MD Whistleblower

I have satellite radio in my car.  I listen to 2 or 3 stations.  I have a deluxe version of cable TV, giving me access to hundreds of channels.  I watch a handful of them.   There is no way, of course, that I could simply pay for the 7 stations I watch.   For example, if I want HBO so I can watch John Oliver’s uproarious Last Week Tonight on Sunday, I have to purchase some package of useless channels to secure my HBO spot. I listen to CNN often in the car.  This network blares out ‘Breaking News’ every 5 minutes or so.  I wrote to them demanding an explanation for these idiotic announcements, but they couldn’t break away from the avalanche of breaking news to respond to me.  In times past, ‘Breaking News’ meant that the Germans surrendered, Truman beat Dewey or that Neil Armstrong planted his feet firmly on the lunar landscape.  I also wrote twice to CNN asking how many minutes of commercials occupy Wolf Blitzer’s hour long...

I read an interesting piece this morning about a medical renegade who turned his back on one of the most powerful health care systems in the world.  It’s not easy to push back against a leviathan.  If I give you an oar, I doubt that you could change the direction of a cruise ship.  But sometimes, a single person can make a wall fall down.  Remember, the brave Chinese man who faced down an approaching tank in Tiananmen Square, which was captured on an iconic video?  On a lesser scale, an orthopedist, formerly employed by The Cleveland Clinic Foundation, decided that his Clinic bosses were preventing him from offering his patient’s the best medical care possible.  He fired them. "Let's blow this joint!" The Clinic, in a cost cutting move, restricted orthopedists to using artificial joints from only two device companies.  The surgeon had been using artificial joints from another company for nearly 3 decades, and he reported excellent results....

Don’t expect this humble blogger to explain Donald Trump’s broad and sustained GOP support, if our most seasoned political pundits are flummoxed.   Why is this man with no prior political or governmental experience trumping all of his competitors? Is he ahead because he is right on, or is he leading because the competitors are way off? Like most folks, the conventional politicians are by and large an uninspiring lot who offer scripted screeds that are canned and calculated.  Indeed, most political junkees like me can almost orate their stump speeches, since they vary little from speech to speech. Trump Appears to have no 'Special Interests' The conventional candidates often rail against ‘special interests’, a pejorative term that conjures up an evil group that is possessed by greed that tramples over the public good to serve themselves.  I challenge you to identify a candidate who has not spewed vitriol against these nefarious ‘special interests’....

This blog has discussed conflicts of interests.  Indeed, every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice.   This issue is not restricted to the medical universe.  Every one of us has to navigate through similar circumstances throughout the journey of life.  If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than it might if the client were paying a flat fee.  The fee-for-service (FFS) payment system that had been the standard reimbursement model in medicine has been challenged and is being dismantled because of obvious conflicts that were present.  (This is not the only reason that FFS is under attack, but it is the principal reason offered by FFS antagonists.)  Physicians who were paid for each procedure they performed , performed more procedures.   This has been well documented....

The medical arena, like society at large, is permeated with self-interest. This reality makes me very skeptical that comparative effectiveness research, which I support, will get airborne. In medicine, every heath care reform, new medicine, new medical device or revised medical guideline is at some constituency’s expense.  Recognizing and dismantling conflicts of interests is one of our greatest challenges and threats.  When I was a gastroenterology fellow over 20 years, our department was active in new technologies to crush and dissolve gallstones and stones that had wandered from the gallbladder into the liver pipes. Millions of dollars of R & D were spent and the procedures were done in specialized centers in the U.S and abroad. The treatments were cumbersome and only modestly effective, but the treatments continued year after year. Then, laparoscopic cholecystectomy arrived, a new operation that could remove gallbladders with much less pain and recovery time. At t...

The Cleveland Browns have been in the news this week, and not because of newfound success on the gridiron. While sports is not among my highest priorities, I have developed increasing interest over the years since professional sports is religion to so many here in Cleveland and in Ohio. Cleveland sports teams all enjoy great success, provided that success is not defined by victories. It’s not if you win or lose but how…  I watched the Cleveland Browns compete against the Pittsburgh Steelers two Thursdays ago. I cringed as I witnessed our young quarterback, Colt McCoy, take a blow to the head that could have landed the perpetrator a 10 year prison sentence had this act occurred on the street. I wasn’t worried that McCoy would have to miss the rest of the game. I feared that he might have to miss the rest of his life. Violence sells tickets. If an activity requires a participant to don a helmet and a coat of armor, then clearly it is an unwise activity for a human to engage in. M...

There is a serious and expanding effort to address corruption in medicine. Regulators and lawmakers are addressing cozy relationships between physicians and industry to protect patients from financial conflicts of interests that may skew doctors’ medical advice. This is murky territory since not every potential conflict is corrupt. For example, is it acceptable for an orthopedist to benefit financially by using a particular artificial hip if the physician believes that this is the best product available for his patients? Does this practice become ethical if the physician discloses this financial arrangement? Are his patients entitled to know the actual dollar amount that the doctor receives? Is it proper for a gastroenterologist to receive a generous honorarium by a heartburn drug company to speak to primary care doctors about reflux treatment? Could this physician be trusted to offer truly objective information to his primary care colleagues with the company’s pharmaceutical represent...