the mentally ill with it.
"'Either take an implant or go to jail' is a kind of coercion hidden as a choice," Wolpe said.
But Siegel disagreed, saying that "it may be coercive, but would you like to have the decision or not?"
"Without it, you'd go to jail," he added. "Everything in life is coercive. If I don't work, I don't get paid. Am I coerced to work?"
According to Siegel, doctors would not use the drug abusively. He also noted that injections that release antipsychotic medicine over a period of weeks or even a month are already available and in use by some patients.
The usage of these shots may serve as precedent for usage of the new implant, said Siegel. "We don't give [the injections] against people's will."
Additionally, Siegel said that protesters of the new implant constitute a "very, very small minority."
"By and large, doctors are very careful not to do things they are not supposed to do," Siegel said. "There's no mileage in doing things to people they don't want done."
Siegel spoke of a 206-patient survey he conducted at various Health System hospitals as well as other mental health centers in the area. Forty-two percent of the patients surveyed said they would consider having an implant if it was available, he said.
But David Oaks, director of Support Coalition International -- which describes itself as leading the "psychiatric survivors' liberation movement," finds problems with much more than just the implant.
"The technology in and of itself is not the issue.... It's the history of abuse in the mental health system," he said.
According to Oaks, there is a risk of permanent brain damage with neuroleptic drugs, a risk doctors fail to mention.
"It'd be like the University of Pennsylvania building a nuclear plant in the middle of campus and no one questioning the hazards," Oaks said.
Siegel said that the FDA is unsure of whether the implant is a drug or a bio-instrument. An FDA representative told him, "There's never been a product like this."
