MD Whistleblower

I was recently queried on a product called Deplin, which claims to have anti-depressant effects when added to a conventional anti-depressant.   Not surprisingly, as a gastroenterologist, I have never prescribed this, although a psychiatrist I contacted has never prescribed it either. Although a prescription is required, Deplin is not classified as a drug by the Food and Drug Administration (FDA).   It is labeled as a medical food, an important distinction that the public should be aware of. Years ago, a medical food product, EnteraGam, was introduced as a ‘treatment for diarrhea.   This is when I first became acquainted with the medical food designation. Let me offer readers some 'medical food' for thought. The FDA does not assess medical foods as they do for conventional drugs and medical devices.   The prescription drugs that you are taking have passed through years of intense testing under the scrutiny of the FDA, whose approvals means the medicines are bo...

I recall when urgent care offices proliferated and were often housed within pharmacy chains.  This latter arrangement was symbiotic in that the pharmacy provided a convenient venue for patients who then purchased their new prescriptions in the pharmacy.  And a patient entering the pharmacy for a medical visit is likely to make unrelated purchases while strolling the aisles. These sites are generally staffed by nurse practitioners (NPs).   I have worked with these excellent professionals for many years now,.  Beyond urgent care settings, NPs also work in hospitals and many other venues caring for patients with complex medical issues. When the urgent care option came onto the scene, there was stiff pushback from doctors who railed that the quality of care would be below par.   “Nurse practitioners are not doctors,” they warned.     My suspicion then was that doctors had unspoken concerns unrelated to medical quality.   The reason that NP-directe...

All of us have viewpoints on various issues and policies.   We have opinions on the criminal justice system,  immigration issues,  and eligibility for health care benefits, to name 3 examples. For many of us, our opinions evolve as we gain life experience and wisdom, which change how we view the world.  I regard this as personal growth which we should all welcome and aspire to.  I acknowledge that there are some bedrock principles that should remain stable. For instance, the tenet that physicians should serve their patients’ interests and not their own should persist.   With age, comes wisdom. We have also seen folks change their positions, sometimes rapidly, using a pathway different from the personal growth process I noted above.  Views can change rather suddenly when an issue affects someone or a loved one more directly.  For instance, a champion of strict law and order might feel that leniency is in order if his own son faces expulsion from a ...

Physicians, at least most of us, are not businessmen.  Yet, we are negotiators.  When I was in private practice, for instance, we were running an actual business.  There were negotiations with our landlord, with insurance companies, with vendors and with new hires.   Now, as an employed physicians, all of these issues – and many others – are out of sight and out of mind.  But I am still negotiating.  With whom, you wonder? I negotiate with my patients. I’m not suggesting that my doctor-patient relationships are cold, transactional events.   Hardly.   But every relationship, either business or personal, requires give and take.   Sometimes one party gives up some space to accommodate a compromise, and other times the partner behaves similarly.   Indeed, every successful relationship that I have participated in or witnessed is a breathing and flexible organism.   Negotiating with patients is less formal than is depicted here. ...