Introduction
Dorothy Abrahams had colon cancer. She underwent numerous surgeries as well as chemotherapy. There seemed to be not much success because she was still bedridden for the past twelve years. While recovering from the surgery and chemotherapy she developed insomnia and so, aside from painkillers, she needed the help of secobarbital to act as a sleeping pill. When the doctor discovered that there is no medical basis for the insomnia, the physician suspected that the patient is now a full-blown barbiturate addict. He decided to slowly replace secobarbital’s active ingredient with milk sugar so that after a few months Ms. Abrahams was already taking placebos instead of the barbiturate. Surprisingly it was a potent placebo and it was able to help Ms. Abrahams fall asleep and get her much needed rest. Based on the pertinent facts of the case the proponent of this study finds nothing wrong in the continuous prescription of placebo even if the patient is paying $60 per year for a few grams of milk sugar.
Overview
The new pharmacist is between a rock and a hard place. His medical training and all the things that he learned outside the classroom walls, especially the values that he learned at home, prompts him to tell the truth. He is not comfortable hiding that fact that he is selling milk sugar. He is tempted to take the easy way out and justify his actions as the result of merely following orders from his boss. Yet he needed a more ethically acceptable reason why he will continue with the ploy to sell placebos to Ms. Abrahams. The following discourse may help him to understand that he is not deceiving Ms. Abrahams but what they are doing is to help her recover from the dreadful effects of cancer as well as to cure her addiction of barbiturates.
Dorothy Abrahams is dying. At least that is what can be surmised from studying her case. She is suffering from the effects of colon cancer and the only thing that kept her going all these years is a series of surgical operations and chemotherapy. Furthermore, she is bedridden and one can only imagine the added suffering of being unable to move and unable to perform activities that she used to enjoy prior to illness. She is in pain and therefore the doctor prescribed secobarbital a type of barbiturate to help her sleep. But even after the doctor found out that there is no organic explanation for Ms. Abraham’s insomnia, the patient was still requesting the secobarbital.
The only thing that can give her the rest that she craved for is the said barbiturate. The only thing that can give her the much-needed respite, from a life without joy and satisfaction, is the highly effective narcotic. Based on the information given it can be assumed that the doctor is well aware of the placebo effect which can be loosely understood as mind over matter or simply the concept that what the mind can conceive the body can achieve. The doctor decided to gradually add milk sugar into the potent mix of barbiturates – the said drug that was supposed to have cured Ms. Abrahams of insomnia. He kept on adding until the concoction is more milk sugar than potent secobarbital.
Analysis
The new pharmacist was in a moral quandary but he need not be troubled because the pharmacy was doing the right thing in selling placebos to the said patient. They are not deceiving her and in fact they are helping to improve her quality of life after surviving colon cancer. This can be further understood by taking a closer look at the actual nature of Western medicine as well as the main goal of the medical profession.
The goal of the medical profession is wellness and to assist patients to recover from illness. When a person is happy and healthy the doctor is still an integral part of life because they are supposed to prevent sickness and diseases from occurring. There is therefore a reason for the regular checkups. When approaching a certain age there it is imperative to undergo tests to detect early signs of breast cancer. For men far advanced in years, it is time to consult specialists dealing with prostate cancer.
But more often than not, doctor-patient relationships occur in times of sickness. For many, this is the only time in their lives when they will go to a physician. Once the initial meeting between doctor and patient had already taken place, it is the responsibility of the doctor to assist in the recovery process. But if the problem is too serious, if the disease has already reached the final stage, the responsibility of the physician is to ease the pain and the suffering of the patient.
Thus, the number one function of the doctor is not the dispenser of medicine. Medication is simply a tool but his most important role is the one outlined above. For example, if a patient complains of a minor cough, the physician is not forced to prescribe drugs but to determine the best way to treat the problem. The doctor can advise the patients to take in plenty of water and rest for a while from whatever stressful activity he or she has been doing in the past couple of days. Then the doctor can bid the patient adieu, no guilty feelings, no second-guessing. If the doctor will decide to forego the use of drugs then it is his prerogative to do so.
It has been made clear that the role of the medical profession is not to be the agents of pharmaceutical companies. In other words, if there are alternative means to treat colds for instance without having to dispense chemically processed drugs then it must be considered as a mark of excellence. This is highly commendable because no one can be certain of the long-term effects of synthetic drugs. This will bring the discussion to the next level of the study which is the attempt to understand the real nature of Western medicine.
It can be argued that for many diseases Western medicine can be described using one or all of the following concepts, that it is: a) reactive or b) suppresses the symptoms without really dealing with the root cause of the problem. When one talks about Western medicine as being “reactive” it means that it is the opposite of being proactive – there is no plan or no preventive measures being observed that can prevent diseases from occurring. It would be better if physicians are more proactive in their approach and train to acquire the skill of preventing diseases rather than becoming experts in treating the same.
There are also many cases when Western medicine failed to correctly diagnose the health problem of patients. It is common to hear stories about patients undergoing a battery of tests only to be told that there is nothing wrong with them. The patients can feel that there is something wrong with their body and yet their lab results could not corroborate that assertion. So the patient goes home with the nagging fear that there must be something that the doctor failed to detect.
Yet in cases where doctors are very sure of their prognosis, they are quick to prescribe medication and this is where the next level of the study will commence because Western medicine does not really treat the root cause of the problem, in most cases the symptoms are taken cared of while the doctor is powerless to deal with the main source of the problem. One good example is the use of a drug that is supposed to stop diarrhea. The patient ingests the drug but the chemicals contained in the drug will not really stop diarrhea it will only stop the loose bowel movement by preventing the person to move his bowels.
If the diarrhea is caused by toxins or another form of poisoning, the diarrhea tablet that was ingested will never be able to neutralize the toxin but there is a false sense of relief because the patient is no longer aware of any symptoms of the said health problem. Thus, the toxins remain in the body while the patient believes that he or she is already cured. The same thing can be said of the medicine that is supposed to treat a cough with phlegm. When the patient takes in the said medicine the cough and the phlegm will temporarily stop and at first, it seems that the prescribed drug is doing wonders. But the truth is the drug simply suppressed the ability of the human body to cough and to create phlegm.
It does not require a Harvard-educated doctor to understand that coughing is the body’s natural means of expelling foreign matter. There is probably a good reason why a person will do the coughing reflex when sick; it could be the body’s natural mechanism at work to help the respiratory system deal with a problem. Thus, suppressing these reflexes can be harmful to the body. Western medicine is not only infamous for this sort of technique – providing temporary relief but not complete cure – it is also infamous for sometimes being as destructive as the disease itself. There is no better example than chemotherapy.
Conclusion
Based on the preceding discussion that dealt with the nature of Western medicine as well as with the clarification on what is the main goal of medical science one can argue that Dr. Little is correct in his decision to help Ms. Abrahams with the use of the placebo. Using the information gleaned from the previous discussion the placebos are no longer seen as a tool for deception but in fact, a tool to ease the pain of Ms. Abrahams minus the negative consequences of taking in a synthetic drug. Thus, Dr. Little should be congratulated for being able to accomplish his goals without using chemicals.
It must also be pointed out that when Ms. Abrahams became addicted to secobarbital she no longer was suffering solely from colon cancer but this time she is also suffering from drug addiction. Dr. Little may have approached the problem with this in mind. The good doctor was not merely treating the colon cancer and its complications but he was also treating drug addiction. By giving her placebos Dr. Little was trying to hit two birds with one stone and he should be commended for that action.
With regards to the newly hired pharmacist, he should stop worrying about the use of placebos. The $60 dollars is an insignificant amount compared to the suffering that will be experienced by the patient if she will get addicted to barbiturates. The said pharmacist should not reveal to Ms. Abrahams that the drug she is taking is full of milk sugar, not because there is a desire to deceive her but the non-disclosure will ensure that the “placebo effect” will continue. If Ms. Abrahams will know that she is taking milk sugar then the psychological impact of that revelation may worsen her condition or it will make her crave more barbiturates. She will then become a full-blown addict.
Since the pharmacy is practically selling milk sugar to Ms. Abrahams then the new pharmacist can use his knowledge of the placebos as a bargaining chip and ask the owner to lower the cost of the medicine even further. There can be many ways to reduce the price of the drugs without raising suspicion, one that may force Ms. Abrahams to ask why she is only asked to pay a fraction of the actual cost of secobarbital. One way to do this is to give her discounts on account of her age and also on account of her being a loyal customer. Based on the said revelation about the nature of the Western medication, the main responsibility of health workers as well as the reduction in the cost of healthcare, the new pharmacist will have enough reasons not to tell Ms. Abrahams that she is taking milk sugars instead of barbiturates.
Reference
Joan Callahan. Ethical issues in professional life. Responsibility: edited by Joan C. Callahan. Imprint: New York: Oxford University Press, 1988.