Sunday, February 24, 2013

Do Probiotics Work? Marketing Mania Tramples Science

My kids know that I enjoy a spirited argument.   During the days when the dinner table was our public forum, I tried hard to offer a responsible voice of dissent on the issues before us.  I admit now that the view I espoused was not always my own, but one that I felt merited inclusion in the discussion.  I still do this with them and to others in my life who are willing to succumb to probing of the mind.   I willingly subject my own mind to the same process. 

Because I am a gastroenterologist, folks assume that I have special expertise in nutrition.  I should, but I don’t.  Perhaps, medical education has evolved since I was in medical training, but in my day, a soft subject like nutrition was bypassed.   I am hopeful that I can remedy this knowledge vacuum in the years ahead.
These days, nutrition is part of the burgeoning tsunami of wellness medicine, a discipline that races beyond known science as it seeps into the marketplace.

Several times a week, I am queried on my view of probiotics, which are bacteria that confer health benefits on the human who ingests them.   If you were to survey the public, I suspect that a majority would express that probiotics promote health and are effective in treating or preventing various maladies.
These products are included in the billion dollar enterprise of alternative medicine that is not subjected to any Food and Drug Administration (FDA) oversight.  Their claims are very difficult to study and there is no standardization in the industry of what constitutes probiotic treatment. This a different universe that conventional drugs inhabit.  These medicines, prescribed by physicians, are subjected to rigorous oversight by the FDA and must demonstrate safety and efficacy.  Alternative product purveyors, free from these constraints, can appeal to our New Age beliefs with promises that are seductive but unproven.  They promise better health but don’t have to prove anything. 

If you were in the business of selling medicine, would you choose to spend gazillions dollars and several years praying your drug gets through the FDA, or promote a probiotic that a public is ready to swallow on faith?   If you’re stuck on this question, then consider my alternative blog MDWhistleblower for Dummies for remediation.

Do probiotics treat or prevent disease?  Are these companies overpromising?   Clearly,  the marketing claims are a light year or two beyond verifiable and supportive science. 

I know that many of us want probiotics to be the panacea for what ails us.  I know that wellness and preventive medicine have become a religion for many of us.  I suggest that we need some Old Fashioned wisdom to restrain New Age converts.

Don’t misunderstand me.  I’m not dissing Alternative Medicine acolytes.  Does their stuff really work or is  belief of efficacy sufficient?   Why aren’t these companies utilizing the scientific method to determine if their potions are just placebos?   Kick this issue around your own dinner table and make sure that dissent is on the menu.

Saturday, February 23, 2013

Are Medical Bloggers Smug?

I love words.  When I write, I never resort to a thesaurus.  I enjoy the struggle of trying to find the right word.  There’s not a day that passes that I am not in the dictionary looking up a new word, or more likely, looking up the definition of a word for the 3rd or 4th time whose meaning I cannot recall.  I find that until I use the word, the definition is dangling out of reach.   There are many words that I think I use correctly, yet when I verify the actual definition, I find that I have been using the word more creatively than, perhaps, I should. 

Indeed, recently I engaged in some verbal sparring over the word responsive.  I had thought that this word could be used to describe a response to an inquiry that was on point, not evasive and forthrightly addressed the matter at hand, yet I did not find this meaning included in the definition of standard dictionaries.

Here’s how I have used the word.

“Have you read the latest Whistleblower masterpiece?  Doesn’t that guy have a great wit?”

“I think his blog is part of a vast right wing conspiracy and he should be thrown over the fiscal cliff!”

While the response above may be true, I would describe it as not responsive to the initial inquiry.
Here’s the dictionary entry:

1.      Reacting quickly and positively.
2.      Responding readily and with interest or enthusiasm.

While my meaning is not included above, I’m not ready to wave the white flag here.  Being quite sure that this term is used regularly by lawyers when attacking a witness’s answer as being not responsive, I consulted informally with an attorney acquaintance of mine.  I will keep his identity private as if his colleagues discover that he rendered any advice without a clock ticking, I would fear for his personal security.  This officer of the court confirmed that my usage is proper.

So, I am not prepared to concede and am girding my loins for further verbal combat.

In the old days, there were several hard cover dictionaries strewn about the house, and another in my office. I am reluctant to admit publicly that it was a delight for me to slowly turn the pages and scan word entries, lest if my kids are reading this, they may erroneously conclude that their father is a nerd.  There is nothing nerd about me.  Yes, I read our encyclopedia volumes from cover to cover as a youngster.  Didn’t everybody?     And so I turn C-SPAN on from time to time…

Consider the word hubris.  What does it mean precisely?  Is it arrogance?  Smugness?  Superciliousness? 

Here’s Merriam Webster’s definition.
Exaggerated pride or self-confidence.

One could say that there is plenty of hubris in this blog, although I deny that the author is culpable.  I am but a modest and humble scrivener.  I agree, however, that there is hubris contained within these pages.  When I post on Obamacare and its Democratic cheerleaders, one can’t ignore their hubris.  When describe a plaintiffs’ bar that asserts that the tort system is a paragon of justice, it is beyond a reasonable doubt that these guys are guilty of hubris.  When I write of physicians who defend their parochial interests over the great good, readers can sense a dose of hubris. 

Perhaps, I am truly the smug one here.  Indeed there have been comments over the past few years that have accused me of suffering from Subacute Smarmyitis.  Do readers concur with this diagnosis?   Kindly leave comments, which I hope will lack hubris and be very responsive. 

Shout out to NZ and to LSP for being players in the responsive repartee.

Sunday, February 17, 2013

What Starbucks Can Teach Doctors

I’m sitting in a Starbucks now pleased that I found one of the few plush purple chairs to sink into.  While this is not my regular coffee haunt, I will patronize them at times.  I cannot drink their high octane coffee and will order some milder tasting overpriced beverage instead.

I don’t come here for their food and drink.  I come in spite of them.  I buy a drink and consider this my rent for the time and space. 

I am put off that one can’t use traditional English when requesting a specific beverage size here.  Is there something wrong with the conventional terms small, medium and large?  You won’t hear me utter the highfalutin descriptions tall, grande or vente.  If I want a medium hot chocolate, my usual purchase, then those will be my chosen words. 

At Dunkin Donuts, where coffee is velvet, the staff sport T-shirts emblazoned with the statement:

Friends Won’t Let Friends Drink Starbucks.

This should replace In God We Trust as our national motto.

Yet, this place is packed.  The car line at the drive through was a dozen cars long.  Folks will wait 20 minutes in line to buy an overpriced beverage that could be used as industrial insecticide.

How do they do it? 

I wish my office waiting room could lure crowds like this.   Perhaps, I have a chronic case of Frappuccino envy.  There’s brilliant marketing and branding going on in the guts of Starbucks.  As a gastroenterologist, I’m supposed to know something about guts, yet I admit that I am mystified.  They have convinced us that this is the hip place to hang out, and we march to them like lemmings.  It reminds me of the cosmetics industry, which has masterfully convinced us to pay too much money for stuff we don’t need.

A Lemming Craving Caffeine

Medicine is a different beast, but maybe we private practitioners can learn a few things from these marketing mavens.

I need to start revising my medical terminology.

The Old Loser Term          The New Cool Hip Lingo
You need a colonoscopy        May I offer you a Colonoscopuccino?
You have a large ulcer            You got a Vente Gastriato Macchiato
Skip hemorrhoid creams.       Go No Whip!

Perhaps, I can partner with these guys.  Anyone who manages to get their stuff down their gullet will surely need a gastroenterologist.  

Sunday, February 10, 2013

New York City Soda Ban is a Hard Swallow

New Yorkers are headed toward leaner times.  The New York City Health Board recently approved a ban on large sized soft drinks proposed by Mayor Michael Bloomberg.  Is Big Government now targeting Big People’s Big Drinks?  Does the government have the right to restrict free choice 0n what we eat or drink?  Does the argument that this is a necessary public policy initiative pass the smell (or taste) test?  Will this edict result in measurable weight loss?  Do we know as fact that weight loss saves health care dollars or do we assume so simply because the conclusion appears logical?
First, the policy is riddled with nonsensical exceptions.  If banning large drinks is right and proper, then why not ban them all, not just certain sizes at certain establishments.  Does it make sense to ban large drinks at movie theaters, but permit continued guzzling at convenience stores and vending machines?  If the product is evil, then shouldn’t any size of these life threatening beverages be poured down the drain?  Does it make sense that unlimited refills of smaller size sodas are permitted?  So far, does the policy seem rational and coherent?
Once the measure takes effect in March, movie patrons can still live dangerously and stay within the law simply by ordering several smaller sizes of the poison potions.  Thirsty customers can outfox the ban by purchasing multiple smaller sodas.  These folks who are carrying 3 or 4 small size drinks, rather than a supersize beverage, could easily spill them placing themselves and other moviegoers at risk of serious injury.  Those who adhere to the letter and spirit of the new policy by purchasing only a single small beverage may not have sufficient liquid to wash down the palm oil coated popcorn.  As a gastroenterologist, I foresee several cases of clogged esophaguses with popcorn gumming up gullets. I think the government will have huge legal exposure on this issue.
Popcorn - An Innocent Victim
Do we think that New Yorkers who are forbidden to purchase large size drinks at certain locales will seek out celery stalks and carrot sticks? 
Folks who try hard to lose weight have a hard time doing so.  Folks under the ban won’t get slimmer just because the government restricts one food class at a certain size at some locations. 
Why stop at soda?  If pop is the enemy, then shouldn’t ice cream, candy, cake, doughnuts and fried foods be prohibited?  I am sure there are those who would support a government mandated menu that we would all be forced to swallow.  For these do gooders, government knows best.
Explain to me please why banning soda is necessary public policy while liquor and cigarettes are legal in any quantity.
I want to drink what I choose.  But I'm not drinking the Kool Aid.

Sunday, February 3, 2013

Same Day Doctor Appointments? Read the Fine Print

Cleveland and northeast Ohio are not hospitable to private practice medicine.  I should know.  I’m one of them.  Private practice is fading as health care reform suffocates it by design.  When this occurs, the public will have lost physicians who, in my view, have practiced patient advocacy and service at a higher level than our employed counterparts.  Keep in mind that the first half of my professional career was spent as an employed physician and the latter half as a private practitioner.  So, I know the advantages and drawbacks of each model first hand. Of course, there are employed physicians who are outstanding doctors and private practitioners who are not, but I maintain that a physician who owns his business has a stronger incentive to provide excellent service to patients and to referring physicians.  This just makes sense.  Don’t we find that when we shop or dine out or stay at a Bed and Breakfast that there is a different level of service from those who own these businesses?  If a store closes at 5:00 pm and you arrive at the locked door at 5:05, would your chances of gaining entry inside be greater if the boss were there rather than an employee?  Get the point?

I recognize and have expressed in this blog that there are advantages to the employed physician model which eliminates and reduces conflicts of interest that confront those of us who practice in the private arena.  However, doctors on salary and the institutions that employ them face their own unique conflicts and challenges that can interfere with their healing mission.  Fee-for-service medicine leads to over-utilization while models that restrain costs may restrict care, access and service to patients. 

One service that our small gastroenterology practice offers is rapid access for patients who need or desire an expeditious appointment.  This is tough for sprawling and expansive group practices, as we have in our neighborhood, to duplicate.  Yet they try.  The big dog medical institution in town is now advertising that they guarantee a same day appointment to any patient who desires it.  Sounds good so far.  I wondered how they could pull this off since it’s a vexing task for me even to reach these docs on the phone, let alone try to arrange a timely appointment for one of my patients.  Here’s the sleight of hand.  Sure, the institution will grant the patient an appointment, but it’s not with his doctor and may even be across town in a satellite location.  Is this what most of us have in mind for a same day appointment?  While it’s a tricky marketing ploy, it’s a poor play at customer service.  These patients would do better to present to a local urgent care, which offers a same day visit with a doctor who is likely less than 10 minutes away.

Years from now, when we are all enjoying Cadillac care at Chevrolet prices, where will I be?   Private practice will be long gone, but my skills will still be useful.  I’m hoping I can land a position as a docent in the Fee-for-Service wing in the Museum of Medical History.   I’ll be paid on salary, of course, like doctors will be everywhere.