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03/09/2018

BioethicsTV (March 5-9): #ChicagoMed, #GreysAnatomy-Vaccination & Medical Marijuana

by Craig Klugman, Ph.D.

Chicago Med (Season 3; Episode 11): Harms of not vaccinating

An infant comes to the ED with a case of whooping cough. She has had her first vaccinations. As it worsens, we learn that he was recently exposed to his cousin who had a cold—which may have been a mild case of whooping cough. The cousin has never been vaccinated because his father does not believe in it. Dr. Manning calls the father an “idiot” and lectures him on how dangerous not vaccinating a child is for others. Later when talking to Halstead, she says, “I can’t stand it. No matter how much science we give people, no matter how proof, they just go on believing what they want to believe…What is wrong with people? Why do they keep clinging to this myth?”

The reality is that unless a person has an allergy to something in the vaccines, they are safe. In some states, a person can practice autonomy and choose not to vaccinate themselves. An argument could be made that not vaccinating children, and thus putting them in harm’s way, is problematic. The problem with not vaccinating is that the potential harm does not stop with oneself or even one’s children, but rather extends to the entire community and everyone with whom that unvaccinated person comes into contact. An individual choice not to vaccinate endangers everyone.

Grey’s Anatomy (Season 14; Episode 14): Medical Marijuana

Although it took a while, Grey’s has finally taken on the issue of medical marijuana in Washington state. A 12-year-old cancer patient undergoing chemotherapy is having nausea and lap of appetite that medications cannot control. Her doctor, Karev, wants to give her an NG tube. As a singer, she would prefer not having that. Instead, she asks for medical marijuana, specifically an oil. She needs authorization from the hospital, her primary doctor, and her grandmother. A resident says it helps with the pain, nausea, and even PTSD. Karev is initially opposed, saying it’s not approved or regulated by the FDA. Karev quickly changes his mind and is taken aback when he approaches the grandmother for her signature. She is appalled by the idea and does not want Karev turning the patient into a drug addict “like her parents”. The grandmother fires Karev and states that she’s taking her granddaughter to another hospital. At the end of the episode, the patient is nausea-free and eating a large hamburger. Her grandmother smiles. We are left to assume that she got the marijuana.

In reality, the studies on the values of medicinal marijuana are still being done. The little that does exist suggests that marijuana is helpful for people undergoing chemotherapy for nausea, loss of appetite and pain. However, such research has not been done on the use of the oil-based form, as is used in this episode. A recent survey found that pediatric oncologists generally are in favor of marijuana in their minor patients but felt less comfortable in legally certifying them for use. The process in Washington (where the show takes place) is not as simple as this episode made it seem. First, the patient needs an authorization; second, the patient registers and gets a card; third, the patient purchases plants, clones or seeds from a licensed  grower. The missing piece in this episode is that we do not learn how the procurement of the oil is done—the patient is a minor so cannot purchase. The grandmother seems reluctant. And in general, physicians cannot purchase medication for patients. Would the hospital pharmacy have it? Doubtful.

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