Medicine in the Service of Vanity

Steroids, Nose Jobs, and other Freaks and Abominations
Part 1

The entire country is up in arms over the use of performance-enhancing drugs in sports. I am not sure why. If you know why, then comment here. It seems, once again that we are living in an amazing world of media hypocrisy.

Don't get me wrong. I don't like the use of steroids, EPO, growth hormone, and other juices in my beloved baseball but ever since the devil incarnate - Walter O'Malley - took the greatest team in the history of baseball, the Brooklyn Dodgers, out of Brooklyn and brought them to the Plastic City on the West Coast (Los Angeles), I knew that baseball was just an entertainment business.

There are two questions we need to think about:

1. Are sports the only business that uses pharmaceutical or traditional medicine techniques to enhance performance?
2. When do we accept performance enhancement and when do we not?

In sports we are using drugs. In the entertainment industry we are using plastic surgery - another performance-enhancing use of medicine. In professional wrestling we encourage and expect the use of steroids. The same is true for professional body-building.

We extend resource after resource to help Olympic athletes in the national training center in Colorado Springs to run one-hundredth of a second faster when we can't even get pediatric immunizations to children in the ghettos of this rich land.

Let's review a bit where medicine came from and how far we have strayed.

There are many oaths in medicine. Every physician took one or another. Why have we fallen so far from this grace?

Here is a review of the major oaths:

• Oath of Hippocrates
• Physician's Oath
• The Loma Linda University Physician's Oath
• The Oath of Amatus
• The Physician's Oath and Prayer of Maimonides

Let's pull out a few choice tidbits from each:

Oath of Hippocrates:
I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked...

Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret

Physicians' Oath:
The World Medical Association, Declaration of Geneva (1948). Adopted by the General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968.

I solemnly pledge myself to consecrate my life to the service of humanity;

I will practice my profession with conscience and dignity; the health of my patient will be my first consideration;

Loma Linda University Physician's Oath
The wholeness of my patient will be my first consideration.

I will maintain the utmost respect for human life. I will not use my medical knowledge contrary to the laws of humanity. I will respect the rights and decision of my patients.

I will hold in confidence all secrets committed to my keeping in the practice of my calling.

I will lead my life and practice my art with purity, and honor; abstaining from immorality myself, I will not lead others into moral wrong doing.

The Oath of Amatus
by Amatus Lusitanus (1511-1568)
I never in my medical practice departed from what has been handed down in good faith to us and posterity; that I have never practiced deception, I have never overstated or made changes for the sake of gain, that I have ever striven that benefit might accrue to mankind

I have never produced disease. I have favored no druggist unless he excelled others in skill in his art and in character. In prescribing drugs I have exercised moderation guided by the physical condition of the invalid.

The Physician's Oath and Prayer of Maimonides
May I never see in the patient anything but a fellow creature in pain.
Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill.

Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures.

May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.

Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of of ficious relatives and know-all nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.

I want you all to spend a bit of time absorbing all that these say and then let's explore why in the world we allow Team Physicians of professional sports teams to look the other way when it is obvious the players are taking a variety of medicines that will increase their performance in the short-term but shorten their lives in the long-term.

Why do we allow people who went to medical school call themselves Plastic Surgeons when they are taking knives to people's faces in the name of pure vanity?

Why should we care at all? Why don't we just let people do whatever they want to their bodies for whatever end? Maybe it is because these people - the athletes and the actors are pawns in the lives of the billionaire moguls that profit from these entertainment industries.

We are so outraged with public health issues like second-hand smoke but turn the other way when medicine itself is used for non-medicinal purposes.

Dr. K.

Related Topics: FDA: Halt Unapproved Steroid Drugs, Anabolic Steroids

Technorati Tags: steroids, doping, performance enhancing drugs, cosmetic surgery

Pharmas Try to Do Something RIght

...after trying to rip us off first...

In the NY Times Business Day section there was an interesting article.

"Heart Pill To Be Sold By Itself"

Here is the story in a nutshell:

1. One of the big pharmas developed a new drug called torcetrapib
2. This drug increases good cholesterol (HDL)
3. The current heart drugs called statins (Lipitor, Zocor, Crestor) only lower bad cholesterol (LDL)
4. Experts say this new drug that raises good cholesterol could be a great advance
5. Torcetrapib is introduced to the public with the requirement that it must be prescribed in tandem with a statin drug made by the same company.

In my opinion, this is a terrible ethical error. It is bad to attach an important drug to a different class of drugs for a few reasons: a) not all patients need the drug you are attaching it to, b) some patients may have serious side effects to the drug you are attaching it to c) some patients may have had better responses to competitors' products than the drug you are attaching it to.

The outcome:

• Said pharmaceutical company gets its proverbial butt whooped in the medical and legal community
• Questions about antitrust issues arise
• Cardiologists complained
• The prestigious New England Journal of Medicine criticized their strategy in a long and prominent article.
• Pharma bows to the criticism and changes its strategy.

The article starts with an interview of their top scientist, who defended the combo strategy (pre-criticism). He spouts off an excuse about needing to check the new drug with every statin-type drug to make it safe. Boy is that stupid. Why doesn't he say you need to test it with every freakin' happy meal from McDonald's? It's about the same -- might as well expose yourself immediately.

The article then quotes their President of Worldwide Development who confirms they have changed their strategy (post-criticism). Is this because their top scientist is a yo-yo head? No. This genius is quoted as saying "We didn't appreciate how this would be perceived." What the heck does that mean?

I will tell you what it means. It means that they tried to fool the American medical community but they did not think they would get caught. They did not "appreciate" how their irresponsible behavior would be "perceived." Did they expect a medal for trying to pull the wool over our eyes? I'll bake them a cake this week.

Two doctors quoted in the article seem commend the company for their strategy change action. The heck with that. You don't get credit when you do the obvious correct thing. You are just supposed to do it.

One doctor, who is doing a clinical study for them "lauded" them for its decision and said "[This company] is ALLOWING physicians to make intelligent choices for patients." Well excuuuuuuuse me. I thought doctors made intelligent choices for their patients for high level reasons and not because pharmaceutical companies ALLOWED them to.

I am sure we have our ethical priorities on ass-backward if we think pharmas ALLOW physicians to do anything. Physicians write for their drugs. Last year this particular pharma had sales of $51 billion dollars. I guess that using the same logic, they ALLOWED physicians to make them a gazillion dollars.

Listen, here is the bottom line. They are making a drug that may work. It may be the best thing since the invention of the PEZ dispenser. They tried to squeeze out more profits at the expense of patient health.

They got caught. Let me repeat that for the ethically challenged -- THEY GOT CAUGHT. They were forced to change. They changed. You don't get lauded for that. You should be smart enough to know right from wrong in the first place. Next time get your act together Pfizer and do the right thing from the start.

Parenthetically, I am personally on their statin drug. Next presciption I am changing to another statin. Now that I am ALLOWED to make intelligent choices this will be my first one.

Dr. K.

Related Topics: Panel: FDA Needs Drug Safety Reforms, Brand Rx Prices Rise Another 6.3%

Technorati Tags: torcetrapib, cholesterol, prescription drugs