Feel-good medicine: yesterday and today

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I’m on summer break but I thought you might enjoy this piece, published a year ago in the August 2014 issue of the Nob Hill Gazette.  The version below is slightly edited compared to the original.

In their recent book titled, Dr. Feelgood: The Shocking Story of the Doctor Who May Have Changed History by Treating and Drugging JFK, Marilyn, Elvis, and Other Prominent Figures, Richard Lertzman and William Birnes chronicle the startling career of Max Jacobson, a physician who specialized for decades in treating celebrities with his personally concocted injections of vitamins, human gland extracts, and high doses of amphetamines.

Operating from a filthy office in Manhattan, Jacobson showed no regard for basic medical hygiene and never obtained a basic medical history from his patients. Yet, over the years, he dispensed untold quantities of his “cocktails” to political and show business superstars suffering from fatigue, pain, or lack of stamina. For some of his patients, such as Cecil B. DeMille, the German-born doctor was a paragon of modern medicine. But others saw their careers and personal lives ruined as they became addicted to the treatments, and a few might have actually died as a result of it. The authors of the book relate instances where, under the influence of Jacobson’s amphetamines, President Kennedy’s behavior became wildly erratic. They even speculate that a motive for his assassination might have ensued.

Max Jacobson’s story might seem like a sordidly entertaining tale from a bygone era. Nevertheless, given our current love affair with medications (one in five adult Americans takes a psychiatric drug, and 70 percent of the U.S. population takes some form of chronic prescription medication), it behooves us to reflect on the professional and ethical failings of Jacobson’s practice to help keep our way of “better living through pharmaceuticals” within healthy boundaries.

So what’s so bad about feeling good? This question is also the title of a memoir written by Doctor Robert Freymann, another “Dr. Feelgood” of that era who also treated celebrities with amphetamines and who, along with Jacobson, lost his medical license in the early 1970s after a report in The New York Times triggered an investigation by the state medical board. To defend their mode of practice, Freymann and Jacobson argued that making patients feel better is an essential aspect of the work of a physician, an aim that they tried to pursue relentlessly.

This seems like a valid point. After all, alleviating suffering is a major goal of medicine, and the manner in which the two doctors prescribed amphetamines was—at the time—perfectly legal. Kennedy had suffered for years from a number of medical conditions, including weak adrenal glands and chronic pain from a back injury. He might have felt that the standard therapy provided by his regular physicians at the White House was ineffective, and he solicited Jacobson’s help in good faith. Others sought out Jacobson for relief of chronic sinus headaches, joint pain, or other ailments that seemed effectively relieved by the injections. Should these patients have gone on to suffer indefinitely? By what measure can an addiction be distinguished from an effective therapy for a chronic problem? And if the treatment is safe, is a tradeoff between suffering and becoming dependent on a drug ever worth it?

These questions can be difficult to clarify if we don’t apply principles of good medical practice. To begin with, it is important to recognize that subjective feelings do not always reflect the well-being of the whole person. The “self” is more than a state of mind, and the integrity of the patient can be jeopardized even as he or she experiences a sense of well-being. In addition to psychological wellness, the person’s health must be measured in its totality, including its biological, social, and spiritual aspects. Many of Jacobson’s patients were convinced that they were getting better, while their spouses or co-workers could clearly notice their gradual disintegration.

Drugs that modify brain chemistry are commonly prescribed today and can be helpful in treating depression, anxiety, and hyperactive disorders. But a good response to such pharmacological therapy does not mean that a particular condition is simply a chemical phenomenon. Jacobson felt that his patients needed “a boost,” as if they had somehow become deficient in one substance or another. He provided the shot but never peered into the personal, familial, or social factors that attest to the complex reality of the individual. These factors can be fundamental either as a cause of, or a remedy for, an illness.

Mental fatigue or distress can also be an appropriate response to a given situation. This might be particularly true for celebrities who are subjected to the extreme pressures of a culture of mass communication. To treat politicians or show business stars, as Jacobson did, so that they can perform at a high level is nothing short of doping—regardless of the safety of the means used. The world of sports has come to recognize that athletes must compete to the best of their natural abilities; the rest of society does not always share that attitude.

Because feeling good is not a fail-safe indicator of health, any cure or treatment should be pursued with great candor by the physician. Jacobson seldom revealed the contents of his syringes, but his patients also typically chose to remain ignorant. When Bobby Kennedy once questioned the treatment that his brother was receiving, the President famously retorted, “I don’t care if it’s horse piss, it works!” Even today, with our strong emphasis on the principle of informed consent, the situation can get murky if physician and patient are not grounded in a sound medical and ethical framework.

To alleviate suffering in others is noble. At times, this requires the use of drugs for the rest of a patient’s life. But, in medicine, finding the right course of action calls for honesty, humility, compassion, and a commitment to true health. A feel-good lookalike will not do.