[ExI] medical ethics question, was: RE: Medical power of attorney for cryonicsts

[spike]

>... On Behalf Of Mike Dougherty

>>... If I explain my theory, show him my calculations, give him my source 
>> for bex and share my recipe, would I still be in the green on the ethics
scale?

>...What exactly do you fear would or could be misconstrued about
this?...I'm not sure how this is so much different than recommending a
vegetarian diet or crossfit exercise regimen... Mike
_______________________________________________


I think I am ethically in the lime-green here.  I was hoping our local
med-eth guru John would echo those sentiments, give me a little reinforcing
affirmation, or advise me to knock it off forthwith, along with a line of
reasoning I can follow.

Mike, what can be misconstrued, you ask?  Well this: I have been thinking
about this bexarotene finding for a couple years, reading up on retinoid
receptor stimulants, mechanics of the blood/brain barrier and so forth.  If
I even suggest there might be theoretical benefits of a therapy to a
desperate patient, even a well-informed one, I have no good way of knowing
if it helped, or even if it did harm.  I am not with him, haven't really had
any meaningful contact with him in the last 20 yrs, so I wouldn't know.  So
I would be offering possible false hope to both him and his family, for a
theoretical treatment based on sketchy evidence and by a person without
qualifications.  

We do know for sure that bexarotene fixes Alzheimer's mice, or certainly
helps the hell out of them.  That result has been replicated.  We have no
data on humans and it isn't clear how we can ever get it unless we do crazy
stunts like this one.

But the worst part of it is that I would not be with the patient to follow
on his progress.  In the feedback controls world, that would be known as an
open-loop, which is always a bad thing.  That's where the hesitation comes
in.

Another thing: his bride would be with him.  They have been happily married
for 57 years so she would be qualified to make the call on the efficacy,
sort of.  The families of Alzheimer's patients want to see an improvement so
badly, they see an improvement so badly.   Regardless of what medications or
therapies are being used, they see an improvement so badly.

We know that bexarotene does other bad things, such as suppressing thyroid,
which can be compensated with the right meds.  If we get a positive result,
and a retired doctor starts reporting it, we could cause a roaring stampede
of other desperate patients to try it, most of whom have no access to the
compensating meds or the sophistication to know which to devour in what
dosages.  Those already suffering from low thyroid will perish.  If so, did
we kill them?  Did I? 

Another thing: you know some older people who do not have Alzheimer's will
follow the line of reasoning that made methamphetamines so popular.  If you
have a cold and take meth, you feel better!  So what if you don't have a
cold and you take meth, will you feel better?  Plenty of people say yes.
So, OK, you have Alzheimer's and you take bex, you get smarter.  If you
don't have Alzheimer's and take bex, will you get smarter?  Plenty of people
may try it, and the results could be fatal.  If so, did I kill them?

Dr. Rafal, you are probably the best qualified person here to comment, not
on the specific scheme (considering your professional standing I would not
recommend that) but rather on the medical ethics aspects.  Right now you are
my wise older brother (who is younger than I am) and I will most likely do
whatever you suggest.  

Thanks for the comments Mike.  Do make another scoop at it please, and dig
deep within, as I know you are capable of doing.

John, we are eager to hear from you on this too sir.

spike