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Smallpox Vaccines, Medical Ethics & Prozac Cartoon Characters | The Nation

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Smallpox Vaccines, Medical Ethics & Prozac Cartoon Characters

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Dr. Marc answers readers' question every other week. To send a query, click here.

About the Author

Dr. Marc Siegel
Dr. Marc Siegel is a practicing internist and an associate professor of medicine and a fellow in the Master Scholars...

Also by the Author

The city lacks the resources to address its residents' urgent mental health needs.

The United States has fueled a worldwide overreaction to the threat of a bird
flu pandemic, putting AIDS, malaria, malnutrition and other crucial
global health programs at risk.

Dear Dr. Marc,

How about the use of cartoon characters in TV commercials for Prozac? My 7-year-old knows about Prozac because of these commercials. Fortunately, we have talked with him about how mental illness is not always from a chemical imbalance, but the commercials did make an impact on him. Any possibility that the ad agency is targeting children?

John Bollinger
Atlantic Highlands, NJ

Dear John,

You bring up an excellent point. Clearly a child who sees a cartoon character they like might then ask for the product, which is potentially quite harmful. In addition to possibly targeting children, I suspect the larger purpose of cartoon characters in this context is to show off a durable, malleable and cheerful character who would then be associated with the drug. Remember, cartoon characters don't have sexual dysfunction or stomach upset or dizziness the way a normal human being might from Prozac. The implication is that if you take Prozac you can be animated too. You can fall off cliffs and come out unscathed like Wyle E. Coyote.


Dear Dr. Marc,

Can you explain the various federal proposals to provide prescription drug assistance to the elderly? This would include both the Democratic and Republican versions.

Jane Kelley
Chicago, IL

Dear Jane,

Essentially, the Republicans use big-business dollars and corporate tax incentives to fund much of this privately--while the Democrats try to draw the money more from the government, especially Medicare. The problem with both programs is that neither considers that the drugs themselves may be overpriced, that many are duplicates and that many are unnecessary. Universal coverage of prescription drugs may be essential, but not necessarily of ALL our current drugs at ALL these prices.


Dear Dr. Marc,

In your introductory article you mention the "question of mandatory HIV testing for convicted rapists, which has been miscast as a civil rights issue on behalf of the convict." This is, in my opinion, an ethical problem in which the relative rights that the involved people have to protection and privacy are being weighed. But it also has evident connotations regarding public health. My question would be: Can questions regarding ethics, vulnerability, social exclusion and public health be separated?

Karen Cronick
Caracas, Venezuela

Dear Karen,

I think the key word in your question is "weighed." When weighing all these issues, ethical as well as health and social, it seems clear that any decision contains a value judgment. But what is ethics, if not a weighing of different values? In this case, a woman's health, and potentially that of an unborn fetus, may be put in jeopardy by a hidden disease dispensed by a rapist. I don't believe the issues can be separated. In my mind, the rights of a victim in such a case outweigh the rights of the criminal. If a choice is mandated by circumstance, we must choose to preserve the civil rights of our victims.


Dear Dr. Marc,

I and several friends in Takoma Park, Maryland, came down with West Nile Virus at the end of the summer. We have been astonished at the lack responsiveness from health officials, the ignorance of health providers, the dearth of information about the disease and the inaccuracy of the available information in regard to the impact of it on healthy people.

On the Centers for Disease Control website and in news articles, the prevailing wisdom is that only the elderly or folks with compromised immune systems are in danger. Healthy people often don't get sick or suffer "mild flu-like symptoms," and may not even know they have it.

We have been sick for nearly three months--headaches, severe neck stiffness and pain, rashes and terrible fatigue. One of my friends missed two full weeks of work, then remained part-time for another week or two. She was very seriously ill. We are all healthy women in our 40s to early 50s, who work out and seldom get sick.

One of us had to talk her health plan into allowing the blood test. My doctor was the most sympathetic, and finally from him I was given the news that the symptoms could last three to six months. We had heard this from no other health professional.

Since then, we have heard absolutely nothing from health officials--no follow up, nothing.

I guess there's no profit in coming to terms with a virus that only makes people sick but for which there is no real drug or treatment. What's up? Why the silence about this very debilitating disease? What do we have to look forward to?

Margaret Swedish
Washington, DC

Dear Margaret,

This is a tragic and frustrating example of what can happen when something hits the media and flames are shot out via the public megaphone. It doesn't automatically follow that individual patients will get the proper attention. You are so right that age is not the only factor; this year's cases affected younger people than before. It is shocking that you had such difficulty getting the appropriate tests done. Of course, the only treatment for this virus is supportive, and I certainly hope that over time, your remaining symptoms will fade.


Dear Dr. Marc,

Don't you think politicians would finally get serious about providing healthcare for the approximately 40 million uninsured if they were required to pay for part (or all) of their health insurance premiums?

Most of us out here in the "real world" have to pony up 20 percent, 30 percent, 50 percent and even more for our health insurance, while our employers pay the remainder. I work for a health insurer, and the situation is no different for me.

But in California, politicians' health insurance is paid in full with our tax money. I'm sure it's much the same for other states. I actually visited the Capitol recently and was told by Representative Dave Cox that "there is no healthcare crisis." How can politicians be expected to solve a problem they don't have themselves?

Kimberly Davis
Fair Oaks, CA

Dear Kimberly,

Certainly true--though keep in mind that even when the proletariat does triumph, they may immediately occupy the palaces of the old lords. In the meantime, we are represented paradoxically by those who don't live with our day-to-day problems, including the cost of healthcare--and therefore can't truly relate to the frustrations.


Dear Dr. Marc,

I am 70 years old and I received my smallpox vaccination when I was 6 years old. In case of a terrorist threat, would I need another one?

Betty J.Geissler
Hatfield, PA

Dear Betty,

Good question--keep in mind that if and when such a threat occurs, there may be a safer, more modernized vaccine available. One is currently in clinical trials at the National Institutes of Health. In direct answer to your question: Though I believe you may have some residual immunity from your original vaccine, a booster at least would be necessary in the event of a threat.


Dear Dr. Marc,

Great idea for a column! Here's my question(s):

How is the kind of malnutrition in rich countries where the poor can also be obese different from malnutrition in poorer countries?

What absurd portion of healthcare spending in the United States goes to senior citizens in their last weeks of life? How much mortality and morbidity would be saved if these resources were rationed to people with a better long-term outlook? Do other countries have a better way to do this? What kind of ethical principles do they base such rationing on?

Did you get the idea of the name for this column from the longtime "Doctor Dollar" column at the magazine Dollars & Sense?

Phineas Baxendall
Cambridge, MA

Dear Phineas,

We made up the name for the column ourselves. High fat and high carbohydrate diets are our problem here. In poorer countries it tends to be a lack of protein or vitamins. It's hard for me as a physician to comment on or orchestrate rationing of care. It is a valid question, but hard to devise a law that would take into account patient-by-patient differences.


Dear Dr. Marc,

When I discuss the issue of AIDS with friends, I often hear the opinion that a cure won't be found because it's more profitable to medicate than to cure. It's also often stated that current AIDS research is probably being determined by "what's most profitable," not "what's best for patients." Could you provide some factual information on the state of the AIDS research "industry"?

Jason Rhodes
New Haven, CT

Dear Jason,

I really don't believe it. I think the ameliorative treatments have been a godsend. To be sure, they are way overpriced, and it is outrageous that the drug companies can be compelled to offer drastic discounts to third world countries in order to save face, as of course they should do, but not offer these same discounts to poor people here in the US. Still, the intention to find an effective vaccine is there, and much research is currently being done in this area in serious laboratories.

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