Sunday, April 12, 2009


By a lucky accident, I stumbled upon one of the greatest books I have ever read. The book is “At Your Own Risk: The Case Against Chiropractic” by Ralph Lee Smith, who is some kind of genius. You can read it here.

I’m only halfway through it, and its forty years old, but the things you read in it are unbelievable. It is one astounding revelation after another about the origins of chiropractic, the drive to create a money making bonanza for its founders and “students”, the complete disregard for human life and morals, the love of pseudoscience and “gadgets” that do nothing, and the inability of the government to stop them.

Out of curiosity, I visited the American Chiropractic Association’s website, to see if 50 plus years and a lot of scientific discovery had changed their mission, or at least whittled away some of the more ridiculous ideas they purport. I love these quotes from their website

Doctors of Chiropractic are physicians who consider man as an integrated being

"Chiropractic is a drug-free, non-surgical science and, as such, does
not include pharmaceuticals* or incisive surgery.

With regard to the core chiropractic principle, which holds that
the relationship between structure and function in the human body is
a significant health factor and that such relationships between
the spinal column and the nervous system are highly significant
because the normal transmission and expression of nerve energy are
essential to the restoration and maintenance of health.

For those who don’t know, these guys used to state that they could cure every disease by manipulating out the “subluxations” of the spine. Of course there is no reason scientifically why this should be the case, but whatever.

I dispute that they are physicians of ANYTHING! And of course it’s drug free. Drugs would WORK and their treatments DON’T! And of course the nervous system is “highly significant”. It just isn’t the reason you had a coronary event or pneumonia or meningitis or gallstones or leukemia. And what is an “integrated being”? Is that like Dr. Manhattan from Watchmen?

Chiropractors are, at best, glorified massage therapists, and at worst, greedy fortune hunters with a license. My dream is that one day, all their “schools” will be closed and they’ll all have to get real jobs.

Thursday, April 9, 2009


I haven't posted in a year??? That's just because I've been trying to make enough money so I can pay my taxes, so Barack Obama can just give it away to the poor banks. God, I feel so sorry for those bankers, having to beg for change, not knowing where their next meal is coming from, working long hard days trying to manipulate the economy. THEY'RE ENTITLED TO THOSE BONUSES DAMMIT!!! WE HAVE A CONTRACT!!!

I know this has little to do with medicine, but I work my ass off to make a living, and I make too much money to get any rebates/stimulus/etc, so I choose to vent.

Medicare gave a slight raise this year, I detect about 2 bucks for my visits. Medicine is in the toilet.

Sunday, April 13, 2008


The Sunday Times Week In Review section contained this nifty letter:

To the Editor:

Thank you for bringing attention to the growing problem of access to primary care in Massachusetts. The problem has been worsened by our universal health care initiative, which was missing a strategy to increase the number of providers to serve the increase in patient load.

Your article, however, focused on increasing the number of doctors to solve the primary care shortage. Nurse practitioners have been filling this role for more than three decades by providing the best in health care.

We are the future of primary care. Make an appointment. We’re open.

Robb Stenson West Falmouth, Mass., April 7, 2008

What universe am I living in? The buffoon can’t be serious! It’s just not possible. Nurse Practitioners are the future of primary care? They are providing the BEST in health care? No one, and I mean NO one in their right mind could believe such a thing. Not even Robb Stenson (and by the way, why the two ‘b’s? Does that stand for BIG BUFFOON??) asks to see an NP OVER a doctor! That’s right! I don’t see any NP hospitals and people clamoring to see NP’s INSTEAD of doctors! They are ANCILLARIES!!! Did they forget that?

It truly makes me just want to give up. Can Internal Medicine be devalued any further? Why do I teach it to med students, when apparently NP’s are the future anyway? And they wonder why students don’t want to pursue a career in IM. Jackasses like Robb Stenson apparently feel they are better than IM doctors and they have a tenth of the training.

I give up. The Apocalypse of Medicine is surely upon us.

Sunday, March 16, 2008


The New York Times published a story on the front page of Sunday’s paper about a drug used to treat Gaucher’s disease. The drug is a enzyme replacement for the inherited deficiency in glucocerebrocidase. I was not even aware that the disease can present initially in adulthood. I’ve never seen a patient with it. Not surprising, since only about 20,000 individuals in the United States have ti (according to UpToDate).

The drug in question, Cerezyme, is made by the Genzyme company. As the Times’ Andrew Pollack reports:

Sales of Cerezyme totaled $1.1 billion last year, making it a blockbuster by industry standards.”

Yeah, I’d say that’s a blockbuster by industry standards. Or ANY freaking standards. Of course, any drug rep whoring for Pfizer will tell you, it’s the R AND D costs that make these drugs so expensive. The article goes on to say:

But critics say the company’s development costs were minimal, because the early work on the treatment was done by the National Institutes of Health, which gave Genzyme a contract to manufacture it. And analysts estimate the current cost of manufacturing the drug to be only about 10 percent of its price.”

When the government hands out these “contracts” to private companies, they don’t seem to care too much about the general public, do they.

Now, I’m all for businesses making a profit. I’m no socialist. However, just as the public (and the government) have decided that doctors should not be aloowed to make too much money, so they (and the government) should not allow ANY healthcare providing entity to make any amount of money they want. This goes for Big Pharma, for medical equipment companies, for medical insurance companies, etc. etc. Since physicians are supposed to be putting patients first, why the HELL aren’t these other companies forced to do the same? It’s not as if they have different customers than doctors do. It’s not as if they are getting the money from a different place than doctors are.

And another thing, if this drug is costing insurers 1.1 billion dollars a year (and I’m assuming none of that is being paid for out of pocket by patients), then how can doctors be primarily to blame for rising healthcare costs? I don’t cost anywhere NEAR that much. Think how much money could have been saved if the United States had just set up the drug manufacturing for Cerezyme by itself. No profit would have been sought. The drug would probably be like 100 bucks a shot.

BUT NO!!! Let’s cut reimbursement to all Primary Care doctors, so we can heap billions of dollars for a drug that treats a few thousand people. Makes perfect sense. In CRAZYLAND!!!

Monday, March 3, 2008


I was just watching the travesty that is the CBS Evening News with Katie Couric. They reported that in Texas (and even Iowa) many people fly to Mexico for healthcare and prescriptions to reap the delicioso savings available in a town called Metmoros or something like that. Apparently a doctor’s office visit is as low as THREE BUCKS! (He says a visit to a US doctor is 125 bucks. Where the hell did he get that number?)

And then they plant some truck driver making next to nothing who says “The American Healthcare system is a TRAVESTY!”

Byron Pitts is, I am sure, a nice guy. But does he make any mention of the fixed costs that doctors have that they probably do NOT have in Mexico. Rent, for instance, for the Primary Care doctor in my office is FOUR Thousand DOLLARS A MONTH! That’s probably, like, a million bazillion pesos. But I’m guessing the rents are not so exorbitant south of the border. Also no mention of electricity costs, malpractice costs, billing and overhead costs.

If I charged each patient 3 bucks (which the CBS Evening News seems to be exhorting me to do) then I see my practice lasting about 4 weeks, until the rent is due.

I mean, three into 4000 is 1333, so I only have to see 66 patients day to pay the rent. What’s left for my bartender?

I’m guessing neither presidential candidate is going to advise people to go to Mexico for healthcare, a la Mike Bloomberg telling NYC residents to go to Starbucks if they need a bathroom. And doctors are scapgoated, once again, for the rising costs of healthcare. And one of their brilliant proposals is to lower the poverty rate so more people will qualify for Medicaid. I can't wait to get 30 bucks instead of three for an office visit. (and 7 bucks for a follow up in the hospital. Woo hoo!)

Saturday, October 13, 2007


My apologies for not writing in so long. There are many things I read that I want to blog about, but then I watch television.

I want to get right back on the train with a round of applause for one of the best articles I have ever read in the New England Journal of Medicine. Their critical appraisal of “Chronic Lyme Disease” (and I LOVE the quote marks) was short and sweet, and there are so many takeaway messages.

The first, of course, is that there is NO good evidence of any such entity in the medical lexicon. What I mean to say is, it is NOT A RECOGNIZED INFECTIOUS DISEASE! Here’s a quote from the Infectious Disease Society of America website:

an extensive review of scientifically rigorous studies and papers available to date, has determined that there is no convincing biologic evidence to support a diagnosis of chronic Lyme disease after completion of the recommended treatment

But don’t tell the chowderheads at so-called “support groups” like this one. They are all over the country (even in places where Lyme is NOT endemic), composed of rich people, and have NOTHING BETTER TO DO but use the internet to obsess over their pathetic lives.

Apparently, for the believers, you do not even need to have a positive antibody test against Borrelia burgdorferi to make the diagnosis., because it might not be valid unless done by a “specialty laboratory”, which is, of course, a scam, since they are performing tests that are not even validated or supported by the FDA, and are using criteria that are based only on their own fantasy values.

This is the second takeaway message: that there’s a sucker born every minute. In this case, the sucker is the poor sap (or self-important “expert” patient) who seeks out the “Chronic Lyme specialist” (laugh heartily, men-of-science) for weeks, months, even YEARS of chronic antibiotic therapy which is proven to do NOTHING except cause complications of side effects and catheter infections (one resulting in DEATH, according to the article).

The article goes on to discount every theory that the “Chronic Lyme” fraudsters purport. But the most disturbing part of the article comes near the end. Here’s a quote:

The attorney general of Connecticut has begun an unprecedented antitrust investigation of the Infectious Diseases Society of America, which issued treatment guidelines for Lyme disease that do not support open-ended antibiotic treatment regimens

An attorney general is actually pursuing legal action against an academic society because they disagree with his unscientific view of a bogus clinical entity that is disproved by science. Saying I am shocked and nauseated does not begin to describe my true feelings. How is this possible in 2007? Why are lawyers pretending to be scientists??? Does this guy own a bunch of these “specialty” clinics or something?

That’s the final takeaway message: science is now being dictated to by people who have absolutely no idea what they’re talking about, and aren’t interested in real research.

Thank you Henry M. Feder, Jr., MD er al, and the Ad Hoc International Lyme Disease Group for the article of the year!!

Tuesday, September 25, 2007


My wife recently took my 18 month old to a pediatric neurologist that was recommended by our pediatrician. I like our pediatrician. She’s very direct and “old school” and is highly competent. So I trust a recommendation from her.

She may be right, and this pediatric neurologist may be great. However, I would never know because my wife told me that she NEVER EVEN GOT TO SEE HIM!!! No, she saw the Nurse Practitioner (cue scary music). And then when my wife protested, the staff told her “Oh, don’t worry. The doctor will come in to see your child afterward”.

Well, that turned out to be a gigantic load of bird-plop! He wasn’t EVEN IN THE OFFICE!!!

I called the doctor himself to protest this shoddy treatment. He reassured me that his NP was his “partner” for six years, that the NP had published more papers than the doctor had, that the NP’s capabilities were superb.

I told him that, while all of this may be true, there was one indisputable fact: I know what kind of training (for the most part) a pediatric neurologist has received. I have NO FREAKING IDEA what kind of training a pediatric neurology NP has received. And what’s more, I really don’t care! I don’t care if the NP has written 100 papers, published in every major journal in the nation (well, actually that would be pretty cool).

Also, I object to his use of the word “partner”, as if his credentials were somehow equivalent with the NP’s. What is he thinking?

Look, I understand why NP’s exist. It’s an economic reality of office based practice. It increases the number of patients that can be seen. However, when it comes to a very specialized group of patients, especially nervous parents who obsess about their little one, for whom they’ve lost so much sleep (SO MUCH) in the last 18 months, I think an NP is not good enough. And shame on his staff for lying about his availability. (He states he was stuck at another hospital, which I understand. But the staff completely misled my wife).

I will never employ an NP to see my patients for me. End of story. Ditto for PA’s. They can draw blood, they can do post visit counseling, they can hold a patient’s hand.

But they aren’t doctors.