Week4_HumanBodyandMedicine by Dennis Yeh

After reading both versions of the Hippocratic Oath, I have come to the realization that many doctors may face challenges or situations where the Oath may conflict with a doctor’s well-meaning intentions.  Like Captain Barbarossa in Pirates of the Carribean said: “the code is more what you’d call ‘guidelines’ than actual rules.”

As an example of this, consider common and well-advertised cholestorol-lowering drugs such as Lipitor. There have been many tests that show a correlation between high LDL cholesterol levels and fatal heart conditions. LDL’s role in the body is to rebuild artery and tissue walls by building up cholesterol, while HDL’s role is to remove cholesterol from the artery walls.  A diet rich in high LDL content foods has been correlated with higher risk of stroke or heart attack, but these studies are CORRELATIONAL and DO NOT prove causation.  Despite this fact, a majority of the world refers to HDL cholesterol as “good” cholesterol and LDL cholesterol as “bad” cholesterol.  Two years ago, Pfeizer unveiled a new “miracle drug” that was in the final stage of clinical trials after 15 years of testing.  The revolutionary drug, Torcetrapib, which was proven to boost HDL levels while lowering LDL levels.  However, the body depends on an equal balance of both HDL and LDL in order to survive.  By causing such an imbalance between the two types of cholesterol, many test subjects suffered holes in their arteries, supposedly due to high levels of HDL eating away at tissues and arteries.  In 2006, the drug was abandoned completely, due to a 60% increase in deaths observed among patients taking Torcetrapib and Atorvastatin versus taking Atorvastatin alone.  However, it wasn’t until independent safety monitors discovered the unexpectedly high number of deaths with its use that Pfizer decided to drop the clinical trials.  In fact, just three days before they announced the discontinuation of the drug, Pfizer’s chief executive Jeff Kindler was quoted saying “This will be one of the most important compounds of our generation.” Why did Pfizer take so long to discontinue studies on Torcetrapib?  Were they trying to protect the $800 million they had invested in the drug?  My question is, how is this event governed by the Hippocratic Oath?  Pharmacists are not doctors, they never deal with patients face-to-face, but are simply responsible for experimenting with different concoctions until they find something marketable and profitable.  However, the pharmaceuticals they create have very serious and real consequences.  Should pharmacists and their companies  be forced to take the Oath and consider the potential for their creations seriously injure or kill patients?

These days, it seems like doctors and pharmaceutical companies are more interested in profits than ethics and morals. In this day and age, it seems like more and more cases of doping in sports with HGH and anabolic steroids appear in the news every year, despite common knowledge of the dangerous side effects, such as testicular atrophy and ” ‘roid rage.”

Harrison attacking Francisco during Superbowl XLIII, 2/1/09.
A case of unfriendly competition, or ‘roid rage?

In addition to these examples, one must also consider where medical science will be in the future.  Some modern innovations such as stem-cell research seems to be in a grey area with regards to the Hippocratic Oath.  Stem-cells seem to have many legitimate applications, and may be able to prevent many fatal diseases.  In this regard, it falls under “I will prevent disease whenever I can, for prevention is preferable to cure.” in the modern Hippocratic Oath.  However, with the idea of synthesizing organs and cloning tissue, stem-cells also fall under “Above all, I must not play at God.” With contradictions such as these, it is obvious that the Hippocratic Oath is outdated in some respects, and needs updating.  Just as how the founding fathers of America never anticipated several facets of the American Government (such as the creation of political parties, which some of the founding fathers opposed because they felt it would divide the country), it is impossible to account for all of the other possibilities and scientific achievements in the future.  Rather, I feel that we should treat the Hippocratic Oath as a limited set of guidelines with a domain over the “classical” practice of medicine, until it can be revised or “amended” like the Constitution.

-Dennis Yeh

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