Respectful Insolence

There’s one thing I like to emphasize to people who complain that this blog exists only to “bash ‘alternative’ medicine,” and that’s that it doesn’t. This blog exists, besides to champion science and critical thinking (and, of course, to feed my ravenous ego), in order to champion medicine based on science against all manner of dubious practices. Part of that purpose involves understanding and accepting that science-based medicine is not perfect. It is not some sort of panacea. Rather, it has many shortcomings and all too often does not live up to its promise. Our argument is merely that, similar to Winston Churchill’s invocation of the famous saying that “democracy is the worst form of government except all the others that have been tried,” science-based medicine is the worst form of medicine except for all the others that have been tried before. (Look for someone to quote mine that sentence soon.)

It’s not even close, either. SBM has produced far and away better results than any form of medicine that has come before it, which is why it’s always puzzled me that so much of “alternative” medicine seems to be a throwback to ancient, pre-scientific, sometimes religion-based medical systems that existed in the days before germ theory and a rudimentary understanding of human physiology. After all, it wasn’t until William Harvey in 1626 that doctors even knew for sure that there was a direct connection between the arterial and venous system, for example, and the sphygmomanometer wasn’t invented until 1881. Monitoring blood pressure didn’t become routine until the early 20th century, and monitoring the diastolic blood pressure wasn’t routine until the 1920s.

Despite the rapid advances in the treatment and prevention of disease due to science-based medicine there’s still one area that SBM needs to do better in, and that’s regulating our own. To me, the license to practice medicine is a privilege, not a right. That I should even have to emphasize such a statement is bothersome to me, but all too often medical licenses, once obtained, seem to be treated as a right that can’t easily be taken away. That’s not to say that actually getting to the point of being licensed and board-certified isn’t difficult. It is. There’s the need to maintain excellent grades in college, after which there’s medical school and residency, both of which can be quite brutal. But once a physician is fully trained, board certified, and licensed, it seems that medical boards bend over backwards not to take away his license, seemingly even if he’s providing treatments so far outside the standard of care that they might as well be magic.

The case that provoked this complaint from me is one I’ve written about before, namely that of the Winkler County, TX family practitioner, Dr. Rolando Arafiles, Jr.. At the time, Dr. Arafiles was selling dubious supplements, hawking colloidal silver, promoting Morgellon’s disease quackery, and had anti-vaccine propaganda on his website. It turns out that — finally! — Dr. Arafiles is facing the Texas Medical Board for his substandard practice, as documented in a story on Medscape entitled Physician in Whistle-Blower Case Charged by Texas Medical Board:

The Texas Medical Board (TMB) has charged a family physician at the center of a nationally publicized whistle-blower case involving 2 nurses with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation, and other violations.

The charges follow a report that the 2 nurses — Anne Mitchell, RN, and Vickilyn Galle, RN — made anonymously to the TMB last year about patient care rendered by Rolando Arafiles, Jr, MD, at Winkler County Memorial Hospital in Kermit, Texas, where the 2 nurses and Dr. Arafiles worked.

After the TMB contacted him about the report, Dr. Arafiles asked the sheriff of Winkler County to investigate its source. The sheriff, the physician’s acknowledged friend and patient, traced the report back to Mitchell and Gale, who were then charged in a state court with misuse of official information, which is a third-degree felony.

The American Nurses Association at the time called the criminal prosecution “outrageous,” arguing that nurses were obligated to stand up for patient safety.

A local news report on the case can be found here:

Readers might recall that Dr. Arafiles achieved notoriety when these two brave nurses reported their concerns about Dr. Arafiles’ substandard care to the Texas Medical Board. However, it should be noted that the failure to discipline Dr. Arafiles is not simply a problem of the TMB. Remember, prior to going to the TMB, Galle and Mitchell had taken their complaint through formal channels at the 25-bed rural hospital where they worked, Winkler County Memorial Hospital. Their complaints were in essence ignored. Moreover, it’s not as though these problems were subtle. They weren’t, and they became apparent immediately after Dr. Arafiles joined the medical staff of Winkler County Memorial Hospital, as I documented. More appallingly and all too often not mentioned or barely mentioned is that Winkler County Sheriff Robert Roberts, Jr. was not only just Dr. Arafiles friend and patient, but he had been in business with Dr. Arafiles selling supplements. In fact, during crossexamination, Dr. Arafiles even described how Sheriff Roberts had sold his nutritional supplement called “Zrii,” going so far as to hold meetings at the local Pizza Hut to recruit other sellers. No wonder when it came to chasing down these nurses, Sheriff Roberts transformed himself from Barney Fife to, as I put it, Jack Bauer on crack. At least he didn’t torture anyone — physically, that is. He certainly tortured Mitchell and Galle mentally and emotionally, destroying their careers in the process with his misuse of his power.

To bring this post back to the topic of SBM and how state medical boards too often fail to restrain or discipline physicians who not only don’t practice SBM but practice medicine far enough outside the realm of SBM to be dangerous, let’s take a look in light of what we know about Dr. Arafiles the charges pending against him before the TMB:

In a complaint filed last month with a state administrative court, the TMB charged Dr. Arafiles with 9 instances of substandard care. In 1 case, the TMB stated, he sutured part of the rubber from suture-kit scissors to a patient’s torn and broken thumb (in his trial testimony, Dr. Arafiles said he was attempting to stabilize the fracture). And when another patient was admitted to the hospital for an abscess caused by methicillin-resistant Staphylococcus aureus, Dr. Arafiles rubbed an olive oil solution — not on the hospital’s formulary and not approved by the US Food and Drug Administration for this purpose — on the abscess, according to the TMB. The nurses had reported to the TMB that Dr. Arafiles promoted the use of herbal medicines.

A copy of the TMB complaint can be viewed here.
I’m going to be honest right here. This doesn’t sound very bad at all compared to Arafiles’ promotion of Morgellons disease and anti-vaccine quackery, as well as his hawking of colloidal silver to treat H1N1. As a surgeon, I may frown on suturing part of the rubber from a suture kit scissors to a patient’s thumb as a not particularly effective way to stabilize anything but, given that disposable suture sets are sterile, it probably didn’t do any harm. I doubt I’d recommend yanking Arafiles’ license over this mistake alone, although I’d probably recommend that Arafiles have more than a bit of education over the proper way to suture. As for rubbing olive oil on an MRSA abscess, it’s true that this is inadequate treatment in and of itself for an abscess. Although some abscesses can be treated with antibiotics alone, the vast majority of abscesses require drainage of the pus in order to heal. For skin abcesses, that usually ends up meaning “lancing” the boil, cleaning out the pus, and packing the wound daily. If the only thing Dr. Arafiles was doing were rubbing olive oil on the abscess, then there’s no doubt that would be substandard care. According to the complaint, which I received after I had written most of this piece, apparently that’s all he did; so he deserves to be dinged here. An untreated abscess can lead to sepsis and even necrotizing fasciitis, which can be life threatening.

Upon perusing the list of charges brought by the TMB against Dr. Arafiles, I found it odd that the TMB focuses on these things, rather than Dr. Arafiles’ egegrious offenses against SBM that are easily found on the Internet. More serious are the charges in this list:

The TMB also alleged that Dr. Arafiles:

  • diagnosed hypothyroidism in 1 patient without any testing and diagnosed the same disorder in a second patient despite normal thyroid function tests;
  • prescribed hormone replacement therapy (HRT) for a woman whose lab work showed testosterone, estradiol, and progesterone levels within the normal range — HRT was contraindicated for the woman because of a history of deep vein thrombosis, which reoccurred after HRT was initiated;
  • performed and billed for unnecessary genitourinary exams;
  • failed to adequately document the care he provided; and
  • engaged in witness intimidation regarding the 2 whistle-blowing nurses.

The first two complaints are common in the “alt-med” world. Suzanne Somers, for example, appears to believe that virtually every woman needs supplementation with “bioidentical” estrogens, while diagnosing thyroid disorders based on dubious tests or not tests at all also appears to be a cottage industry. There’s a lot of quackery in both areas, that’s for sure. More disturbing is Dr. Arafiles’ performing unnecessary genitourinary examinations. Usually, when a state medical board examines such a complaints, it’s almost always a male physician doing unnecessary pelvic examinations. Failure to adequately document care is a bit of a catch-all; I daresay that virtually every physician could be accused of that for one or more patients if someone looked at his or her patient charts.

All of these are bad. Indeed the charge of witness intimidation should go far beyond mere action against his license by the TMB. This is a felony. Given that the Winkler County prosecutor, Sheriff, and Dr. Arafiles himself are clearly part of a good ol’ boy network that closed ranks against these “uppity” nurses, the Texas state attorney general should investigate and press charges against not just Dr. Arafiles, but against Sheriff Roberts as well. What I can’t help but note is the selectivity of the choice of the TMB, given that many of Dr. Arafiles’s other offenses against the standard of care and medical ethics were right there on his website, Health2Fit, which Dr. Arafiles has eliminated since February and is not archived anywhere that I can find. I knew I should have downloaded the entire website when I was writing about this last in February. Fortunately, I kept several pages because I knew Arafiles’ website would disappear down the memory hole soon, including its links to other Morgellons sites and the section where it sells “Alka Vita Silver” to cure various ailments, including H1N1. Here are some screen shots from my archive of Dr. Arafiles’ Health2Fit website. (Note that Dr. Arafiles claims ownership of Health2Fit on his LinkedIn page.)

Here’s where Health2Fit sells a “water alkalinizer” for $1,495 (click on images to embiggen):

i-da758367831cdb9635863e4327f3d2d8-Alkalinizer-thumb-400x372-53354.jpg

And here are some of the claims Dr. Arafiles made for his alkalinizer:

i-5fbaf66edb166bfb65c1f50b8758079d-alkalinizerclaims-thumb-400x372-53357.jpg

Here’s Dr. Arafiles’ quack Miranda warning, which is quite extensive:

i-8dbbaf480da81cc410b7bf004a064ee6-ArafilesQuackMiranda-thumb-400x224-53360.jpg

Finally, here’s the page where Dr. Arafiles sells colloidal silver and claims that it is efficacious against H1N1:

i-e4a12214cf30b0d2699f9d94a5ea97d8-ArafilesH1N1-thumb-400x394-53363.jpg

There are other examples, such as Dr. Arafiles taking a homeopathy course taught by Sherri Nakken and belonging to a group of physicians who prescribe intravenous hydrogen peroxide and bioluminescence therapy (whatever that is), but I think I’ve made my point, which is that Dr. Arafiles appears to have committed far more serious offenses against the standard of care and SBM than what the TMB is charging him with. In fact, other than the charge of witness intimidation, the charges that the TMB is bringing against Dr. Arafiles remind me more than anything else of the government’s prosecuting Al Capone for tax evasion. Of course, Al Capone went to jail and spent some time in Alcatraz, but it was rather unsatisfying that it was for a much lesser offense. Worse, there’s no guarantee that Dr. Arafiles will even have his medical license revoked. As I pointed out before, state medical boards are often very loathe to strip a doctor of his medical license.

As I’ve pointed out before, the Arafiles case is about far more than just Dr. Arafiles. It’s easy for physicians like myself, who have never practiced in rural areas with few physicians but rather always in large cities or heavily populated suburban areas, to come to think that this is the way that medicine is practiced everywhere. I know I’d never be able to get away with what Dr. Arafiles got away with for as long as he got away with it. I can be easily replaced. Physicians like Dr. Arafiles cannot, and don’t think that they don’t know it. Add to that the problem that most state medical boards are understaffed, underfunded, and enforce regulations that are insufficient to deal with all the issues with which they are charged, and it’s not surprising that it takes truly egregious offenses to get their attention. Does anyone think that Dr. Arafiles would be likely to be facing the TMB this way now if he hadn’t been the focus of an internationally reported case and been caught using his crony the Sheriff to find out who had reported him and make sure they were punished. True, Galle never went to trial and Mitchell was acquitted by the jury in less than an hour, but neither of them have found work since then. Awards for integrity and bravery, as deserved as they are, don’t change that, nor does a $15,850 fine against the hospital.

Unfortunately, because most states devote too few resources to their state medical boards and the enforcement of laws and regulations governing physician conduct, most state medical boards are very reluctant to go after physicians practicing “alternative” medicine as being below the standard of care because doing so involves a value judgement regarding medical science and evidence. Also, most state medical boards are made up of physicians, and if there’s one thing about physicians it’s that we all realize that all of us, even the best among us, are one mistake away from a potentially bankrupting malpractice suit. Consequently, physicians tend to be loathe to be too critical of other physicians, much less sit in judgment of their decisions or the science (or lack thereof) by which they justify their decisions. It’s far easier to go after physicians who are impaired due to drugs or alcohol, who commit obvious crimes, or who sexually abuse patients. These are offenses that virtually everyone understands and condemns in a physician (or anyone else, for that matter). No need to adjudicate on scientific evidence or clinical trials. As Kimball Atwood put it:

When a physician is accused of DUI, “substance abuse,” being too loose with narcotic prescriptions, throwing scalpels in the OR, or diddling patients, the response of a state medical board tends to be swift and definitive. Shoot first, ask questions later. After all, the first responsibility of the board is to the public’s safety, not to preserving the physician’s livelihood. One might therefore expect that a physician accused of using dangerous, substandard treatments would face a similar predicament. As you’ve undoubtedly guessed, such is not the case.

Indeed, it is not, and Kimball proceeded to provide four examples.

Then there’s the issue of licensure itself. As we have pointed out numerous times right here on SBM, there is a concerted effort by proponents of unscientific medical modalities, such as naturopathy, to obtain licensure, or at least to make the law more friendly to them. Perhaps the most spectacular example of the latter tactic is that of Dr. Rashid Buttar. Regular readers will recall that Dr. Buttar has been under investigation by the North Carolina Board of Medical Examiners for quite some time for his tendency to diagnose cancer patients and children with autism as having “heavy metal toxicity” and then to treat them all with some variant of his chelation therapy, plus lots of supplements and other woo, of course. He even referred to the board as a “rabid dog” at one point, something that most people accused of breaking the law would probably be well-advised not to do before their case reaches trial.

Dr. Buttar, however, apparently had reason to be confident. During the last two or three years, during which time the NCBME was investigating him, Dr. Buttar led a charge by the North Carolina Integrative Medical Society to get legislators to change state law to make it friendlier to practitioners of alternative medicine. He succeeded. As a result, the board didn’t think it could succeed in stripping Dr. Buttar of his medical license or even banning him from treating cancer patients and children:

Dr. Rashid Buttar, whose alternative medical practice in Huntersville has been under scrutiny by the N.C. Medical Board for a decade, has accepted a reprimand from the licensing agency.

But Buttar, who was facing potential restrictions to his license, instead can continue offering unconventional treatments as long as he asks patients to sign a form acknowledging his practice is outside the mainstream.

The reason was clear:

Mansfield, the board’s attorney, said a change in state law, which took effect in October, was partly the reason. The law, one of those that Buttar had pushed for, prevents the medical board from disciplining a physician for using non-traditional or experimental treatments unless it can prove they are ineffective or more harmful than prevailing treatments.

It’s an astounding double standard. All Dr. Buttar has to do is to have patients sign in essence a waiver, an acknowledgment that what he is doing does not meet the standard of care and is not validated by science, and he can do whatever he wants, even treat autistic children with urine therapy to “boost their immune systems.” He doesn’t have to prove a thing; if the board wants to go after him it has to prove that “non-traditional” treatments are ineffective or more harmful because North Carolina law now deceptively conflates experimental treatments (which don’t get to the point of being experimental without a lot of preclinical evidence) with “non-traditional” treatments (which often have little or no good scientific evidence for their efficacy). In other words, Dr. Buttar and his ilk don’t have to demonstrate that their woo works; authorities have to demonstrate that it doesn’t. It’s a perfect reversal of what the standard of evidence should be in medicine, and means that North Carolina is now as quackery-friendly a state as there is. Meanwhile, doctors with ethics who treat patients according to science-based guidelines have to justify their treatment decisions. Nor is this a problem that is confined to the United States. Just consider how long it took the U.K. to finally strip Andrew Wakefield of his license to practice medicine.

If we as physicians are ever going to counter this problem, we’re going to have to accept that the problem exists and then do two things. First, we have to restrain our longstanding impulse to circle the wagons and protect a member of the tribe at all costs, even when we know that member has stepped far afield from the land of science-based medicine. Second, we have to lose some of our reluctance, particularly at the state medical board level, to pass judgment on non-scientific treatments like homeopathy, naturopathy, or others. Being a shruggie is no longer acceptable. Our system of regulating physicians and protecting the public from quackery is clearly broken. Will we rise to the challenge to fix it, or will we allow promoters of unscientific medicine to infiltrate and destroy it?

In the meantime, here’s hoping that Mitchell and Galle prevail in their civil suit against Dr. Arafiles, Sheriff Roberts, Winkler County, and Winkler County Memorial Hospital, among others. A message needs to be sent that complaints against physicians practicing below the standard of care should not endanger the livelihood of the whistleblower. Just as importantly, a message needs to be sent that championing useless and even potentially dangerous unscientific medicine is jsut as much a danger to patients as being a prescription mill or practicing medicine while intoxicated.

Comments

  1. #1 Rene Najera
    July 20, 2010

    He sutured plastic from the scissors to stabilize the thumb? So, in a hospital with a multitude of other devices to achieve the result, he resorted to McGuyver-like procedures?

    Then again, it’s Texas (my country of origin). They outlaw homosexual sex but decriminalize bestiality. Enough said.

    Anyone heard of Double-O Swango? I wonder how much “professional courtesy” is to be blamed for how slow this whole thing moved?

  2. #2 Paul Browne
    July 20, 2010

    Excellent post Orac,we can only hope that justice will soon prevail and Dr. Arafiles soon looses his licence to practice…though no doubt he’ll soon set up as some sort of alt med practitioner and avoid having to deal with all that pesky medical ethics nonsense.

    Do you know if Michelle and Galle have a legal fund that supporters can donate to? Taking even a civil case against the criminals who persecuted them will not be cheap.

  3. #3 Todd W.
    July 20, 2010

    @Paul Browne

    Visit the Texas Nurses Association‘s web site. I believe that have a donation page.

  4. #4 Paul Browne
    July 20, 2010

    Thanks Todd, I ought to have spotted that:-)

  5. #5 James Sweet
    July 20, 2010

    In regards to H1N1, his website stated that “Deaths and illnesses have been mild.” What, pray tell, is a “mild death”?!!?

  6. #6 Todd W.
    July 20, 2010

    @James Sweet

    Also note that the screen shot for colloidal silver states “FDA approved for Swine Flu”, which is blatantly false. Colloidal silver is not approved for marketing for the treatment of swine flu. So, not only was he marketing woo, we was running afoul of Federal regulations. Both FDA and FTC probably could have gone after him, if his site were still up.

  7. #7 ranggaw0636
    July 20, 2010

    He even referred to the board as a “rabid dog” at one point, something that most people accused of breaking the law would probably be well-advised not to do before their case reaches trial.

    Is he seriously called them that?

  8. #8 AndyD
    July 20, 2010

    I’m neither a doctor nor a scientist but ran my sceptical blog for two years before finally shutting it down three weeks ago.

    The primary reason I “gave up” was the fact that there are millions of fully-qualified scientists and doctors out there who aren’t complaining about the things I, as a mere layman, find mind boggling. If my local doctors aren’t complaining long and loud about anti-doctor TV quacks, for example, then who am I to do it for them? I note a sense of “accommodationism” from the vast, vast majority of the science-based team.

    As you say, “being a shruggie is no longer acceptable” – until professional bodies get serious about this stuff, it’s going to be an uphill battle to get laypersons (and media and politicians) sufficiently interested to generate major, long-lasting change.

    We all owe thanks to those who do speak out. So, thanks.

  9. #9 augustine
    July 20, 2010

    Orac,

    Are they going to come after you or your colleagues for prescribing Avastin quackery to cancer patients? No, because all you have to tell your status quo friends is “Science told me to do it”. And they’ll look to both shoulders and shake their heads with approval.

    http://health.newsplurk.com/2010/07/1-billion-year-riding-on-ok-of-drug.html

    “$1 billion a year riding on OK of drug Avastin”

    http://www.statesman.com/news/nation/fda-avastin-doesnt-extend-lives-of-breast-cancer-807678.html?cxtype=rss_news

    “FDA: Avastin doesn’t extend lives of breast cancer patients”

    ONE BILLION DOLLARS! That’s a lot of wasted resources poured into the “scientific” peer-reviewed medical system.

    And the SBM bloggers are concerned that non-allopathic care is wasting money. Contradictions. Contradictions.

    ORAC: “When the results of early clinical trials in humans were not nearly as impressive as the results in mouse models, there was great disappointment, although angiogenesis inhibitors like Avastin are now being shown to be useful as adjuncts to chemotherapy for colon and breast cancer, among others. However, compared to the hype, the fairly impressive benefits of, for example, Avastin appear to be very modest indeed. Expectations matter.”

    Modest benefits? Useful adjucts to chemo? You are too generous. But the science told you to be. I doubt you would extend such generosity to placebo.

  10. #10 Denice Walter
    July 20, 2010

    Water woo is a *prima facie* defining feature of quack marketting ( see Mercola’s, NaturalNews’, Gary Null’s website stores): promoting distrust of public water concerning its contamination and especially, its fluoridation ( I’m sure Rene could expand upon this topic ),then selling filtering systems, alkalinizers, and other more fanciful treatments ( homeopathy, vitamin water, energy water, etc.). Interestingly enough,the soft drink industry has not left this arena purely to the woo-meisters (“Coke and Pepsi Re-invent Water”;Bloomberg Business Week.com;2/19/09.)It’s funny to hear this stuff promoted in NYC,which has a history of “good”( healthy and tasty) water. Seriously, you can buy a water filter for $7, then wave your hands over it yourself for the added magic.

  11. #11 T. Bruce McNeely
    July 20, 2010

    @augustine:

    Avastin is put on the market as a promising agent. Further studies reveal that it isn’t as effective as anticipated. This information is widely disseminated. FDA approval may be revoked.

    When was the last time that happened with an alt med treatment?

  12. #12 Matthew Cline
    July 20, 2010

    “Deaths and illnesses have been mild.”

    He probably meant “deaths and illnesses have been few“.

  13. #13 symball
    July 20, 2010

    An Example of the GMC (regulators of doctors in the UK) actually taking action against a registered Quack is the current case of Dr sarah myhill, who seems to using a similar tactic to Buttars. Unfortunately for her it is not quite so easy to change the law here so she might be on to a loser with this one.

    Details can be found on the Bad science forums amongst others- be warned the thread is 10k comments long- but you will get the gist in the first couple of pages.

  14. #14 Harrell
    July 20, 2010

    One problem for medical boards going after altmed quacks, is the rate of failure such prosecutions. See, e.g., http://www.villagevoice.com/2010-06-01/film/quack-quack-goes-burzynski/

    If TMB can’t succeed with as blatant a quack as Burzyński, I think that they would be deterred in such future prosecutions.

  15. #15 Paul Browne
    July 20, 2010

    T.BruceMcNeely@11:

    Well said, augustine is resorting to the usual exaggeration and quote mining that quacks like to indulge in.

    It’s worth pointing out that Avastin has been shown to be an effective treatment (though certainly not a cure) for colon cancer, Glioblastoma multiforme, and lung cancer, with other indications also being studied in clinical trials

    http://www.automatedtrader.net/real-time-dow-jones/6080/-study-confirms-safety-of-roche039s-avastin-in-lung-cancer
    http://en.wikipedia.org/wiki/Bevacizumab

    Even where advanced breast cancer is concerned the question is whether the modest (but nevertheless real) benefits observed in the clinical trials justify the cost of the drug, and with the high cost of Avastin this is not an easy question to answer.

    http://www.automatedtrader.net/real-time-dow-jones/6153/fda-panel-asked-to-consider-avastin039s-use-in-breast-cancer

    My feeling is that we are still only starting to figure out how we can get the best out of angiogenesis inhibitors in the clinic, so that they can fulfill their early promise.

  16. #16 Rene Najera
    July 20, 2010

    RANDOM COMMENT HERE ABOUT EVIDENCE-BASED STUFF FOR AUGUSTINE TO DECONSTRUCT.

    (Judging by the time he starts spewing to when he stops, I’d say Auggie is somewhere in the Left Coast.)

  17. #17 Dr. Mary Johnson
    July 20, 2010

    Orac, you are preaching to the saved. Alas, until recently, it’s been a small church.

    As I have pointed out here before, not only do Medical Boards fail to discipline these QUACKS, they resoundingly fail at protecting the doctors and nurses who might report them from retaliation.

    The North Carolina Medical Board is positively GIFTED at talking out of both sides of its mouth. For instance the Board’s President has very recently lectured his minions that it’s our DUTY to report bad care/bad doctors. But he leaves out the part about not counting on the Medical Board doing anything to help you when your life is ripped to shreds because you do. In fact expect the Board to dive under their desks and STAY there:

    http://drjshousecalls.blogspot.com/2010/04/lesson-on-medical-oversight-in-north.html

    And AndyD is absolutely right. I’ve been in the blogosphere for FIVE years BEGGING for help. NO ONE CARES. My story deserves to be on 60 Minutes. But the MSM is so bespotted with the “progressive” notion that the government knows best when it comes to healthcare, that they REFUSE to even look at stories like mine. After all, the NHSC NEEDS millions more in Federal/taxpayer money to bring primary-care doctors to PoDunk. Never mind that the NHSC’s track-record on oversight and protecting-its-own SUCKS . . . and recruitment does not begin to equal retention.

    In North Carolina, after being fired and ostracized and unsuccessfully SLAPP-sued for doing my DUTY (the mess I cleaned up and reported was all so “embarrassing” to the hospital that employed me), I’ve actually had to recently listen to Thom Mansfield and the President of the Medical Board AND the NC Attorney General’s office all tell me that while they “sympathize” mightily with me/my case, they don’t have the POWER/jurisidiction to do anything about what happened!?! It’s just fricking incredible. These state officials – charged with medical oversight and protecting the public – have the cahoones to argue with a straight face that they cannot do anything about a non-profit shielding bad medicine/an over-reaching doctor and breaking the law.

    But Rashid Batar barely gets a slap on the hand for stunts like injecting urine into a child!?!

    WHAT THE HELL?

    Now, I suppose the “jurisdiction” argument would be a good excuse if the Board/DHHS/JCAHO had not been aware of my situation since 1998 – or if they had taken legislative action to plug the black holes of oversight I fell through.

    What REALLY burns my butt is that so many of the Buttars and Arafiles of this world are now claiming to be “whistle-blowers” . . . whining about being “persecuted” . . . and (as in the Texas case with the nurses) putting good people through HELL.

    It’s maddening.

  18. #18 Dr. Mary Johnson
    July 20, 2010

    Related – On the subject of whistle-blowing, the following Housecalls post was submitted to this week’s “Grand Rounds” and apparently was rejected (I guess naming names and bashing the AMA is just not “PC”):

    http://drjshousecalls.blogspot.com/2010/07/sayeth-ap-many-docs-dont-blow-whistle.html

    I sincerely hope the Texas nurses kick some major butt in Court. Indeed, I’ve considered filing a similar action in North Carolina – against the agencies that let me swing in the wind. But in North Carolina, the Courts and the lawmakers are a HUGE part of the problem – as Dr. Buttar’s wacked-out consent order with the Medical Board more than proves.

    On what planet does it make ANY sense?

  19. #19 David N. Brown
    July 20, 2010

    @9:
    “ONE BILLION DOLLARS! That’s a lot of wasted resources poured into the `scientific’ peer-reviewed medical system.”
    Sounds fairly TYPICAL to me. By all accounts, any pharmaceutical R&D of importance is going to run into hundreds of millions at least, whether it leads to a marketable product or not.

  20. #20 augustine
    July 20, 2010

    “Sounds fairly TYPICAL to me. By all accounts, any pharmaceutical R&D of importance is going to run into hundreds of millions at least, whether it leads to a marketable product or not.”

    That’s not R & D. That’s sales!

  21. #21 Andreas Johansson
    July 20, 2010

    intravenous hydrogen peroxide

    Is that as insane as it sounds?

  22. I was walking past a make-up shop in NYC (near GCT on Lexington) a couple weeks ago and there was a placard in the window for some “rejuvenation cream” (i.e.: bullshit) that claimed to be “EVIDENCE BASED” Wow. So the woo-woos are even taking over the language of science. Next up: “certified anecdotal evidence”

  23. #23 tresmal
    July 20, 2010

    augustine:

    That’s not R & D. That’s sales!

    No. It takes hundreds of millions of dollars to bring a new drug to market. Source. Source.

  24. #24 David N. Brown
    July 21, 2010

    Augustine,
    “That’s not R & D. That’s sales!”

    Are you saying you doubt that developing drugs costs money?
    This really doesn’t need to be an issue as far as whether to trust “Pharma” marketing. The more a drug costs to develop, the bigger the incentive for the manufacturer to find some way to sell it.

  25. #25 steve frey
    July 21, 2010

    Doctor(s), I’m sure Dr. Rolando Arafiles, Jr is everything you claim that he is and I have no issue with that but please, for the love of God, do not allow his wrong doings to have any bearing on the Morgellons issue. I will make the same challenge here as I have at other blogs where Doctors express their opinions about the validity of condition that they have no personal experience with, examine an individual that claims to have morgellons with a simple 30x magnifying device, that’s all I ask, step up Doctor’s, take the challenge. Just say the word and I will begin the search for someone in your area.

  26. #26 Lawrence
    July 21, 2010

    Morgellons – really? And you’d think that if all it took was a 30x magnifying glass to find, well – there would be quite a bit more evidence than we have right now (which is about zero).

    And Augie getting upset again at “Big Pharma” because of the amounts of money involved – well, R&D is hugely expensive, and not just for the drugs that happen to make it to market. For every one drug that gets approved by the FDA, there are fifty or more that never make it through the extensive testing process.

    Of course, the homeoapathic & alternative medicine practicioners are just giving away their stuff for free right? I mean, they don’t make money on anything they sell either, right?

    But then again, when you don’t have to go through clinical trials or get actual approvals or even prove that the stuff is safe to put it on the market, I bet their profit margins may be a little higher than most.

  27. #27 Leslie Durr, PhD, RN
    July 21, 2010

    Unfortunately for “scientific-based medicine” it was two nurses who blew the whistle on this quack. If orthodox docs would police themselves and each other, the TMB would have to act in timely fashion. It’s a long, long pattern of grumble but turn the blind eye – to patients’ detriment.

  28. #28 MikeMa
    July 21, 2010

    @Lawrence,
    The homeopathic fairy water is pretty much all profit. There is some overhead for office space, magazine subscriptions, soothing music (cds of which are also for sale and probably duped in the back), receptionist (cd duper), and office furniture. But $200/hr for consultations and $50 for month’s sugar pills multiplied by 50-100 consults a month is a good living. Drumming up 50-100 credulous souls just isn’t that hard.

  29. #29 T. Bruce McNeely
    July 21, 2010

    @steve frey:

    I haven’t examined a patient with Morgellons, but I have seen a few samples of the stuff they produce. It’s a mixture of fibres and other stuff consistent with environmental debris and clothing every time.

  30. #30 mikerattlesnake
    July 21, 2010

    @augustine

    No more posts on this issue until you address #11.

    Here’s some questions you might want to ask yourself:

    1) How was it determined not to be effective? Was it a team of brave homeopaths working on these treatments? Maybe some folks from generation rescue? Mike Adams? (Hint: it was doctors and scientists)

    2) What is the current response to this information? How are doctors and scientists preceding forwards? Are they ignoring and covering up the evidence of an ineffective treatment or are they proceeding cautiously while looking for more evidence and other potential uses for the therapy?

    3) Is it more valuable to implement a potentially helpful cancer treatment (that has been shown to be safe and potentially effective with a reasonable mechanism of action) and have it be shown to be ineffective, or to withhold that treatment until all tests of efficacy have been exhaustively completed? It’s all about risk/benefit (and plausibility) analysis.

    4) How would you have approached this situation differently? If you saw a potential cancer treatment that was effective in animal studies, was safe for patients, and had a plausible mechanism of action in human patients how would you have proceeded?

  31. #31 MikeMa
    July 21, 2010

    @mikerattlesnake,
    Special medal of honor for duty above and beyond the call.

    Good points but you addressed them to a moron. Augie rarely addresses any questions directly. Even more rarely more than one. You gave him 4. The 4th is the more important and there are a number of possible Augie-answers from the ridiculous to the sublime.

    Wait until definitive safety tests are done.
    Wait until risks are zero.
    Get a chiropractic adjustment – no drugs needed.
    Get 30x fairy dust from the local homeopath to re-balance his shakra.
    Eat organic, vegan, holistic, ayurvedic food.
    Pray.

    In no way will you get Augie to allow pharma into his bod. He’s ‘Purity of Essence’ crazy no doubt.

  32. #32 mikerattlesnake
    July 21, 2010

    I don’t necessarily do it for auggie’s sake (though it would be awesome if he actually reflected on his position once in a while and responded to criticism), but more for anyone reading who might think he has a point. The fact that he can’t/won’t answer basic questions that should be considered before taking the position he has taken should convince any bystanders that he’s got nothing but hot air on his side.

  33. #33 MikeMa
    July 21, 2010

    @mikerattlesnake
    I understand. You, Todd, Chris, T. Bruce, Rene, and many, many others have done this all along – helping the rest of us understand. It is why I fight calls for Augie’s banishment. Cheers!

  34. #34 Bruce Gorton
    July 22, 2010

    Hydrogen peroxide and bio luminescence therapy – almost sounds like a water drip coupled with pretty shinies.

  35. #35 steve frey
    July 26, 2010

    Lawrence, Yes as odd as that may seem to you all it takes is the willingness to think outside of the box and actually examine an individual that claims to have an illness mainstream medicine doesn’t believe exists instead of taking the easy way out by labeling morgellons sufferers as delusional, simply look for yourself like the the few Doctors that support the morgellons issue have, that’s all you have to do.

  36. #36 Scott
    July 26, 2010

    This despite the fact that whenever doctors actually DO examine such patients, with a 30x magnifier and far more powerful tools, they never find any evidence to suggest that “Morgellon’s” actually exists…

    The best evidence ANYONE has EVER been able to assemble in favor of the proposition is, well, nothing. And yet you persist.

  37. #37 henri weemaels
    August 3, 2010

    Ola,

    Le docteur Rolando Arafiles a raison. Ce n’est pas un charlatan. La maladie du morgellon est bien réelle et l’utilisation du silver colloidal apporte des résultats.

  38. #38 Antaeus Feldspar
    August 3, 2010

    Ola,

    Le docteur Rolando Arafiles a raison. Ce n’est pas un charlatan. La maladie du morgellon est bien réelle et l’utilisation du silver colloidal apporte des résultats.

    What’s French for “back it up or pack it up”?

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