MD Whistleblower

It can be daunting to keep track of new drugs, particularly if the doctor is not prescribing them regularly. During my medical training, I generally was familiar with all of the medicines that patients were taking.  Not so anymore.  Now, it is more likely than not that when I review medication lists, that some of the drugs are unknown to me.  I do my best to remain current in my own specialty – itself a challenge.  I am no longer well versed in the medicines used to treat diabetes, heart conditions and various autoimmune diseases, among others conditions. Medical illnesses that formerly were managed with just a medicine or two now have many more options.   And the medication lists keep growing.   I wonder at times if some of these new pharmaceutical additions truly add a material advantage over existing options.   For instance, there is an array of effective heartburn medicines that I believe are largely equivalent to each other with respect to safet...

Why do so many unproven recommendations get incorporated into medical dogma?  Put a jacket on so you don’t catch cold! Stress causes stomach ulcers. Caffeine causes _______.   (Fill in the blank since it’s blamed for everything!) Sugar makes kids hyper. Colonic cleansing rids the body of evil toxins. We accept many recommendations as true in the absence of data or in some cases even if data refutes the claim.   Some folks still believe that the measles vaccine causes autism which is been roundly debunked.  And dislodging these myths takes effort and time.   When I was a younger doctor, antibiotics were routinely prescribed for sore throats and presumed bacterial ear infections.. When these patients recovered, the antibiotics were credited with the salutary outcome.   Doctors were simply following the teachings and customs of that era.   Nowadays, physicians approach these patients much more conservatively, but this did take a while. Foll...

In two prior posts , I have offered my steep skepticism that probiotics deliver on the claims their manufacturers make.  By not being classified as actual drugs, these products leapfrog over traditional Food and Drug Administration scrutiny and are marketed directly to the public who seeks relief from various chronic diseases – conditions that conventional medicine doesn’t handle well. While I have lambasted the lack of medical evidence underlying probiotic treatment claims, in fairness, I will now offer an opinion that also has no supportive medical evidence.   So, probiotic enthusiasts may wish to call me out as well. I worry about unproven but plausible risks of long term probiotic use to the individual users and to society at large.   These products  are tampering with our own bacterial ecosystem that we don’t yet truly understand, always a dicey prospect.   And keep in mind that if you scan the labels of probiotics that fill several shelves in reta...

Recently, I stated that probiotics are marketed and sold free from the strict scrutiny of Food and Drug Administration  (FDA) oversight that our prescription drugs routinely undergo.  And this is just how these companies want it.  Trust me, if probiotics had to endure the same vetting process that actual drugs go through, most of them would be snuffed out along the way. Here’s a simplified glimpse of how the system works. Yo ho, hey hey, keep away from the FDA! Many probiotics are classified by the FDA as dietary supplements, rather than drugs.   Indeed, it is this classification that allows the industry to thrive.   The FDA regulates supplements much more leniently than they do conventional prescription drugs that must endure years of intensive vetting and successive clinical trials.  The drug approval process is so rigorous that most drug candidates will not reach the finish line.  The FDA maintains high standards for safety and efficacy....

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 sub...

Why are millions of Americans actively seeking out complementary medicine?   The lack of robust supportive evidence for many of these treatments has not diminished their appeal.   Indeed, demand for them is higher than ever and I anticipate continued growth.   Here in Ohio, the legislature has sanctioned medical marijuana for nearly 2 dozen maladies in the absence of persuasive and sound scientific evidence of efficacy.   For my rant on this, I will refer you to a prior post and I would welcome your response. Why then do intelligent and informed patients seek out alternative medical treatments that are unproven and are unlikely to be covered by their insurance companies?    In most cases, they do so because conventional medicine has failed and frustrated them.   Every medical specialist and general physician sees patients with recalcitrant medical issues that defy diagnosis and successful treatment.   Is it any wonder why such patients would ...

Some time ago, I saw a woman who traveled across state lines to see me to receive yet another GI opinion. She had been having daily gastrointestinal symptoms for a decade despite an exhaustive and repeated series of tests arranged by multiple different gastroenterologists.  Her symptoms remained unexplained and I suspected that they were unexplainable. I have seen many patients like this who suffer from chronic abdominal pain, nausea, bloating, bowel issues and other digestive complaints who have been evaluated by prior competent gastrointestinal specialists.   It is terribly frustrating when there is no explanatory diagnosis to explain the misery.   Sometimes these patients ask, ‘Am I crazy’?   Of course, they are quite sane.   Many common digestive symptoms simply don’t light up on our diagnostic tests.   Bloating and nausea, for example, are unlikely to be explained by a scope exam or a CAT scan or other studies. So, what should these suffering indiv...

One of the most vexing issues for patients and their doctors is dealing with unexplained abdominal pain.  Indeed, over the course of my career, I have treated thousands of these patients.  Every day, one or two of them are on my office schedule. Many of them have had abdominal distress for decades.   Many have had several visits to emergency rooms and have seen multiple gastroenterologists and other doctors over the years.   Diagnostic tests are done and often repeated in the ongoing quest to find an explanation.   When I review a patient’s entire medical record, I am often astonished to learn how many CAT scans have been repeated to evaluate the same pain. These patients understandably are operating under the notion that the medical profession should be able to explain the cause of their pain. This is the primary reason that these individuals seek care.   This is, after all, the job of a doctor.   In addition, they also want decent pain control so...

 Over the past few weeks, several patients I saw faced a common challenge.  This is a situation I have confronted in the past, but what was unique recently is that multiple patients in a short period of time were in the same situation. This was not a medical issue.   In fact, many of the individuals were feeling perfectly well.   This was not a financial issue, such as the patients were in the dreaded ‘doughnut’ or their particular medications were not covered by their insurance companies.   This was not a second opinion request from patients who suspected that their gastroenterologist (GI) of record may have missed something. Here’s what happened.   A gastroenterology practice that had been in the community for decades closed down.   Suddenly, tens of thousands of patients with an array of digestive maladies were let loose to find a new digestive nest to occupy.   I’m sure that every GI within 20 miles of my office has been affected.   M...

From time to time, patients asks my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments.   The logic sounds plausible to interested patients.  Over time, toxins accumulate and leech into the body wreaking havoc.  Indeed, using the label ‘toxins’ already suggests that these are noxious agents.  If one accepts this premise, it is entirely logical that cleansing the body of these injurious agents would have a salutary effect. Not surprisingly, the health benefits of hydrotherapy usually target very stubborn and vague symptoms and conditions that conventional medicine do not treat adequately.  It makes sense that if your own physician is not making sense of your chronic fatigue, for example, that you would entertain other options.  I get this.  Who wouldn’t want to enjoy having more energy, better concentration, an enhanced immune system or delayed agin...

Several times each week, I am asked about the value of probiotics.  Many of my patients are already on them, based on a personal recommendation or an advertisement.  As a gastroenterologist, I routinely treat patients with all varieties of diarrhea conditions, such as irritable bowel disease, ulcerative colitis, Crohn’s disease, lactose intolerance, celiac disease and the highly feared gluten sensitivity.  Many of them arrive in the office with a probiotic in hand waiting for me to pass judgment.  These patients look to me as a Digestive Supreme Court Justice as they sit on the edge of their chairs waiting for my ruling in the case of Probiotics vs Disease.   First, let’s all be clear on what a probiotic is.  Probiotics are bacteria that provide health benefits when consumed.   Stop a moment and consider how bizarre this concept is.  Physicians have been fighting germs since the days of Louis Pasteur.  We have taught the public for ...

Many of my patients are taking herbal supplements, or so they think.  This herbal and health supplements industry likely is envied by traditional pharmaceutical companies.  The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA).  Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known or a new medicine is proved safer and superior.  While it’s not quite a crapshoot, there is a strong element of chance at play here. Roll the Dice with the FDA? Herbs and the supplements that are saturating our airwaves escape FDA scrutiny.  They will only draw governmental fire if they are deemed to be dangerous.  They are required to use certain language in their promotional materials that differs from traditional FDA approved prescription medicines.  Take a look at this example: Fosamax:  The FDA has approved this for the treatment an...

Readers know that I am skeptical over the efficacy of complementary and alternative medicine.  This is not merely a demonstration of my inborn skepticism, but doubt based on the fact the so much of their claims are untested, unproven or refuted. I don’t regard the above comment as controversial.  It is factual.   I’ll let readers decide if it is but another example of the arrogance of conventional physicians who worship on the altar of evidence based medicine.  Recently, I read a column in The New York Times by a university professor who was treated for a cold in China by drinking fresh turtle blood laced with grain alcohol.  In a day or two, he felt better.  Cause and effect?  It’s not easy to talk someone out of a view that a pseudoscientific remedy healed them.  Why should we do so?   If a patient tells me that his fatigue has finally lifted after giving up guacamole, do I serve him or the profession by pointing out th...

I’ve posted a piece on this blog on the issue of faith and reason in healing. Indeed, the protagonist of that post is an inspirational figure, a selfless man who exudes grace and humility. I was honored that the post was shared with many Catholic clergy who appreciated my heartfelt words for one of their own. Faith and reason reentered my medical universe recently. A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related the tragic news to his 3 children, ages 3, 5 and 8. Was this the appropriate time for the physician to relay such ominous news to a patient and family? Was it prudent for the overcome husband to share this traumatic news with his 3 young ch...

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 m...

In American society, packaging trumps contents. Look at both the Democratic and the Republican presidential nominating conventions we all just endured. In the old days, these conventions had a purpose – to select nominees. Now, they are scripted, grandiose infomercials that insult our intelligence more than they inform us. They are coronations. I heard great oratory, decent rhetoric and pabulum. The spectacles wasted tons of money that could have been devoted to charity or some other worthy cause. As marketing and political folks understand well, packaging sells products. Think of this the next time you are choosing a bottle of shampoo off the shelf. Are you really buying the sleek bottle? Are you voting for the sleeker and more likable candidate? Except for Mitt Romney, it seemed that every other speaker was raised in a log cabin. Lincoln would have no advantage if he were running today. There’s plenty of packaging and fluff in the medical universe also. Complementary and altern...

Garden Hoses in Assorted Colors A few times each month, a patient asks me for my opinion on colonics. They ask me because I am a gastroenterologist, and I am supposed to know this stuff. After 2 decades of performing colonic intrusions, I should be well qualified to respond to these alimentary inquiries. To those who are unfamiliar with the concept of colonic detoxification, I offer a brief rationale of the procedure. Those who have been lured into the Fraternal Association of Rare Toxins (acronym not provided) have been persuaded that stagnant stool within the colon is a source of toxins that seep into the body causing disease. According to the anti-toxin crowd, when stool overstays its colonic welcome, it can lead to chronic fatigue, lassitude, restlessness, irritability, mood disorders, skin rashes, arthritis, cardiac rhythm disturbances, seizures, allergies, dementia and the murky diagnosis of candidiasis, or yeast infection. This symptom list could apply to half of my medical ...

Shark Cartilage: Cancer Cure? There’s a new term that has entered the medical lexicon. The word is wellness. Hospitals and medical offices are incorporating this term into their mission statements, corporate names, business cards, medical conferences and other marketing materials. The Cleveland Clinic Foundation has appointed a Chief Wellness Officer, an intriguing fluffy title that does not clearly denote this individual’s role and function. This is deliberate, as the word wellness is designed to communicate a ‘feel good’ emotion, not a specific medical service. Just a click or two on Google will lead you into the wellness universe. Here’s a sampling. Institute of Sleep and Wellness Wellness Institute of America Naturopathic Wellness National Wellness Institute Physicians Health and Wellness Center Physicians Wellness Group There’s even a sponsored ad on Google where one can search for physicians, presumably trained in the medical specialty of wellness. I was dismayed ...