Putting Looks Before Health

Some stop taking medications because it makes them unattractive

(July 21, 2003) - He's a 43-year-old man who lives outside Boston, works in investment management and has had HIV for six years. He asked that his real name not be printed.

Bob is a savvy, health-conscious guy, a gay man who takes his body and his physical appearance seriously.

"No one wants to age, especially gay men," he confides easily. "It's the Peter Pan syndrome - we never grow up." Besides, he says, he has to look good to be successful and "the people I work with don't know I have AIDS."

But last year, the AIDS drugs he had been taking began causing lipo-atrophy - loss of fat tissue in the face that leads to sunken cheeks and a gaunt appearance. So Bob stopped taking the drugs.

"I gambled," he says simply. "I didn't like the facial changes."

It may sound - and sometimes be - foolish to sacrifice health for beauty. But the fact is, taking some calculated risks with health to enhance attractiveness is as old as humanity.

"People all over the world modify their bodies in ways that are painful and sometimes dangerous, to enhance their beauty," says Sally Engle Merry, a Wellesley College anthropologist.

Millions of women routinely endure pain, and damage their feet, from pointy, high-heeled shoes. The booming plastic surgery business is another obvious indicator of how much we value looking good. For the privilege of acquiring more fashionable noses, perkier eyelids and skinnier stomachs and thighs, Americans suffered some and spent a whopping $7 billion.

The real rub, psychologically and ethically, comes with more complicated decisions such as Bob's that involve weighing the value of attractiveness against the medical risks of using, or not using, powerful drugs.

Steroids, used to treat asthma and rheumatoid arthiris, clearly work, but they cause disturbing side effects, including the puffylook dubbed "moon face." Some people with arthritis get so upset about the result that they taper off steroids too quickly, says Dr. Paul Romain, a rheumatologist at Cambridge Hospital.

It's a delicate dilemma for both patients and doctors: "When you lose control over your appearance, you lose control over your own privacy," he says.

Weight gain is another all-too-visible side effect of many drugs. Some anti-schizophrenia drugs like Clozaril and Zyprexa trigger an average weight gain of 15 pounds and sometimes 100 pounds or more, says Dr. Donald Goff, a psychiatrist at Massachusetts General Hospital. "A lot of patients don't want to take these medications," he says, adding that weight gain "is a serious threat to a person's general health."

Drugs that cause weight gain pose an especially wrenching dilemma for young women with anorexia and bulimia who are terrified of looking fat yet need psychiatric medication, notes Dr. David Herzog, an MGH physician.

Cancer patients on chemotherapy often face the same problem, says Barrie Cassileth, of Memorial Sloan-Kettering Cancer Center in New York. Now that there are good drugs to control nausea and vomiting, weight gain is viewed as an increasingly common problem, she says.

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As for Bob, his physician, Dr. Cal Cohen, research director for Community Research Initiative/New England, is supportive of the delicate balancing act between appearance and health.

The advent of better AIDS drugs in recent years has certainly been a plus, he says, yet "there are disfiguring toxicities from some of the drugs, which make people look sick."

Bob's solution was to have monthly injections of a substance believed to boost collagen in the face. He's also decided to go back on his AIDS drugs for three months to "tromp the virus down," then take another year off.

Source: Baltimore Sun

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