‘Smart’ drugs could be bad idea

This issue covers performance-enhancing drugs, prostate cancer options, and transgender health.

In today's hypercompetitive world, there is an ever-increasing drive to be stronger, smarter, faster, better. Of course, hard work is one way to achieve these results, but research indicates that more people may be turning to so-called “smart” drugs to help them get an edge. Such off-label use could conceivably have benefits but also raises a host of ethical issues for internists and other physicians to consider when weighing patients' requests. In our story, staff writer Mollie Durkin talks to experts about how “smart” these drugs really are and what to do when patients ask for them.

Decisions about prostate cancer treatment can be notoriously complex, with patients and physicians choosing among such options as hormones, radiation, surgery, or watchful waiting. And once a treatment decision has been made, its effects on a patient's future care and an internist's comanagement can be far-reaching. Our story in this issue looks at why some experts consider prostate cancer a chronic disease, how side effects of treatments should be managed, and what the long-term effects of some treatments might be.

In the most recent U.S. Transgender Survey, conducted in 2015 by the National Center for Transgender Equality, 33% of transgender people reported having one or more negative health care experience, such as being verbally harassed or being refused treatment due to their gender identity. Our story takes a look at the subtle and unsubtle biases that transgender patients can encounter in primary care and how internists can help counteract them. Something as simple as modifying intake forms to ask for the name patients prefer to be called can make a big difference to inclusiveness, experts say.

Another inside feature in this issue looks at common ear, nose, and throat problems that present in internists' practice and notes how savvy assessment can help determine whether they will require a referral. Patients with sinusitis symptoms on only one side may be dealing with a nasal mass or a polyp, while hearing loss can be related to conductive or to sensorineural causes. Vertigo and tinnitus aren't usually worrisome, but the former can indicate stroke in the presence of other symptoms and the latter can sometimes point to a vascular problem.

Finally, our Physician Profile focuses on a former College leader who is leading in government as well. Mandy Krauthamer Cohen, MD, MPH, FACP, the recently appointed secretary of the North Carolina Department of Health and Human Services, past chief operating officer and chief of staff at CMS, and a past Chair of ACP's Council of Student Members, talks to us about the wide reach of health care policy, why working in state government offers some tangible benefits, and the one item she can't live without.

Would you, or do you, prescribe “smart drugs” to your patients? Let us know.


Jennifer Kearney-Strouse
Executive Editor