‘Mad’ world a bit ahead of its time
“Mad Men,” season premiere, AMC, July 27.
The premise: It’s 1963, and Don Draper (Jon Hamm), a 36-year-old creative director for Sterling Cooper advertising agency, needs a physical. He visits his regular physician, whom he hasn’t seen in “quite some time,” acknowledging that he has a high-tension job and that he consumes five alcoholic drinks and two packs of cigarettes per day. The doctor discovers that Draper has high blood pressure. He starts Draper on reserpine to bring down his blood pressure and phenobarbital to help him relax, but he doesn’t explain potential side effects, including depression or erectile dysfunction. In a subsequent scene, Draper appears unable to perform sexually with his wife, Betty (January Jones).
The medical questions: Would a 1960s physician have treated a blood pressure elevation immediately? Was reserpine a common first-line treatment for hypertension in the 1960s? Would depression and sexual dysfunction have been considered as potential side effects? Was phenobarbital commonly used to treat stress? Were the effects of cigarettes on overall health known?
The reality: “Many hypertension experts in the early 1960s were still saying that elevated blood pressure wasn’t bad for you and that reducing it could cause damage to important organs such as strokes and heart attacks,” says Dr. Suzanne Oparil, director of the vascular biology and hypertension program at the University of Alabama School of Medicine. Dr. Henry Black, president of the American Society of Hypertension, points out that some experts at the time were even insisting that blood pressure elevation was an “essential” compensation for having stiff arteries and was necessary to get blood to the heart, brain and kidneys. The original Veterans Administration (now Veterans Affairs) study showing the benefits of anti-hypertensive treatment (reducing the risk of strokes, kidney disease and aneurysms) wasn’t published until 1967.
Before then, the smarter doctors anticipated those benefits and aggressively treated elevated blood pressure promptly, but there were no clinical guidelines set.
Draper’s doctor does seem smart, Black says, but he adds that “even now we don’t consider the diagnosis of hypertension established unless you’ve had elevated readings three times separated by at least a week. In those days they would have been even more cautious and not started treatment right away.”
Reserpine, derived from alkaloids in the root of an Indian plant, was discovered in 1931 and was still commonly used as a treatment for hypertension in the 1960s -- just as the show depicts, though Dr. Carlos Ferrario, director of the Hypertension and Vascular Research Center at Wake Forest University School of Medicine in North Carolina, points out that by 1963 reserpine was no longer used as frequently as a newer drug, Aldomet (methyldopa). Reserpine was known to cause sleepiness, nose bleeds, gastric distress, depression and sexual dysfunction. Black believes a doctor likely would have alerted patients to the potential side effects.
Phenobarbital was commonly used to treat hypertension and stress, and 1960s doctors were aware that stress contributed to elevated blood pressure.
As far as cigarette smoking is concerned, the U.S. surgeon general’s report expressing concerns about smoking wasn’t published until 1964. Earlier, physicians didn’t know about the association between smoking and lung cancer or heart disease, though many did realize that smoking led to lung infections and asthma. Draper’s physician was once again ahead of his time in his understanding that cutting down on cigarette smoking is good for you. “The medical scenes in this season’s premiere are reasonably realistic,” Black says.
Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear.” In The Unreal World, he explains the medical facts behind the media fiction. He can be reached at firstname.lastname@example.org.