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Memorial Sloan Kettering in Bed With Industry

Is there corruption in the medical profession?   Recall Captain Renault’s iconic rejoinder to Rick in Casablanca. “I’m shocked, shocked to find there is gambling going on in here!” In any enterprise with billions of dollars at stake, and when different players have competing interests which may not coincide with the public’s interests, there will be skullduggery.   How do you think our Defense Department and its relationships with vendors would look if we were able to shine a bright light on all its faces?   Do you think it’s possible that a weapons manufacturer might argue, through lobbyists and salesmen, that its weapons are essential to national security and superior to those of a competitor?    How about when a congressman argues for the continued purchase of military equipment manufactured in his district that military experts state is no longer needed?   And, there’s the quintessential and craven corruption of legislators refusing to close military bases in their dis

Medical Device Sales Rep Kills the Sale

A few weeks before writing this, two device salesmen came unannounced to our small private gastroenterology practice.  They were hawking a product that could quickly and non-invasively determine how much scar tissue had formed in a patient’s liver, a useful tool for assessing patients with hepatitis and many other liver conditions.  We are physicians, not entrepreneurs.  We do not regard the colonoscope as a capitalist tool.  Yet, these two salesmen were barraging us with facts and figures on how much money we could make off their product.  They knew the insurance reimbursement rates and could quickly calculate our practice’s return on investment depending upon our projected volume.  They recognized that the cost of their device would be beyond our reach and offered to sell us a ‘refurbished’ product at a huge discount. Liver Sales Reps Ignored the Liver! For a host of reasons, we were not interested in acquiring the device, which we could not afford. Here’s what was

Why I am Against Genetic Testing?

  Just because something is legal, doesn’t make it right.  Just because we enjoy a right of free speech, doesn’t mean we should be verbally insulting people. Just because the Food and Drug Administration (FDA) approves a treatment or a test, doesn’t mean we should pursue it. The FDA has given approval to 23andMe, a private company, to provide genetic testing directly to individuals.  The results provide genetic risks of contracting several medical conditions including Parkinson’s disease and Alzheimer’s disease.  No prescription or physician visit is needed.  While 23andMe execs and marketers will undoubtedly claim that their mission is to empower the public, this does not tell the whole story.   Indeed, many patients who undergo the testing will be worse for having done so.   I would never submit to the 23andMe home testing program myself, nor would I counsel my patients to do so.  It seems bizarre that the incredibly complex and nuanced medical issue of genetic risk

Whistleblower Holiday Cheer 2018!

‘Twas the night before Christmas, And all through the House, The creatures were stirring, And ready to pounce! Why wait for Mueller? What could he teach? We already know That we must IMPEACH! With Dems in the House So anxious to blame, Their strategy is… Ready! Fire! Aim! Both Chuck and Nancy, Will not take the fall, Not on their watch, Will there be a wall.  The Dems are all joined, In salivation, At the prospect of, Investigation! We watch GOP Twirl and deflect, Supporting a man, They just won’t reject. The only Repubs Who show any fire, Are senators who Announced they’ll retire.  While all of us watch With ire and confusion On Russia and Stormy And ‘No Collusion!’ The press and our pols Care nothing for us It’s ratings and votes That drive their bus.  Is there no honest man True to the bone Who can rescue us all, Perhaps, Michael Cohen? And Dancer and Blitzen And Warren and Boo

Medical Paperwork Overwhelms the Profession

Does any living, breathing human believe that there is not enough paperwork in our lives?  While we are all burdened, I believe that the medical profession is uniquely deluged with an absurd volume of documentation requirements, most of which should be filed under ‘N’ for nonsense.  Ask any physician or nurse about this and have antacids on hand as you will soon see some sizzling smoke emerging from the medical professional’s nostrils. Each hospitalized patient has a tremendous amount of recorded data which nurses painstakingly document.  This requirement fails on two fronts.  It takes nurses away from time at the bedside.  Additionally, most of the stuff they document is not viewed by physicians or others on the care team.  For example, I rarely read the nurses’ notes.   Is this because I do not value the nurses’ opinions on my patients?  Hardly.  Instead or perusing their written descriptions of my patients’ progress, I use a sophisticated, high-tech technique to obtain their in

Chinese Researcher Defends Gene-Edited Twins -The World Must be Wrong

Physicians confront alcoholism regularly.    Indeed, nearly every day on my hospital rounds, I treat patients who are suffering the ravages of alcohol abuse.    While these patients may have a genetic predisposition toward alcohol abuse, or faced other personal pressures and demons, ultimately the disease is initiated by a person who made an unfortunate decision.   I do not judge these individuals as their doctor, any more than I do my hepatitis C patients who contracted the virus as a result of intravenous drug use.    But, when are examining the causes of these maladies, personal responsibility and accountability must be considered.   In fact, failure to do so will frustrate our efforts to prevent various injurious addictions.   Physicians and others have heard the vignette when an alcoholic denies his addiction despite that every other person in his life feels otherwise.    “They are all wrong,” he states emphatically. 'I can quit anytime.' There are many ex

The Risks of Drug Side Effects - A Case for Caution and Humility

I prescribe heartburn medicines every day.    There’s a gaggle of them now – Prilosec, Nexium, Prevacid, Protonix – to name a few.   As far as experts know, their primary effect is to reduce the production of stomach acid.   This is why they are so effective at putting out your heartburn fire.   In simple terms: no acid, no heartburn. I am quite sure that well-meaning physicians like myself do not understand or will ever know all of the unintended effects of tampering with a digestive process that took a few million years or so to evolve.   Are we so arrogant that we believe that these drugs only target gastric acid production?   They are absorbed into the blood stream and course through every organ of the body.   Is it not conceivable that certain tissues might be sensitive to these foreign invaders?   Might there be unintended consequences that occur far downstream well beyond our horizon similar to a butterfly effect.     Do we really think that gastric acid is present just