Sunday, August 27, 2017

Jury Blames Talcum Powder for Ovarian Cancer - No Evidence Needed!

I have written about talcum powder previously.  Indeed, I have not only opined on the slippery substance, but I am also a regular consumer of the product.  Talcum powder has become magic legal dust that brings forth zillions of dollars to those who have been attacked by the poisonous toxin. 

Just last year, I informed readers of $55 million and $72 million judgments to cancer victims who used powder against the manufacturer Johnson & Johnson.  Earlier this year a Missouri woman was awarded $110 in damages. 

Recently, a jury in California, where the cost of everything is stratospheric, ordered J & J to pay damages to a victim of ovarian cancer.   The jury clearly wanted to send the company and corporate America a monetary message that went beyond the pinprick judgements that were issued against J & J last year. 

Readers at this point are invited to consider what would constitute reasonable damages if it were proven true that the product caused the cancer and the company knew of this risk and did not provide adequate warning to the public.   Make your guess before reading on.

Here are some price comparisons to test your sanity

Private Gulfstream Jet                     $70 million
Penthouse in NYC’s Plaza Hotel    $40 million
Alexander Hamilton Autograph             $1,000
Bentley Automobile                            $230,000
100 meter Superyacht                    $275 million
California Jury Award                    $417 million

You may resume breathing now.  Of course, the plaintiff’s attorneys were able to string  a circuitous array of dots that connected talcum powder to cancer in front of a jury who was likely more sympathetic to a dying victim than to a megacorporation.  But, sympathy is not evidence and being a successful company does not define negligence.   


Few strands of GW's hair is a bargain at $22,800!

This mega-judgment is rendered beyond absurd when one accepts that there is no convincing and consistent scientific conclusion that talcum powder is the responsible agent.  The studies have largely demonstrated an association, which are not designed to determine cause and effect.

What should product manufacturers do?  Should every package include a boxed warning that the product can cause misery and death just to cover themselves?   Perhaps, not. This would only give customers anxiety, pain and suffering.  Guess what would happen next?

Sunday, August 20, 2017

Yikes! There's Food Stuck in My Throat! The Steakhouse Syndrome Explained

While I typically offer readers thoughts and commentary on the medical universe, or musings on politics, I am serving up some lighter fare today.  Hopefully, unlike the patient highlighted below, you will be able to chew on, swallow and digest this post.  If this blog had a category entitled, A Day in the Life of a Gastroenterologist, this piece would reside there.

I was called to the emergency room yesterday to attend to an elderly woman who had steak lodged in her esophagus.  While this sounds life threatening to ordinary folks, it poses no mortal danger.  The airway is uninvolved and normal respirations proceed without interruption.

These patients, while fully alive, are rather uncomfortable. 

This is one of the tasks that gastroenterologists are routinely called to undertake, often at inhospitable hours.

Sometimes, these folks have known esophageal narrowed regions where food that is not masticated with enthusiasm can hold up.  On other occasions, a person with a totally normal esophagus tears into a steak like a famished wolf and forces down a mass of meat that has no chance of passing through.  Bar patrons who are inebriated and then grab a handful of chicken wings are prime candidates for an emergency room visit with a gastroenterologist when the wings just won't fly through.  And, if granny forgot to put in her dentures before biting into a chicken sandwich…


Don't bite off more than you can chew.


No one involved enjoys the experience, and the procedure has more risk that our routine scope examinations of the stomach and esophagus.   Usually, these episodes can be prevented with proper attention to making wise food choices and chewing well. 

How do we get the job done?  Basically, we serve as plumbers and use our usual scope instrument to unclog your food pipe.  (Reminds me of a joke when a customer complained to a plumber over his bill.  "I'm a doctor, " the customer said, "and I don't charge that much!"  The plumber replied, "I used to be a doctor also, but I wasn't earning enough money."

The curious aspect of this case is I asked the woman prior to the procedure if she has difficulty swallowing foods with regularity.  She responded that the only food that she has consistent difficulty swallowing is the type of meat she ate that day.

Can you guess my next question?

Sunday, August 13, 2017

The Heartbreak of Psoriais - Guilt by Association

I was asked this week for an informal opinion by someone who was advised by his dermatologist to take a biologic medicine for psoriasis.   Now, my knowledge of this disorder is barely skin deep, yet knowledge alone will not set you free in the murky world of medicine.  Knowing something is not as significant as knowing when to do something.


Can guacamole really cause cancer?  Read on.


Biologic medicines, which have surpassed in frequency the nearly omnipresent TV ads for erectile dysfunction, are expensive medications that have risks of serious, albeit uncommon, side effects.  And, unlike chemotherapy for cancer, which has a finite course, biologic medicines are administered forever, that is without a clear stopping point. 

The individual who questioned me was not suffering from insufferable psoriasis and was satisfied with the conventional topical treatments he has been using for years.  His dermatologist offered the biologic in an effort to reduce his risk of heart disease.  Let me try to explain.

If you GOOGLE psoriasis and heart disease, you will find a surfeit of hits claiming some kind of connection between the two conditions. However, if you GOOGLE any two items on any subject, you are likely to hit upon some ‘connection’.   I just randomly GOOGLED guacamole and cancer and sure enough, there is a 'connection'!  Presumably, the dermatologist accepted the psoriasis-cardiac connection to be one of causality, meaning that psoriais can cause heart disease.  Extrapolating beyond this FAKE NEWS, he assumed that treating the psoriasis would mitigate the risk of an adverse cardiac event.   It is exactly this false reasoning that so often gets patients into trouble.  The logic of the intervention seems sound, but it is entirely specious.

The facts are here that there is no proof that psoriasis causes heart disease.  Clearly then, it makes no sense to treat the skin condition hoping to prevent a complication for which there is no proof that psoriasis causes.  Psoriasis may be associated with or linked to heart disease, which understandably suggests to an ordinary patient that there is a strong connection where Condition A causes Condition B.  I address this fallacy several times each week when I am asked if heartburn medications cause hip fractures or dementia.  They are associated with these complications in a statistical sense, but have not been shown to cause the complications.

Say I publish a study showing that tall individuals are associated with high blood pressure.  This does not mean that height is responsible or that we should hope that our children remain short.


Do you think that this blog is associated with astute and discerning readers?   If so, can I write next week that reading the Whistleblower blog is powerful brain food?

Sunday, August 6, 2017

Will Genetic Engineering Save or Sink Humanity?

We cannot let the anecdote rule over us.   We don’t make sound policy if we are swayed by isolated emotional vignettes.  Of course, a vignette describes a living, breathing human being, but we must consider the greater good, the overall context and the risk of letting our hearts triumph over our heads when making general policy.  Consider these examples.

If an expensive drug treatment program keeps 5 addicts clean for 6 months, do we champion this success in asking for funding to be renewed while omitting that 400 enrolled addicts failed?

If an experimental medical treatment seems to be effective in one patient with a stubborn disease, should physicians lurch toward it leaving aside standard treatments which have been subjected to Food and Drug Administration approval and years of clinical experience?

If a high school student attends an SAT prep course and achieves a near perfect score, do we conclude that every student should enroll in this course?

It is natural to be drawn to a shiny object, but on closer review, the shine often tarnishes quickly.

Earlier this week, we learned of an astonishing scientific breakthrough that seems utterly fantastic and futuristic, even though it has actually occurred. Scientists amended the DNA of human embryos to correct a mutation - a genetic defect - that causes a very serious medical disease.   This suggests that with additional research and testing that embryos who otherwise might be destined for misery could be rescued. 

We will hear heartwarming and breathtaking anecdotes that, if considered in isolation, will generate excitement and support. 

Would you argue against the following headlines?

Embryo with fatal cystic fibrosis mutation saved.

Tay-Sachs embryo rescued from fatal outcome.

Hemophiliac embryo expected to live normal life.

As is always the case, there will be ethical mission creep, despite the usual bromides that “scientists and research institutions will conform to the highest ethical standards”.   The fact that there is a fortune to be made in the genetics industry can be expected to alter the direction of our ethical compass.  And, while the initial rollout will be discussing how genetic intervention can reverse the course of devastating and fatal diseases, does anyone believe it will stop there?  Once the concept has been normalized, other medical conditions will be targeted.   The creep will be inexorable.  Boundaries will be shattered.


Einstein said 'God does not play dice with the universe.'

Should we?


Who doesn’t want a perfect child?  Over time, how will all of us regard the disabled community or even folks of average intellect and ability?  Will a disabled person be defined as anyone who is imperfect?

Beyond medical mission creep, I believe there is a very serious risk that genetic engineering will be used to achieve non-medical results. 

Imagine that you are new parents.  If medical science could perform a procedure that would add 20 IQ points to your child, would you pursue it?  Would you submit to a minor DNA tinker that would produce an excellent athlete or a musician?  See where I'm going with this?

Are you really ready for the curtain to rise on the Genetic Engineering Show?  I'm not.  To me, all this sounds like coming attractions of a horror show.






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