Placebo Gazette #25
(Keeping Our Finger On The Prostate Of Medicine)
12/29/04
1. A Tough Loss For The Medical Community
2. MRI This
3. Medicaid and Drugs
4. Multi-Cleanse
5. They Want Moore
6. Placebo Journal Update
7. Feedback For The Placebo Journal
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My prayers go out to those affected by the Tsunami on the other side of the world. Anything I say in this Gazette really pales in comparison to that tragedy.
1. A Tough Loss For The Medical Community
For those that missed the headlines, Dr. Jonathan Drummond-Webb was found dead on Sunday. He committed suicide. This guy was huge in the medical field. He was a renowned child heart surgeon and revered by the community and his patients. He was only 45 years old! The AP reported that his friends believed he suffered a sudden bout of depression recently. You think? Sorry, folks, but there has got to be more to this story than that. And his depression may have been going on for a long time. It is so sad to that a guy who was that famous, that rich, and that good a surgeon would take an overdose of medication and end it all.
I did some researching about Dr. Drummond-Webb and found a lot of interesting stuff. Dr. Jonathan Bates, chief executive officer of Arkansas Children's Hospital, was quoted by the AP as saying that said Drummond-Webb worked tirelessly to save his patients. “Some would say they saved 98 out of 100,'' Bates said Sunday (after they found his body). ''He looked at it and said I lost two out of 100.'' So he obviously was an obsessive perfectionist to a fault and didn’t take any loss well. In 2002, ABC did a miniseries/documentary called ICU and included Drummond-Webb because they were attracted by his record of 830 surgeries in 18 months with only a 2 percent mortality rate. I did some math and that would come to 46 surgeries a month! To say this guy was a workaholic is an understatement. I looked into this television series and found a 2002 review on the web by a Simon Orchard. It was fascinating. Here is part of the article:
The head of the team, Dr. Jonathan Drummond-Webb, is more Garry Shandling than George Clooney, but if you are interested in a case study on the God complex, he's your man. His wife, a former doctor, has given up her practice to support him in his life's work. My biggest question, after watching the first episode, is, in what way can she support him? They don't have children because, as his wife recites, "Jonathan always jokes that he doesn't want to come home from work to more crying babies." Nice. She rarely sees him because he spends seven days a week at the hospital, often sleeping in his office. He doesn't appear to leave her with anything of himself that would require support.
The hypochondriac playwright George Kaufman once described the perfect doctor as "one who, when he's not examining me, is home studying medicine." If this is your ideal, then Drummond-Webb is the man for you. He calls the hospital constantly from home. When he does find some free time, he uses it to train for triathlons. Indeed, type-A personalities are over-represented on the hospital's staff. Of the six doctors profiled on the first episode, three are avid triathletes, and, in the hypertensive tradition of go-getters, they compete furiously with each other. It would be a relief to see any one of them lie down, read a newspaper, or just relax for a minute.
Even then they felt Drummond-Web was a case study on the God complex (perfectionism). He had no desire for kids. He rarely saw his wife and when he did, he was a ghost. He had little free time but used what he had to call the hospital or train to be a triathlete. With all this, why didn’t anyone see his suicide coming? I will tell you why. The answer is that no one thinks about caring for the caregiver. For all intents and purposes, Drummond-Webb had it all. He was the best doctor in his field. He was physically in shape. He must have been rich as hell. He had everything except he just didn’t know it.
A few days before his death, Drummond-Webb had saved another child. The youngster needed a heart pump until a donor heart was available. The surgeon performed the first surgery earlier in the year and the subsequent heart transplant later on. He even went to Houston from Arkansas to personally retrieve the donor heart when it became available. Afterwards, he gave the kid his own office recliner so he could sleep better in his room. "Walk out, and don't come back," Drummond-Webb told the teenager as he left the hospital. No one thought that it would the doctor who would never come back. Drummond-Webb also told The Associated Press, ‘‘this is a high-risk business. We see children walking out, we also see children who do not make it.'' Now the one who didn’t make it was Drummond-Webb
Personally, I was hit hard by this story. No, I am not depressed or suicidal. I have been burned out, though. I couldn’t take all the whining and crying I was hearing and it was really upsetting to realize that all that crying and whining was coming from me. Luckily, I recognized my problem early enough to at least do something about it. Commiserating with others allows me to laugh and not take life as seriously. It also makes me realize that I am not alone in this crazy field of medicine. I hear thousands of stories a year from doctors who share them with me. It is the reason why I lecture on burnout. I am, however, amazed that with the thousands of medical conferences going on each year that so little attention is given to physician’s health (physical and mental). I should be busy lecturing about it every day somewhere but unfortunately I am not. The reason, I believe, is that the medical establishment blows this whole issue off completely. We are afraid to touch the subject. I think in general, doctors are perfectionists. Doctors don’t like to fail at anything. Doctors are workaholics. Drummond-Webb may have been more excessive in these areas but he wasn’t alone. Studies on physicians' suicide show modestly (men) to highly (women) elevated suicide rate ratios (Am J Psychiatry. 2004 Dec;161(12):2295-302.) Other studies have shown a relatively high level of certain mental health problems, particularly depression, which may lead to drug abuse and suicide. One in four doctors are on antidepressants. We as physicians are expected to be perfect and make no mistakes. This is impossible to accomplish. Acknowledging the opposite (that we are human and will make errors) is also unacceptable to both us and the public. These two contradictions put us in a constant battle with ourselves. Lastly, the biggest problem plaguing physicians is loneliness. We are afraid to open up to each other lest we be judged. We are afraid to tell a colleague that “these patients are killing me” or “I’m killing these patients” or “I am thinking about killing myself”. Dr. Drummond-Webb left a note to his wife. I don’t know what it said but I am willing to bet it is a lot of what I described above. I never met you, Doc, but I am sorry that you went so young.
2. MRI This
Penelope
Patsuris on Forbes.com reported on the misuse of MRIs and the overuse of all
radiological imaging procedures. In fact, “growth in medical scans
has been far outpacing that of other medical services, rising 9% per capita
between 1999 and 2002, compared with 3.3% for other services,
according to government data.” Shouldn’t we be able to scan everyone? Isn’t
healthcare and all the radiological scanning you want a unalienable right
granted to us by our forefathers? So what if it may cost upwards of $110
billion by 2007. So what if a patient is a smoker and wants a CT scan every
year to make sure he catches the cancer early. Don’t all Americans deserve it?
The article states that imaging rates are increasing by 40% to 50% a year. That
means one thing - more money for radiologists and the equipment makers of these
machines! For the rest of us that means that someone has to foot the bill. In
other words, we bankrupt Medicare even more or the insurance companies pass the
bill onto the rest of us by increasing premiums. The articles states that
defensive medicine is not the only reason for the increased radiological
imaging. There is also the fact that many non-radiologists now own their own
scanners and get a nice profit from its use. The article points to a 1994
study that showed that doctors who owned imaging equipment ordered 54% more MRIs,
27% more CAT scans and 22% more ultrasounds, compared with those who referred
those procedures to outside doctors. The bottom line is that technology is not
always a great thing especially if Americans rely on it. Greed and fear has led
us to a bad place.
3. Medicaid and Drugs
Did you know that the government health care program for the poor spent more than $31 billion on prescription drugs in 2003, triple the amount spent 10 years earlier? It turns out that the private insurers pay a lot less. Really? Our government is not fiscally responsible? Five large retail pharmacy chains showed that drug stores paid an average of 22 cents for seven widely prescribed generic medicines, but received 56 cents in reimbursements from Medicaid. That is a nice profit. Add to this that Medicaid fraud from certain pharmaceutical companies is also costing taxpayers hundreds of millions of dollars and you have an example of a socialized medical system that is bleeding out.
4. Multi-Cleanse By Michael Gorback MD
I only heard part of this on the radio today while out shopping. It was an infomercial for Multi-Cleanse, which cleans out your bowels. Here's what I learned in only 5 minutes.
- The blood supplies all of the tissues. The intestines supply the blood. Ergo, if your intestines are dirty your tissues will be dirty. You can't go wrong with logic like that! Well, actually you can't go right . . .
- The FDA has determined that by the time you're in your 40s you have several pounds of undigested toxic fecal matter clinging to your intestinal walls. (Question: what is the FDA doing investigating stool clinginess? No wonder Vioxx slipped by them. They were all busy with the FDA Stool Adhesive Study)
- You need to use this product to rid your body of "toxins". As with most quack cure claims about "toxins", the actual toxins were not named.
I heard one caller, "Gary", who sounded like he was reading from a script. Gary was very concerned about clinging fecal matter and toxins. The guy pushing this stuff asked Gary the following question, which I paraphrase:
"Gary, are your stools the same caliber and length as your children's stools, allowing for the relative difference in size?"
Now, this is something I must have missed in Review of Systems Class in medical school. I have no idea what my kids' stools look like, since they are now 15 and 12, and have been potty trained for years. Try this in the office and see what happens (My prediction: the patient carefully edges sideways out of the room, keeping their eyes on you the whole time, never to return). My response to this question would be "What kind of sicko checks his kids' stool caliber and length? Or even his own? And who cleans the tape measure afterwards?"
Gary, however, was able to answer this question without hesitation. He was certain that his stools were disproportionately smaller than his children's stools.
Aha! No wonder Gary feels bloated and sluggish! However, Gary will get all the "special attention" his colon could ever want when they haul him off to jail for being the pervert that he is.
But what about the rest of us? Obviously, stool adhesion is a serious problem that requires national attention, along with breast implant toxicity, which existed long enough to make several lawyers very wealthy. When subsequent data showed they were wrong, they did not offer any refunds. But hey, when doctors are wrong we don't give refunds either. Sometimes we give apologies, but not cash. Let's not throw stones, ok?
But I digress. We need to quantitate just how much stool is being hoarded in middle aged and elderly intestines (apparently this is a cumulative process that only gets severe in middle age). We have ideal height and weight tables. We have cholesterol target levels. We need guidelines for healthy stool caliber and length, adjusted for age and body weight. The old Victorian rule of thumb "Once around the pan and tapered at both ends" simply will not suffice (for one thing, we have indoor plumbing now).
If terrorists ever cause a shortage of human feces, we can tap these reserve intestinal sources. It's our duty as health care professionals to help Multi-Cleanse do their job for the American Public - both for "enhanced health" and national security.
We need data and we need it fast. What is desperately needed is a National Fecal Adhesion and Stool Dimension Study. I suggest that we all start collecting our stools, then tag and bag them with our age, weight, and height, and send them to the Multi-Cleanse people for entry into a national databank. Perhaps we could also subsequently get enemas and send that along for quantification of clingy residue that has been washed out, for correlation.
(Or maybe that lawyer guy from Boston who e-mails the Gazette would like to do the study?)
5. They Want Moore
The Los Angeles Times reported that at least six drug companies are telling their people to watch out for filmmaker Michael Moore. I had heard rumors about him doing another scathing documentary for about four months. Some reps had told me that monetary offers of up to $10,000 were being offered if they would help him dupe the pharmaceutical company or the doctor. The article says he really wants to discover devious stuff about the health care industry, which includes the insurance companies, HMOs, the Food and Drug Administration and drug companies. Hey, wait a minute, that sounds a lot like what I do! Anyway, Pfizer, Wyeth, AstraZeneca, Sanofi-Aventis, Synthelabo and GlaxoSmithKline have all warned their employees to steer clear of him. Come to me, Michael, we can talk. Actually, I take that back. The way he edits his films, he could spend time following the Pope and make him look bad.
6. Placebo Journal Update
We are hard at work with the February issue of the Placebo Journal. It will be our 21st issue and it is looking great. Be sure to check out our new female libido testosterone patch called Modic. To get started with the next issue, click here:
http://www.placebojournal.com/subscribe.htm
7. Feedback About The Placebo Gazette
In General
About Mark Breakstone
Doug,
Your attorney buddy piously claims Mass law has a "contingent fee system which discourages lawyers from bringing unmeritorious cases or face bankruptcy". So let me see....overall plaintiff's attorneys win 3 of 10 juried cases. I'm sure that the 70% of 'winning' doctors will be delighted to learn that since plaintiff's attorneys win big pay-outs for only 3 of 10 of their malpractice lottery tickets, the economic extinction of these reckless members of the bar is just around the corner.
Sir Snort Alot
Doug,
So great to get my day brightened by the gazette. I do take the liberty of forwarding your creation to my friends both in medicine and at the university. Your attorney friend did a wonderful job defending himself. To his credit, he focused his comments on his practices and not on his profession as a whole. Why do you suppose he was so defensive? The only thing his comments serve to show is that there are incompetent, dishonest, arrogant and rotten people in every profession but sadly a disproportionate number of those jerks are practicing law. As one of my retired lawyer friends said “It is a license to steal.”
Thanks again pal!
Nip Boyes, PHN, MSN-FNPc
Hi Doug,
"Revenge of the Malpractice Attorney " in the last gazette reminded me of
this joke:
Q: What do you have when you've got a bunch of lawyers up to their necks in
cement?
A: Not enough cement!
(of course, this also works for (a) politicians, (b) bureaucrats or (c)
television preachers, depending on one's particular slant.)
JM
Doug
There is much that
can be said to answer Mark Breakstone's polemic. However,
as a pediatric surgeon who trained in part in Boston (where I assume Breakstone
practices) I question the accuracy of his statements. Reputable pediatric
surgeons do not repair simple umbilical hernias in 5-week old infants. Either
the age is wrong or it is a different procedure. And anesthesiologists do not
"abandon" their patients after surgery - they turn them over to recovery room
nurses who usually know what to do if the patient has a problem, and will call
the anesthesiologist immediately. Breakstone may just be inventing or
exaggerating the rest of his examples, as well.
Peter S. Liebert, MD
Dear Dr. Doug,
All we have to do is take malpractice out of the hands of private, for-profit attorneys. Have each state appoint medical attorney generals (attorneys general?) who investigate and prosecute malpractice claims. Any monetary judgments, after covering the salaries of these investigators, would go into the public health and prevention budget of that state. It may sound like a bad idea to put the state in charge of anything you care about, but at least the money might go towards getting kids to quit smoking, instead of some bastard's new Beemer (the slick 2005 2-seater roadster, no less). And there would be oversight for those claims that actually are based on poor medicine. Meanwhile, how about holding medical malpractice lawyers accountable for defense costs if their lawsuit are found to be frivolous or without medical merit (like 95% of malpractice suits).
Alternatively, we could tie rotten pork chops to their balls and throw them into the piranha tank at the Boston aquarium. I'm pretty much 50/50 on this one.
Olde farte medical student and Portland Native,
Thomas Savadove
Dear Doug,
Is Mark Breakstone real or did you just make him up as a fiendish relative to the PJ clan? He sounds stuffy and not real.
SP
Editor’s Note – 100% real. Mark, can I give your email out to show people?
About VBACs
Dr. Farrago:
While I can appreciate Dr. Eric Reinertson's comments about the VBAC issue, he does err with his American history. The pamphlet "Common Sense" was written by Thomas Paine (who advocated American independence from Britain), not Ben Franklin. Franklin edited "Poor Richard's Almanack", a yearly compilation of sensible aphorisms and philosophies.
Although I'm retired, having put in my 50 years, I appreciate reading the comments you publish. Listening to my younger colleagues lament over medical practice today, I realize "I got old" just in time.
Merry Christmas,
Lee Sataline, M.D.
About Female Physician Pay – Part II
Is WW short for Wendy Whiner?
I resent the smug crap about “female physicians having their lives in order” and interpret the pay differential differently. In my 22 years experience, they don’t want to work as hard as male physicians, but they want the same pay while their male colleagues pick up the slack. It’s great if everyone can work at a leisurely pace, as one group I know does, but it requires several bodies to pull it off successfully. More often, they pull a Camille, asking you to help because “golly, they are just so far behind” delving into patients’ psychosocial issues they are ill equipped to handle, or because they have to take the little darling to dance class.
I think I did a fine job balancing work and life. I had 50:50 joint custody of three small kids and had plenty of time for them. I didn’t socialize with other physicians because I didn’t like most of them and I’m not defined by those two letters. I’ve been working locum tenens for the past 9 years. I make about 1/3 of what my colleagues in private practice make, but I have about 4 months off a year, nowhere near the stress and, unlike many of your readers, I still like what I do. It’s a tradeoff I’ve made willingly.
Dr. Rivera
About Dr. Hurwitz
According to the Washington Post this morning Dr. Hurwitz was found guilty of drug conspiracy on 50 counts and acquitted him on 9 others and deadlocked on 3 of the 62 count indictment. His $2 million bail was revoked. Will send you the link of the article if I can. (http://www.washingtonpost.com/wp-dyn/articles/A3213-2004Dec15.html?referrer=emailarticle)
Peggy Williams Johnson
The Oldest (and only so far) PJ Groupie
Feedback about Feedback
Good morning Dr.Doug,
I noticed Laura Hendrickson's query about my retardation in the Placebo Gazette #24. As a writer, I enjoy playing with words. Instead of considering myself retired, I consider myself retarded by a system that refuses to look away from my 75 years of age and will not allow me to continue working. I still have the expertise, the experience, the will and the brain but when I send my résumé, the most I get is an interview and then the Big Silence, Thus, I feel retarded in my progress forward by age discrimination. My years in clinical pharmacology have been most rewarding for my employers. They made the millions and kicked me out when they did not need me anymore or did not like what I told them. They have also been rewarding to me because it allowed me to influence the lives and health of millions of people, rather than on a one to one patient basis as in practice. I have met some of the best medical brains in Canada, USA and Europe and throughout these 37 years, after my 7 ears years in practice as a FP, I kept on learning.
The closest I have been to practice was when I went back to being a 1st year Resident in Internal Medicine at age 60: it lasted 6 months and I was relieved to get fired by the Chief of Medicine, who had given my spot for a younger and probably smarter young Turk. Keep up the good work. I might write a few things for you because I have a lot to say. How about this:
"The failures of Drug Safety." as an example. I've seen plenty of it.
Au revoir and SVP send my comments to Laura with "mes hommages".
Lucien Joubert MD
Until next time, keep smiling, keep laughing and keep out of the sample closet.
Doug
King of Medicine
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