Thursday, July 14, 2011

Nose puppies and breast implants

An early Dilbert™ cartoon has Our Hero approach a sidewalk vendor whose sign advertises NOSE PUPPIES for the reasonable price of $1.00. The vendor explains that nose puppies are ceramic puppies that you insert in your nostrils. “‘Find a need and fill it.’ That’s my motto.”

The market, he explains in the next day’s strip, for ceramic puppies was rather small, and he wasn’t doing too well … until he hit on the idea of putting them up people’s noses. “I don’t want to get rich. I just want to leave the world a little better than I found it.”

“Nose puppies” is a good description for items that marketers have decided we “need” but serve no real purpose other than to bubble cash out of the hands of the improvident and into the coffers of the rich. Sometimes they work as advertised; sometimes they don’t; almost always they’re unnecessary.

Case in point: who was the genius who decided to create windshield wipers that turn themselves on? Who is so freaking lazy they can’t be bothered to flip a switch? (On the other hand, I can see definite value in cars that parallel-park themselves, since I’m not the best judge of distance … but I still wouldn’t call it a “need”.)

But here’s a more serious case in point: breast implants. This is the idea that transformed the once-noble subdiscipline of reconstructive surgery into the corrupted cash-cow makers of freak shows it is today.

Strictly speaking, no woman — even one who’s had a radical mastectomy — really needs a boob job. Breast implants can’t replace or augment the breast’s primary function (feeding infants). Men who really love their women accept the equipment the women came with; men who need to have a fixation on breast size indulged aren’t men worth a woman’s emotional investment. Women who don’t like what they were given by Nature need to learn to feel comfortable within their own skin, not a couple of bags of silicone.

The thing is, we know this to be true. Moreover, in the most secret corners of their souls, plastic surgeons know this to be true. However, while 98% of medical schools in the US have some modified, modernized version of the Hippocratic oath, according to Dr. David Graham, “… many modern oaths have a bland, generalized air of ‘best wishes’ about them, being near-meaningless formalities devoid of any influence on how medicine is truly practiced.”[1] There is little enforcement of any version, and no sense that the doctor is morally accountable to the larger community of physicians or society.

What does this mean? It means that the boundaries of what constitutes unnecessary surgery, once the great moral taboo of the surgeon, are harder to recognize and easier to cross. Since the big money in plastic surgery is no longer in rebuilding faces crushed in accidents but in indulging human vanity and silliness, the patient decides whether a particular procedure is necessary … which is not unlike allowing the junkie to decide whether cocaine is required.

The archetype of surgery attached to no sense of medical ethics was the late Michael Jackson. There wasn’t a single thing done to his face that could be grounded in an authentic sense of necessity. Yet because Jackson was not only pathetically (not to say pathologically) insecure but rich to boot, he could afford to pay the kind of bucks it takes a plastic surgeon to create a sort of metrosexual Frankenstein’s monster … as one comedian observed, to change him from a black man to a white woman (although what woman would want that huge cleft chin?).

While Jackson was the archetype of unnecessary surgery, the sine qua non is abortion, with euthanasia and assisted suicide following closely on its heels. Very, very rarely is there a medical condition that warrants the immediate termination of a pregnancy; most of the time, doctors push for it as the easiest option, the one requiring the least risk and least effort on their part.

The original Hippocratic oath holds, “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.”

One modern version, written in 1964 by Dr. Louis Lasagna of Tufts, reads, “Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.” But what is “playing at God” if it’s not taking on one’s own shoulders the decision to directly take life?

Doctors are not mere technicians, nor are they mere suppliers of goods and services. They are members of one of the oldest professions, one that for centuries has sought to cure and heal … “to help, or at least to do no harm”.[2]

Moreover, they’re not robots or vending machines. Infused with the same innate human dignity as their patients, they should never be asked to set their consciences aside, or to provide services that have little medical value and serve only to sustain vanity, silliness or insecurities. They should never be put into a position where they’re allow or expected to take human life, not even at the request of one who wants to die.

Most of all, we should work on returning our culture to an authentic sense of true human needs. The Madison Avenue definition is twisting us into a culture of insecure narcissists.

And we in turn are turning the practice of medicine into the provision of nose puppies.

[1] Source: Journal of the American Medical Association, 12/13/00, cit. in Peter Tyson, “The Hippocratic Oath Today”, NOVA Beta (, 3/27/01, retrieved 7/14/11.
[2] Hippocrates, Of the Epidemics, 1:2:5.