Many people, including some doctors, believe that medical knowledge, drugs, and other technology should be used only for the amelioration or prevention of disease. This is also the position of the Food and Drug Administration (FDA). Medically improving the normal human condition is anathema to these people—a good example is the attitude that many doctors had toward plastic surgery when it first became available. New drugs (or new applications for old drugs) that are available to many of us will widen this already serious schism in medical philosophy. These include extant drugs that increase normal human intelligence, slow aging processes, enhance sex and other sensory experiences, and give us greater control over our body weight and emotional states, to give just a few examples.
Nothing is perfectly safe. This means that we must assess the possible benefits and risks of the use of any substance, whether synthetic or natural, drug or nutrient. Risks include discomfort or even physiological damage from side effects, time and money invested, and forgone opportunities. In some people, for example, vitamin E use will initially produce a temporary rise in blood pressure, which could be hazardous for some heart disease patients.
Some doctors think that they should decide for you what level of risk is acceptable to you for a particular benefit. This is the source of a controversy that extends far beyond the medical sphere. In this column, we write about scientific reports on drugs and nutrients we use and describe our experiences with them, but just because we have found a particular benefit/risk ratio acceptable does not mean that you will. The optimal doses for us will differ from yours. You must make an assessment based upon your own values and physiology.
It is not possible in a short column to include a comprehensive description of all possible risks that may be associated with a particular drug or nutrient. Whole books have been written on the subject. No one should embark upon a course of taking substances without investigating carefully, preferably by referring to primary scientific literature. The Physician's Desk Reference is very useful (and was recently the third-best-selling hardback book in the country). It is important to have regular clinical laboratory tests for basic functions, such as those of blood, liver, and kidneys. You should consult with your physician (if you're not satisfied with yours, get another), who can order tests and prescribe drugs.
In medicine today there is a large gray area of illicit (not FDA-licensed) but not illegal technology. A good example is that of the gout medicine Anturane®, which was recently found in a human clinical trial to reduce by 74 percent the risk in males of death from a second or subsequent heart attack. The FDA has not approved Anturane® for this purpose, yet prescription drug usage surveys have shown that over 90 percent of new prescriptions written for Anturane® are for heart patients, not for gout victims.
It is perfectly legal for a doctor to prescribe a drug (except for "controlled substances," such as amphetamines and narcotics) for any purpose he chooses, whether or not the drug is approved by the FDA for that purpose. Since the FDA approves drugs only for the prevention or treatment of specific diseases, finding a doctor who will prescribe drugs for nonapproved uses is very helpful to anyone wishing to experiment with approved drugs that may have wider utility than supposed by the FDA or that may even improve a normal human function.
We now see offered a wide range of nutrients in health food and vitamin stores. The public buys an immense number of health-oriented books and periodicals that purport to advise them on the use of these substances. Much of the advice found in popular books and magazines is incorrect. The point we want to make here, however, is that it is possible to sell nutrients without even making claims for them because books are making such strong claims for some of them. Although the Proxmire vitamin bill of the early 1970s prevents the FDA from regulating the sale of nutrients (unless they can prove them to be hazardous), including vitamins A and D, the FDA still prohibits purveyors from making health claims on the label. As we have all seen, many small firms are making claims for their nutrient products in advertising (other than the label) and are becoming ever more bold in doing so.
Even unapproved substances such as thymosin (a thymus hormone showing great promise as an anticancer drug, as well as being a powerful immune-system stimulant) may be legally manufactured and sold intrastate. When people catch on to this, there will be even more freedom of choice in the medical marketplace.
Medical organizations are changing, too. The American Medical Association once claimed to represent essentially all American doctors, with about 90 percent joining. A majority of new doctors now choose not to join the AMA. Where the medical profession once spoke with nearly a single voice, that is no longer true.
Medical philosophy used to be a monopoly of doctors and regulators who were able to impose their values on everybody else at the point of a policeman's gun. This is changing. The availability of more and more options in medicine—not just for the prevention and cure of disease, but for the improvement of normal human function—means that personal medical decisions will become ever more frequent and complex. The key to evaluating these opportunities rationally is good information, particularly primary scientific literature, and inexpensive literature searches, such as MEDLARS, offered by many large medical school and university life-science libraries.
In the final analysis, the central moral and philosophical question is freedom of choice. Do you choose your own combination of risks and benefits based on personal values, or does some authority choose for you and enforce that choice with the apparatus of police, courts, guns, and prisons? Whose life is it, anyway?
Sandy Shaw and Durk Pearson are consulting scientists and authors. A list of scientific literature on this topic is available through REASON. Send a stamped, self-addressed envelope and ask for H&W references, May. Copyright © 1982 by Sandy Shaw and Durk Pearson.
This article originally appeared in print under the headline "Health & Welfare: Conflicting Medical Worldviews".