MD Whistleblower

For a few decades, I did not treat patients with Hepatitis C (HCV) infection, despite aggressive marketing by the pharmaceutical companies and cheerleading by academics.   I was an iconoclast as most of my gastroenterology colleagues were HCV treatment enthusiasts. They argued that if the virus could be eradicated, that there was evidence that these patients could avoid some horrendous HCV complications, such as cirrhosis, liver failure and cancer of the liver. I’m certainly against cancer and liver destruction, but I have thought that the evidence that HCV patients who vanquished the virus would be saved from these fates was somewhat murky.   Treatment proponents would argue that the medical evidence for thes claims is solid, but I wonder to what extent their favorable bias toward treatment influenced their judgment.  We physicians know that a doctor or a drug company will seize on  particularly studies that supports their views.  Studies that challenge t...

This past week high school students across the country walked out of school for 17 minutes to show solidarity with the 17 fallen Florida students and their families.   There is not a human being among us who disagrees with their mission, except for a few deranged and cowardly murderers.  These kids are crying out for more restrictive gun laws. Although I will offer a controversial view below on the walkout, let me say with clarity and sincerity that I am proud of these kids.  Since the horror in Florida, I watched them speak to us with passion, poise and eloquence.  While many of us may not agree on the best path forward, we can all agree that we have great kids in this country. These kids are right and have a right to demand to be safe. Schools have always been an oasis for our children, places where they are to be nurtured, educated and protected.   I know that there are many teachers who would serve as a shield for their students in any situation, as t...

Last week, I opined about a decision by Anthem to deny paying for Emergency Room (ER) care that it deemed to be non-emergent.   My point was that insurance companies should not be obligated to pay for routine, non-emergent care, recognizing that we need a fair and reasonable method to define a medical emergency.    In my view, payment should not be denied to a patient who reasonably believes he needs ER care, even if the symptoms are (hopefully) found to be innocent after a medical evaluation. For example, if a patient develops chest pain at 10 o’clock p.m., and is worried about an acute cardiac issue, he should call 911.   If the ER determines that chest pain is simple heartburn, it would not be reasonable for Anthem to deny payment for this ‘non-emergent’ condition.    We’re all a little smarter after the fact once we know the outcome. Some medical complaints, however, are never medical emergencies.   If you want ER care for a runny nose, a c...

We live in an era of demonization.   Political adversaries are not opponents, they are villains.   Commentary that contrasts with our views is labeled ‘fake news’.    Presumption of innocence?   R.I.P.   Civil discourse has become a quaint memory.   Why would one debate respectfully when today’s tactic is to talk over and demean your adversary?   On the morning that I prepared this post, I read an article reporting that one of Ohio’s largest insurance companies, Anthem, is denying payment for non-emergency care provided at emergency rooms   (ERs).    In my view, this article was slanted, unfairly tilting away from the insurance company, an easy target to attack.    I think that a typical reader would conclude that the company was greedily trying to claw money away from sick customers.   An anecdote was offered describing a denial of payment for emergency care for abdominal pain that did seem improper, although th...

Reasonableness is like pornography - hard to define, but we know it when we see it.  (with a nod toward U.S. Supreme Court Justice Potter Stewart.) It’s interesting how folks classify themselves on the political spectrum.  Most individuals regard themselves as moderate, independent and reasonable, regardless of their views and positions.  Try asking an extremely  partisan political conservative how he classifies himself and you will hear terms such as ‘family values’, ‘mainstream’ and ‘pro American’.   A politician on the far left is more likely to describe himself as ‘Progressive’, rather than as a 'liberal fanatic'. The point is that unreasonable people believe that they are reasonable. I read an account of an episode that occurred last week in Cleveland that hinged upon the legal meaning of the word reasonable.   A 16-year-old boy with various allergies joined several friends at an expensive restaurant.  Without providing advance not...

In our practice we have an open endoscopy system, as do most gastroenterologists. This means that other physicians – or patients themselves – can schedule a procedure with us without seeing us in advance for a consultation.  Of course, we are always pleased to see any of these patients for an office visit in advance, but many patients prefer the convenience of accomplishing the mission in one stop.  This is reasonable for patients who truly need our technical skill more than our medical advice. Our office screens these procedure requests in advance to verify that no office visit is necessary.  While this process works very well, it is not infallible.  There have been times when a patient arrives to our office poised for a colonoscopy with accompanying medical issues more complex than we had expected. No vetting procedure is failsafe.  Have you seen the TSA statistics when they are tested in identifying dangerous items hidden in luggage?  Even though ...

In our society, there are absurdities that simply defy reason.   In the past week or so, I have read about an individual who was denied the ‘right’ to bring a peacock on board a plane for comfort.   Just this morning, I read of a women who was cruelly denied to fly with her comfort animal – a hamster.   Readers are invited, if they dare, to use their preferred search engine to discover the tragic denouement regarding this hapless hamster. 'Let me comfort you.' * If a person needs a peacock, a snake, a pig, a kangaroo or a pterodactyl for airborne support and comfort, then perhaps flying is not for you.   The rest of us have some rights also.   Rent a car. The medical world has its own exhibits in the Theater of the Absurd.   Here’s our latest performance. Our medical practice received notice last week from The Centers for Medicare & Medicaid (CMS) that we owed the federal government money.   Apparently, according to federal brai...