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When is healthy not enough?

Drugs that help us feel and perform better than normal can present a dilemma.

Until recently, doctors have aimed to keep people functioning at a "normal" level. At the Cooper Clinic, a primary tool we recommend to achieve this is exercise. Regular readers know the emphasis I place on using physical activity as "medicine." Many studies have shown that active people not only enjoy longer lives, but also better lives. Consequently, exercise is a vital part of anybody's preventive health program.

Of course, when it comes to living better, good habits are not the only tools available. Numerous medications have been developed that have dramatically improved how well we live. Problems that previously disrupted the lives of millions now can be controlled: migraine headaches, depression, sleep disturbances, ulcers, allergies ... the list goes on and on.

But somewhere along the way, it has become clear that with some medications and procedures, we actually can feel better than "normal." Elective cosmetic surgery (to help us look young) has increased tremendously over the last generation. Prescription medications are another example. The first time I heard about Viagra, I thought, "When this stuff hits the market, guys left and right are going to want it, whether or not they have a problem." Boy, was I right! Since Viagra was introduced in the late 1990s (followed by Levitra and Cialis), men with no erectile problems have been taking it simply to try to improve their performance.

Similarly, other medications prescribed by "anti-aging" doctors have been used to improve strength, stamina and vigor. Today's professional baseball sluggers are the perfect example. Some of these über-athletes, with help from performance-enhancing supplements, now smash previously unattainable records. Improved training? Yeah, right.

And it doesn't stop on the athletic field. With the advent of drugs used to treat attention-deficit disorder came the knowledge that in "normal" individuals, such medications make it possible to work late hours, concentrate more effectively and even pull all-nighters without feeling repercussions later.

There are those who say, "Why not?" If we can make ourselves feel and perform "above normal," who's to say we shouldn't? Well, besides the possibility of significant and sometimes dire medical consequences from drug misuse, there's an ethical dilemma for doctors. Using medications for things other than what they were designed for (called "off-label" uses) is murky territory, especially when the drugs are used simply to make someone feel better than normal. There are physicians who come down on both sides of this argument. As for me, I'm as eager as the next guy to fight Father Time. But until we have a better understanding of the potential hazards with off-label drug uses, I'm sticking to what I know works: exercise. It's as effective as anything we know at slowing down the aging process. And it's a lot cheaper, too.

Contributing editor Tedd Mitchell, M.D., is president and medical director of the Cooper Clinic in Dallas. He writes HealthSmart every week.