Medical ethicist Art Caplan joined Boston Public Radio for his regular Wednesday segment. Each week, Caplan tackles ethical questions surrounding medical issues. On Wednesday, Caplan talked about the rationale behind prescribing drugs for the elderly, the role "bad luck" may play in the likelihood of getting cancer, reality TV in the E.R., and sledding bans.
Caplan said prescribing drugs for the elderly is a very delicate enterprise for doctors. Often, older patients are prescribed multiple drugs, each of which may have contraindications.
"It even has a name: we call it 'poly-pharmacy,'" Caplan said. "They do interact, and one of the reasons we have pharmacists (...) is to watch for interactions on the other side."
Caplan said doctors and pharmacists provide natural counterbalance — pharmacists check over the prescriptions for red flags. "You can't just get a pill from a particular doctor," Caplan said. In the elderly, prescription vigilance is especially important. Doctors may try different combinations before finding one to deal with the medical issue.
One disease that requires many different medications — cancer — was back in the news last week when Johns Hopkins researchers attributed up to two-thirds of cancer cases as simply "bad luck."
Caplan said the study was successful in illuminating the tenacious mechanism by which cancer spreads.
"Cancer is related to cell divisions, and (...) our cells are dividing over time," Caplan said. "Eventually, a mutation may occur in a dividing cell, and that becomes cancerous."
Lifestyle still plays a large role in cancer determination. "There's still a third of it that's still linked up to things like smoking," Caplan said. "I don't think I'd take up tobacco-chewing tomorrow morning." Obesity has also been linked to certain forms of the disease. Ultimately, age may be the biggest determinant.
"Old age is certainly a factor in cancer," Caplan said. "Most people, if they live long enough, they're going to get cancer." Caplan joked "insufficient kale ingestion" wasn't a likely indicator.
Recently, The New York Times chronicled the case of Anita Chanko, a woman who tuned in to ABC's reality-TV show, NY Med, and realized her late husband, Mark, was part of the show. Mark had been hit by a sanitation truck in Manhattan, and died in the emergency room where the show was being filmed. Anita Chanko heard her husband's last words on live television.
"This is just ethically inexcusable. You have people taping in E.R.s, and yeah, they blurred out the face (...) but they played the voice," Caplan said. "I mean, really? This [is] voyeurism, and we feed it when we watch it."
Caplan said media outlets have approached him about a similar arrangement, and he was unequivocal. "I say, 'What are you, nuts?'"
Caplan cited celebrity drug rehab shows as being equally egregious. "Why are we on TV talking about their drug habits?" Caplan asked. "It makes your hospital famous. None of that makes any difference! It's all unethical."
Sometimes residents at teaching hospitals are brought in to watch and in some cases perform the same kinds of duties as doctors. Caplan said having doctors-in-training observe is different from having television cameras in hospitals. It can also be advantageous. "You do have the right to say no," Caplan said. "I probably wouldn't say no, because the more people that come around, [looking in on you], it sort of gets you an extra level of care."
Finally, Caplan was skeptical about cities like Dubuque, Iowa that have banned sledding in some city-owned spaces. "You probably should ban pony rides because I've seen people" get hurt, he said. "I think this is just looniness to start getting into. I mean, you certainly couldn't have a playground if you're going to have liability drive what's going on."
But what about protecting kids?
"If you're a parent, and you're worried about this, then it's on you to put a helmet on the kid," Caplan said.
