From Lamont, Florida, USA:
My 30 year old son-in-law was diagnosed with 1ype 1 diabetes a year ago, and since the genetically-engineered insulins currently being forced on the diabetic population often have unpredictable peaks, he has been having difficulty maintaining relatively level blood glucose levels. His doctor recommended that he switch to glargine (LANTUS) -- an insulin-like material that garnered FDA approval, and has been linked to some negative results in European studies. When he declined to become a guinea pig for his doctor, the manufacturer and the FDA, his doctor chastised him for being uncooperative and told him to find a new doctor. Is this typical behavior for diabetologists? If the patient wants to be involved in the decision-making regarding his own care can his physician ethically refuse to continue to care for him, and at the same time refuse to refer him to any other doctor? Has the Hippocratic Oath become an ethical and moral anachronism?
Something doesn't make sense here. If your son-in law is truly being asked to participate in a study of Lantus (insulin glargine), all studies require informed consent of the participant, and investigators are required to clearly explain all the possible unknowns and side effects. Informed consents usually also contain clauses that state that the patient's treatment will not be compromised if he refuses to participates or drops out. If your son-in -law's doctor is refusing to treat him if he refuses to participate in a study, this is unethical and should be reported to the local hospital Institute Review Board (IRB).
It is more likely that your son-in-law and his doctor just aren't seeing "eye to eye". If this is true, your son-in-law would probably be better anyway to find another doctor who is willing to work with him.
Additional comments from Dr. David Schwartz:I am sorry that you and your son-in-law feel so negatively about the medical profession, and I hope that your son's physician (and other physicians) do not interpret the Hippocratic Oath to be an "anachronism." Having said that, however, we do unfortunately live in a very litigious culture: medicine remains an art, with a lot of science, but an art none-the-less. Oftentimes, ill people expect "magic" (I use that term very loosely) whereby disease gets much better or symptoms resolve with little more than "a pill" -- just like on TV. Your son-in-law's physician may be sensing some of the anger that you are displaying and may be aware of other issues not presented in your letter (such as poor attention to meal planning, glucose monitoring, or other possibilities) that s/he feels may be setting the stage for a bad outcome. A physician caring for an adult can only offer recommendations; the patient chooses whether or not to follow them. I absolutely feel that a competent adult should take an active role in decisions about their care, and I'd bet that your son-in-law's diabetes doctor feels that way, too.
I presume that the recommendation was made to begin Lantus which is FDA-approved, but no, we don't have 30 years of experience, and it is a genetically manipulated insulin. If your son-in-law does not wish to feel "like a guinea pig," then he should not take this insulin. On the other hand, his physician is under no obligation to care for him, either. So, if the physician feels that trust and rapport have dissolved between him/herself and your son-in-law, it may be in everyone's best interest for your son-in-law to seek care by a physician that he feels more comfortable with.
Original posting 18 Jun 2001
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