MD Whistleblower

Medical marijuana is a smokin’ hot issue in Ohio.  Marijuana enthusiasts targeted our state constitution again this year with another amendment attempt, which failed.  Instead, our legislature passed House Bill 523, which will legalize medical marijuana use.  As a physician, with some training and experience in prescribing medicines to patients, these marijuana machinations are medical madness.  Is this how we want to bring new medicines to market? I think it is absurd that a specific medical treatment – or any medical treatment - should become a constitutional issue.  Do we want to establish a constitutional right to a specific medicine? Why stop at marijuana?  Why not start circulating petitions for constitutional amendments for screening colonoscopies, mammographies and MRI’s for back pain?  Patients with chronic lumbar disk issues have rights too!  The Ohio bill specifies an array of medical conditions that could be treated with marijuana, including AIDS, hepatitis C, i

Would you have elective surgery in the nearby major teaching institution on July 4 th ? Why not, you wonder? Prowling around the hospital wards every July are the fresh faced interns wearing starched white coats, with stethoscopes draped across their shoulders, with pockets stuffed with reflex hammers, K-Y jelly, and various cheat sheets to rescue ailing patients. These guys know nothing.  How do I know this?  I was one of them.  Luckily, I knew that I was clueless and never pretended that I could treat athlete’s foot or even a splinter. Imagine you are in a hospital bed in early summer complaining of chest discomfort.  Your nurse summons the intern who speeds into your room peppering you with questions.  Before you finish your answer to a question, another question erupts.  This physician is barely out of his shrink wrap and is understandably anxious that he is witnessing an impending cardiac catastrophe.   With his spanking new stethoscope, he establishes that there is a

Readers are not aware of my personal view on abortion, and they won’t be after this post.  While abortion seems on its face to be a complex biomedical issue, interestingly, those with firm views on either side do not describe it as a great moral quandary.  Those who ardently favor abortion rights, and those who oppose them in equal measure, often express that this is not a controversial issue.  For them, it is a clear issue of right and wrong, with each believing that the other side is entirely wrong and misguided.  This observation applies best to those who are toward the poles of the abortion question.  If you believe that an embryo and a fetus are human beings, than abortion is murder.  Not much room for debate here.  If you do not confer personhood on an embryo and a fetus, then a right to abortion is a woman’s right to freedom and autonomy.  Clear cut argument here also .  Of course, many thoughtful individual wrestle with this issue and do not grasp it in the black and white

”I am apt to believe that it will be celebrated, by succeeding Generations, as the great anniversary Festival. It ought to be commemorated, as the Day of Deliverance by solemn Acts of Devotion to God Almighty. It ought to be solemnized with Pomp and Parade, with   Shews , Games, Sports, Guns, Bells, Bonfires and Illuminations from one End of this Continent to the other from this Time forward forever more.” Who authored the above? Hint: His signature demonstrates excellent penmanship!

Medical ethical issues confront physicians daily.  Most of us contemplate ponderous ethical dilemmas, such as end-of-life care care, allocation of the limited supply of organs for transplant or our unequal access to health care.  Many ethical decision points are rather quotidian, not situations that would serve as content for bioethical conferences. Here are some examples of everyday ethical issues that physicians deal with. A patient asks his doctor to support a claim for disability that is not warranted. A patient asks his gastroenterologist to change his constipation diagnosis after the fact so that his colonoscopy is covered more fully by the insurance company.  An employee in a doctor’s office, whose own doctor is booked solid, requests an antibiotic prescription for a urinary tract infection from her physician boss. A physician falsely claims to an insurance company that he has tried certain medicines on a patient in order to gain approval of a desired medication. A

The value of anything becomes apparent when it is taken away from you.  Nothing profound here about one of life’s central truths.  It is an ongoing challenge not to take life’s gifts for granted.  I have never known hunger or lived without shelter. I have never been unemployed or suffered a serious illness. I pay my bills.  I have 5 children who enjoy excellent health and are forging pathways toward their dreams.  I love the people I work with.  I have found new love in the 6 th decade of life.  And, I have ice cream every day of my life. It would be shameful to have been bestowed so much and then to complain about some of life’s trivialities.  But, I am human. The Mother of All Gifts Consider the following list of events.  Has any of them ever dampened your mood, made you angry or resulted in an outburst of coarse language?  You find yourself in a traffic jam which delays your arrival to a meeting by 20 minutes. Your lengthy and detailed e-mail to a client suddenl

“There are three kinds of lies: lies, damned lies and statistics.”   There is much truth in this quotation of uncertain provenance.  We see this phenomenon regularly in the medical profession.  We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test.  Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical gymnastics to shine a favorable light on their product.   It’s massaging, not outright mendacity.   The promotional material that pharmaceutical representatives present to doctors is riddled with soft deception. A favorite from their bag of tricks is to rely upon relative value rather than absolute value.  Here’s how this works in this hypothetical example. A drug named Profitsoar is tested to determine if it can reduce the risk of a heart attack.  Two thousand patients are participating in the study.  Each patients receives either Profitsoar or a

Like nearly every gastroenterologist, we have an open access endoscopy system.  This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance. Why do we do this?  We offer it as a convenience so patients do not need to make two visits to see us when it is clear that a procedure is necessary.  For example, a referring physician doesn't need our consultative advice for his 50-year-old patient with rectal bleeding.  He just needs us to do a colonoscopy.  We have a strict screening process in place to verify that these patients are appropriate for our one-stop colonoscopy program.  If we have concerns about medical issues or potential informed consent capability, then we arrange for these patients to see us in advance. However, no screening process is perfect.  On occasion, someone shows up whom we might have preferred to see in our office first. How should we handle these situations?  We don't a

I am in coffee shops several times per week.  I prefer independent establishments with atmosphere and authenticity.  For that reason, it is rare to spot me in a retail coffee outlet whose HQ is in Seattle, Washington.  This past week, as I was carrying my café mocha to my table, I spied some board games stacked up on a table.  On top was the game pictured below. This brought back warm memories of playing this game as a young kid.  It recalled the wholesome and beautiful childhood that my parents gave me.  Millennials might not appreciate the raw and fierce competition of games such as Candyland, Chinese checkers or Trouble, which has caused a huge void in their lives.  Looking back and remembering gives meaning to our lives.  We remember a song, a joke, a celebration, a concert, a speech and relationships.  Isn’t it amazing how hearing a song from years ago captures a mood? This weekend, we remember and ponder something of infinite meaning and importance.  We remembe

Patients are amazing creatures.   The current breed is hyperinformed on medical information and has an ever expanding reservoir of physician data to trove through.  I’m not just referring to physician reviews on Angie’s list.  Soon, the public will be encouraged to review our success and failure rates with respect to medical treatments, how much cash the drug companies grease us with, all disciplinary actions, comparison with peers, complication rates, medical malpractice entanglements and how much Medicare reimbursement we have received. There will be published quality benchmarks on physicians so that the public can see how their physicians scored on these various quality measurements.  I have opined throughout this blog that I feel that these measurements are tantamount to taurine excrement.   Sadly, reimbursement will be tied to these results with physicians who don’t rate high enough having some of their income confiscated.  Physicians who don’t make the grade may game the syst

Physicians are expected to be hostile to insurance companies.  Indeed, a prior Whistleblower post directed arrows in their direction.  They are an easy target, often vilified for their greed and perceived indifference toward those they insure.  Ask most of us if we think insurance companies favor profits over patients, and most of us will respond that profits prevail. Insurance companies are businesses, not charitable undertakings.  Sure, we all like free stuff.  Or, if it’s not free, we prefer that someone else pays for it.  We are outraged at the costs of chemotherapy, hepatitis C treatment and biologic treatments such as Humira and Remicade, leaving aside the zillions of dollars it takes to research, develop, manufacture, market and monitor innovative new drugs.  We want to drive a Cadillac, but only pay for a Chevy. We want to pay for this... ...and drive this. No person, business or organization is wrong all of the time.  Consider the following practices. 

I’ve never had the pain and agony of having a kid who is truly sick.  Broken bones and minor surgeries don’t count.  Even one of my kid’s bout with malaria doesn’t rate, as this illness was easily cured. Parents of kids with chronic illnesses would sacrifice anything to help their kids get better or to suffer less.  In the news recently is a conflict between families of kids with Duchenne muscular dystrophy and the Food and Drug Administration (FDA).  A very small study of an experimental drug called eteplirsen suggested some benefit.   Understandably, the families want the FDA to grant approval so that their kids and others could have access to this drug that will fight a dreadful disease that is fatal.  Families argue that these kids have nothing to lose and can’t wait another 5 years waiting for more definite evidence of efficacy to emerge.  The FDA is legally required to approve drugs that are safe and effective.  Obviously, the definitions of safe and effective are subjec

Every four years, abortion gets more press and attention as the candidates compete for electoral support.  My own position on this issue is not relevant for the points I offer here.  We all know that candidates massage their position on abortion and on other issues in an attempt to maximize their voter support.  It’s fun to watch them thread the needle as they dance and pirouette for us.  They are performers who can be as flexible as the amazing acrobats on Cirque du Soleil.  The emphasis, if not the content of their message, changes depending upon the audience.  Al Gore was ridiculed when he sported a more southern accent when he was campaigning below the Mason-Dixon line.  Donald Trump was clearly unprepared for the abortion question when he rhetorically collapsed during a typically vigorous and frenetic interview with MSNBC’s Chris Matthews.  Of course, you don’t really have to prepare on an issue if you already have a principled position.  You can just tell the truth.  Tr

Earlier this year I read about a medical study that concluded that a diet high in saturated fat won’t kill you after all.  Moreover, piling on polyunsaturated fat won’t save you. Hee hee.  I love this stuff.  Established medical dogma back flips every 10 years.  Butter in, butter out.  Hormone replacement treatment for perimenopausal women is mandatory, until it isn’t. Who knows what to believe when even doctors are confused or just don’t know. We have a medical industrial complex that is a beast that needs to be fed.  It fuels itself on our fidelity to medical practices that are labeled as truths.  ‘Wellness’ rules.  How many decades did the public and the medical community preach that the P.S.A. blood test saved men’s lives?  While I believe that urologists were sincere in their mistaken beliefs and practices, there was a whole industry behind the scenes that was fueling the fire.  It was good business for hospital operating rooms, medical device companies and radiation

What’s all this chatter I hear about how hard it is to lose weight?   Relax.   Obesity has finally been conquered.   Those stubborn extra pounds that you’ve been stuck with will soon melt faster than a popsicle on a steamy summer day.   Although I am a practicing gastroenterologist who deals with nutritional issues routinely, I did not learn of this breakthrough in my medical journals or from experts in the field.   I learned it just by listening to the radio. I’m in the car several times a day, so I get my share of radio time.  Not a day passes that I don’t hear an ad for some kind of fat-busting pill or potion.  The products are different but the pitch is always the same. Obesity on the Run! Rapid weight loss No excercise No work or effort.  Pound magically disappear This seductive pitch is followed by testimonials from smiling ‘customers’ posing on the beach who corroborate the amazing result.  Their script usually includes: 'I've tried everything

Of course, patients are entitled to medical care around the clock.  You would not expect to show up at 2:00 a.m. at an emergency room to find a ‘Closed’ sign.  If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor.  Patients are aware that when they call the doctor at night, that they are unlikely to reach their own doctor.  Similarly, when a patient is admitted to the hospital, they will likely be attended to by a hospitalist, not the primary care physician.  Such is the reality of medical practice today. No Patient Zone at Hospital Here are 3 types of after hour calls that merit mentioning. (1)One of my partner’s patients calls me because the diarrhea is still not better and it’s been more than 3 months.  While I completely understand the frustrated patient’s rationale for calling, there’s not much I can do in these circumstances.  It is generally not helpful to call a

Some issues do not need to be studied.   For example, would we expect the National Institutes of Health to fund a study to determine if drivers wearing blindfolds have better outcomes?   In the past few weeks, the National Football League (NFL) has conceded that head trauma is linked to chronic traumatic encephalopathy (CTE), a fancy term that means brain damage.  Of course, there have been multiple studies that have examined this question.  And, in a nod to the tobacco companies, the NFL for too long failed to admit what any school child could have deduced.  Smashing your head several hundreds of times against the ground or another helmeted gladiator does not promote good brain health.  Sometimes industries will cite their own ‘studies’ that astonishingly contradict what our intuition and common sense tell us should be true.  Would we accept the results, for example, of a movie industry  ‘study’ that extolled the health benefits of popcorn? Sometimes, in medicine, we need a s

Trump is roaring toward securing the GOP nomination in Cleveland this summer.  While I am excited that the convention will occur in my city, I expect chaos and gridlock downtown.  I won’t be visiting the Rock and Roll Hall of Fame, or any of our city’s other outstanding attractions, during that week. I think that Trump may garner the necessary 1237 delegates prior to the convention.  For self-serving reasons, the trailing 2 candidates are stating that no candidate will meet the required threshold and that the convention will select the nominee according to rules, yet to be decided.  My candidate Kasich – who has won only Ohio – crows that it’s now a 3 man race!  Sorry, John.  Wining 1 out of 32 states, while Cruz and Trump have won 9 and 19 states respectively, does not make this a 3-way tug of war. The New White House? The media is preoccupied to determine if the candidates and the GOP establishment will award Trump the nomination if he falls a few delegates shy and the

I am not a woman.  I cannot contemplate the physical and emotional experience of carrying a pregnancy and birthing a child.  I imagine that it is a singular experience that is as deep and awesome today as it has always been.  We have all seen the explosion in reproductive technology with in vitro fertilization, surrogate mothers, fertility agents and other emerging techniques.  This process, beyond the high costs, can create anguish for those who are on this journey. I have felt in many instances that the ethical ramifications of some of these techniques are minimized or dismissed.  Sadly, we often do stuff because we can, not because we should.  Do we really think we can stop human cloning? Recently, a woman in Cleveland had a cadaver uterus placed during an extremely demanding 9 hour operation on 2/24/16.  This was the first time this was performed in the United States.  Only a handful of these operations have been performed worldwide.  This woman, who has adopted children,

Proton pump inhibitors, or PPIs, are among the most common drugs prescribed in the United States.  They are extremely safe and highly effective for gastroesophageal reflux disease (GERD).  Are there potential side-effects?  Of course.  Look up the side effects of any of your medicines and you will soon need an anxiety medicine to relieve you of side-effect stress.  The side-effect lists of even our safest medicines are daunting.  PPIs are associated with a growing list of potential serious side-effects, at least according to the lay press.  A few clicks on your computer, and you will find that these medicines can cause pneumonia, C difficile colitis, malabsorption of nutrients, bone fractures and anemia.   The latest report to emerge links these drugs with dementia.  In the past two weeks, I’ve been questioned about this repeatedly by my patients.  One stopped her medication from fear that her heartburn medicine might be incinerating her neurons. Enemy of Heartburn Medicines

The nutrition police are at it again.  They demand that food products that use genetically modified organisms (GMOs) in their processing inform us of this on the product’s label.  They argue, not only that consumers have a right to know how their food is prepared, but also that manufacturers should be required to disclose when evil GMOs are utilized.  (Keep in mind that most of the food that we consume includes GMOs, a fact likely unknown by most of us.) Proposed Label For GMO Foods This labeling demand from the nutritionistas is a little hard for me to swallow.  I don’t want to hear about polling that demonstrates that most American favor mandatory labeling.  I guess we cite poll results when they support our views and dismiss them when we don’t.  Donald Trump is ahead in every poll.  See my point? There is no scientific evidence that GMOs harm our health.  Fear is not evidence.  Political correctness is not evidence.  Indeed, the Food and Drug Administration requir

There was a tragedy in France recently that did not involve offensive cartoons, radicalized jihadists or terrorists masquerading as refugees.  Innocent French citizens were taken down by a profession whose mission is to heal and comfort.  A medical clinical trial careened off the rails and crashed.  Were these volunteer study patients properly informed?  Are medical study patients here in the U.S. truly making a free choice? From time to time, friends, patients and relatives ask my advice if they should participate in a medical experiment.  While I am a doctor, I usually say no.  And, once I explain to them the realities of medical research, they usually say no also. While my colleagues may chastise me for not encouraging my patients to join clinical trials, my primary obligation is to advocate for the patient before me, not for society.  If physicians contemplate changing this ethical construct to consider the greater good when we advise patients, then we need to engage the