Thursday, May 27, 1999

Simple truths about doctors and drug tests




BY LAURA PULFER
The Cincinnati Enquirer

        Using unsuspecting people as lab rats is contemptible. Especially if they're already very sick. Surely we don't need a federal bureaucrat to tell us that. Do we? That's not very complicated.

        If you knew somebody had epilepsy, for instance, you wouldn't give her a sugar pill, then wait for a grand mal seizure you could videotape. If you knew somebody had diabetes, you wouldn't take away his insulin. And you wouldn't ask his permission to study diabetic shock while he was in the middle of an episode.

Worshiping white coats
        We ordinary people don't make these decisions. Doctors do. And the way drugs like insulin become available to them — and to their patients — is through drug testing. This is where it gets a little complicated.

        Luckily, the people who have the power to sort it out are not bean counters or muckrakers or sales reps. They are physicians. You know, the ones who scored highest on their SATs, the ones who got into good schools, then stayed in them long after the rest of us were out making money. The bookworms. The brains.

        Arrogant? I forgive them. It requires a tinge of superiority to bring yourself to put your hands on a pulsing human heart. Rich? Most make less than professional athletes and have much higher batting averages.

        They all take an oath. There's not a separate oath for doctors who pursue patient care in the lab. Or for those who have decided to specialize in diseases of the mind. Sick is sick. Whether you have to have your gall bladder removed or you still hear helicopters over the rice paddies.

Angels and soldiers
        The University of Cincinnati, with considerable self-congratulation, has announced plans to stop psychiatric research known as “challenge” studies, or chemical tests that provoke psychotic symptoms.

        This announcement is not in advance, but in the midst of a federal investigation including not only UC but the Cincinnati VA Medical Center. UC and the VA hospital, along with several other research centers across the country, will be poked and prodded by the Office for Protection from Research Risks, a division of the National Institutes of Health.

        Investigators probably will speak to Patricia Reynolds.

        She has already gallantly opened her medical records to The Cincinnati Enquirer's Anne Michaud and Tim Bonfield. Ms. Reynolds, who suffers from manic depression, was recruited for research shortly after being admitted through University Hospital's emergency room last year. Was she capable of consenting to the study?

        “They were listening to a person who claimed to be an angel,” she says.

        Allen Buettner, a Northside resident with bipolar disorder, is saddened to see UC criticized, insisting, “I must have cutting-edge medications.”

        And we want him to have them. Besides, we know research and testing is one reason Ms. Reynolds now has the medication necessary for her to complain with such vigor. Her drugs were no doubt tested first on another human being. We must trust that the brave human guinea pig was acutely aware of the consequences.

        We know for sure a doctor was on the case. A white-coated healer.

        One of my enduring medical memories is sitting in our family doctor's waiting room. I'm sure he made all the appointments for the same time, then just took us in order of arrival. Luckily, we were provided with handsome 2-year-old issues of Ducks Unlimited to read until it was our turn.

        Unless you were bleeding from the ears, you waited in line. The emergency cases went first. The regular sick people next. The pharmaceutical salesmen, with their big black suitcases full of little bottles, went last.

        A lot of healing comes in those little bottles. A lot of money, too. That's the simple truth. Even those of us not smart enough to become doctors can figure this out. We just want to know that those people in white coats still put sick people first.

        E-mail Laura Pulfer at lpulfer@enquirer.com or call 768-8393. Author of I Beg to Differ, she appears regularly on WVXU radio, NPR's Morning Edition and Intermedia's Northern Kentucky Magazine.

        Laura Pulfer's column appears in the Enquirer on Sundays, Tuesdays and Thursdays. Call 768-8393 or fax 768-8340. She can be heard Monday mornings on WVXU radio (91.7 FM), and as a regular commentator on National Public Radio's Morning Edition. E-mail her at laurapulfer@enquirer.com

PULFER ARCHIVE