Top Healthcare Conversations of 2008

Many of the great healthcare thinkers and bloggers wrapped up 2008 with end-of-year considerations of the important developments in their fields, and some looked ahead with predictions for 2009.

The “Ashley Treatment”: Hard Choices for Life Enhancement

Life enhancement innovations like cosmetic neurology, 20-15 LASIK, non-therapeutic abortion, body modification and other elective surgeries are an inevitable part of medical care in a free society. Enhancing the life of your child should be included in that list.

Enhancement Amok: Barry Bonds’ Choices

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The notion that the patient knows what’s good for him gets kicked in the head with the chilling story of baseball’s Barry Bonds and his long-time affair with drugs to improve his game. A Sports Illustrated  excerpt from the new book Game of Shadows by Mark Fainaru-Wada and
Lance Williams (see video interview) describes the Bonds regimen and the coterie of semi-medical experts pushing him drugs:

In addition to growth hormone and testosterone, doping calendars showed
that Bonds used insulin along with steroids; the drug’s anabolic effect
was significant, especially when used in conjunction with growth
hormone. He also popped Mexican beans, fast-acting steroids thought to
clear the user’s system within a few days. The label of the container
read, "Andriol. Undecanoato de testosterone" — in English:
testosterone decanoate. Early in the 2001 season, the calendars
indicated Bonds tried trenbolone, a steroid created to improve the
muscle quality of beef cattle. Within the year it would be the chemical
foundation for a new formulation of the Clear, the undetectable steroid
Conte obtained from an Illinois chemist, Patrick Arnold.

The SI.com web package presents the issue from all angles, describing how athletes and their facilitators lied, cheated and broke the law while chasing record book glory, fan acclaim and multi-million dollar paychecks.

Cosmetic Neurology: “Are Better Brains Better?”

Anjanchatterjee_1If you could take a pill to run faster or jump higher, would you?  How about a drug to keep you sharp when you’re up all night? Or a treatment to make you feel happier or deal with a bad memory? Of course, we have all that now, but steroids. blood doping, amphetamines, cocaine, whiskey and anti-depressants are illegal, expensive or tightly controlled, mostly because of nasty side effects like fatal addiction.

University of Pennsylvania neuroscientist Anjan Chatterjee (at right) wrote a paper last year for Neurology titled Cosmetic neurology: The controversy over enhancing movement, mentation, and mood.  [PDF]

Chatterjee describes how medicines created to cure neurological disease might someday be applied to neurological enhancements. "Are better brains better?" he asks, and discusses the possibilities for medically improving things like movement, memory, attention and mood. "Would you give your child a medication with minimal side effects half an hour before piano lessons if it meant that they learned to play more expertly? … Would you take a medicine that selectively dampened memories that are deeply disturbing? Slightly disturbing?"

And if we could, does that mean we should? (Doesn’t it really mean we will?) The Chatterjee paper contains an excellent discussion of inevitability, ethics, justice and the role of the physician as cognitive science, but it seems to me that "elective neurology" might be a more accurate term.

LASIK’s Unfair Advantage?

Tigercover_1Slate’s William Saletan recently asked the question "If steroids are cheating, why isn’t LASIK?"  Performance-enhancing drugs are generally viewed as unsportsmanlike, and last Spring’s Congressional inflammation on baseball’s use of steroids was notable for its posturing and zero-tolerance attitudes. But Saletan reports on athletes like Tiger Woods who get laser eye surgery that gives them better than 20/20 vision; Woods ended up with 20/15, meaning he can see at a distance of 20 feet what someone with normal vision sees at 16 feet, an obvious advantage on the course. Saletan notes that after LASIK, Tiger "won seven of his next 10 events."

Testimonials and videos on the LASIK.com web site describe how pro athletes improved their scores and standings once they were LASIK-enhanced, and the pitch to amateur athletes to be just like their heroes is explicit. Like Direct-to-Consumer pharma marketing, like Medical Tourism, like Viagra et al., innovations in marketing and medicine keep ratcheting up consumer expectations of health and well-being.