Sunday, November 14, 2021

Why I Oppose Medical Marijuana

I don't really oppose medical marijuana, only the process that has brought it to market.

In general, I hew to the philosophy of  ‘leaving it to the professionals’.   Yes, I support all of us engaging in some measure of due diligence, but I try to select advisors and professionals whom I trust. If they have knowledge and experience that I lack, shouldn't their views carry more weight than mine?

In my own life, and probably yours, there are many areas in which I simply am not capable of any due diligence. If a car mechanic, for example, recommends that an expensive part needs to be replaced, I can only hope that this is truly necessary.  If the folks we deal with are honest and experienced, then things will tend to fall into place as they should.  Obviously, for this to work out well, several assumptions need to be true.

Many people today soundly reject the ‘leave it to the professionals’ philosophy.  For most of my life, the curricula in our public schools was dictated by education professionals.  When I was a student in grade school through high school, I don’t recall any protests or objections to our courses of study.  Yes, I’m sure that if our assignments, book reports, reading materials and classroom discussions were viewed through today’s prisms, that there would be many legitimate issues to criticize.  But, the zeitgeist today seems to be to criticize and protest everything.  Dialogue is neither encouraged nor practiced.

Indeed, there’s a benefit today to reject professionals' advice.  Candidates today are buoyed by championing the rights of parents to have a real voice in what their kids are being taught in public schools.  Police departments are being monitored by citizens who do not have formal training or experience in law enforcement.   I’m not weighing in on these issues, only pointing out how the situation has flipped. 


Medical Marijuana Approved by Legislators!
(What Have They Been Smoking?)
                                                                 

Here in Ohio, a bill has recently been sponsored that would add various medical indications for medical marijuana use including autism, muscle spasms, headaches, arthritis and other conditions.  In my view this is ridiculous.  I’ve written before and continue to be believe that elected legislators should not be making medical decisions.  Not only do they have no requisite training and experience, but their mere involvement politicizes the process.  It’s axiomatic that politicians support stuff in order to get folks to vote for them.  How is such a process defensible with regard to medical care?  (Hint, it isn’t.)  And to those who defend it, why not then have lawmakers decide on drugs or treatments for heart disease, Alzheimer’s disease or cancer?  Do you think that lobbyists or corporate donors might be able to influence legislators on adding a disease or two to the medical marijuana list?  (Hint, answer 'yes' here.)

Sure, there are medical studies out there that show medical benefits of marijuana.  But, this is not sufficient.  Medical marijuana, like any proposed medical treatment, must be subjected to rigorous and impartial scientific inquiry with final approval or rejection falling to the FDA, where this authority resides.  

There are spheres of society where professionals must remain in charge, even though others voices should be heard.  If you want medical advice, then ask a doctor.  If there’s a rattle in your car, then don’t ask me.

 

Sunday, November 7, 2021

How to Treat Your Upset Stomach

There is a general fascination with the medical profession.  Consider how many television shows over past decades have had a medical motif.  And today’s patients are so ├╝ber-informed and empowered, that at times they dabble with the practice of medicine themselves as an avocation.  When a patient, for example queries me about Barrett’s esophagus and dysplasia or if I intend to test them for H. pylori, a germ that resides in the stomach, then I know by their use of medical terminology that the office visit will be a  "peer to peer” experience.

So, I’ll ask my erudite reader-practitioners to respond to the following medical inquiry. 

A patient is suffering from a chronic upset stomach (called dyspepsia) nearly every day.  The cause of the condition cannot be ascertained, and the treatment options are wanting.  Assume that the medical professional has undertaken an appropriate evaluation and that no cause has been discovered.  Assume as well that there is no established treatment for the condition. Nevertheless, it is commonplace for doctors to offer various prescriptions to these patients.


The stomach often hurts for mysterious reasons.

If you were the doctor, which of the following would you advise?

Tell the patient that there is no effective treatment for his condition and that he will need to continue to live with it as best he can.

Tell the patient that, while there is no proven remedy, that there are various medicines to consider that the he has prescribed to others.  You recommend one of them.

My guess is that most readers and patients would prefer option #2 for reasons that need not be explained.  Most doctors and patients would rather do something than nothing.

As medical professionals know, and often lament, there are too many drugs being prescribed.  We know this and yet we physicians are the perpetrators.  And, the public has an outsized appetite for pharmaceuticals.  This has proved to be an unshakable cycle to break. 

What could be wrong about offering a prescription to a patient with unexplained dyspepsia? 

  • Physicians and patients should be guided by science and truth.
  • It is not fair to expend resources on ineffective medicines
  • It is not ethical to expose patients to risks of adverse reactions without any reasonable promise of benefit.
  • Physicians should not serve as willing accomplices in the over-medication of our society.
  • The medical profession and the public should come to terms that not every medical symptom has a pharmaceutical remedy.

So, what could be done for these patients?  There is a rising role for integrative medicine and other alternative medical practices for patients with unexplained and unexplainable medical symptoms.  And, if a conventional doctor like me starts carping that those alternative folks operate without data or proof, then point out that  we medical doctors have been doing this forever.

 

 

 

Sunday, October 31, 2021

Was the Alec Baldwin Shooting Accidental?

Even casual followers of the news are aware that actor Alec Baldwin killed one associate and wounded another during a film rehearsal.  It was a horrible tragedy that captured the nation’s attention.  How could such a thing happen? This is the same question we ask when we learn that a surgeon has removed the wrong kidney.  

I’ll leave aside how much attention this tragedy has received in comparison to the intentional killings that occur daily in cities throughout the country.  While all lives are equal, it does not seem that every life receives the same attention.

Based on what is now known, it does not seem to me that this shooting was a mere accident that occurred from pure happenstance.  Of course, the shooting was not intentional, but it appears that there was a reckless disregard of established firearm safety protocols.  Investigators will surely discover how a live bullet ended up in Alec Baldwin’s gun.  More facts are emerging daily that indicate a laxity of gun safety and multiple deviations from industry standards.  I suspect that the ongoing investigation will only further highlight the negligent behaviors that culminated in a tragic homicide that should never have occurred.  Criminal charges are possible.

If my tire is punctured while driving and my car hits a tree, this is an accident.

If I notice that my front tire is deflated, and I take it for a drive anyway, is it still an accident if the tire blows and I hit a tree?

Live Rounds on the Set?


I’ll admit that I don’t know much about filmmaking, and I know even less about firearms.  But, I know quite a bit about safety processes and protocols to minimize the risk of adverse events.  We are all aware that airline pilots methodically run through a checklist before every flight to verify that everything is in proper order.  We would likely feel less secure if pilots simply took a quick scan of the cockpit and then flashed us a thumbs up.  This checklist is the result of intense research and experience and is designed to catch any item that is out of line.  The key is that this process must be faithfully executed every time without exception. 

Physicians understand this process well.  Before every surgery or medical procedure, the team participates in a ‘time out’, when the patient’s identify is confirmed as well as the intended procedure and any potentially complicating factors.  Does the x-ray with the broken hip hanging in the operating room correspond to the patient about to be put under?  Complacency and indifference can lead to tragic outcomes. We have all heard about patients who had the wrong organ removed or received medication intended for another patient.  The checklist procedure minimizes the risks of these outcomes.

I surmise that the results of the Alec Baldwin investigation will show serial deviations of process that involved multiple individuals all of which led to a horrible outcome.  Does this sound like an accident to you?

 

Sunday, October 24, 2021

Jeopardy Host Sidelined but Still Kept His Job?

When improper actions are followed by proportionate and predictable consequences, it serves as an incentive for us to behave better.  Let’s face it.  We are not hardwired to do the right thing. If we were, then there would be no need for thousands of laws, rules and regulations to guide our behavior.  We need laws against theft, insider trading and assault because we have accepted that our natural human inclinations often lead us astray.

And, if we were moral creatures by design, parents, teachers and religious leaders would not have to devote so much effort to teaching us to do the right thing.

When a consequence is hollow it threatens our confidence in the integrity of the system.  When a professional athlete has committed assault, the investigations and punishments have seemed to be a very different process than we would expect if an ordinary person, like me, were the accused.  We have all witnessed examples of this over the years.

Some time ago, Mike Richards, who was anointed as the designated new host of the Jeopardy game show, was pulled from his position based on prior offensive social media postings.  Yet, he continued to serve as the show's executive producer.  How does this make sense?  If the company believes that his violation of social norms rendered him unqualified to host the show, how does he still serve as a corporate leader?  Was Sony, who produces the game show, trying to calibrate the minimum level of punishment that would satisfy critics and yet still permit his employment?  Don’t companies realize that these tortured attempts to thread the needle nearly always come back to prick them?


Sony's Corporate Policy

It took a full 10 days for Sony to do what it should have done at the outset.  Richards was removed from the executive producer position.  Sony, however,  was not held to account for this clumsy bungling.

We can’t legislate or incentivize every behavior.  Many acts are wrong and yet escape accountability. Try this hypothetical.  An individual refuses the COVID-19 vaccine and has no medical or religious exception.  His mask, when he does don one, is dangling underneath his nostrils.  Consider some potential outcomes

He infects several people one of whom requires a ventilator.

He spreads the virus at work causing a work shutdown.

He does not reveal to his dating partners that he is unvaccinated.  Two of them become ill.

He infects his grandchild who contracts COVID-19.  His classmates must now return home for remote learning for a period of time.

Should there accountability for this behavior?

 

Sunday, October 17, 2021

Will We Be Wearing Face Masks Forever?

I don’t foresee them disappearing from the public landscape anytime soon.

I think there will be a segment of the population that will continue to wear masks even after the pandemic has subsided.  Indeed, there are parts of the world where donning a face mask is routine.

And as we have all seen, there is a vocal segment of the population that will refuse mask wearing regardless of the circumstances.  For example, sitting governors, with a keen eye for politics, have ordered that no mask mandates can be instituted in their states.  Score 1 for Politics and 0 for Science.

Just as our country has not experienced its last hurricane or wildfire, there are other pandemics lurking over the horizon.  So, over time, mask wearing will rise periodically when nature’s germ warfare strikes us again.



'The Mask Stays!'


I also suspect that many health care institutions will require their staffs to wear masks long after the public will have been advised that masking is no longer advised.  These hospitals and medical facilities may truly believe that ongoing mask wearing will offer protection with no downside.  And, it may serve as a branding function to reassure the public regarding the institution’s culture of safety.  Many medical images – a stethoscope, the nurse’s cap of yore, the white coat, the doctor’s black bag and a surgical mask – are viewed favorably by the public. 

Have you ever noticed how often physicians being interviewed on television are wearing a white coat when there isn’t a patient in site?  Image matters.

I don’t envision that a face mask will become a permanent wardrobe accessory for me.  But I expect to see others masked up on ground and air transportation, in theaters and at sporting or entertainment events.  Perhaps, our marketing gurus, who spend their professional lives convincing us to buy products that we don’t need, will convince us that masks are cool.  Imagine a 30-second ad spot during the Super Bowl depicting a biker on a Harley cruising up a dirt road, sunlight gleaming off the motorcycle, mask in place... 

 

 

 

 

 

Sunday, October 10, 2021

Doctors Spreading COVID-19 Vaccine Misinformation

(As published recently in cleveland.com)

Should a physician who spreads misinformation on coronavirus vaccines lose his medical license?  Would this violate the doctor’s right to free speech?  Shouldn’t physicians be able to offer their patients counsel and advice that differs from mainstream medical thought? 

Every profession has ethical and legal requirements to maintain the integrity of the profession as well as the public trust.

·      If an attorney lies to a judge, then this lawyer can expect to be severely sanctioned. 

·      If a public-school teacher instructs science students that the world was created exactly as recorded in the Book of Genesis, then professional repercussions are expected.

·      If a police officer is discovered to have planted evidence to justify an arrest, then the officer will likely face criminal penalties.

In the medical profession, there are also professional and ethical boundaries that practitioners must respect.  Consider these flagrant violations.

·      A doctor falsifies a medical record to buttress his legal defense in a medical malpractice case.

·      A physician accepts a kickback for sending referrals to a colleague.

·      A physician performs unnecessary procedures to make money.

·      A doctor submits false documentation when applying for hospital privileges.

Such breaches may very well jeopardize the doctor’s professional standing and even his personal liberty. 

This past July, the Federation of State Medical Boards (FSMB) stated that doctors who spread misinformation on Covid-19 vaccines risk disciplinary action which could include revocation of their medical licenses.  The FSMB instructs that physicians are obligated to share medical advice that accords with sound science and medical judgment.

The State Medical Board of Ohio requires every licensed physician to report misconduct which includes, among other behaviors, a colleague practicing below minimal standards.  Indeed, a physician who fails to report suspected misconduct to the Board may face disciplinary actions.


                         

Hippocrates, remember him?


One would expect that physicians who promote false information regarding Covid-19 vaccines would be ripe for sanction.  Remember the Ohio physician who testified before a House Health Committee hearing this past June that coronavirus vaccines magnetize recipients?  In the doctor’s own words, “… they can put a key on their forehead. It sticks.  They can put spoons and forks all over them and they can stick...”  The Plain Dealer recently reported that her medical license was just renewed by the State Medical Board of Ohio for 2 years, an automated process that does not mean she is not also under a confidential disciplinary investigation.  Let’s hope that the Board does the right thing.

Her testimony might make for a compelling Twilight Zone script, but it has no place in the medical landscape.  This is not a free speech issue. It’s a competency issue.  

Governing bodies of professions have rules and standards that must be enforced if they are to mean anything. 

Scientific support for coronavirus vaccines is overwhelming - much more solid than for many other standard medical treatments that physicians prescribe every day.  I wish that my own advice to patients was in the range of >90% effective with almost zero risk of serious complications. 

Millions of Americans have become ill and hundreds of thousands have died from this virus.  And there will be more to come.  If a medical practitioner is advising against coronavirus vaccines on medical grounds, or recommends ivermectin as a treatment or promotes misinformation that risks the health of patients and the community, then please sell your snake oil elsewhere.  You took an oath upon becoming a doctor.  And if you willfully violate it, as well as the medical profession’s clear standards, then you should be called to account.  We physicians must denounce anyone who purveys deception and misinformation that threatens everyone’s health, even if it is one of our own.