FRAMED LIKE A PAINTING

I always like to give a figurative explanation of health and disease to my patients using the words “flow" and “chaos”. Flow is health. Chaos is disease. We need to have flow in our thinking, in the digestion of our emotions, in the fluidity of our blood, in the functioning of our gastro-intestinal system, in the production of our hormones, in the movements of our joints, in the communication between our cells, in short, in our body, mind and soul so that it can all be reflected in good health. But I have this perception that nowadays there’s   no flow in the practice of Medicine. In other words, there’s no flow (lightness) of conduct in our profession lately. One example: I used to have a personal and a professional Facebook account. I assumed this personal one was supposed to be more informal, with a little bit of more freedom to write. I thought I was connected to “friends” anyway. Then, once I made an innocent post on a very known pharmaceutical product used for sleep disturbances, which has Humulus lupulus (hops) in its formula, the same plant with great active compounds found in IPA (Indian Pale Ale) beer. That is why IPA is considered to be  better for sleep than the other beers. I made a post just out of curiosity, really. The focus was on IPA beer, not on the pharmaceutical product. The problem was that I mentioned its brand name in this personal Facebook account. Do you believe this was enough to be considered an ethical wrong choice of conduct? In my view, it should be considered that we have been through an incredible change in the rules and regulations of marketing and publicity in the last 5-10 years and that it is very difficult for us, medical doctors, to keep up with them. I also believe that, in a "friendly environment”, the ethical or related councils should give one, two, three warnings of misconduct when we do go against these rules and regulations before actually giving it a "shape" of accusation and punishment. The feeling of blameworthiness haunts us day and night.

A SAD STORY

This time I was accused of I violating the article 75 of the Brazilian Code of Medical Ethics. Art. 75: It is prohibited for the physician to refer to identifiable clinical cases, display patients or their portraits in professional advertisements or in the dissemination of medical matters, in the media in general, even with the patient's authorization. The thing is: true, I might have done something wrong in the scenery of medical publicity, but a little  bit of understanding and, maybe, kindness would have made it acceptable without punishment. As I said before, just a warning would have been enough. What happened? In 2015, I had this patient in his fifties with the diagnosis of amyotrophic lateral sclerosis, a classical adult-onset motor neuron disease [2,3]. Over the last years, he had evolved with progressive muscle weakness, atrophy and spasticity [3], slurred speech, trouble in swallowing and twitching in the tongue, getting to the point of almost total paralysis: he could basically only move his eyes. Needless to say that he was under ventilator support [3]. It was so impressive, really heart-breaking. I couldn’t understand why someone was supposed to go through such a heavy burden in life. Honestly, it made me feel desperate inside. I didn’t know much about the disease itself, but I felt that I could help him with my knowledge on diet and supplements to improve his nutritional, metabolic and hormonal status and, maybe, have a little better quality of life. I ordered as many laboratory tests as possible at the time to check his inflammatory parameters, levels of minerals, vitamins, thyroid and adrenal function, toxic metals, that is, a thorough  evaluation. I was amazed when one of the patient’s daughter told me that many doctors had said “there was nothing to be done”. In other words, it was considered a helpless condition. However, I realized that there was a lot to be done. Omega-3 fatty acids, vitamin D, A, E, C, B12, methylfolate, calcium pantothenate, pyridoxal-5-phosphate, inositol hexanicotinate, riboflavine, sulbutiamine, magnesium, zinc, manganese, selenium, glutathione, acetyl-L-carnitine, PQQ and coenzyme Q-10 were among the wide range list of supplements prescribed for him [4-7]. I actually bought them myself for months on end once the family was very poor, financially speaking. I started to make regular visits to them, although they lived about two hours away from me. I was treated like “an angel”, as  his youngest daughter used to say. I also kept an eye on his wife who had a very tiring routine taking care of him, the children and the house, obviously neglecting herself. Initially I couldn’t work on his diet because he was getting fed only on enteral nutrition. Two or three months later, he started moving his head again. After a while, he could eat normal food twice a day, orally. I helped the family to have some organic production of vegetables in the back garden. That was awesome. Slowly, he started moving his hands and legs, but not much. At some point, he started to give amazing laughs, moving his neck back and forth and interacting much more with relatives and friends, although he was never able to speak again. One day, one of his daughters posted some pictures of us all together in one of my visits to the family which always used to happen on Sunday mornings. The problem was that she “shared" the photos with me in my private Facebook account and, for that, I was accused of exposing the patient. It was assumed it was a “professional advertisement”. Definitely not. It was more of a Sunday gathering of friends registered with a photograph, as most people do in social media. Notwithstanding, I did something apparently wrong: I asked to these Facebook "friends" if they could help me with some money to buy this patient’s supplements, which were fairly expensive. Actually only a few of them did help. The problem was that I gave the number of a private bank account which was not in use at the time. I didn’t see any problem with that, because I thought private Facebook accounts were actually “private”. The bank account could be checked at any time, if required. Anyway, it doesn’t really matter now. This patient lived for another six years and died from respiratory complications in the middle of the Covid-19 pandemic. I will never forget his broad smile and tears of happiness whenever I arrived at his house to see him. 

HUMANS WITHOUT HUMANITY

It is a bit dramatic to say so, but, true, we, humans, are most in need of some humanity,  including the medical world. To say that reminds me of one of the most well-loved Victorian poets, Alfred Lord Tennyson (1809-1892), when he wrote:

We are not now that strength which in old days Moved earth and heaven, that which we are, we are,  one equal temper of heroic hearts, made weak by time and fate, but strong in will to strive, to seek, to find, and not to yield.

Such beautiful words! As you can see, they were written in the XIX century and are still meaningful to us. Anyway, let’s not give up and fight for a more noble, dignified and humanistic Medicine, as we used to have. With love and glory, as proposed before in the previous articles.