Innerstate is a 2007 documentary film that chronicles the "inner states" of three adults living with chronic diseases of the immune system: psoriasis, Crohn's disease, and rheumatoid arthritis. The film was produced and directed by Chris Valentino and is notable for being entirely funded by Centocor Inc., a biomedicines company. According to the New York Times, the film is "an unusual form of soft-pedal marketing of a blockbuster drug, Remicade". Remicade (Infliximab) is a pharmaceutical used to treat auto-immune diseases made by Centocor, a unit of Johnson & Johnson.
The New York Times hypothesized that Innerstate was probably the first film to be both originated by and entirely funded by a drug company, although previously drug companies had helped fund other documentaries on diseases. Despite this, the film does not mention Centocor or Remicade. Not mentioning the drug means it does not have to conform to strict U.S. Food and Drug Administration (FDA) regulations that require detailed explanation of the health risks of therapies.
Innerstate follows the journeys of three very different adults on similar paths. The subjects are Jason, diagnosed with psoriasis, Janie, diagnosed with rheumatoid arthritis, and Ray, diagnosed with Crohn's disease, all diseases of the immune system, which may be characterized by immune deregulation, chronic inflammation and tissue damage. In total, they affect millions of people worldwide, while also having a profound impact on their families, friends and loved ones.
The film opens with a long shot of a suburban highway, giving the viewer the distinct feeling of taking a road trip or journey. Through the film's progression, first-hand accounts are intertwined to show how Jason, Janie and Ray, people with different illnesses and from different backgrounds, share an important bond with each other. Each has a unique story to tell, but their "inner states" are similar in that they found the strength to keep striving for their dreams by staying focused on overcoming their conditions.
About the subjects:
Each subject is introduced individually, their stories of diagnosis, treatment and living their dreams, told first-person as well as by friends, family and physicians, are intertwined throughout the film. Although the film was funded by a pharmaceutical company, the participants were not paid.
Jason Knott is a Texan man with psoriasis. Jason is introduced first. Since the age of six, Jason struggled with what appeared to be a skin disease. The first signs appeared in the form of a sore on his leg from a new pair of cowboy boots his parents had given him. Rather than healing like healthy skin, the sore evolved into a scaly skin "plaque." Within months, nearly 80 percent of Jason's body was covered in red, itchy, sometimes painful lesions on his scalp, face, legs, arms and torso.
Jason's parents took him to multiple doctors in search of an accurate diagnosis and effective treatment until finally dermatologist Dr. Alan Menter diagnosed Jason with severe psoriasis. Initially, his parents were relieved because they believed their son's condition could be controlled. He spent his elementary school summer breaks enduring a lengthy, rigorous daily treatment regimen in which he was covered in a tar substance for five to six hours, then immersed in a medicated bath, exposed to UVB light, then covered in an additional topical treatment and finally, wrapped in plastic. Unfortunately, even the most radical therapies available at the time did not control Jason's psoriasis.
Though Jason experienced many emotionally dark moments, throughout his childhood and adolescence, his parents, friends and Dr. Menter helped him learn to live with the physical symptoms of itching, cracking and bleeding as well as the emotional symptoms of frustration, isolation and depression. Throughout his adult life, Jason would start new treatments only to find that they lost effectiveness over time, or, all too often, failed to work at all. Without the support of his family and friends, Jason would have lost all hope.
Ray Ciccarelli is a former NASCAR driver from Maryland with Crohn's Disease. Growing up in Maryland, Ray and his older brother Dion dreamed of racing cars. Today, Dion is a rising star in the NASCAR Grand National Division, while Ray's racing career is finally back on track after his dreams were derailed by the devastating symptoms of a disease.
Ray first experienced painful abdominal cramps and persistent diarrhea in 2001. His doctors attributed his symptoms to a poor diet and recommended a healthier lifestyle. Despite his best efforts to adjust, Ray knew things were getting much worse. In May 2002, instead of watching his brother compete in a NASCAR race at Dover International Speedway, Ray spent the entire weekend inside his home, unable to move due to debilitating stomach pains and constant diarrhea.
Ray's symptoms persisted and became so severe that he lost 110 pounds in just four months. Fatigue and joint pain compounded his digestive complications forcing him to put his racing career on hold. His family began to suffer as well, as he could not work, race or fulfill his duties as a father to his two sons. Soon Ray had to avoid the simplest of everyday tasks out of fear of urgently needing to use the restroom.
After months of suffering, Ray's mother urged him to go to the hospital, where he was finally diagnosed with Crohn's disease. His gastroenterologist prescribed pills to control his condition during flare-ups, but Ray still struggled with the debilitating symptoms of his condition and the 22 pills that he needed to take each day.
Along with the severe physical problems, Ray's illness exacted an emotional toll. Once happy, outgoing and social, Ray became increasingly withdrawn as his symptoms worsened. He also became completely debilitated and had to rely on family members for even his most basic tasks. The film shows how Ray has been able to not only get his racing career back on track, but most importantly, how he is able to spend more time with his family and be the father he has always hoped to be.
Janie Feliz is a singer from Texas with rheumatoid arthritis. Janie has overcome more challenges in her 21 years than most people twice her age. In a short time after her diagnosis with rheumatoid arthritis (RA), the joints in Janie's feet, knees, hands and wrists grew inflamed and swollen, resulting in extreme pain and debilitation. The slightest of changes in her environment, bumps in the road or air rushing out of a vent, sent shooting pains through her body.
Always ambitious, optimistic and eager to succeed, Janie focused her attention not on her disability but on her true passion--singing. While singing opened new doors for her, many aspects of Janie's life remained limited due to her RA. During the next five years, Janie tried several medications to control her symptoms. Early in her treatment, her doctors prescribed prednisone, a steroid used to reduce inflammation in her joints. While the treatment temporarily relieved some of her pain and swelling, her symptoms persisted and the side effects of the medicine caused her physical and emotional hardship.
Despite her struggles with RA, Janie put her heart and soul into music, recording albums and performing in concerts in her hometown of Dallas, Texas, and other cities across the country. At one concert in Minneapolis, Minnesota, Janie's pain was so great her father brought her to the stage in a wheelchair. Determined to perform, Janie stood and gave an electric performance and after leaving the stage, Janie collapsed into the wheelchair, too tired and weak to continue standing.
Today, Janie is celebrating the release of her third album and she continues to write music with hopes of moving to Nashville, Tennessee in the near future. INNERSTATE documents how Janie learned about RA and how to manage her disease and how she is now able to pursue her music dreams despite her disease.
The film was promoted through doctors' offices, and then presented through online screenings. There were also 14 theatrical screenings that included live Q&As with doctors.
Innerstate premiered on February 21, 2007, at the Directors Guild of America Theater in New York, NY. Throughout the course of the premiere and local screenings, Innerstate attracted the attention of national and regional media including The New York Times,CNBC, Philadelphia Inquirer, Boston Herald, The Dallas Morning News and the Atlanta Journal Constitution. In addition, the film enjoyed a strong presence in patient blogs and forums as well as on YouTube where thousands have viewed the trailer.
The National Psoriasis Association approved of the film, calling it "a great way to get the word out about the disease" and "fair and balanced". They had previously distributed a film, My Skin's on Fire by Fred Finkelstein, which was part-financed by another pharmaceutical company, Genentech.
As press became aware that the film was supported by Centocor, Inc., initial coverage focused on skepticism surrounding the pharmaceutical industry and whether this documentary might be a veiled attempt at direct-to-consumer advertising. Following the premiere and several screenings in cities throughout the country, the focus of the media coverage shifted to the personal stories of the subjects in the film, as well as the millions of people living with similar chronic diseases.