The world of reality TV just raised the bar -- moving from wife swapping and home building into the high stakes world of real-life medical care.
The new show -- ABC's Miracle Workers -- rolled out nationwide earlier this month with this hefty promise: "When a person's life is on the line and doctors insist that nothing more can be done, it's time to turn to the Miracle Workers," says its promotional ads.
The show's premise: To showcase cutting-edge medical procedures through the eyes of the patients who experience them -- and in the process teach us a little something that might help solve some of our own health problems.
Ethics Issues
In the premier episode March 6 we meet a man blind since childhood who receives a cornea transplant and a woman disabled with back pain who receives a titanium disc implant. Not surprisingly, by show's end the blind man sees, and the disabled woman walks -- all thanks to the Miracle Workers.
But as warm and fuzzy as this sounds, some medical ethicists say this time Hollywood has gone one tinsel-tinged toe over the line.
"Should we give away refrigerators? Sure. Trips? Yeah. Fur coats? Who cares. But when we turn the quest for medical care into Queen for a Day, we have gone too far -- ethically," says Arthur Caplan, PhD, chairman of the department of medical ethics at the University of Pennsylvania Medical School in Philadelphia. "A show that gives out good medicine as a prize is immoral."
Getting good care, he adds, should be our right, not our privilege; as soon as we turn it into a privilege, Caplan says, we run the risk of only a privileged few receiving it.
The show's executive producers Justin Falvey and Darryl Frank, don't see it quite that way.
"Just because we can't help everybody, does that mean we should help nobody? And if through helping a few people, the information we present can help many … then I think we are doing our job," says Falvey.
The Cost of the Cure
As anyone who's ever paid a doctor's bill can tell you, medical miracles don't come cheap. The producers say most of the patients had good insurance; when they didn't the show picked up the tab -- or got the hospitals or doctors to donate their services.
As good as this sounds, medical ethicist Celia B. Fisher, PhD, says it raises a big red flag.
"Is the payment that's promised contingent upon the patient's agreement to air the story? And even if it isn't, to what extent does the patient really understand that? Is there a sense within the informed consent that they are signing away their rights?" asks Fisher, director of Fordham University Center for Ethics Education.
Moreover, she says concerns are magnified if the procedure fails to deliver promised results.
"Let's say the family does not want the show to air the failure. Does the show still cover expenses, and aftercare? And is that made clear to the patient? If not, there is obvious exploitation and a coercion that doesn't belong in medicine," says Fisher.
The producers say that thus far there have been no failures but acknowledge it could happen. If it does, Frank says they'll "carefully weigh all the options, taking into consideration the wishes of the patients, their families … as well as everyone involved in the show."
In terms of follow-up care, the show has tried to help. In an arrangement with CVS Pharmacies, patients requiring long-term medication (such as is necessary with an organ transplant) receive a $25,000 pharmacy voucher to help defray costs. They say other follow-up care is decided on a case-by-case basis, frequently determined by the doctors or the medical centers involved.
What's Really New?
Ethics issues aside, for most viewers the real value of the show will likely lie in the procedures themselves. More specifically, will we come away learning about anything really new?
Although some of what will be shown is readily available in many leading medical centers, in other instances the show easily hits the top tier of cutting-edge care.
Indeed, that seemed to be the case in the second show when doctors used a procedure known as deep brain stimulation (DBS) to treat Tourette's syndrome -- a neurological condition. The treatment had only been tried on this disorder 12 times.
Ultimately it was successful. But in a statement offered by the Tourette Syndrome Association, viewers are cautioned to view DBS as "highly experimental," reminding us that "in many cases, currently available medications and behavioral therapies do bring substantial relief."
Weighing the Risks
In another segment, however, 4-year-old Adrian Keller received a highly risky operation to correct a severe form of scoliosis. But in this case, the Scoliosis Research Society views the cutting-edge procedure as legitimate and probably necessary.
"Treatment options are limited for very young children with severe spine and chest wall deformities," says spokesman John M. Flynn, MD, associate chief of orthopaedic surgery at The Children's Hospital of Philadelphia.
While Flynn tells WebMD the surgical solutions are "new, complex and under constant evaluation," he says the treatment as depicted on Miracle Workers addressed all the major issues. And without it, he says, the child probably would have experienced significant problems with lung growth.
Finding Your Own Miracle
As to whether or not you too can become the show's next miracle -- you may have better luck hanging out at your local ER than sleeping on the steps of a Hollywood studio. The producers tell WebMD they cast the show by reaching into communities to find those with unmet medical needs -- contacting medical organizations, hospitals, community centers, even fire and police departments.
"Anywhere there was a sense of community where people could alert us to a person who had a medical need that was not being met by what was offered thus far -- we reached out to them," says Falvey. Today, they have a web site and an email address to help.
In other instances, however, they tell WebMD they found the cutting-edge procedures first, and then tried to match them to a patient.
"Sometimes the doctors that we were hoping to profile, or a hospital that understood our goal, would recommend a patient who would be a good candidate for a specific surgery. And sometimes we would find the patient and then help them find the doctor. Every case was different," says Frank.
But if doctors or hospitals are recommending patients, experts say the ethics issues once again take center stage.
Conflicts of Interest?
The American Medical Association's report from its Council on Ethical and Judicial Affairs states: "As advocates for their patients, physicians should not allow the care they provide or their advice to patients regarding participation in filming to be influenced by financial gain or promotional benefit to themselves, their patients or their health care institutions."
Moreover, Fisher adds that "If they are choosing patients based on who is photogenic, or who has an evocative back story, that's wrong. Whenever a decision to offer medical care is based on anything other than medical need, it becomes an ethical issue."
While the show's producers tell WebMD that sometimes factors other than medical need does figure into choosing patients, they don't see that as a conflict with medical ethics.
"There is a lot of psychological pressure that goes into having your medical care filmed and televised, and the simple truth is not every patient can cope with that -- or wants it. From our standpoint, we have to find someone with a medical need, and the right mindset, and whose personal story will help inspire others to also find help," says Frank.
As a further safeguard the show employs four full-time medical professionals -- two leading surgeons and two experienced nurses -- to take patients through the decision-making process and ensure they understand the risks and the benefits of what they are being offered.
Still, some experts say that allegiances can be hard to define.
"There are dual issues here -- the needs of the patient and the needs of the show. And they may not always be the same, and that remains a concern," says Fisher.
The Good, the Bad, the Grateful
While the show may not be perfect, it's tough to argue against a concept that helps sick people get better while raising public awareness of important diseases and potential cures.
That said, experts say it's vital that we view it in the proper perspective.
"Understand this is the 'Photoshop' version of medicine. You are never going to meet a woman who looks like the women you see airbrushed on magazine covers. And you will never find the kind of airbrushed medical care that you see on this show," says Caplan.
So, he says, learn from what the show offers, but don't resent your own doctor if the care on TV seems so much better.
Fisher also cautions not to view the show as having the ultimate medical answers.
"What you are seeing is one treatment approach. It may not be the best one -- it's just the one that met all the show's nonmedical criteria. This is not objective medical reporting, it's medical entertainment," says Fisher.
Finally, both Fisher and Caplan remind us to never to place the importance of what we see on TV over and above the medical opinions of a personal doctor we know and trust.
By Colette Bouchez, reviewed by Louise Chang, MD
SOURCES: Arthur Caplan, PhD, chairman, department of medical ethics, University of Pennsylvania Medical School, Philadelphia. Justin Falvey, producer, Miracle Workers. Darryl Frank, producer, Miracle Workers. Celia B. Fisher, PhD, director , Fordham University Center for Ethics Education, New York City; John M. Flynn, MD, associate chief of orthopaedic surgery, The Children's Hospital of Philadelphia; spokesman, Scoliosis Research Society. Tourette Syndrome Association statement on Miracle Workers. American Medical Association report, Council on Ethical and Judicial Affairs, 2001.
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