Television Ethics: "Private Practice"

The TV show, "Private Practice," hasn't impressed me with its medical, social or psychiatric integrity. But, I found myself watching it tonight, October 24th, and was more impressed than usual. Tonight's show touches on a cutting-edge bioethics topic that was also mentioned at last week's American Society of Bioethics and Humanities.

Major Multiple Spoiler Alert!!! Don't read more if you've recorded the show to watch later.


(Let's forget the thread on the women who come in for their pelvic exam by the kid midwife - where the only exam the women are evidently getting is the actual *pelvic* exam. No eyes, ears, throat, lungs, breast or abdominal exam. My Family Physician, head-to-toe, cradle-to-grave soul can't bear it.)

(And we won't even ask the Mama in me how I feel about 13 year olds having sex. You might be surprised that I don't freak or judge, though, and pretty much treat the girls the same way that the lead doc does. The difference is that I go out of my way to explain to families when they first come to the office that I consider their child my patient in his or her own right and ask permission to treat without notifying - and, of course, without billing - them if the teen requests that I keep silent. I've always been able to convince the young person to turn to their parents for help, but manage to keep privileged information privileged as long as possible. As far as I know, I've only had one family leave my practice after I explained my policy.)

Okay, back to the cutting edge bioethics topic.

One of the guest characters asked the internal medicine doc for a medicine that helps patients forget.

Actually, the medicine, propanolol, will not help her forget. However, it can help some patients stop feeling the panic and other horrifying emotions that come after a near-death or traumatic event like a rape that causes "Post Traumatic Stress Disorder."

MSNBC had a review, here, about the treatment last year.


The technique can be used to blunt the emotional memory -- not the actual memory or physical damage -- of the traumatic event. Adrenaline or epinephrine is the "fight or flight" hormone or drug that is released when there is stress. It's what causes what I call "the near-car-wreck" feeling that we feel, well, when we nearly have a car wreck.

Epinephrine gives you a boost of energy, pumping sugar, cortisone and other hormones into the body, to allow that fight or flight response. Do you need to take off and escape or stand and battle with whatever it is that is threatening you? Epinephrine is also involved in stimulating the bone marrow to make blood and other organs to heal faster, too.

Unfortunately, sometimes the body makes epinephrine inappropriately, when there's no real danger or when the danger is not severe enough. When that happens, we call it a panic attack or an anxiety attack as people experience the physical and emotional symptoms that are associated with real danger. Their bodies are telling them that they are in danger, but there's no actual threat to confront. When it gets in the way of your life, it's a disorder. Long term panic and anxiety that can be related to a past trauma, and that sometimes causing a person to feel as though he's reliving the trauma, is called Post Traumatic Stress Disorder.

Propanolol is a "beta blocker" that blocks epinephrine and which we often use to treat hypertension and even panic attacks. If used during the time after a traumatic event in which the long-term memories are set in the brain and/or in conjunction with behavioral therapy, it appears that the memory is disconnected, "disassociated," from the emotions that the patient experienced during the trauma and during the flashbacks when the memory makes the patient feel as though he's reliving the event, later. The treatment of PTSD that seems to work best is behavioral therapy, teaching the patient to control his own body's reaction.

Some ethicists are concerned that we may blunt a necessary healing function of epinephrine and the other body and mind effects of the stress reaction. However, I think of the treatment of stress disorders in the same way that I think of treatment of pain. Pain may help us prevent injury and warn us of a threat to our health. But we treat pain that is out of proportion or that is not useful to protect us.