Thursday, October 31, 2019

How NSO Group Helps Countries Hack Targets

A blockbuster lawsuit involving the most popular chat app in the world and the most infamous spyware company in the world has given us concrete details about how the secretive Israeli spy firm NSO Group helps countries hack journalists, activists, and other targets around the world.

WhatsApp, which is owned by Facebook, filed a lawsuit against NSO Group in a California court on Tuesday. NSO makes Pegasus, a surveillance product that hacks cellphones and is used by government agencies around the world to intercept and read data on the hacked devices. WhatsApp alleges that NSO was sending malware to take control of phones via WhatsApp and was using Facebook infrastructure as part of its hacking campaign.

Pegasus has been used by Saudi Arabia, Mexico, United Arab Emirates, and other countries with questionable and poor records on human rights to hack activists, dissidents, and journalists, according to internet watchdog Citizen Lab, which monitors spyware for the University of Toronto.

Few outside of the governments that use Pegasus have details about how the software actually works, but screenshots of the software and a contract included in the WhatsApp lawsuit have helped confirm some of Motherboard's own reporting about how Pegasus is implemented. In simple terms, NSO provides hacking as a streamlined service, which means a lot of the actual tech is in the company’s own control, and NSO can offer hands-on assistance to the government employees who use it. In public statements, NSO has tried to distance itself from the actual hacking.

“We have no way to know what they do it the system,” Omri Lavie, one of NSO’s co-founders, said on a podcast in 2017, according to a translation on an Israeli website. “I don’t want to know. I don’t want to be an intelligence partner.”

The contract and our reporting suggests that NSO is much more involved in hacking its targets than it has publicly said. NSO has maintained that it merely sells tools to governments and that it does not have specific knowledge of who its clients hack.

Do you work or used to work at NSO Group? We’d love to hear from you. Using a non-work phone or computer, you can contact Lorenzo Franceschi-Bicchierai securely on Signal at +1 917 257 1382, OTR chat at lorenzofb@jabber.ccc.de, or email lorenzo@motherboard.tv. You can contact Joseph Cox securely on Signal on +44 20 8133 5190, Wickr on josephcox, OTR chat on jfcox@jabber.ccc.de, or email joseph.cox@vice.com.

That's important, because WhatsApp accused the Israeli surveillance software maker of using WhatsApp’s servers to help its government customers around the world target more than 1,400 people in 20 countries, including more than “100 cases of abusive targeting of human rights defenders,” according Citizen Lab, who helped WhatsApp in its investigation. It's one thing to help a government spy on suspected terrorists and child abusers and another to help authoritarian governments target activists and dissidents critical of those governments, as the United Nations's Special Rapporteur on Free Expression David Kaye pointed out in a letter to NSO sent earlier this month, which noted there is a "legacy of harm" facilitated by NSO.

A source who works in the offensive cybersecurity industry and is familiar with NSO software said in an online chat that in at least some cases, NSO customers are given an interface to work with the company to use its tools.

“You get a big server installation. You get a website,” they said, referring to an interface where customers can input target information—such as a phone number—as well as see the target’s data after they get hacked.

NSO also helps some customers craft phishing messages that the target is more likely to click.

“Then engineers help you setup a believable message that sends to targets [sic] via your infrastructure,” the source added.

NSO-interface-map
NSO-interface-calendar
Screenshots of NSO’s customer interface, taken from an old leaked brochure

NSO employees not only help customers set up the system, but troubleshoot it for them. Some NSO engineers, who are essentially IT support for customers, sit in the same room when operations are run, according to the source, who said they have seen NSO’s products in action, and who asked to remain anonymous to discuss sensitive topics. (A second source with direct knowledge of NSO’s operations confirmed that customers get a server, an interface. A third source confirmed some customers have NSO engineers on site.)

Most customers don’t have visibility into the tools used in the attack; they just type in a target phone number and NSO's system handles the rest.

This description of NSO's level of involvement is backed up by a contract included in the WhatsApp lawsuit. The level of support NSO gives customers depends on how much the customer pays.

That 2015 contract, between the National Communication Authority of the Republic of Ghana, NSO, and a local reseller, shows the spyware company offering four levels of customer support for Pegasus. Ghana's purchase of NSO tools was previously reported by Ghana Business News.

NSO offers four tiers of support. At the lower end, NSO says it will provide basic software and hardware installations and troubleshooting. For Tier 4, the contract says NSO will offer technical support by an "R&D [research and development] Engineer," including "Isolating, tracking and fixing operational issues," and "Technical evaluation and allocation of defect reports within R&D."

"The Company will provide the End User with assistance in operating, managing and configuring the System as well as resolving any Software technical issues," another part of the contract reads. The "Support Period Consideration" costs 22 percent of the overall system price, which for Ghana was $8 million, according to the contract.

Ghana-NSO-Contract
The four tiers of support that NSO customers can choose from, according to a contract with the Ghana government.

The contract also details the specific hardware NSO provides to the client to operate the system itself. In the Ghana case, this laundry list includes Dell produced servers and Intel processors.

The NSO staff may not press the Enter key to actually hack the target, but they are involved in essentially every other step of the process, according to the sources.

Mexico, which has spent a reported $80 million on NSO software between 2011 and 2017, flew a phone to NSO’s offices so that the engineers could install spyware on it before the phone was delivered to the infamous drug cartel leader Joaquin “el Chapo” Guzman, according to Israeli publication Ynet News.

Pegasus customers, then, get a locked-down workstation that’s as easy to use as possible, since some customers don’t have the knowledge, skills, or time to learn the intricacies of hacking targets who use modern smartphones made by Google and Apple.

We asked NSO three specific yes or no questions. A company spokesperson responded with this statement: “Under no circumstances does NSO operate the systems that are licensed to our customers; to do so would violate many laws and regulations, as well as our own policies. NSO’s products are only provided to intelligence and law enforcement agencies after a strict licensing and vetting process, and after training the clients use the system on their own for preventing and investigating terror and serious crime.”

Saudi Arabia, which has been reported to be an NSO customer, came under fire last year for killing former Washington Post reporter Jamal Khashoggi. After Khashoggi’s death, news reports revealed that his close circle of friends was targeted with NSO spyware.

After public pressure mounted on the company, NSO said that its software wasn’t used against Khashoggi. It is unclear how NSO can simultaneously say it does not know who its clients target while stating its software was not used against a specific person.

“It is possible that some companies are making genuine attempts to address the charges of complicity in surveillance-based repression and abuses,” Kaye wrote in his letter to NSO. “There are, however, virtually no public disclosure and accountability processes to verify such claims.”

Subscribe to our new cybersecurity podcast, CYBER.



from VICE https://ift.tt/36mSTZR
via cheap web hosting

Meet the Two Democrats Who Voted Against the Impeachment Inquiry

The House just voted to formalize the impeachment inquiry into President Donald Trump, with nearly unanimous support from Democrats.

Nearly.

Two Democratic representatives, Jeff Van Drew and Collin Peterson, a moderate freshman from New Jersey and a Minnesota Dem in the Trumpiest blue district in the country, respectively, defied their party voted against impeachment.

The same couldn’t be said for the other side of the aisle, where not a single Republicans defected, unless you count former Republican-turned-independent from Michigan, Rep. Justin Amash.

Read: Democrats Vote to Move Forward With Impeachment — Even Though They Don't Have To

Still, Thursday’s vote offered little surprises or substantive change. Democrats did not need the vote to proceed with their impeachment inquiry, which is already moving at breakneck speed. Instead the vote simply formalized their efforts, and signaled a more public phase of the investigation.

Earlier this week, there were eight Dems who’d yet to voice support for the impeachment inquiry, and most of them were from red districts they flipped for the first time in 2018. Given that 9 out of 10 Democratic voters support the impeachment inquiry, most of the representatives on the fence eventually came around to support impeachment.

Van Drew and Peterson didn’t.

Here’s what you need to know about the two Dems who broke with their party on Thursday:

A Dentist from New Jersey

Van Drew’s a dentist who represents the good people of southern New Jersey, including Atlantic City. He’s got a long history of taking unconventional stances and flouting the party line. As a state representative in New Jersey, he opposed gay marriage in 2012 and voted against a bill to allow guns’ magazines to hold a maximum of 10 bullets. He’s not in favor of raising the minimum wage, either. He’s got an A rating from the NRA.

After serving since 2002 in the statehouse, Van Drew was elected to Congress for the first time in 2018. He hasn’t been getting along great with the national Democratic party leadership since then. He voted against House Speaker Nancy Pelosi’s leadership in the House earlier this year.

“There’s only 13 months, not even anymore, until an election,” Van Drew told reporters as he headed to the floor for the House vote on the impeachment rule Thursday. “I think, let’s let the people choose. Let them impeach if they want to impeach.”

Read: Democrats Are Going After Their Biggest Impeachment Witness Yet: John Bolton

Van Drew isn’t in the easiest district — Trump carried it by a four-point margin in 2016 after President Obama won it by eight points twice. But 11 other freshman Democrats hold Trumpier districts and still voted with their party on this measure.

Republicans struggled to recruit well-funded candidates in Van Drew’s district in 2018, but they appear to have their man for 2020. David Richter, the former CEO of a construction consulting firm, already has more than $400,000 in his campaign war chest, and will use it to try to unseat Van Drew next election.

“The bar for impeachment is very high,” Van Drew added. “There’s a reason that nobody has been successfully convicted of an impeachment in the history of the United States of America.”

A Moderate in Trump Country

If Van Drew is a contrarian, Peterson appears to be voting against impeachment to shore up his independent brand and hold a seat in a vulnerable blue district. And while Van Drew’s vote irritated House Democrats, Peterson’s move may cheer some on. It’s a sign he may be leaning towards running for reelection in 2020, something Democrats have been worried about.

Though Peterson’s held onto his seat since 1991, his district went for Trump back by 30 points back in 2016.

He’s a moderate who knows the rural district that he represents has moved hard away from his party in recent years. He voted with Trump half the time, according to FiveThirtyEight’s count. He voted against bans on offshore drilling as well as a bill that would require background checks on all gun sales.

“If anyone thinks a partisan impeachment process would constrain President Trump, they are fooling themselves,” Peterson previously said in a statement.

In 2018, Trump voiced support for Peterson’s Republican challenger, Dave Hughes, by calling the incumbent “Pelosi Liberal Puppet Petterson [sic].”

Cameron Joseph contributed reporting.

Cover: House Speaker Nancy Pelosi of Calif. is seen at her chair as House members vote on a resolution on impeachment procedure to move forward into the next phase of the impeachment inquiry into President Trump, in the House Chamber on Capitol Hill in Washington, Thursday, Oct. 31, 2019.



from VICE https://ift.tt/2JEclYn
via cheap web hosting

Dormitorium

In what's become an annual Halloween tradition here at Terraform, Geoff Manaugh brings us an unsettling and mind-bending work of speculative fiction—this time delving into the untapped recesses of our unwaking lives. Enjoy. -the ed.


The lights in the room began to redshift, assuming a nostalgic yellow hue that reminded the man of the incandescent bulbs in his childhood bedroom. Objects looked tea-stained, antique. Small blemishes appeared like watermarks on the cream-painted walls. The transition was so slow the man didn’t notice it at first, until the room was the color of burnt orange, like the light of a campfire, then the red of a desert sunset, then something much darker, like barrel-aged wine.

The man responded exactly as they said he would, his eyelids growing heavy, so heavy they fluttered, before, against his will, he closed them.

The room went dark.

*

The word dormitory, his guide had explained as she stood facing him in the elevator on their way up to the top floor, his floor, where he would be staying for the next five nights, means place of sleep.

“It comes from the Latin word dormire,” she’d added. “The English word should actually be dormitorium, of course. Like auditorium. A place for listening. That comes from audire. Which means ‘to hear.’” The guide was young, had short hair, and seemed excited by etymologies. She had introduced herself in the lobby by name, but the man, to his embarrassment, had missed it.

Seeing his lack of reaction to the subtleties of Latin vocabulary, the guide smiled and changed the subject. “You’ll dream well here,” she said instead.

The elevator chimed. Its steel doors slid open. A long hallway stretched beyond, blue LEDs glowing along the floorboards like airplane safety lights.

“What’s that they say about going through doors in a dream?” the guide asked.

The man laughed. “I have no idea,” he replied. “What do they say?”

She moved out of his way and gestured forward. The man stepped through.

*

The building was a converted college dorm near the city park, in the heart of downtown, across the street from a mattress shop called Slumberland. That, his guide said, was a mere coincidence. With its ornate façade of worn brick punctuated by limestone-framed windows, the place exuded an old-world charm, its masonry walls giving the street a honeyed, geological glow every sunset.

Until five years ago, when a massive new campus development near the river had made the building redundant, it had been part of the university’s residential system. Rather than tear it down, the school had given it over to the neuroscience department next door; using federal grants and a donation rumored to have been as high as $60 million from a Swiss computer-memory billionaire, the neuroscience department had tunneled through the adjoining walls and was remaking the place from within. This former dorm was now set to become the most advanced sleep-research facility in the United States. Smart lighting, 3D laser-projection, immersive surround-sound audio in every room, and brand-new MRI machines in a lab whirring away on the basement floor. Apparently, only an institute in China was better-funded.

The man was there for two reasons: to make what sounded like easy money—$1,000 a night for a 5-night, all-inclusive stay—and, in return, to participate in a sleep study that had something to do with dream recollection, but the man wasn’t in it for the science. He had already made a list of things he wanted to buy with the extra money and he was counting down the days until he could spend it.

The initial questionnaires had been simple enough to game, he’d thought. They had asked if he had vivid dreams—he did, so he wasn’t lying, but, given the context, who would have stated otherwise?—and whether he was a deep sleeper. The right response to that one was harder to judge. The man had hedged, and wrote, “Usually.” Finally, he gave them permission for a police background check and submitted a set of fingerprints.

He was accepted into the program.

*

The man’s accommodations for the next five nights were more spacious than he had expected. It was, in fact, a suite. Its main room featured a double-height domed ceiling that brought to mind a planetarium. (A planetarium, the man thought: a room for planets. He almost said something to his guide, but refrained.) There was a small kitchen and an array of modern furniture—a table, chairs, empty shelves. The bed, in a separate room with heavily soundproofed walls, was king-size, with a tasteful blanket like something he’d see in a design magazine. At the very least, the man would be comfortable.

On the other hand, much of the building remained unfinished. Nearly every door in the corridor leading to the man’s guest room had small piles of tools outside, including buckets spattered with paint, and he had heard a distant droning sound. It could have been HVAC, but the man thought it was someone sawing.

Picture hooks had been installed on all the office walls, he saw, but only one actually held anything. The man walked over, leaned in. Ignoring his own reflection in the glass, he saw two Renaissance engravings placed one beside the other: they showed the same room, drawn according to precise lines of perspective, but one had most of its doors and windows closed, the other, all those apertures thrown open.

“Damn it,” his guide whispered behind him.

The man turned to see her fidgeting with a remote control in front of an enormous TV. She seemed flustered. The logo of the unit’s manufacturer gleamed on-screen. Finally, she managed to change the channel and the logo disappeared, replaced by an image of the building they were standing in. It took the man several seconds to realize it was not a photograph but a live video feed. Just thirty minutes earlier and he would have been on it, heading inside to this very room.

For all the luxury, the man thought, it felt like he’d arrived a week too early. The building wasn’t ready, nor was its technology; for a sleep study, of all things, the whole experience seemed strangely rushed. The man imagined work crews stomping up and down the corridor at all hours while he tried to sleep, and he wondered if he would hear them. He wondered if he would dream about them. It was a building made for dreaming, he thought, but what if he dreamt of the building itself?

“Your study-lead will be here in a half-hour,” the guide said, checking her phone. “In the meantime, feel free to unpack or read through the manual.” She pointed at the desk. “It explains how to use the room.”

The man must have looked baffled or unprepared, because his guide smiled again and asked him if he was okay.

“Of course,” the man replied. He glanced around the room, at the domed ceiling, at the TV that had already switched back to its manufacturer’s logo. “Just taking it all in.”

*

The psychologist slid a folder across the table toward him and told him to take a look. Unlike the guide, she was older than the man, by at least a decade, and was wearing formal business attire.

The folder, he saw, held four photos arranged in a grid, each image depicting a different building. There was a warehouse, a corporate office that appeared to be abandoned, a strip mall, and a suburban home. The photos were black and white, clinical, neither stylized nor artistic, almost like crime-scene photos.

The man scanned each image, one to the next and back again. He wasn’t sure what he was being asked to do.

“What am I—what am I looking for?” he said. “What is this?”

The psychologist held a stylus in one hand, a tablet computer leaning against the edge of the table between them. He couldn’t see what was on the screen.

“One thing we’re testing,” she said, “is memory and projection.”

“That’s two things.”

The psychologist paused, ignoring the remark, her gaze moving from the man’s face down to the photos. “We want to test different source materials to see how they influence dreams. Visual cues. Audio cues.”

At first, he thought she’d said clues.

“Do you work for the school?” he interrupted. The man was restless; he had walked into the building only an hour earlier and the reality of spending five days there, in a windowless suite cut off from the world, was starting to unsettle him. He needed easing in.

“The school?”

“The university,” he said.

“Oh—no, we’re federally funded. That was all explained in your contract. We’re just using these facilities. Renting them. It’s a bit of a rush!” The psychologist smiled apologetically. “In fact, we’re the first people in the building.”

“How many other people are here?” he asked. “In the study. Am I the only one?”

“Would that disturb you?” she said. “Would you hesitate before entering an unfamiliar building on your own?” The psychologist seemed intrigued by this.

“Of course not,” the man lied.

“Good. But there are many others, on different floors. I’m meeting three more participants after you, and we brought on six yesterday. Then there’s tomorrow. And we discharged five last night.”

“Wow,” the man replied. “What’s the rush? I mean, for a sleep study, why so—”

“Timelines,” the psychologist said, cutting him off. Her response was vague, her previously apologetic smile now empty. “Shall we continue?”

“Of course.”

“This study works with cues,” she repeated. “Things that might affect the content and meaning of dreams. In this case, we want to start with buildings.”

“Buildings?”

She slid another file across the table. It seemed exactly like the others: four buildings in the city somewhere, one with a CLOSED sign hanging in its front door. The man could see reflections of clouds in the building’s upper windows and bits of trash outside on the sidewalk.

“Wait,” he said, disappointed, “is this about architecture?”

“It’s about memory,” the woman corrected. She stood up and gathered her files. “And projection.”

“So it’s about two things,” the man replied.

*

“Are you awake?”

The question shocked him. The man looked around the room, at the psychologist across the table from him, at the blue lights illuminating the domed ceiling overhead, at the personal objects he remembered unpacking mere hours before. How long had he slept? An hour or two at most, the man thought. The only thing he knew was that strong digital lights had turned on, emitting a harsh blue glare, he had stumbled into the front room, and the woman walked in just a few minutes later.

This, he would later learn, was called blueshifting.

“I think so.” The man glanced down at his hands, as if trying to see through them. They seemed reptilian in the synthetic blue light. “Yeah,” he said. “I’m awake.”

“We wouldn’t want you confused about that,” the psychologist replied. “What did you dream?”

The man exhaled. “God,” he said, “give me a minute. I need to remember.”

After some false starts, the man described a series of unfinished dream sequences. A subway ride where the stations made no sense; a conversation with a girlfriend who, in reality, was just a woman he often saw at the gym; a walk down a street with some buildings—

The psychologist interrupted him. “Describe the buildings,” she said. “Were they in the photos you saw? Try to remember.”

The man thought for a second. Everything had happened so quickly, he had nearly forgotten the photos.

“That’s a good question. I don’t know. They were like anything you’d see on a main street. Hardware stores. Liquor stores. Maybe a bank. Can I—can I see those photos again?”

“No.”

Memory and projection. They assessed one another.

The psychologist tapped something on her screen. “Try to remember the businesses. Think carefully. Every detail is important.”

“That’s all I remember,” the man said. “You know, let me get into the swing of things, sleep some more, dream some—”

“It’s a very short study. We have timelines.”

“Okay,” the man said, “okay.” He still didn’t understand what could be so urgent about a sleep study, but he would roll with it. “One of the businesses. It was, like, a paint store.”

The psychologist stopped writing. She stared at him.

“Is that—wrong?”

“No, no, a paint store,” she replied. “That’s great. That’s interesting.” She tapped her stylus against the screen, thinking. He got the impression she was hiding something, keeping details to herself. “Anything more?” she asked.

The man shook his head. “Not really. No.”

In the silence that followed, the psychologist reopened one of her files. She flipped through a collection of paperwork inside, pulling out a photo that she placed face-up on the table. “Did it look like this?”

The man looked down at a black and white photo of the paint store from his dream.

Holy shit,” he whispered. “Sorry—it’s… That’s amazing. That’s the paint store.” He picked up the photo, as if to prove it was real. “How did you do that? How did I do that?”

“That’s what we’re studying,” the psychologist answered. “We’re going to add something new this time. Are you ready?”

He held out his arms. “I’m a captive audience.”

“A mother’s first role,” the psychologist said, “is to protect her children.”

The man laughed. “What?”

The psychologist repeated herself.

“Are you asking me if I agree with this statement?”

“Agree or disagree,” she said, “it’s just a prompt. Like the photos. ‘A mother’s first role is to protect her children,’” the psychologist repeated.

*

Getting to sleep this time around was nearly impossible. They had given him a plastic bottle full of supplements that the manual described as similar to melatonin. Non-habit-forming. 100% natural. Clears the system in less than an hour. If he ever had trouble sleeping, they’d said, a single capsule could coax him back to dreamland.

He swallowed two.

* * *

The man blinked in the blue light, groggy, half-asleep.

“What did you dream?” the psychologist asked.

The man thought for a second, regrouping. He said he had walked further up the street—the same street, he emphasized, amazed by this. The same street, he said again. He had even dreamed the same buildings. “It was the same damn thing!”

“That’s perfect,” the psychologist said. “That’s exactly what we want.”

Although it was nearly night, the man continued, the sky was a deep mineral blue, like a medieval painting, and the sun was somehow streaming up, he said, casting strange, narrow shadows down the block. And, the man added, remembering something, the streets were empty. No one was out—no one, anywhere—but that made sense. He couldn’t see it, but, the man knew, there was some sort of event nearby, like a sports stadium. Everyone was there. They were watching a game, leaving the streets deserted.

The psychologist nodded, taking notes. “You said the sun was shining upward. Could that have been the stadium lights?”

“Huh,” the man said. “That’s interesting. You mean, were stadium lights shining up into the sky?” He nodded, thinking it through. “Yeah, you might be right.”

“Excellent,” the psychologist said. “Excellent. Was there anything else?”

The man thought, then shook his head. “No,” he said. “I think that’s it.”

* * *

The psychologist had ended the interview with a new prompt, playing the man an audio recording. It sounded like noises picked up in the back of someone else’s phone call. Accidental sounds, like passing traffic or stadium noise. The man couldn’t tell.

But very quietly, almost imperceptibly, there was something else.

The man heard a quiet voice.

A kind of whisper.

*

“What did you dream?”

The man blinked. The light in the room was like staring at a computer monitor.

“I was walking,” he answered, “toward this—this really creepy building. Up the street. It was starting to rain and I walked up toward the front door. But I didn’t look inside. I sort of stood there, beneath an awning. I could hear a distant crowd roaring. I knew… like…”

The psychologist waited. “Yes?”

“I had this feeling.”

“You had a feeling?”

The man said he knew someone was inside—watching him. No, no, not watching him, he corrected. The man thought for a minute. He had a feeling someone was waiting for him. Waiting for him to arrive.

The psychologist seemed very interested in this.

“Where was this person?” she asked.

Where, not who, the man noticed.

He made his way back through the dream slowly, almost reluctantly. The truth was, the man knew, something about the dream had rattled him. Someone inside the building wanted him to arrive—because they were lost. They were trapped or perhaps caught by something—he couldn’t tell. He just knew there had been a terrifying weight to this knowledge, a sense of genuine horror.

“I don’t remember,” the man said. “I just knew it was a boy.”

The psychologist leaned forward. “A boy,” she said. “Tell me about the boy.”

The man adjusted himself, sitting up straighter. “I didn’t know much about him. In the dream, I mean. I just knew he was inside and I could help him—I could find him. The boy wanted help. Does that make sense? He wanted to be rescued.”

Hearing himself speak, it felt resonant. Symbolic. He was going to rescue a trapped boy.

The psychologist began writing something. For the first time, he thought, she seemed excited.

“There was definitely a boy inside?”

“Yes,” the man said, encouraged. “A boy who—who didn’t know how to get out. He needed me to find him.”

The psychologist was nodding, writing things down.

“This is interesting—very interesting,” she said. “Okay, let’s get back to the building.”

*

They went back and forth like that for several sessions, an interview every four hours, the man disoriented both by lack of sleep and by far too much of it, the psychologist offering several more prompts along the way (“The first one into darkness turns on the light,” she’d said, then she’d brought out more photos, this time of different men). Each dream, the man inched further down the street, gathering more details, the shock and familiarity of redreaming the same scene quickly wearing off.

When the psychologist casually remarked how much time had passed, the man was astonished. These breaks between sleep, filled with questions, had become such a blur that time in the world outside had disappeared entirely. As part of the study, of course, the man had signed away his electronic devices and the room itself had no clocks.

His only remaining connection to the world now was the live TV stream of the building he’d been sleeping in. Whenever he looked, he saw cops out front, entering and exiting, often one man in particular, a black cop with a kind of handlebar mustache, talking to his colleagues on the stoop. Was there a police station nearby?

It’s already been two days, the psychologist said. Two days. The study was moving quickly. The man was doing great, she added, but they were nearly at the halfway point and they needed to step things up. This was essential—even urgent.

The psychologist pressed the man, in his next dream, to go inside. Open doors. Peer through windows. If the boy wants to be rescued, she said, let’s rescue him.

“We need you to be confident,” the psychologist explained, “If you see a door, we need you to open that door. If you see a closed room, we need you to step inside.”

The man fidgeted with his hands, cracking a knuckle.

“Don’t be afraid,” the psychologist urged. “They’re just dreams.”

Dormitorium
Jean DuBreuil, La Perspective Pratique. Second Edition. Parts I, II, and III. (1679)

*

The man inhaled and held it. A long sigh. “I had kind of a nightmare this time,” he said. “I didn’t like it.”

“Oh?” the psychologist replied. She sounded unexpectedly pleased.

Sitting beside her this time was a man. In his mid-forties, with greying hair swept back away from his face, he looked attentive, focused. She had introduced him as an architect.

Speaking to both of them, the man described his dream. That building with the boy—it was a kind of warehouse, he said. No, it was like the building next to a warehouse, like an office or business headquarters. Maybe two or three stories tall. Small windows.

“The windows faced east,” the architect said.

It took a few seconds for the man to realize it wasn’t a question.

“What do you mean?” he said. “How do you know that?”

The architect looked at him, as if judging how much he should say. “There are certain archetypes—universal forms or symbols—that come up again and again in architectural dream analysis. We see them all the time. Houses on steep hills, cabins in the woods, dark office towers in the city at night. Each has its own meaning. Eventually, you start to see patterns—including where people dream windows will be. Windows facing east in a dream mean something different than those facing west.”

The man nodded, debating whether or not this was all bullshit, but also realizing he had no idea how to tell what direction the windows had been facing.

“You said it was sunset,” the architect explained, as if reading the man’s mind. “You said earlier that the building was backlit, against the sun. That means you were facing west. So the windows you saw would be on the east side of the building. Correct?”

The man nodded, impressed by the logic. “That actually makes sense.”

“As you can see,” the psychologist broke in, “I brought along an architect because I thought he could help with the details. He can model buildings, make adjustments. Is that right?”

“That’s exactly right. I can build a model of your dreams with basically any details you tell me. Then we can use the model to spur more memories. We can add colors, window treatments, the sizes of specific rooms and hallways. Want to see an example?”

“Of course,” the man said.

The architect asked him to go back through his dreams, from the beginning. The row of shops along the street. The paint store. The warehouse building. The approximate location of the sports stadium. If there were any cars parked out on the street.

“Okay,” the architect finally said. He placed his laptop down on the table and pointed up. The man and the psychologist both craned their heads back. “Based on our interview,” the architect said, “this is the street you’ve been dreaming. Take a look. Let me know if it’s accurate.”

An image appeared, projected into the middle of the dome, hovering there like a plane of light. Using what resembled linked thimbles on both his thumb and forefinger, the architect began turning his hand in the air.

“This changes the depth of field,” he said, “so we can—” The architect twisted his wrist and the model snapped flat. “—zoom in to various degrees of detail.” He stretched the model open again, expanding it. “Do you recognize anything? Take your time.”

The man grinned despite himself, amazed at the model rotating above.

“Do you recognize anything?” the architect repeated.

“I do,” the man said. “It’s incredible.”

The effect was uncanny: the man was looking up at a digital reproduction of his dream, down to specific building fronts and loose trash. It was as if the architect had seen this street before and had had a model simply cued up, ready to go.

Nevertheless, the man saw, it wasn’t perfect. Some details were wrong. He thought the roofline of one of the buildings had been higher in his dreams, for example. He had also stood beneath an awning, out of the rain, but the awning was missing.

Other than that, he said, it looked great.

“You said it was more of a nightmare this time,” the psychologist prompted. Her face glowed in the light of the man’s dream shining above. “Why?”

“Because I went inside.”

*

The man had noticed something, but he didn’t want to mention it. Not yet.

His dreams were changing.

He hadn’t said anything at first because he wanted to see where this was going, but he thought he had figured it out. The study. He thought he knew what they were really testing him for.

The man was dreaming about himself, he thought. In fact, he was confident: he was the boy who was lost somewhere in the city. He was the boy who was trapped. The whole thing was a symbol. A metaphor.

The boy he was trying to rescue was himself.

The study, the man thought, increasingly convinced of this, was a form of experimental therapy.

Rescue the boy, the man thought, because the boy is me.

*

“You went inside,” the psychologist replied. “That’s excellent. Thank you. What did you see?”

The man had walked into the building, he said, past a desk, toward a small stairwell and hall. At the top of the steps was a corridor with black doors stretching away into the darkness. He knew the boy was up there, he said, trapped behind one of the doors, but he had the feeling someone else was in the building with them. Listening to his footsteps.

The psychologist seemed too excited to speak.

“Were there any lights inside?” the architect asked, filling the silence. Even the architect’s bearing had changed, the man noticed. Poised, concentrated. Alert.

The man said, yes, he remembered a faint glow above one of the doors. “There was a light sort of inside—” The man closed his eyes to remember. The light wasn’t coming from the first room, he thought, but somewhere deeper inside the building, further back, from a room behind the first room. The boy, he said, was back there.

The architect started typing something into his laptop as the psychologist jotted notes. He must be onto something, the man thought. The conversation felt driven, intense.

“Can you tell us how many doors there were?” the architect asked. “In the hall? Do you remember?”

“Christ,” the man said, “this—this is really a test.” He thought for a minute, pushing himself. The man closed his eyes again—but there was something wrong. He was distracted. It wasn’t the building that was confusing him. No, it was the sky. He remembered the sky, and the stars, and the way the trees had cut black silhouettes against the building. It was all familiar somehow.

“The number of doors,” the architect insisted. “Let’s start there. Count down the hall until you get to the door with the boy.”

“Please,” the psychologist said. “We’d love to know.”

She and the architect both stared at him across the table, expectant.

“Okay—there were… like…”

It was the trees, the man realized. He had seen those trees before. It was the view from his childhood bedroom, their branches against the sky. The same stars. He had seen it every night, looking out at the world, lying awake. His dreams had changed to depict his own childhood house.

“Sorry,” the man said again. “I don’t remember.”

The psychologist slumped in her chair. “There is a lot riding on this,” she said. “We need to find the boy. Do you understand? We need to do it soon.”

The man just looked at her. “I want to find him, too.”

*

“I added some details here,” the architect said, looking up at his own model. He had changed his clothes before the session, which seemed like a deliberate way to mark the passage of time.

He pointed up at a small door beneath the stairs. “Most buildings of this era tend to have that sort of thing,” the architect said. “A crawlspace. A kind of storage closet. Does that look familiar? Did you see that?”

The man closed his eyes. “I think so,” he said. “Yes. I… I think I walked past that.”

“Do you remember a lock on the door?” the architect asked. “On the outside of the door?”

The man tried to remember. “I saw something there, yeah. Like, three—three circular objects. Vertically, in a row. One, two, three. Were those locks?”

The architect typed something into his laptop, looked at the screen as if to check the results, then glanced back across the table. “Potentially,” he said. “Next time, pay close attention to that door. Specifically, how it’s locked. We might need to get inside.”

“Got it,” the man replied. He started to say something else, then stopped, chewing his lip for a second. They both waited, expecting him to continue the description. Instead, he said, “It’s… it’s been longer than five days, no? This is day six. Maybe even day seven.”

The psychologist’s expression dropped. “No,” she said. “That’s not right at all.”

“Are you sure? I think it’s day six.”

The architect fiddled with his laptop, as if no longer a part of the conversation.

“There is still time left,” the psychologist answered, speaking slowly now, as if the man was a very slow child, “but there won’t be if we don’t find which room the boy is in. Do you understand?”

The man had to admit, they seemed as committed to the idea of him finding himself as he was. He liked that. He thought of the five thousand dollars they were paying him, of how close he seemed to be to finding the boy—to finding himself—and he shrugged, as if embarrassed he had ever made a scene. In fact, the man could hardly believe that these experts and resources were available, helping him find and rescue his younger self. For therapy, he thought, it was ingenious, the kind of thing he might actually pay for.

“Totally,” the man said. “It’s just… you know, there are no windows and… anyway, I think I heard something.”

“You heard something?”

“A sound.”

“What kind of sound?”

“Nothing specific. The sound of—” The man stopped. “That recording you played. It was like that. A kind of whisper.”

The psychologist and the architect exchanged a quick look.

“From behind this door?” the architect said, rotating his hand and zooming-in on the crawlspace. The model expanded in space, filling the entire dome.

“No, from the hallway upstairs. I went upstairs.”

What the man didn’t say was that, when he did so, the entire dream had changed around him; what had been a warehouse had become the upstairs of his own childhood home. He had been walking down the hall toward his own bedroom.

“You should have told us,” the psychologist replied. “How many doors did you see?”

“Four,” he said, describing his old house. There was his room, his parents’ room, the bathroom, his brother’s.

“That’s… that’s not right,” the architect replied. The psychologist shot him a look. “I mean, the kinds of numbers we see—the symbols—are… they’re usually in groups of twelve. It’s standard dream symbolism. Jungian stuff.” He faltered, looked down. “All doors represent something,” the architect continued, shifting in his seat. “Every wall, every window. Are you sure there weren’t twelve doors upstairs?”

“I don’t think so,” the man replied. “I saw four. I’m sorry.”

He caught the psychologist briefly shaking her head.

“The challenge here is about resolution,” the architect insisted. “We need to get to a very high degree of dream resolution. Does that make sense?”

Dream resolution,” the man repeated.

“Yes. Now, we are confident there are twelve doors. Which door leads to the boy?”

*

The architect came alone this time. The psychologist, he said, was still busy with another participant; “something came up” was the only explanation he offered.

The man ignored her absence. The truth was, he knew absolutely now that he was looking for himself—and he was close, he thought, perhaps just one door away. His dreams now took place almost entirely in his childhood home, and he thought the architect would be pleased by this. He thought that was the entire point of the study.

To rescue the boy.

As the man’s descriptions changed, however, the architect began to look uncomfortable. He seemed hesitant even to continue and eventually put his laptop down, no longer typing.

“What’s up?” the man asked.

The architect studied the model hovering above them. He rotated it. Opened it. Closed it.

“Are you sure the building changed like this?” the architect said. “It changed—but the boy was still inside? You’re positive?”

“Is that bad?”

“We can’t afford to look in the wrong place. Especially not now. Did this warehouse—this office—really become a suburban hou—”

“Yes,” the man interrupted him. “It did. It’s the house I grew up in. And I dreamt about a different room this time—my old room. I opened the door and went in. There was a boy in it.” The man felt triumphant; he had solved the puzzle. “The boy was me.”

The man had been expecting validation, but the architect glanced down as his laptop as if to avoid eye contact. After a few seconds, the architect spoke. “You should be open to the possibility that the boy is not you,” he said, “and that there might be something else going on. I mean, your dreams might mean something else.”

This, the man thought, was immensely frustrating. He was on the verge of a breakthrough, of connecting with his younger self—which seemed to be the entire point of the damn study—yet the only people he could talk to about it didn’t care. In fact, they seemed actively disappointed. Worse, it was like they would have been on his side—they would have helped the man find himself—but only if he described the right building.

The disassociated urgency of the last few days must have gotten to him, because the man’s feelings flipped in an instant, from enthusiasm to sheer petulance.

“We can’t have your conscious mind interfering with the study like this,” the architect continued. “You have to let go of that. Trust the dream. Don’t try to shape it. Follow; don’t lead. Can you do that?”

“You guys are too hung up on the architecture,” the man muttered.

“Excuse me?”

“You’re too fixated on the building,” the man said, speaking up. “I thought this was about my dreams. If we’re going to talk about my dreams, let’s talk about the building that’s actually in my dreams. Not whatever building you want me to study.”

The man wanted to tell the architect about his old bedroom, about the house where he had lived until he was ten years old, about reading books by flashlight at night and dreaming of… well, a life that was nearly the opposite of his own. A life unlike anything he led today. He had lost sight of that version of himself. He was finding it again.

And this dream therapy, the man wanted to say, had been the perfect intervention. He had actually wanted to say thanks. Thanks for reminding me of the boy I used to be. Thanks for—

“Let’s agree that you’ve made progress,” the architect said, “and we’re almost there. But let’s be open-minded about what these dreams might be, not distracted by—”

“Distracted?”

“Distracted. What if I said this is an ideal chance to prove something? That it’s our chance to demonstrate something completely new? But we can only do it if you find the boy.”

The man, thinking this must be part of the test, pictured his younger self huddled in his room near the window, looking out at the trees and stars, dreaming of a future that had yet to come to pass.

I am the boy,” the man said. “That’s the entire purpose of this study, right? I am the boy.”

*

It seemed far too soon, just another glitch, but the lights began to blueshift.

The man got up after what felt like twenty minutes’ sleep and stumbled into the front room, one hand hiding his eyes. The door lock buzzed open and a woman walked in.

“We found him,” the guide said.

The man hadn’t seen her in days. In fact, he’d forgotten she existed. What happened to the architect, to the psychologist?

“It was someone who started last night,” the guide continued. She seemed elated. “Her dreams worked. We found him.”

The man didn’t understand. “Found who?”

“The boy.”

He had no idea what she was talking about. “There was another boy?” He thought back to those dreams about himself, trapped in his old family house. Wasn’t he the boy?

It occurred to the man then that he might still be dreaming, but the room around them continued to blueshift. That color alone at this point, would jolt him wide awake, if only due to habit.

The guide looked at him, her expression changing, as if realizing she had said too much.

“Your time is up,” she said, smile fading. “Just some final paperwork and you’re good to go.”

Seeing the man’s confusion, the guide tried a different approach. “How did you dream?”

*

The man spent the rest of the day catching up on texts and email after five days away from his device, then he met up with a friend for a quick drink. Which became two drinks, then three.

Then he was back in his apartment, looking around at its anticlimactically mundane amenities. No dome, no 3D laser projection, not even a king-size bed. He turned on his TV and showered, opening a bottle of beer he had forgotten was in the fridge and sipping it, naked, staring around at his apartment as if seeing it for the first time. Street noises blared in from outside and the windows were bright with the spectacle of shops, cars, and buildings.

The man lay down. The market across the street had closed for the night; its afterhours lights stained the man’s curtains a deep, wine-like red, making him yawn. It felt like the study all over again, the room redshifting, his mind drifting, everything slow—

He opened his eyes.

“—found the boy in a warehouse near the stadium,” a voice on the TV said, “where he had been held for nearly a week. His abductor was taken into custody without incident.”

Found a boy?

“Police say they launched the raid this morning after receiving an anonymous tip—”

On screen, the man saw, was a building he recognized. No, he thought. Its front door. Its windows. Its roofline. No fucking way.

“—in an unexpected end to a kidnapping saga that had local police and the FBI scrambling—”

It was the same goddamned building.

The man lay there in the red half-light of his room, dumbfounded, watching as a camera crew went inside the building. Someone offscreen began interviewing a cop, a black cop with a handlebar mustache— that mustache—in front of a door with three locks in a row, top to bottom, one, two, three—

“We’re just happy we can bring the boy home to see his parents,” the cop said. “That’s all that matters now. We tried new techniques—”

But the man was just staring now, his eyes unfocused, the camera centered on a dark staircase, the hall at its top lined with black doors. Twelve doors.

The man switched off the TV. He lay there in bed, watching lights move across the ceiling.

He couldn’t sleep.



from VICE https://ift.tt/34gbLrC
via cheap web hosting

It’s Nearly Impossible to Sue a Cop for Shooting Someone. These Democratic Candidates Are Trying to Change That.

Want the best of VICE News straight to your inbox? Sign up here.

It’s nearly impossible to sue an individual cop for shooting someone in the U.S. And with police departments and prosecutors repeatedly letting officers off the hook, several Democratic candidates want to make it easier for victims or their families to go after the perpetrators themselves.

This week, former Texas Senator Beto O’Rourke and Mayor of South Bend, Indiana Pete Buttigieg said they hope to either reform or outright abolish a defense tactic known as “qualified immunity.” It’s ostensibly intended to shield cops from a deluge of lawsuits for just doing their jobs.

But the standard has also roadblocked lawsuits accusing cops of tasing a pregnant woman, handcuffing a crying 7-year-old, and unfairly siccing a police dog on a surrendering person. In many cases, attorneys don’t even want to take up the cases because they know it won’t go anywhere. And that leaves cops with little-to-no repercussions.

“Qualified immunity is one of the almost secret drivers of police violence, particularly among black and brown communities,” said Somil Trivedi, a senior staff attorney with the ACLU’s Criminal Law Reform Project.

“Qualified immunity is one of the almost secret drivers of police violence.”

With his announcement, O’Rourke joined Sen. Elizabeth Warren, Sen. Bernie Sanders, and Julian Castro, who all want to amend qualified immunity in some way. Buttigieg, however, is the only candidate who said he would end the standard entirely through legislation. That would have huge ramifications for the nation’s approximately 18,000 federal, state, county, and local law enforcement agencies — and open up a new pathway for justice against individual officers.

“Civil rights cases will be significantly less complex and time-consuming to bring,” said Joanna Schwartz, a law professor at the UCLA School of Law.

When someone wants to sue over a police-involved shooting or any other egregious conduct, they typically have to go after the department as a whole. And they have to prove they were wronged by a systemic problem or an official police department policy, which is a high standard to meet.

Without qualified immunity, it’s not that police officers would have to pay out of their own pockets for wrongdoing, since civil damages are almost always paid out by the government and not the cop. But people would be able to hold a single officially legally accountable, which can feel like the only path to justice, especially when criminal charges and firings are so rare.

The ACLU, alongside the conservative group Americans for Prosperity, also told the Supreme Court last year that the defense tactic is eroding community trust with police and that “official accountability is in crisis.”

“Officers who violate someone's constitutional rights are often shielded from civil rights lawsuits by qualified immunity,” Warren wrote on Twitter in August, when she introduced her criminal justice plan. “That’s wrong — and needs to change. When an officer abuses the law, that’s bad for law enforcement, victims, and communities.”

The Federal Civil Rights Act of 1871 granted people the ability to sue public officials if they violated their Constitutional rights. The law came about in response to states and officials supporting the Ku Klux Klan and citizens having no way to fight back. But since then, the Supreme Court has issued a series of decisions to establish and reinforce immunity for police.

Now, a person who wants to sue an officer has to prove an officer violated a “clearly established” right already outlined in a previous court case using the same context and same conduct. But because so few of these cases make it to court, that can be nearly impossible.

“You’re going to need to find a lawyer to take your case, and that lawyer is going to be very aware of the qualified immunity doctrine,” said Clark Neily, vice president for criminal justice at the Cato Institute. “And even if you can find a lawyer to take your case, you’re going to have to convince a judge that there’s a pre-existing case exactly on point so you can survive qualified immunity.”

For example, someone wanting to sue a cop for, say, accidentally shooting their 10-year-old child, would have to prove there’s adequate precedent for declaring that specific act unconstitutional. If that ultra-specific example doesn’t exist, then judges can say — and did say, in that case — that the person didn’t have the established right to not be shot by police.

“There are plenty of horrific events that have occurred that simply have never occurred before,” Schwartz said. “The message that’s being sent through these cases, even through these Supreme Court opinions, is that officers aren’t meaningfully accountable.”

Cover image: (Mihajlo Maricic / EyeEm via Getty Images)



from VICE https://ift.tt/323NP9e
via cheap web hosting

Millions Are Turning to This Drug for Pain and Anxiety. But There’s Almost No Evidence It Works

When Mary’s* grandmother had her leg amputated at the knee, doctors prescribed gabapentin for her phantom leg pain.

“I remember thinking that was super weird,” Mary said, because she herself had a prescription for gabapentin too. Mary is 28, and has been taking the drug—a generic medication also sold as Neurontin—for nearly a decade. Her doctor gave it to her to balance out the effects of her ADHD medication, Concerta. “Why was something I was taking to take the edge off an ADHD drug also being given to an amputee?” she wondered.

Indeed, the Food and Drug Administration hasn't actually approved gabapentin for either of those uses—gabapentin is approved for treating seizures and nerve pain that can happen after shingles. Yet its reach extends much, much further. A person might receive it for migraines, fibromyalgia, hot flashes, depression, bipolar disorder, restless leg syndrome, anxiety, and a wide variety of other nerve and chronic pain issues. It's even given to cats and dogs with chronic pain.

“It's the ‘let's just throw something at the wall and hope that it magically sticks’ drug," said Jordan Covvey, an assistant professor of pharmacy administration at Duquesne University School of Pharmacy. "There’s a lot of damage that could be happening with that sort of strategy."

Treating conditions like chronic pain, depression, or anxiety is hard. The medications doctors have to offer can come with side effects, the potential for misuse, and sometimes they just plain don't work. Gabapentin has been considered relatively safe, and its broad effects on the brain mean, theoretically, that it could help a wide variety of disorders. It's said to have a calming effect and touted as non-addictive. As a result, it is often the drug of choice when Plans A, B, or C don't work out. And some people say it works for them.

It is often the drug of choice when Plans A, B, or C don't work out. And some people say it works for them.

But recent studies and data are now questioning gabapentin's role as a benign catch-all. They're finding that, when used along with other drugs, gabapentin does have the potential to be misused, and is linked to an increased risk of death when combined with opioids—a connection that's particularly alarming since it's so often prescribed for pain. A handful of lawsuits allege that its use is associated with suicide, a worrying correlation for a medication given to people with pre-existing mental health disorders.

All these emerging risks are compounded by many experts saying that the evidence for gabapentin's non-FDA-approved uses, like Mary’s and her grandmother’s, isn't convincing after all. When it's given to people with depression or pain or anxiety, even if it's not hurting them outright, it might not be helping.

For a drug that may not be providing any benefit, are the risks worth it?

Pharma execs in the 90s lied to the public to get more people to take gabapentin

Despite the fact that there’s new scrutiny on gabapentin, the number of people taking it continues to rise. In the United States, its use more than tripled between 2002 and 2015. Gabapentin was the 10th most commonly prescribed medication in 2017, when there were almost 70 million prescriptions—more than for amoxicillin, one of the most frequently prescribed antibiotics.

The vast majority of gabapentin prescriptions are for off-label uses, or uses not approved by the FDA—an estimated 95 percent, according to a study of nationwide data. One survey found that gabapentin has the highest proportion of off-label prescriptions out of 160 commonly used drugs.

These incredibly large numbers just don’t make sense, said Chris Goodman, an assistant professor of clinical internal medicine at the University of South Carolina School of Medicine, who has published two papers examining gabapentin use in the U.S. There are no well-designed, placebo-controlled clinical trials for several of its off-label applications, said Joe Ross, a primary care physician at Yale University and a researcher on pharmaceutical policy. Some off-label uses may have one or two studies, but the results are either modest or inconsistent—overall, only about 20 percent of gabapentin's off-label uses have data supporting them, Ross said.

Gabapentin, and a similar drug called pregabalin, are referred to as gabapentinoids. Gabapentinoids are shaped similarly to a neurotransmitter called GABA that can block neurons and reduce the activity of the central nervous system. Because interacting with GABA receptors in the brain can lead to many different effects, the idea was that gabapentinoids could possibly affect many other conditions."The problem is that the research doesn’t strongly support the use of gabapentin in pretty much any of these instances,” Covvey said.

Goodman thinks there is reason to be wary of doctors writing so many off-label gabapentin prescriptions: When it was first patented, the company that produced it spent millions of dollars on a deceptive marketing campaign specifically to promote gabapentin's off-label potential. He thinks it's worth asking if the legacy of that marketing campaign is in some way responsible for the sheer amount of off-label use that still takes place today.

The company that made Neurontin, Parke-Davis, was a subsidiary of Warner-Lambert, which eventually got bought by Pfizer. Per 800 pages of documents that have been made public through lawsuits, it’s clear how gabapentin was pushed on doctors: Parke-Davis rated doctors by the dollar value of the prescriptions they could potentially write. They zeroed in on doctors who were influential and affiliated with major medical centers, who they thought could encourage their colleagues to use gabapentin too. The company wrote in their internal documents from the mid 1990s that this strategy would be “one of the most effective ways to communicate our message.” (The documents are in the Drug Industry Document Archive at the University of California San Francisco Library.)

Parke-Davis hired medical education companies to write review papers, original articles, and letters to the editor in medical journals about gabapentin for “$13,375 to $18,000 per article,” plus a $1,000 honorarium for the author. The majority of these articles had “favorable” conclusions about gabapentin, and in most instances the payments were not disclosed.

Parke-Davis executives spent hundreds of thousands of dollars targeting medical residents to—as explained in one document—“influence physicians from the bottom up” and "to solidify Parke-Davis' role in the resident's mind as he/she evolves into a practicing physician.”

The company invested in “education” as a strategy, as when they organized teleconferences that connected paid doctor “moderators” with other doctors. These events were described publicly as purely educational, but one internal memo from 1995 said that “the key goal of the teleconferences was to increase new Neurontin prescriptions by convincing non-prescribers to begin prescribing and current prescribers to increase their new prescription behavior.”

Lecture series were organized with high-profile names in neurology in which the goals were to improve “public relations within the neurology community, etc., as well as [to impact] the volume of Neurontin new prescriptions.”

Parke-Davis hired medical education companies to write review papers, original articles, and letters to the editor in medical journals about gabapentin for “$13,375 to $18,000 per article,” plus a $1,000 honorarium for the author. The majority of these articles had “favorable” conclusions about gabapentin, and in most instances the payments were not disclosed.

Some of the company-funded research was intended to get FDA approval for treating more conditions, but Parke-Davis said internally that the goal of other studies was to "disseminate the information as widely as possible through the world's medical literature generating excitement in the market and stimulating off-label prescribing despite the lack of FDA approval.”

One such research initiative, called Study of Neurontin: Titration to Effectiveness and Profile of Safety, or STEPS, was an open-label study without a control group where doctors gave epilepsy patients gabapentin and increased their dose until they were either seizure-free, or they reached the maximum dosage. More than 700 doctors participated, and enrolled an average of three patients each, and were given $300 per patient.

One placebo-controlled study was delayed because it found that there was no effect on the primary outcome, which was neuropathic pain. Documents showed that the company held the study because “[Parke–Davis employees] should take care not to publish anything that damages neurontin's marketing success.”

The documents reveal that the goal of the study wasn’t to examine the effectiveness of gabapentin at different doses, as the study authors claimed, but to “teach physicians to titrate [finding the most effective dose with the least side effects] Neurontin to clinical effect” and “to give neurologists the opportunity to titrate to higher doses when needed.”

In the New England Journal of Medicine (NEJM) in 2009, researchers took a closer look at the gabapentin studies that were funded by Parke-Davis. One author, epidemiologist Kay Dickersin, said she found a number of reporting biases that affect the results of the research. One placebo-controlled study was delayed because it found that there was no effect on the primary outcome, which was neuropathic pain. Documents showed that the company held the study because “[Parke–Davis employees] should take care not to publish anything that damages neurontin's marketing success.” Trials with findings that were not statistically significant were either not published in full, or were published only after their primary outcomes were changed, which skewed the results to be significant. Other studies were manipulated to minimize or hide negative findings about the drug.

In April 1996, a biologist named David Franklin began working at Parke-Davis. Franklin knew that according to FDA rules, he was not allowed to promote off-label uses of drugs, and yet, the NEJM recounted that an executive allegedly told him:

“I want you out there every day selling Neurontin. ... We all know Neurontin's not growing for adjunctive therapy [when it gets combined with another medication], besides that's not where the money is. Pain management, now that's money...That's where we need to be, holding their hand and whispering in their ear, Neurontin for pain, Neurontin [alone], Neurontin for bipolar, Neurontin for everything. I don't want to see a single patient coming off Neurontin before they've been up to at least 4800 mg/day. I don't want to hear that safety crap either, have you tried Neurontin, every one of you should take one just to see there is nothing, it's a great drug.”

Franklin quit three months later and became a whistleblower, filing a lawsuit that ended with Parke-Davis' parent company pleading guilty in 2004 to resolve criminal charges and civil liabilities and paying $420 million in fines. Despite the lawsuits and guilty pleas, more than ten years later, Michael Steinman, a professor of medicine at UCSF, said it’s hard to know if gabapentin would be so widely used today if it weren’t for all the money poured into the off-label marketing campaigns.

“It certainly didn’t hurt,” he said. “I think the legacy of that has been that off-label prescription of gabapentin has persisted. Gabapetin has found a kind of niche to treat all sorts of things that doctors don’t know what to do with.”

Gabapentin has the potential for misuse and overdose

We know today that gabapentin is not proven to work for as many conditions as Parke-Davis wanted people to believe. But when doctors prescribe their patients gabapentin, it can be without knowing exactly what the approved uses are. Instead they are “largely guided by informal discussion with colleagues or professional meetings, as opposed to prescribers’ evaluation of its merits for a given indication,” according to a 2018 study on gabapentin off-label use.

Seth Landefeld, the chair of the Department of Medicine at the University of Alabama at Birmingham, echoed that doctors will reach for gabapentin in situations where someone is difficult to treat. This tendency has been exacerbated by the opioid crisis—as doctors are searching for alternatives to opioids, gabapentinoid use is increasing, according to a review published by Goodman. The evidence for its use in nerve pain after shingles and diabetic neuropathy created a narrative that gabapentin could be helpful with pain, Goodman said. “From these trials, a house of cards has been built.”

A Cochrane review, a type of highly respected analysis that combines results from multiple studies, found that while gabapentin does seem to provide pain relief for its on-label uses, the support for others was limited. Reviews on other off-label applications, like for migraine, fibromyalgia, mental illness, and substance dependence have “found modest to no effect on relevant clinical outcomes,” according to a 2018 paper in Substance Abuse: Research and Treatment.

While gabapentin certainly has fewer side effects and risks than opioids, Covvey said, there is growing evidence that people—and especially those with opioid-use disorder—are misusing gabapentinoids. That makes pain patients a problematic group to be taking gabapentin—there have been reports of recreational gabapentin use, or intentional misuse, with one study reporting that these cases are increasing at “an alarming rate.” One study found that, from 2008 to 2012, there was a 3,000 percent increase in people saying they used gabapentin “to get high."

It wasn’t until 2017 that researchers conducted a national assessment of gabapentin misuse, and found that gabapentin use showed similar patterns to other medications that are misused. In small studies that included surveys from patients, they found that gabapentin was being used alongside opioids to increase their high. These consequences can be deadly: Using gabapentin at the same time as opioids is associated with four times the risk of “respiratory depression,” which is the main cause of death for overdoses.

One study found that, from 2008 to 2012, there was a 3,000 percent increase in people saying they used gabapentin “to get high."

According to a 2019 report of drug misuse in the U.S. by Quest Diagnostics, use of non-prescribed gabapentin rose 40 percent in just one year, from 2017 to 2018, which puts its misuse higher than that of opioids and benzodiazepines. "This makes gabapentin the most commonly misused prescription drug in 11 states and in the top three drug groups in an additional 10 states," the report said. The same report acknowledged there wasn't a lot of risk for misuse or addiction when gabapentin was taken alone. But when it's taken in combination with other medications, like muscle relaxants, opioids, or even anxiety medications, it can lead to a person feeling high, and the risks increase.

Still, gabapentin is not classified as a controlled substance—which have different regulations for refills—at the federal level. Since 2016, several states have implemented or are creating laws to add more checks to the gabapentin-prescribing process. Ohio, Kentucky, and West Virginia have made it a controlled substance at the state level because of an increase in gabapentin-linked deaths. In January of this year, Michigan classified gabapentin as a Schedule 5 substance, which is the same scheduling as certain cough medicines that contain codeine. Virginia followed suit in July of this year, and Alabama will do the same starting in November 2019.

Ohio, Kentucky, and West Virginia have made it a controlled substance at the state level because of an increase in gabapentin-linked deaths.

Goodman said that, while the opioid crisis didn't help, he thinks the rise in prescriptions would have happened anyway. “The industry influence was too heavy, clinicians were already increasing their use of these drugs prior to the opioid crisis being publicized,” he said. “The most frustrating aspect of this increase in gabapentinoids is that we actually know a great deal about the manipulation of trial reporting, regulators, clinicians, and others—yet here we are."

As a drug for mental health, the evidence for gabapentin is sparse

Even-less examined than gabapentin for other types of pain are the prescriptions for mental health disorders. Mary’s doctor did tell her that gabapentin was an epilepsy medication being used off-label, but also said with confidence that it was helpful as a mood stabilizer. Nicole, a 30-year-old living in Los Angeles who didn't want to use her last name, was prescribed gabapentin in high school for major depressive disorder—her doctor said that gabapentin was effective for evening out mood swings.

But the few studies that exist haven't been able to back those claims. In 2000, there were two randomized, placebo-controlled trials that showed that gabapentin did not work better than placebo for bipolar, and one study found that gabapentin was worse than placebos when treating bipolar mania. Another review on gabapentin looked at studies on gabapentin's effects on psychiatric diseases—it showed some positive results in treating social phobia, but that it was not effective for panic disorder, OCD, or bipolar disorder.

Rebecca*, 31, was given gabapentin for generalized anxiety after trying Celexa and Effexor, two commonly used medications. She said she went home, looked gabapentin up, saw all of its off-label uses and thought to herself: "It can’t possibly do all of this."

Rebecca took the medication, but isn't sure it did much. "I was already on other medications for psychiatric reasons, and I had cycled through so many different pills and dosages that it all blended together," she said. "In retrospect I'm not sure any of it made a difference at all." When she went off of gabapentin a couple of months ago, she didn't notice any symptoms, good or bad.

“I can't think of a single mental health condition or indication where gabapentin should be used,” Covvey said. “None have any strong indication that gabapentin provides any discernible benefit.”

There have been recent claims that taking gabapentin could be linked to an increased risk of suicide in populations prone to mental health issues, though studies on this have been mixed and more investigation is needed. According to Bloomberg, there are more than 1,000 lawsuits accusing now-owner Pfizer of promoting gabapentin for off-label mental health use and alleging that they don't mention the risk for increased suicidality. In 2010, Pfizer settled a wrongful death lawsuit which alleged that gabapentin led to a minister's death by suicide. It was the second suicide-related settlement related to the drug; the first was for $400,000 for a death in Massachusetts.

Meanwhile, the benefits of gabapentin for mental health remain opaque: Some people say it helps them. When Nicole takes it, it does even her out, she said, though she uses it in combination with other medications. “It's hard to tell if gabapentin would really do anything on its own for me, but I do feel comfortable taking it even if what I feel is just a placebo effect,” she said.

Michael, a 41-year-old lawyer in Phoenix, Arizona, was given gabapentin six years ago for anxiety, and takes it because his doctor said it was non-addictive, and he has alcoholism. “Maybe it’s a placebo effect, but I do know that if I start to feel anxiety coming on or if I know that I’ll be in a stressful situation in an hour or so, I can take one or two and feel better," he said.

He doesn’t have many expectations for the drug, but continues to keep it in his regimen anyway. “I’ve run out of my prescription before seeing my doctor and it doesn’t really bother me. I’ve had no physical withdrawals to speak of. If anything it’s more mental if I 'need' a pill and can’t have one.”

It's possible that gabapentin is helpful in certain cases, for certain mental health disorders, or in combination with other drugs—but until more research is done, it won't be clear as to why or when it should be taken for mental health concerns. Given the limited evidence that exists now, experts remain skeptical. “I can't think of a single mental health condition or indication where gabapentin should be used,” Covvey said. “None have any strong indication that gabapentin provides any discernible benefit.”

People who take gabapentin are often in the dark about it

Every drug has risks and benefits. When people take a medication without substantial evidence that it works, the chance they’ll benefit from it is lowered, since they’re now disproportionately exposing themselves to its risks, Ross said. Outside of the potential risks of gabapentin, is it ethical to give a patient a medication that might not do anything, when they could instead take a treatment that might work better?

As long as doctors don't have better alternatives for opioids, or better medications for mental health than current antidepressants or benzodiazepines, gabapentin will continue to fill the gap. “Prescribers are scrambling trying to figure out what alternative therapies are out there to help their patients, and gabapentin is the place that they've turned," Covvey said.

Tatum, a 23-year-old living in Austin, Texas, was prescribed gabapentin two years ago for anxiety. He tried several drugs before that, and while some of them worked, he didn’t like their side effects, so his doctor gave him gabapentin, telling him that it could help anxiety in people who didn't react well to other medications.

Tatum said after taking gabapentin, his anxiety and intrusive thoughts were more manageable. He wasn’t aware of gabapentin’s dicey history, but said he would have taken anything to decrease his anxiety—knowing about it wouldn’t have stopped him.

A nurse practitioner gave gabapentin to Rina, a 19-year-old living in Dallas about a year ago. She didn't explain in depth what it was except to say that it could help with anxiety, and that it was similar to Xanax, but without the risk of getting addicted to it. Rina said she didn’t feel any difference in her anxiety but she did feel tired, and when the prescription ran out she stopped taking it.

This burden of medication trial and error for patients is really high, Covvey said. Trying a dozen different drugs, and dealing with their interactions and side effects, can be exhausting and frustrating. What concerns her is the communication—or lack thereof—that takes place between doctor and patient for gabapentin's off-label uses. Are people being told what the drug is, why they’re trying it, that it’s being used off-label? Are they told about the amount of evidence for what they're trying it for? About its potential for misuse?

“When we go off script without evidence, particularly in instances where we don't discuss that with patients, that really concerns me," Covvey said. "I wonder how often that's happening with gabapentin—if the people being prescribed really understand the actual evidence this is going to work for them."

Are people being told what the drug is, why they’re trying it, that it’s being used off-label? Are they told about the amount of evidence for what they're trying it for? About its potential for misuse?

If doctors are seeing measurable benefits from gabapentin, for mental health or for pain, then Ross thinks it should be studied more systematically. He believes the FDA should require drug manufacturers to do additional safety and efficacy studies once off-label use of a certain medication reaches a certain threshold, say 20 percent of all prescriptions. Otherwise, he said, it ends up being an effort from researchers and patients to ask the tough questions. The FDA did not respond to a request for comment by publication time.

It's on them to ask even simple questions, like is this doing anything for me? And can I stop it? Mary said that gabapentin isn't harming her, but it can cause minor annoyances. Interactions are one: She's been advised not to take NyQuil or CBD with gabapentin. If she takes it too late at night, waking up can be difficult, or lead to a groggy morning. She also takes Synthroid for an underactive thyroid, her ADHD medication, and birth control, and feels it's a lot of medication to juggle. “It adds up, and I would like to not be on all of those,” she said.

Recently, she’s been trying to wean herself off gabapentin. Her doctor now isn't the same one who prescribed the drug, and it can be tough to figure out who to ask for help with that. “One time in urgent care they asked me about my medications, and I mentioned I was on it and they were like: Huh?" She said. "They thought it was kind of odd.”

*Names have been changed to protect medical privacy.

Sign up for our newsletter to get the best of VICE delivered to your inbox daily.

Follow Shayla Love on Twitter.



from VICE https://ift.tt/2N42XPL
via cheap web hosting

Why Twitter’s Political Ad Ban Won’t Make a Damn Difference

Twitter’s announcement Wednesday that it will ban political ads should have a tiny impact on a world dominated by Facebook and Google. But it’s sparked an explosive reaction.

The decision has already drawn a flurry of subjective questions around political speech that suggest enforcement of the policy could be a nightmare. It points to the minefield facing the bigger players as a presidential campaign that could be won or lost on digital platforms heats up.

Since Twitter’s largely symbolic move, top Democratic leaders have already begun suggesting that Facebook should follow suit. But doing so could effectively boost well-heeled advertisers like President Donald Trump and ExxonMobil at the expense of grassroots groups and outsider politicians.

“First and foremost, that money that you’re banning isn’t leaving politics,” said Jessica Alter, co-founder of Tech for Campaigns, a nonprofit that advises Democrats in down-ballot races. “It’s either going to a less-effective medium — which means you need more money to get noticed — or it’s going to a darker place, which means we have less transparency.”

“It’s nice to say that political speech should be earned,” she added to VICE News. “But that’s not how the world works. People spend money on TV, they spend money on mail, and they spend money online.”

Twitter has previously said that it sold just $3 million in political ads during the 2018 midterms, an estimated 1/100 of Facebook’s haul. Yet Twitter CEO Jack Dorsey subtweeted his larger Silicon Valley counterpart’s decision to allow politicians to lie in ads when he shared the decision to go cold turkey on both political ads and the more ambiguous category of issue ads.

“This isn’t about free expression,” Dorsey said in a Twitter thread. “This is about paying for reach.”

The announcement has drawn praise from Democrats including Oregon Sen. Ron Wyden, 2020 hopeful Pete Buttigieg, and former Joe Biden’s aides, who’ve spent the past month trashing Facebook for allowing the Trump campaign to run false ads about the former vice president and his son. “What say you, Facebook?” Hillary Clinton added on Twitter.

But for the foot soldiers who actually fight in the political infowar, it’s not so clear-cut. Marne Pike, CEO of progressive strategy firm Veracity Media, told VICE News that blanket bans of political ads would help established candidates and incumbents. Facebook and other platforms allow challengers to build name recognition and raise money without shelling out big bucks for untargeted TV spots.

Pike said that her firm, which advised Rep. Ayanna Pressley (D-Mass.) in her insurgent campaign last year, spent the majority of its communications budget on digital. “If we couldn't run ads on social platforms, that would have totally changed the race,” she added.

That sort of impact will likely be limited on Twitter, a much smaller platform chock-full of newshounds and other users who are politically active. But with the lines between journalism, advocacy, and advertising increasingly nonexistent, there’s a more fundamental question of how Twitter’s rule will play out.

“What I don’t understand is how they’ll define a political ad...What is an issue ad?” Eric Wilson, a Republican digital strategist, told VICE News. "It opens themselves up to so many more judgment calls that they probably don’t want to make. I’ll boil it down to this: This is not what people were asking for.”

In response to such questions, Vijaya Gadde, Twitter’s head of legal, policy, and trust and safety teams, said the company is still ironing out the specifics of the ban before it goes into effect in mid-November. Twitter’s current definition of affected ads includes those that refer to an election or candidate, Gadde tweeted Wednesday, and “Ads that advocate for or against legislative issues of national importance (such as: climate change, healthcare, immigration, national security, taxes).”

“There's no doubt this decision will also have implications that we don't like,” Gadde added, “but on balance, we felt it was the right choice for us.”

If the month since Facebook’s announcement has been any indication, the result will likely be confusing and contradictory enforcement by Twitter. As one Democratic strategist put it, the company’s early definitions for political and issue ads have “massive, hilarious loopholes.”

Those could become even more apparent with politically active companies. “Nike made Colin Kaepernick the center of their ads,” said Tim Cameron, co-founder of FlexPoint Media and formerly the National Republican Senatorial Committee’s digital guru. “If Twitter decides to air those ads, what about a police union that wants to counter them? It’s such a gray line because, at the end of the day, everything is politics.”

There is another option that Twitter and Facebook have both avoided — and which could require regulation. In an interview with the Columbia Journalism Review this week, Alex Stamos, formerly the chief security officer at Facebook, argued that tech companies should limit how precisely advertisers can target small audiences. That also happens to be the core trick of their businesses.

“Politicians lie all the time,” he said. “What we want is for them to tell the same lies to everybody, instead of being able to hit 50 people at a time.”

Cover: In this Sept. 5, 2018, file photo Twitter CEO Jack Dorsey testifies before the House Energy and Commerce Committee in Washington. (AP Photo/Jose Luis Magana, File)



from VICE https://ift.tt/334ryK0
via cheap web hosting