MovieChat Forums > Awakenings (1991) Discussion > Was rather sickened by one part

Was rather sickened by one part


Hi All,

It's been a long long time since I've seen this, so please forgive me if I've mis-remembered some parts of the story.

I believe that in this movie Robin William's character increases the doses of L-Dopa more and more until a result is achieved. He went beyond what was recommended as a dosage, or beyond what he was authorised to give

If that is true, it's sickening. These people aren't lab-rats. The ends do not justify the means. There is little difference between this man and the doctors who undertook the Tuskegee syphilis experiment. In fact, he's probably more in the wrong as the catatonic patients could NOT give concent - informed or otherwise.

Again, I may have the film incorrectly memorised as it is probably 20 years since I've seen it, but I THINK what I've written above is correct.

SpiltPersonality

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He truly believed it would work and there's really not much damage he could have done to those catatonic people. It was pretty much a "nothing to lose" situation.
I don't mean to impose, but I am the Ocean.

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Disagree.

Let me ask you, if it were your relative and the doctor overdosed your relative WITHOUT CONCENT which resulted in death and/or brain damage, and a week later a drug was developed that proved 100% effective, would you still think it was 'no lose'?

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Dr. Sayer first tested the drug on Leonard Lowe and he did ask his mother for permission...
I don't mean to impose, but I am the Ocean.

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As I said in my OP, it has been a long time.

Did Dr Sawyer (or more importantly, the real Dr he is based on) advise the mother that he was going to give more than the prescribed maximum dose?

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Did Dr Sawyer (or more importantly, the real Dr he is based on) advise the mother that he was going to give more than the prescribed maximum dose?


At first you said "recommended," then you said "prescribed." These two words are not synonymous.

It was my understanding that he himself was the one responsible for coming up with the prescription. That was the process that he was doing. He knew that going higher in dosage was risky but he felt it was worth the risk, and what he was doing was not illegal or unethical. As mentioned, he got written consent from the mother; the particulars of their conversation are not known. I'm guessing she gave him authority to try however he thought best, and that's what he did. Once it worked for Leonard, he was granted support & authority to try with the other patients.

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when you are in an experimental treatment who sets "maximum dose"? what was the determination of "maximum dose"? it wasn't designed for what they were using it for, that alone should cause you to be bent out of shape.

for me though, as someone who has a stepfather with inoperable liver cancer, an uncle who just died from brain cancer, and another friend who completely outlasted the prognostication of his survival with an inoperable brain tumor, i am all for experimenting. of course, by the same token, if the experiment turns me into a vegetable, please do me a favor.

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Go away, or I shall taunt you a second time!

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That's fine. You can say 'experiment on me all you want'... HE couldn't. He was totally unable to give consent.

I have heard of people with HIV/AIDS almost begging for experimental medicine, and can understand/accept/agree with their request, but they are able to GIVE their consent.

As I've said a couple of times, it has been a long time since I have seen this movie. No doubt, with Robin William's passing, I'll see it on TV again while all the tv companies scramble to cash in on his death... err... sorry 'pay tribute'.

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at the point in the story where the dosage was upped beyond previously accepted levels, leonard could give consent. i'm sure that's something the hospital has worked out (or maybe didn't in the 60s). the mother had consent to start and the dosages were acceptable levels.

leonard, as he was falling further behind no matter the dose, let out a "learn from me". in reading up on this a little bit, there was some talk about the experiences with this patient. one was that he definitely wanted them to learn from his plight.

i watched awakenings this weekend because it was available on the DVR. what dreams may come was available before he died and i had already dropped that into our box. jumanji and something else have now come available.

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Go away, or I shall taunt you a second time!

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He asked the mother before giving Leonard any dosage of the drug. Then he increased the dosage steadily until 1000mg. It is not mentioned in the movie what the suggested dosage is. Nor are any side-effects mentioned. It seemed to me that he was experimenting. And since the drug didn't seem to help, he gave Leonard the maximal dosage of 1000mg. It seemed like his last bet.

(Grissom): -Are you a terrorist?
(suspect): -Depends, are you terrified?

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That's a ridiculous argument, as there wasn't anything being done in that field. Do you think he would have gone to such extremes if there had been something that close to release? And there's rarely a 100% effective reversal for something like this, even today.

This will be the high point of my day; it's all downhill from here.

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They kept using multiple shots of Williams' face, concerned, as he ordered the higher doses. He obviously had concerns over possible side effects.




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4) You ever seen Superman $#$# his pants? Case closed.

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I didnt see anything wrong with it - what was the alternative? body chemistry changes everytime it adjusts to a new drug

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I'm really shocked at people on this thread being prepccupied by "the ends jusifying the means." Just because the drug turned out successfully for a short time, does not mean it was handled properly. I don't exactly know how it went about in real life, but I do believe the movie shows it basically as it was. And it did deviate from scientific standards. Everyone is too busy celebrating the doctor's method (in the film anyway) because of the outcomes, but had it gone disastrously wrong, everyone would be singing a different tune.

Double blind studies are supposed to be employed. The doctor and patient (or patient's gaurdian) are not supposed to even know who gets the drug in the early stages. You do not haphazardly increase a drug's use hoping "just a little more" will take effect, It's not supposed to be a one-man-show, where only one doctor is overseeing all of the elements of the "study." Of course, no one cared about these parients except this doctor, so he is hailed as a hero. Technically he had not done anything unethical, given these highly unlikely circumstances, and I do salute him for not viewing these people as "throwaways." Nonetheless, modern science almost never works this way, so I ultimately agree with this OP.

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It's easy to judge history by today's standards, and claim something was done wrong. I see nothing wrong with his actions and the OP doesn't even make sense. The fact that they can't even spell consent also is telling that they probably don't even work in a medical field.

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Completely agreed, even though i don't work in the medical field.

People who don't like their beliefs being laughed at shouldn't have such funny beliefs

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You're 100% correct, SplitPersonality. Read the book by Oliver Sacks. While some of the real patients were able to give consent (more because of the doctor's persuasion and hope than anything else), Sacks damaged most of them permanently, and the treatment wound up killing some of them, either by violent reactions or because they simply couldn't stand L-DOPA anymore.

So, yes--you hit the nail on the head. Precisely.

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Thank you for verifying my beliefs. Good to hear at least ONE person in the world agrees with me :)

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I guess you didn't read my post too. I also agree, and I explained why. It's unfortunate how many romanticize the medicine (as in "the practice of medicine here," although speaking about "the drug" fits too), without giving any thought to the factual details. The facts really are unsettling.

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Sacks might have had some questionable ethics but I´d like to know how someone who is more or less a vegetable, ie cannot respond to external stimuli, is supposed to give consent. lol

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As I mentioned in my first post, consent goes to the patient's guardian if the patient is unable. Really, the term "guardian" is for those who aren't adults or who have not ever been adults in care of themselves--such as Robert Deniro's character who reached adulthood while always being incapacitated. For adults who become incapacitated, the term isn't really "guardian." It tends to go to next of kin, unless the patient made their wishes known beforehand and chose a conservator.

Anyway, be it a "guardian," "conservator," or the next of kin, same rules apply. They oversee the patient's medical decisions when the patient cannot.

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Sorry, I don't seem to get all notifications, and didn't see your post.

Thanks.

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I know this a post a couple years old, but, I finally watched this after many years of wanting, but just never getting to it. I thought what you did, at first. Until I thought of Lorenzo's Oil, another great film. Even though that diesese led to death, I feel similar. These people were alive inside of basically a statue. They were literally trapped inside a vessel but they were alive! I don't know about you, but if that were me, or my child I would try anything to get them out of there! Can you imagine living inside a body you can't escape. You can't tell anyone your wishes. I feel it's a date worse than death. So, I'd try anything. But, the part of this story that is worse than that is the fact they went back into that catatonic state. I feel that is the saddest part. To get the chance to live, then slowly return. If doctors never go against the rules, we wouldn't have things like the rabies vaccine. Yes, sometimes the doctors are wrong. But sometimes they are not. If they are trying this on people who have no other option, that's one thing. The Tuskegee experiment is totally different. That was a horrible thing and not at all the same thing as what this doctor did.

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If you look into the cancer trials going on at Duke University, they are curing cancer that before these treatments were 100% non treatable. The first person did wonderfully. I think, the 2nd or 3rd did die. But they upped the dose and there were complications. That's what a clinical trial is. It's risky. But when you're dealing with a disease that is fatal you have any other options? And yes, this disease in the movie wasn't fatal, but if I had the choice of trying and possibly dying, or living my entire life like that, I'd try. But that's me.

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Whatever the arguments, the procedures shown would not be allowed today.

OTOH, movies show many procedures which are not allowed. Some are prohibited only by human-made laws. Many of the most popular are disallowed by the laws of physics. Some of both kinds are there just to improve the story-telling.

In medical experiments, what's allowed has evolved over the years. A hundred years ago, nothing would have been thought of the drug experiments shown in this movie. Note that the patients are still being given the best care known at the time, up to the ambiguity of the untested drug. To say there is little difference from the Tuskegee syphilis experiment is totally out of line -- those experiments actively denied patients treatments (especially penicillin, once it became available) known to be effective. That's totally different from trying a new drug, one that's generally recognized as safe, in patients who are continuing all known effective care and treatment. (The latter was nothing but warehousing in post-encephalitis lethargica, but that doesn't change the fact that they were getting the best care available.)

Clinical trials start with Phase I, which only determines minimal safety issues, on less than 100 patients. Since l-dopa was already in use for Parkinson's, Phase I was irrelevant. However, any reasonable use would have started with Phase II. It also would have had a control group.

I find that the dosage for Parkinson's is

Initial: 250 to 500 mg orally twice a day with meals.
Maintenance: 3000 to 6000 mg/day in 3 or more divided doses.

There seems to be some differences depending on source. However, I find it very likely that the dosages in 1969 were not much different from this, so there was no chance of overdose at the levels given. In fact, I found myself laughing at the Dr Sayers' agonizing over 100mg increments -- in reality it would have been more like "250 isn't working, let's go to 500".

Edward

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The agonising wasn't over the side effects, it was over the cost. Everybody seems to be thinking its about averse reactions when it's quite clear in the movie that money is a barrier to anything being done in that hospital.

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Everybody seems to be thinking its about averse reactions when it's quite clear in the movie that money is a barrier to anything being done in that hospital.


This is incorrect in my view.

Although the director and hospital board were indeed preoccupied by money considerations, Sayer himself in that specific scene was troubled purely by medical reasons and worried for his patients' health, nothing else.

Firstly, he has sworn the Hippocratic oath after all which clearly states primum non nocere meaning "first, do no harm", which means that the first consideration is the patient's health.

Secondly, he is the one who went to the director with the 12'000$ figure thinking it was worth it and doable. He clearly doesn't think that money should come in the way of treating people in need.

Thirdly and at last, the movie has done a good job portraying Sayer as a good man who genuinely cares for people, it would be rather out of character for him to suddenly equate every milligram of the drug to the amount it costs rather to the potential help it can provide to his patients, or in this case the potential harm it can inflict.


People who don't like their beliefs being laughed at shouldn't have such funny beliefs

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