End of Week (Yikes) Highlights

Ho.

  1. Economic considerations for net neutrality.
  2. So … yuck or not?
  3. Crystalline structure and permanence.
  4. Government leads to wickedness. Why the left wants more of it, is the mystery.
  5. Well, he hasn’t … but the reason isn’t laziness. There’s no constituency at risk … that is the impact on the midterms is minimal if it doesn’t become a scandal. So, ergo, it doesn’t matter.
  6. How supporters of aff action and other less good ideas (reparations) justify racial barriers against Asians.
  7. Bang bang she said.
  8. Huh?
  9. The Crimean prize.
  10. Fair play.
  11. Choices and life.
  12. Journalists being dumb, noted.
  13. I’m pretty sure they all knew what was going on. I keep hearing “I thought they were looking out for me.” This is a lie. You, they, and everybody else around were focused on getting you back in the game. It’s what you wanted. It’s what they wanted. It’s what you got.
  14. Inflation.

38 Responses to End of Week (Yikes) Highlights

  1. Re #13 Sure it’s what they wanted, but a doctor is obligated by law and oath to NOT give you what you want but what is good for you.

  2. Boonton,
    Good for you can reasonably be defined as that thing I really desire.

  3. Boonton,
    I should add, back when I was racing a crash left me with a (at the time) chronic inflammation in my left shoulder. I didn’t go to the local therapist/athletic trainers and doctor to seek treatment because there was still 6-8 week left in the season (well, it might have been 6 after my cracked ribs got to the point where breathing deeply was pain free). Anyhow, the trainer told me specifically that their job was rehab. Not the “stop doing that because it might be harmful” job. An example the trainer gave was if a guy was in for lower back problems, they weren’t going to suggest or tell him not to go on that golf outing he planned. They’d just keep rehabbing his further injury when he got back. The upshot for me was that I should have sought treatment for the inflammation (chronic tendon inflammation is just that because the injury/insult is long forgotten and you get in a state where the inflammation is what is causing further inflammation). All waiting did was mean I had to do a lot of strength training after the inflammation was down because the inactivity had weakened my shoulder.

    Sports and rehab isn’t quite as cut and dried as you pretend and the “best interest” of a competitor who tells you he wants to compete is not necessarily as obviously an “obligation under law” to give you what is good for you.

  4. Boonton,
    And you do realize the actual doctors advice interested in the long term health of the player would be … “don’t play that game”. In the early to mid-80s when many of the players in this lawsuit were playing .. articles in SI and papers pointed out then that the average NFL player left the game with a 90% or greater disability and a 10-15 year shorter average lifetime than those who don’t play. They and everybody knew the consequences of playing the game. To pretend now that they didn’t it just deceit, bad memory, or stupidity.

  5. If you could show me that the docs who administered the drugs said “we’ll do this, it will get you back in the game sooner and you’ll play thru injuries better, but there’s a good chance you’re going to need a kidney transplant before 50 or possibly need drug addiction rehab” then I’d be fine with it. If, however, the docs neglected to say this then how can it be argued it was ‘what the patient wanted’?

  6. buddyglass

    “Good for you can reasonably be defined as that thing I really desire.”

    That’s a pretty expansive definition of the hippocratic oath. Especially given what some folks really desire is a peaceful death and surcease of chronic pain.

  7. It’s a definition that wouldn’t really work for the doctor confronted with a drug addict patient, or even the patient who wants to murder their wife for the insurance money…..

    But I think his argument falters even on that definition.

  8. Boonton,
    Uhm, “what the patient really desires” … and your exception is for patients who are basically suffering from mental illness or insanity. I realize that there are things we can discuss about this, but that route isn’t fruitful.

    Mr Howard,
    Clearly you realize there are doctors who argue that euthanasia is within meaning of the Hippocratic Oath. My main point is that “good” for a patient is not as simple as the doctor figuring out what is best for the patient in the long term. For an NFL player for example, the actual advice would be that no patient under their care ever play football. I have read that every hard tackle is the equivalent for the body as a car crash. A running back gets hit like that 20 or more times a game. Football players don’t like Thursday games because on that day they are still (actual “injuries” aside) sore from punishment of the prior Sunday’s game.

    If, however, the docs neglected to say this then how can it be argued it was ‘what the patient wanted’?

    You seem unaware that many athletes knowingly take PEDs with a plethora of known side effects and documented risks of long term damage and cancers. They aren’t mentally ill. They want the performance. They want to play. This can indeed be argued that this is what the patient wanted.

    Both of Ya,
    I sort of recall a survey of Olympic atheletes, asked “If a non-controlled drug were available that would win you a gold medal but which would shorten your life by 10 (or 20 years … I forget the exact term) would you take it?” Virtually every athlete at that level surveyed indicated that they would take the drug. “Good for you” is not as cut and dried as you pretend.

  9. buddyglass

    “Clearly you realize there are doctors who argue that euthanasia is within meaning of the Hippocratic Oath. ”

    But you don’t argue that, right? Whatever your understanding of the oath, apply that to these doctors.

  10. I sort of recall a survey of Olympic atheletes, asked “If a non-controlled drug were available that would win you a gold medal but which would shorten your life by 10 (or 20 years … I forget the exact term) would you take it?” Virtually every athlete at that level surveyed indicated that they would take the drug

    If you could show said doctors provided such a drug with all these warnings clearly spelled out I’d be willing to ‘excuse’ them from liability.

  11. Mr Howard,
    How do you square a doctor ever letting patient go on a football field with their Oath. Again. All I’m arguing so far is that “the good of the patient” is more complex than long term health.

    Boonton,

    If you could show said doctors provided such a drug with all these warnings clearly spelled out I’d be willing to ‘excuse’ them from liability.

    How do you locate what the doctor said” 30 years ago? Are you under the pretense that someone didn’t know that football was dangerous. The all knew they were looking at almost certain disability and drastically lowered expected lifespan. How do they think that might be occurring? I realize you liberals often would like to nerf the world. But geesh, it sounds like your argument is “players (and patients in general)” are legally expected to be (a) stupid as trees and (b) under no responsibility to understand the risks of what they are subjecting themselves to. The first part is wrong and the second should be. But hey, you’re the knuckleheads that think the answer to contraception is “education” in the third world.

    You seem unaware that many athletes knowingly take PEDs with a plethora of known side effects and documented risks of long term damage and cancers. They aren’t mentally ill. They want the performance. They want to play.

    Yes? Or no?

  12. How do you locate what the doctor said” 30 years ago? Are you under the pretense that someone didn’t know that football was dangerous.

    Doctor’s don’t dispense ‘playing football’, in that field they simply dispense advice. In that case I would be willing to say unless you could prove the doctors were telling the players decades ago that there were no long term risks to playing football, there shouldn’t be liability.

    Doctor’s do dispense drugs, though. If the drug in question had no therapeutic value and was primarily for ‘performance enhancement’ with serious long term risks I would say the burden of proof should be on the doctor that he informed the patient and got serious consent.

    If you volunteer for a clinical study and that entails taking an experimental chemical with unknown effects you will be given a huge debriefing on the risks and consent will be confirmed and kept on file for decades.

  13. buddyglass

    “How do you square a doctor ever letting patient go on a football field with their Oath.”

    Doctors don’t “let” players do anything, because they’re not in authority over them. Doctors give advice about how something will or won’t affect your health and they fix you when you’re broken. Fixing someone up so they can go do something dangerous doesn’t violate the Oath or else all our military doctors should have their medical licenses revoked.

    That said, knowingly minimizing the inherent risks of football (i.e. lying to players) would probably violate the Oath, no? I’m not saying they did that, necessarily, but if they had then it would be a violation.

    In any case, you’re the one who originally said that, essentially, giving a patient what he or she wants is always in the patient’s best interests and, ergo, doesn’t violate the Oath. I pointed out that some patients want to die. So far, I fail to see how your definition (“good = what patient wants”) doesn’t imply euthanasia falls within the bounds of the Oath.

  14. Boonton,

    Doctor’s don’t dispense ‘playing football’, in that field they simply dispense advice.

    Are you being intentionally naive? A doctor clears players as fit to play. This is a judgement call. Yet football is incredibly dangerous (remember average career is about 2 years, leaving with 90% disability and a 15 year foreshortened lifespan). Pretty much every player after the first week (exception kicker and those who didn’t play) are dealing with what would be for you or me a major injury. You apparently think that the patient is completely unaware of this and isn’t requesting that the doctor “do whatever it takes” to get him back on the field so he doesn’t loose his job and the thing he wants to do (play). Furthermore you have several (one or two?) doctors and a bunch of trainers keeping up with about 50 players all of whom have new injuries every week. Yet you figure a 60 minute lecture on side effects be given every week (apparently). Your position depends on unrealistic notions of what the NFL involves as well as completely stupidity on the part of the patient. Neither point is tenable.

    Mr Howard,

    Again, how would a doctor with good conscience ever clear an injured player to go back on the field?

    I don’t think they “lied” to the players. Look, we have trainers going down the team plane after a game handing out powerful (prescription) anti-inflammatory medicines and painkillers to whomever wants them. Without these the players will likely have much difficulty sleeping and will not be able to play next week. You have players getting knees drained weekly, pain killing shots pre-game, and taking pain killers on waking and sleeping.

    So far, I fail to see how your definition (“good = what patient wants”) doesn’t imply euthanasia falls within the bounds of the Oath.

    I said “good” was complicated. And I stand by that. Aren’t you liberals the mulit-cultural crowd? Good as a concept is not among us humans a singular notion. A doctor who thinks euthanasia preferable to months of extreme pain would not be violating is oath to administer lethal dose of morphine. A different doctor with the same patient who feels that euthanasia is not preferable and does not give the lethal dose, would also not be violating his oath.

  15. Are you being intentionally naive? A doctor clears players as fit to play. This is a judgement call.

    Depends on how you define ‘fit to play’. It isn’t defined as “football is not a danger to this particular person over the long run”.

    You apparently think that the patient is completely unaware of this and isn’t requesting that the doctor “do whatever it takes” to get him back on the field so he doesn’t loose his job and the thing he wants to do (play).

    1. Is the doctor actually permitted ethically to ‘do whatever it takes’? The ‘guilded professions’ (doctors, lawyers, etc.) have traditionally been viewed as having a paternalistic duty not just to what their clients happen to want at a particular moment but also to their overall interests. Hence both doctors and lawyers have always been expected at some times to say ‘no’ to clients.

    2. If if you answer #1 with an affirmative, you still have an ethical duty to consistently inform. If a doc is giving a player oxycotin during every game he cannot simply tell him it will ‘get him thru’ the pain of playing that day but also advise on the long term possibilities of addiction and kidney damage. Again the more medical treatment deviates from generally accepted care, the more the burden of proof shifts onto the doctor to show that he provided full and clear information to the patient.

    Again, how would a doctor with good conscience ever clear an injured player to go back on the field?

    Quite easy, if ‘clear’ simply means the doctor finds the player is suffering from no major injury at the moment, then the doctor is simply being honest. Just like a doctor can’t say you’re ‘unfit to drive’ when you’re not suffering from any disability simply because he thinks you’re going to drive to the tobacco store to buy cigarettes.

  16. Boonton,
    I thought of an analogy. You are a smoker. You have developed asthma as a result of smoke inhalation. Your doctor has a choice, tell you to quit smoking or to give you anti-asthma medication. Which is the ethical advice? Let me add a wrinkle. Your job is blowing smoke rings in the circus. You are an expert and can do amazing things rings in rings in rings and so on. To quit smoking you’d also have to leave the profession of your choices. Let me be clear, for his long term health and longevity there is only one answer, quit smoking. However that is not what your patient wants. What do you tell your patient?

    To point #1, every one of the players (as noted) has major injuries which they with assistance in “playing through”. It is never in the patient/players long term health interest to (continue smoking) get on the football field. Ever.

    To point #2, you expect complete stupidity on the part of the patient/player. I get that. I disagree.

    And to your final rebuttal … if ‘clear’ simply means the doctor finds the player is suffering from no major injury at the moment, Re-read the point you are responding to. “clear” is not “no major injury”. “Clear” in a NFL context means the particular major injuries that the player is suffering they can be masked with painkillers and anti-inflammatory medicines to the point to which the player can perform at a very high level. Clear does not mean “no injury” and never has in this context.

  17. In your analogy the doctor would have to advise you to quite smoking, but nonetheless prescribe the asthma medication if you refuse.

    Since you want to dip into analogies, consider this: Driving too shortens your lifespan. Driving carries a non-zero risk of accidents. Hence no doctor should ever ‘clear you to drive’. Granted driving has a much smaller impact on your expected lifespan than playing professional football, but that’s just quibbling over degrees.

    Yet you wouldn’t say simply ‘clearing you to drive’ is no different ethically than, say, prescribing you speed so you could stay awake and drive 24-7.

    “Clear” in a NFL context means the particular major injuries that the player is suffering they can be masked with painkillers and anti-inflammatory medicines to the point to which the player can perform at a very high level.

    Except a doctor cannot ethically give large, uncustomary doses of painkillers and anti-inflammatories to a patient without warning him of the long term risks.

  18. Boonton,
    You’re missing the point. Try again.

    Why would the doctor have to prescribe asthma medication. In the proposed analogy the patient (you) cannot continue smoking if you don’t get anti-asthma medication. Your asthma prevents you from smoking. Why would the doctor have to “advise” you to quit. He just would not prescribe and you’d be forced to quit smoking and subsequently would lose your job. The crux of the question is whether it is ethical to prescribe something which enables and in fact is required so that the patient can engage in very harmful behavior in the context of doing what is best for the patient.

    Why is the doctor giving these painkillers and anti-inflammatory medicines? So the patient can damage himself? Is that best for the patient.

  19. So you’re saying that your asthma untreated will prevent you from ever smoking again. But even if you never smoke again, you’re still suffering from asthma. So how could the doctor refuse to give you the medication?

    Or are you saying you aren’t suffering but if you smoke again you’ll start suffering, unless you get the medication? In that case the doctor effectively has a veto over you smoking, which he may be tempted to use since smoking has a lot of other long term dangers on top of hypothetical-asthma.

    I’m willing to say maybe the doctor can ethically refuse the medication since he doesn’t want to faciliate your desire to smoke. But that’s not really your issue. Your issue is that since smoking is harmful the doctor not only has to advise against it, but must actively frustrate your attempts to smoke.

    Here I think you haven’t made a case. The doctor is free to give you the medication provided he advise you against smoking.

    Now let’s make it more like your NFL analogy. Say the medication does indeed control your asthma but it’s well known that using it for more, than, say 5 years greatly increases the risk of kidney damage. Since you insist on smoking I would say the doctor is free to give you the medication to prevent the asthma but he is obligated to inform you of the long term risks. As your time on the medication stretches from months to years he is obligated to at the min. keep reiterating the risks of long term use. This would be more analogous to the NFL case as painkillers are typically not a problem when used to cover a single injury but their profile changes if you start using them every day with no breaks. The doctor has the obligationt to ensure the patient knows the seemingly trivial side effects of short term use cannot be extrapolated into an assumption of long term safety.

  20. Boonton,

    So you’re saying that your asthma untreated will prevent you from ever smoking again. But even if you never smoke again, you’re still suffering from asthma.

    I’m saying the asthma was caused by the smoking. If you stop smoking your asthma will abate and go away.

    In that case the doctor effectively has a veto over you smoking, which he may be tempted to use since smoking has a lot of other long term dangers on top of hypothetical-asthma.

    Just like in the case of the football player. If you don’t give him the drugs he can’t play. The drugs do not heal him, but enable him to play through/with his injuries.

  21. It occurs that this is a problem of collective action. If one individual player or even team refuses to overuse the drugs, then all that happens is that player or team suffers. If the entire league follows that as a policy, then no one is worse off as the playing field remains level.

  22. Boonton,
    More would change than that, currently there is a 45 or 50 man active roster. That structure would fail if each player was only on average playing 3 or 4 games per season.

  23. There’s a trade off between protecting from injuries and inflicting injuries. For example, if you went back to simple padded helmets the # of injuries prevented would fall. However so would the # of injuries inflicted since you’re going to be a bit more careful if your head isn’t quite as well protected. Most safety improvements in the game have probably had the pro side of fewer injuries outweigh the con side but it’s possible there are some that have been counter-productive on net. I suspect mass drug use might be just one.

  24. Boonton,

    I suspect mass drug use might be just one.

    I suspect if the drugs weren’t made available by team doctors then they’d be gotten in other (less safe/less controlled) ways.

    There are pads and protections available which aren’t being used because the players want speed more than anything else. For example, no players wear a cup … not because they don’t want protection but because the trade off of speed vs protection … protection loses out. The helmet is a funny thing. Actually a soft helmet can be made to protect more (not less) than a hard one. But the helmet is primarily a weapon, not protection. It remains hard for that reason the argument given is that going to a soft helmet would change the nature of the game too much.

    Remember Kurt Warner? Probably not a very stupid guy, but he was stocking shelves at supermarkets before being optioned by the Rams. Then he spent several years making millions of dollars. This is the lure of the (permitted and not-permitted) drugs. Besides the enjoyment the players get from playing and competing at a high level in a game they love, they make very much money at it. This is where the “good” gets complicated regarding the “good of the patient” as a choice for the doctor. My guess would be the life shortening and 90%+ disability after retirement isn’t coming from liver/kidney damage from the drugs .. but from the repeated physical damage from impacts to organs, joints, and brain.

  25. Banning mass use of pain killers is not that difficult. Opiates are easily detected in the blood and an ‘on/off’. But even if we don’t want to go there that doesn’t excuse the doctor from not getting clear proof that the patient was provided real informed consent.

    Since many pain killers are used temporarily without any serious side effects, it is far too easy for a patient to assume long term use will likewise be as problem free. This is a bit different than your comparison to playing football, which is something most people know or at least suspect is likelly to cause long term problems.

  26. Boonton,
    This disclaimer given the demands of a very few doctors and many patients who have the same or similar problems every week, means of the 90 pages of legalese you get at the start of a season, one is the 5 page documenting all the crap that could happen to you if you abuse the anti-inflammatory and pain killers, how do detect such problems and so on. Which every player signs and ignores.

    So drop the whole “warning” thing as a byline. You have 50 guys with varying degrees of injuries every week, who want to be fit to play, who want to sleep tonight, who want to practice and concentrate on preparing for the next game. The doctor’s job is to enable them to do that. Pretending that he has to give every 50 players a 30 minute explanation of the risks and dangers of every medication he gives them is impractical and worse, useless. Pretending that the players aren’t actually cognizant of those risks if it is brought to their attention is naive. This lawsuit is stupid. No way around it.

    Jim McMahon the ’85 superbowl winning Bears quarterback who is in the suit claiming he had a fractured verterbra of which he was not informed … knowingly chose to play with a lacerated kidney. He may or may not have been informed, I believe there are reports also that his memory and mind aren’t what they once were due to concussion/CTS issues. However, it is more than likely if he had been informed … he would have played regardless.

    BTW, did you know Buster Keaton fractured a neck vertebra during the filming of “Steamboat Bill Jr”. It was in the scene in which he pulls the water pipe down to load the steam engine with water and the column of water hits him in the head. He only discovered in later x-rays decades later that he had a prior neck fracture and they figured out it was then. He recalled having headaches for a few weeks at the time.

  27. one is the 5 page documenting all the crap that could happen to you if you abuse the anti-inflammatory and pain killers

    In this context ‘you’ are not abusing the drugs if they are being administered by a doctor. Just like any other patient the doctor’s duty would be to track how much you’re being administered individually and demonstrate that you’ve been alerted and warned in real time.

    Are you telling me that NFL team doctors are not keeping individual patient charts on the players?!

  28. Boonton,
    Abusing drugs is not depending on a doctor. Witness Mr Jackson. Abuse of drugs isn’t at question here. These drugs are required to perform next week. You aren’t abusing a drug if you are taking it to stand and walk and run. You are abusing it if you are taking it to stimulate pleasure centers.

    You’ve dodged the key question. The point at hand is what constitutes the good of the patient and is the patient involved in deciding what constitutes that good.

  29. Boonton,

    Are you telling me that NFL team doctors are not keeping individual patient charts on the players?!

    You’re “?!” indicates real or pretended naivete. I’m going with pretended. In the 60s there were salad bowls pre-game with amphetamines in most/many team locker rooms. Since then the “hand out” of numbing shots, anti-inflammatory drugs, and pain killers (aspirin, NSAID and stronger) pretty freely. You know that. Why the pretense at surprise.

    Consider pre-game chaos. 50 guys are prepping for a game in close quarters. Everything moving, shouting and so on. This isn’t a ward in a hospital. They players know the effects of these drugs on their bodies better than the doctors w.r.t. to performance. Yet you expect a calm, orderly documented process. I don’t think you are being serious.

  30. 1965 was almost 50 years ago, a player then would be in his mid-70’s today, not his mid-40’s.

    You’re not really responding to my assertion. A doctor is required to do more than simply stock a ‘salad bowel’ of prescription medication, even if it is the case that players are allowed to decide for themselves to accept the long term risks of their use for the sake of the game.

  31. Boonton,

    1965 was almost 50 years ago, a player then would be in his mid-70′s today, not his mid-40′s.

    So? 20-40 years later the salad bowl of amph. was replaced by trainers (not doctors) passing through team planes and buses passing out pain and inflammatory meds. There is no essential difference here. You know that.

    You’re not really responding to my assertion.

    Hmm. Turnabout is apparently not fair play. You’ve not responded to dozens of the questions or points I’ve made.

    1. What is good? We had an analogy, smoking and asthma. Does the doctor prescribe asthma medicine to enable smoking? If not, does the fact that the patient’s job requires smoking change the equation?
    2. Why in the paternalistic view of a doctor’s role, does a doctor doing anything to speed a player back to the field where he will encounter more harm?
    3. Why do you think the full risks need to be established every single time a trainer or doctor sees a player? Why do you pretend that the locker room is run at the pace of a clinical hospital?

    Look the essential silliness of this suit might be highlighted by SF safety Ronnie Lott, who bit his lacerated finger off so a trainer could tape it and he could return to the game. Yet these plaintiffs who were doing exactly the same sort of thing pretend the doctors “should have been always looking out for my long term health”. It’s like the tobacco plaintiffs pretending every effing person on the planet didn’t always know that tobacco smoking caused cancer and was harmful, but “gosh” the tobacco companies are at fault for harming peoples. This sort of opinion is unbelievably stupid. If you want to be safe playing football, you have to quit. If you want to not get lung cancer smoking, you have to stop. It’s not the doctor nor the tobacco companies fault.

  32. Boonton,
    You assert, ” A doctor is required to do more than simply stock a ‘salad bowel’ of prescription medication”.

    Why? The “prescription” adjectival modification of medicinal drugs is a legal one only, not ethical.

  33. Look I’m perfectlly willing to be reasonable here. Legally ‘trainers’ are not allowed to dispense medications that require a script. AS you point out script writing is a legal practice, not an ethical one. But that doesn’t change the doctors duty. He still cannot provide medication directly in an unethical manner and if his patient is using medications on their own (say over the counter, street drugs, illegal ones etc.) he has to advise him accordingly even if he isn’t the one holding the script pad in that case.

    If you want to say we shoul allow unlimited use of painkillers ‘for the sake of the game’, then fine. Doctors still have to write the scripts legally and they are ethically bound to at a min. do so with fair warning and advise.

    “We had an analogy, smoking and asthma. Does the doctor prescribe asthma medicine to enable smoking?”

    The asthma medication enables relief from asthma. That the patient wants that relief to continue smoking is a 2nd order effect at arms length from the doctor.

    “Why do you think the full risks need to be established every single time a trainer or doctor sees a player? ”

    No it’s perfectly fine to note that some things have not been studied for the long term hence their risks are unknown. You can’t quite claim this for the use of opiates which have been around over a century.

  34. Boonton,

    He still cannot provide medication directly in an unethical manner …

    And I don’t think they necessarily were.

    If you want to say we shoul allow unlimited use of painkillers ‘for the sake of the game’, then fine.

    If you want to call “using painkillers” to abrogate extreme pain abuse, then fine. But I don’t.

    That the patient wants that relief to continue smoking is a 2nd order effect at arms length from the doctor.

    No. It’s the cause of the asthma. It’s not second order. If a patient comes to you with weight loss and difficulty absorbing vitamins you don’t just prescribe intravenous vitamins and high caloric foods if the cause is a tapeworm. The cause is smoking. I realize you work for a drug company and “more and more stronger and stronger medicines” has its personal appeal to your industry. But actually working against the root cause is a better cure than just treating symptoms. Try again on the asthma/smoking thing. Claiming the cause of the symptom as a “2nd order effect” is not going to fly.

    You can’t quite claim this for the use of opiates which have been around over a century.

    Show me the long term effect studies on using opiates to treat intense pain for for about a half a year at a time for very very very fit young athletes. I don’t think that study exists.

    And I don’t think using painkillers to treat pain is abuse. Do you? Why? (and because it isn’t prescribed won’t cut it as a reason).

  35. No. It’s the cause of the asthma. It’s not second order.

    True or false, nothing forces the patient to start smoking again after the medication fixes their asthma.

  36. Boonton,

    True or false, nothing forces the patient to start smoking again after the medication fixes their asthma.

    True, but getting medication means they never have to quit and not giving medication yeilds a to-fer, the asthma is cured and the patient is not smoking.

    Let’s put this simpler. Doctor has two choices, to prescribe or not.

    Prescribe -> patient smokes and asthma controlled … and continues needing stronger and stronger asthma meds and deals with all the problems of smoking.
    Not Prescribe -> patient ends addiction (loses job) and asthma not controlled, instead it is cured (as it was caused by the smoking).

    It’t not 2nd order. The primary cause is not a “second order” symptom.

  37. True, but getting medication means they never have to quit…

    Have to quit? Smoking is not against the law. Why does the doctor have the right to use an illness as a tool to force quitting on a smoker? Can the doctor go around with a gun and threaten people trying to smoke?

    Prescribe -> patient smokes and asthma controlled … and continues needing stronger and stronger asthma meds and deals with all the problems of smoking.

    Yet as you pointed out nothing is preventing the smoker from stopping…in fact he very well might do so.

    If the stronger asthma meds have side effects and complications, the doctor may have to consider at some point the health benefit of using the stronger medication to stop the asthma may not outweigh the harm of the side effects.

  38. Boonton,

    Have to quit? Smoking is not against the law.

    Oddly quadriplegics have to use wheelchairs even when walking isn’t against the law. Our patient would have to quit because he would have bad asthma if he continued smoking.

    Why does the doctor have the right to use an illness as a tool to force quitting on a smoker?

    Well, this began as a “what is good for the patient” discussion. You have two choices, give asthma meds or not. In both cases the asthma is controlled but in the second (no meds) you also have the added “good” for the patient that he quits smoking. What is good for the patient? In both cases the asthma is controlled, in the 2nd case the patient ends harmful behavior.

    Can the doctor go around with a gun and threaten people trying to smoke?

    That’s a very silly question.

    the doctor may have to consider at some point the health benefit of using the stronger medication to stop the asthma may not outweigh the harm of the side effects.

    Why wait?

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