Why Do People Take Probiotics?

Several times each month patients solicit my view on probiotics. The tens of billions of dollars spent annually by Americans on these agents provides us with overwhelming evidence of an economic truth – marketing works. Conversely, the evidence that probiotics actually deliver on their health claims ranges between thin and absent. Why, then, are they so popular?

While modern medicine has delivered much for the public, there are so many mysterious and chronic afflictions that remain out of reach. Patients and physicians struggle over addressing bowel disorders, chronic arthritis, depression, fatigue, memory lapses, allergies, autoimmune diseases, skin rashes, sleep disorders, obesity and many other stubborn conditions. When conventional medicine fails to deliver, many other treatments of questionable quality emerge. This is undeniable. Claiming benefit, however, should not be sufficient. Any new treatment should be subjected to the same rigorous vetting process that all drugs and medical devices undergo. I certainly understand why a suffering patient is willing to consider treatments that promise relief in the absence of proven benefit. Remember, how many folks during the pandemic were willing to swallow hydroxychloroquine or even ivermectin?

Keep Away from the FDA!

Probiotics are exempted from the standard prescription Food and Drug Administration’s (FDA) drug approval process. And, you won’t find any probiotic manufacturers clamoring to fall under the FDA's firm regulatory hand. Why not? If their products worked as well as they claimed, wouldn’t you think they would want the FDA’s seal of approval? On the contrary, the biggest threat these companies could face is an aggressive FDA testing probiotics for safety and efficacy. Instead, probiotics are permitted to use phrasing such as 'clinically tested' or similar vague language which is not the rigor the public deserves. Consumers should regard such claims of benefit to be advertising and not medical evidence. Advocate for yourself. Research the risks and benefits of probiotics - as you might any proposed treatment - from trusted medical sources and authorities. Then, make an informed decision.

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Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so. The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals. In addition, the alternatives to direct employment are scarce, although they do exist. Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings. Another practice model is gaining ground rapidly on the medical landscape. Private equity (PE) firms have been purchasing medical practices who are in need of capital and management oversight. PE can provide services efficiently as they may be serving multiple practices and have economies of scale. While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier. There must be a reason why so many professions require a uniform. Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele. It certainly doesn’t enhance professional performance. For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings? If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits? The medical profession for most of its existence has had its own uniform. Male doctors donned a shirt and tie and all doctors wore the iconic white coat. The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families. Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR). I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary. And it’s not a fair fight. You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine. I can type well and can do so while maintaining eye contact with the patient. You must think I am a magician or a savant. While this may be true, the birth of my advanced digital skills started decades ago. (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary

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