This Isn’t Fair to Veterans: The President, Spravato and False Hope

Quote from the 1976 movie The Network: “I am mad as hell and I’m not going to take this anymore.”

Here’s the problem. There are lies and there are lies. Some lies are relatively harmless. (You look lovely tonight; New York City is totally safe.) There are other lies that are offensive or misguided. (You are looking fat in that suit; Never visit a city as you might die from all the urbanites.)

Then there are lies that represent lethal ignorance and reflect cold indifference. It is this latter category that was expressed by our President with respect to Spravato, a relatively new nasal spray that offers some promise for some individuals who are depressed and for whom other approaches have failed.

The lie: The President’s remarks made it seem as if we had now solved the problem of Veteran suicides and that the Veteran’s Administration would be buying and then using gobs of this spray to save our suicidal Vets. According to Stars and Stripes in an article dated August 21, 2019, the President used the words “incredible” and tremendously positive” to describe Spravato. Point of accuracy: The President referred to the spray as a stimulant when it is a sedative.

Bottom line, here’s my translation of what the President said: Veterans, fewer of you will die from suicide because of a nasal spray we are getting for your use and at a fair price, all through the VA.

Now, unless that is true, the words of the President are a horribly wrong thing to say. They exaggerate the effect and effectiveness of the drug spray in question. They offer false hope. The President makes it seem as if any Veteran at risk can immediately access this spray and be saved from both depression and suicide.

From the tone and tenor of the remarks, the President makes the spray seem so harmless we should be handing it out to all Veterans and all individuals who are depressed. Hey, let’s just pump the stuff through the air on airplanes and hand it out on campuses where mental illness is on the rise. Gee, all we need is a special nasal spray. Add it to workplaces. Give it away to families following natural disasters. Give it to anyone who experiences a trauma: spray and go so to speak.

But, the Spavato story is not that simple. It is not just a matter of spray and go. It is not a cure-all for all Veterans. The drug has risks. There are protocols for its administration and the testing is far from complete, although the drug’s benefits mean that it authorized for use, risks notwithstanding. If anything, the literature suggests a combination of both hope and caution. Where exactly is the cautionary message in the President’s words? Did I miss that sentence or two?

Without question, this new nasal spray has the potential to help some individuals suffering from intractable depression that has been unresponsive to other treatments. This spray, a derivative of ketamine called esketamine, has the capacity in some patients to lift their depression in the near term (sometimes in hours or days not weeks), unlike most other depression drugs that require “loading.” At this level, the spray seems like a panacea, helping in curbing the plethora of Veteran suicides, which are unacceptable by any measure. And, for depression sufferers, the idea of a fast acting remedy is deeply appealing. Depression, whatever the cause, is debilitating.

But, let’s not oversell Spravato. As a nasal spray, the testing is still in the early stages with relatively small groups of individuals. It must be administered in controlled conditions given the spray’s potential negative effects such as hallucinations and even suicide (the very outcome we are trying to prevent). And, the data are not yet out on the long term consequences of use, the risks of withdrawal and the proper dosing. And, FYI: several individuals committed suicide during one of of the trials while no one in the placebo group died. And, we can’t identify which depressed individuals will get the greatest benefits from the spray; some will and some won’t and we don’t know who is in which group at the get-go.

This is all well-explained in an excellent article in the Atlantic by James Hamblin. https://www.theatlantic.com/health/archive/2019/08/trump-ketamine/596716/

Basically, the President told audiences the following: (1) He had instructed the Veterans Administration to buy a lot of Spravato; and (2) This product has “a tremendously positive, pretty short-term, but nevertheless a positive effect.” (Note the double use of the word positive; we can write that off to poor linguistics.)

I focus much of my time as an educator on student success and I address, in particular, students affected by trauma across the educational landscape. I am not a psychiatrist. But, I have trauma expertise and experience. What the president said totally misrepresents the complexity of both depression and trauma. There is no nose spray that will cure trauma. Trauma is vastly more complex than that and depression is but one symptom of trauma.

If we only focus on nasal spray, we might just not pursue other pathways to deal with both depression and trauma (and they are not the same thing). What about putting some of the monies that the President suggests plunking on Spravato (as one would plunk chips on Number 24 on a Roulette Table and hope for the best) on other possible ways of assisting Veterans facing suicide?

What about some quality suicide alert system with AI capacity that a Veteran can wear and use? What about some therapeudic presence at VA hospital parking lots where Veterans are increasingly going to commit suicide? What about some immediate responsive system that could monitor Veterans when suicide risks become evident, some sort of dashboard that emits alerts to experts? (As a former college President, the idea of an alert that would prevent student suicide has enormous appeal — some way that a system is triggered for at risk students when they exhibit certain behaviors or experience certain bodily changes or drug ingestion?)

I get solving the problem of Veteran suicide. But, it does not rest solely in a nasal spray containing a potentially dangerous, not fully tested drug. I get using the drug in controlled ways when suicide is too imminent and other treatments are failing miserably. But, I do not get false hope. I do not get false promises. I do not get offering non-existent cures.

That’s what charlatans do — they offer hope and cures that don’t work. And, people are disappointed and people are hurt. We need to help our Veterans. But we need to do it with truth and honesty and integrity. Betting on Spravato as a cure-all with the capacity to stop all Veteran suicide is irresponsible. Totally irresponsible. It’s the kind of lie that makes me mad as hell and I can’t take that anymore.