Naked Medicine

My father-in-law is in his 70s and still smokes every day. He’s tried to quit before, but in the recent years has decided that he was old enough to live his life however he wanted, and that included smoking. Nevermind the fact that he has had a quadruple bypass operation for his clogged arteries (and other coronary operations), is on polypharmacy, leads a sedentary lifestyle, and has been nagged by his doctors and us about quitting smoking for years.

I know that many doctors – especially internists and general practitioners/family doctors – often encourage their smoking patients to quit smoking, citing the harms of smoking and the benefits of not smoking relative to the patient’s capacity to heal. Even those of us who do not practice medicine but work in the healthcare field know that smoking wreaks havoc on a variety of bodily functions right down to the molecular level.

Earlier this year, three Greek researchers published a study on why smokers quit or don’t quit smoking in Harm Reduction Journal (source: Harm Reduction Journal, March 29, 2006, 3:13 doi:10.1186/1477-7517-3-13). What they found may give some insight not just to medical doctors with an interest to helping their patients quit smoking, but for those of us with a personal interest to help either our loved ones or ourselves to quit smoking.

A popular assumption many doctors have about smokers quitting smoking is to introduce cognitive dissonance – an emotional state of mind where two beliefs are in conflict with each other. A person experiencing cognitive dissonance will move to resolve that conflict of belief. If a smoker believes that smoking is harmful to one’s health yet continues to smoke, the smoker experiences this contradiction and would move to resolve that contradiction. One would assume that the smoker would then stop smoking – right?

I doubt that smokers would deny the harmful effects of smoking. We can see from what’s happening in society that this is not the case – people still smoke even when they’ve been exposed to anti-smoking campaigns, nagging from friends and loved ones (I admit, I am one of those annoying people who remind their friends that smoking is bad for them), and shock-and-awe pictures of lungs blackened by chronic smoking.

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Dr. Sheldon Cohen‘s keynote presentation at the 8th International Congress of Behavioral Medicine was published in International Journal of Behavioral Medicine (2005 Vol 12 No 3, 123-131).

Cohen summarized 20 years of research on psychosocial influences on infection susceptibility.

Cohen also debunks these pervasive myths of stress and disease:

• Myth: Infectious disease-causing agents is wholly responsible for causing infectious disease.
• Myth: Stress suppresses the immune system, which makes us susceptible to infections and disease.
• Myth: Stress overstimulates cortisol production, which leads to susceptibility to disease.

According to Cohen’s article, infectious disease-causing agents are not sufficient causative agents for disease. Our immune system’s modulating responses against viruses in our body determine whether we become infected.

We would also assume that health-related behaviors like smoking, alcohol consumption, sleep, exercise, and diet contributed to disease susceptibility. Cohen has observed that these behaviors were independent of susceptibility to the common cold across five different strains of viruses (including 3 rhinovirus types).

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This past week’s Sunday “Post Secrets” had a postcard that said, “I don’t care what you said, I still think RLS IS BULLSHIT” sent on a postcard made from a Mirapex (prescription drug for restless leg syndrome or RLS) ad. This generated a flurry of comments in the Post Secret discussion forum, where people talked about experiencing RLS or witnessing a loved one who suffers from RLS.

Hence is the dilemma for direct to consumer advertising by drug companies.

On the one hand, there is a grain of truth in the ethics of drug companies to mass market to consumers a condition that affects a very small percentage of the population. One wonders why a drug company would choose huge media outlets like magazines and television to talk about a drug for a condition a very small percentage of the population suffers from. Would this create false diagnoses? Foster hypochondrias in those who do not actually suffer from the condition, but have become suggestive to think they do based on what little they know about the condition in a 30 second TV commercial?

On the other hand, those who do suffer from the rare condition can feel a sense of relief that they were not alone or “crazy”, that the condition is indeed a medical one requiring medical intervention, and that there is medical help. Even if drug companies try to educate doctors on a rare condition, doctors may not always have time to do a detailed workup and uncover the condition unless the patient proactively offers this information.

As cynical as I am of DTC advertising by drug companies, I still choose having the information out there than not having the information available at all.

Dr. Hsien-Hsien Lei posted an interesting poll on her blog, Eye on DNA: “Would you sell your DNA?” (right column) based on a company that is literally offering people $5000 for their DNA.

As of today, 67 votes were tabulated and it appears that people tend to be a bit possessive of their own DNA, as 34% voted “No way, my DNA is mine and mine alone.” The next group at 24% said that they would sell it for the right price, followed by the altruistic bunch at 18% who said they would freely give away their DNA. 12% additional percent who are willing to give away their DNA has a more practical approach: “DNA is easy to synthesize anyway”.

I’d like to meet the person who is willing to trade her DNA for breast implants. I’m assuming that the person is a “she”, but with cosmetic surgery on the rise for men, you never know if a man would happily opt for a surgically sculpted 6-pack in exchange for his double helices.

Giving my DNA away freely gives me pause. On a practical level, I see freely distributing your DNA as almost the same as publicly posting your social security number, driver’s license, phone number(s), and home address. You never know who ends up with this information. We’re so worried about identity theft these days, who knows what can be done with our biological identities if these fall into the wrong hands?

I voted to sell it for the “right” price, and no, I haven’t considered how much “right” would be. But it won’t be just for $5000, although the company does state, “If your sample is used to generate a replacement organ that we sell, you will also receive a portion of the proceeds.” I’d want to see clauses and contingencies that ensure residual royalties should my DNA miraculously contains an answer to some interesting scientific question (aside from my being a strange specimen to begin with, but that’s beyond this blog!) beyond the current scope of “use”. I don’t have a fierce personal attachment to my DNA and I’d gladly consider a win-win, mutually beneficial arrangement. Having a business transaction ensures that there will be a formal paper trail associated with the process, and safeguards preferably would be in place to prevent fraud and abuse.

So would you sell your DNA?

The FDA has just approved changes to product labeling for popular “lifestyle” drugs Viagra, Cialis, and Levitra. These drugs are meant to treat erectile dysfunction or ED, and my calling them “lifestyle” drugs will trigger the ire of pharma companies, but let’s face it, these types of drugs don’t become blockbuster for no reason.

If you didn’t know, Viagra was born of research on a compound originally intended to treat heart disease. Who knew that the interesting side effect of the compound would create such a media sensation? (not to mention all the lame jokes and commercials accompanying these medications)

The FDA began investigating the potential link between Viagra and similar drugs with hearing loss after reading a case report published in April 2007 in the Journal of Laryngology & Otology. The agency found 29 post-marketing reports of sudden hearing loss in one ear for patients taking Viagra and similar compounds. Now, the FDA wants the drug makers to warn consumers taking ED drugs about the risk of sudden hearing loss after “a very small number of patients” reported sudden hearing loss, sometimes with ringing in the ears and dizziness. Patients who experience sudden hearing loss are advised to stop taking the drug immediately and get medical help.

Given the number of prescriptions that have been dispensed for Viagra and family, 29 reports of sudden hearing loss really isn’t a “big” number. However, let’s take this in the context of the current media attention on children’s cough medication calling to be banned because of less than 60 total deaths over the span of more than 35 years (1969-2006). Even if infant deaths due to cough mixture were attributed to inappropriate dosing, 29 drug-related adverse events of anything these days may be too many to be ignored.