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Wellness in the Headlines
(Don's Report to the World)
Ethics In Action
Everyone is ethical. Prisons are packed with ethical occupants, as are law firms, legislatures and so on. When people say they are ethical, most really believe it. They may not be ethical but they think they are. The disconnect between self-image and reality occurs because we all tend to interpret things in our favor. Almost invariably, such resolutions seem genuinely ethical at the time.
To appreciate how this applies to most situations, it might help to summarize a specific health care controversy while noting ethical issues and how they get resolved. An example might be the manner in which large companies advertise to the public and otherwise vie with each other to sell tools for obesity surgery. Easily overlooked is the fact that such services may offer dubious benefits to patients, yet the enterprise is highly profitable. An inherent conflict is thus created, and the benefit of the doubt is not likely to be cast with the choice that offers missed income opportunities.
The situation is that multiple parties (manufacturers, investors and doctors) want to sell gastric bands for elective weight-loss surgery. Is there clear evidence that gastric banding does more good than harm nearly every time, most of the time or occasionally? No. But, there is money to be made and the whole complex of variables is convoluted enough that anyone who stands to profit from the endeavor has a hard time not concluding that it's probably (or clearly!) worth the risk. The fact that the risk and cost are borne by the buyer (patient) is easy enough to overlook, if any time is taken to ponder the question of whether such a course of action is ethically appropriate.
With this thinking, silicone bands are wrapped around the upper stomach of the hopeful gastric band recipient. Thereafter, food intake is restricted and patients lose weight. Success? Ethical? An article in a recent Wall Street Journal investigation by Ronda Rundle ("Competitive Squeeze: Industry Giants Push Obesity Surgery," March 31, 2008; Page A1) makes one wonder. A few problems have been associated with this procedure, including the following:
- The device sometimes moves around after implantation - and thus does not work.
- It wears out quickly.
- Follow-up surgeries are often needed.
- There are risks of infection, causing complications and additional problems, including death.
- Less risky procedures can be as or more effective - and less expensive.
- Many insurance companies won't pay for this procedure. As a result, patients have to bear the $15,000 to $40,000 cost.
In some cases, it could have been worse for those who elected this dubious procedure - without the gastric band option, many might have been talked into the more invasive gastric bypass procedure. Of the nation's 15 million morbidly obese, only one percent have gone for the latter fix, but that's still a lot of hazardous but no doubt profitable procedures. The less drastic gastric banding is popular in Europe and Australia, as well as the US, thanks to heavy advertising targeted directly to consumers.
Banding is now used for diabetes treatments, as well. Advertising claims for banding for any purpose are not affected by FDA rules. The head of the Cleveland Clinic's bariatric program told the WSJ reporter cited above that the ads for the procedure exert a powerful influence on all concerned. No surprise in reading that, given the long history of pharmaceutical advertising exceeding the amount of funds spent on developing new drugs.
In a recent Swiss study, 380 patients who underwent laparoscopic gastric-band surgery over a ten-year period from December 1996 to November 2004 were studied. Those who were older, had poor eating habits and a taste for sweets, in particular, had poor outcomes. Hardly a surprise, but it raises another ethical query -- is it fair to expect that lifestyle changes will follow surgical fixes, and thus prevent the recurrence of the same problems? The Swiss patients usually required more than one procedure to repair the banding. (Source: Norra MacReady, American Society for Bariatric Surgery, "Study Identifies Predictors of Poor Outcomes After Bariatric Surgery," June 15, 2007.)
So, although it seems that "everybody does it," it's not unfair to ask if advertising directly to consumers is ethical. Are most consumers capable of assessing ads for surgical procedures? It's a question that would draw a crowd of diverse consumers and providers, if there were such forums accessible to all for impartial ethical discussions about medical goods and services.
In a commentary at the website JunkFood Science, Sandy Szwarc offers an insight on the ethics of such medical encounters: "If you've been wondering how the actual research on lap bands could differ so much from everything you've been hearing, it might be that salesmen often see the facts differently than scientists."
That's what it all comes to. Ethics. Judging when something is ethical is not so easy or likely to end in decisions at odds with near-term rewards, as suggested I hope in these brief examples.
Be well. Look on the bright and ethical side of life.
Domain: mentalSubdomain: emotional intelligence
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