Two recent posts raised some ethical questions about the practice of a very public doctor who has proclaimed himself (on the front page of his website) to be an expert on testosterone replacement therapy.
Leading TRT expert Dr. Crisler is now available for consultations, lectures, advanced physician training, conference hosting, interviews, and more.
Well, Dr Crisler was apparently not happy with my critique. He was kind enough to drop by and leave several comments explaining why, the first and longest I will reprint here. He has also sent me a great deal of traffic from his own message board which is hosted at musclechatroom.com (a somewhat ironic name given Crisler’s avowed opposition to the use of anabolic steroids).
Anyway, it would only be polite of me to elevate his response to its own thread (with commentary of course).
While I have been the subject of Internet attacks over the years–from nitwit steroid users to Doper Doctors I have gone after–I have yet to see one as vicious as this. It’s amazing what people will post, hiding behind their computer monitors, under an assumed name. What troubles me is that it is from someone who is supposed to be a colleague. If you just would have called me, I would have been happy to clear up your misconceptions–before you libeled probably the most anti-steroid doctor in the country.
I wasn’t aware that my posts constituted “vicious attacks”, but everyone is entitled to his own opinion. I do not necessarily consider myself a “colleague” of Dr. C., but the most useful critiques are generally those one receives from one’s peers, so I’m not sure what his point is. Am I supposed to be a part of some medical “conspiracy of silence”, a medical omerta? As to the “assumed name”, I, like many bloggers, write under a pseudonym but I am not anonymous. My profile links to my real name in several different ways, but keeps it a click or two away to cut back on spam. It’s a common practice. Also, whining about the identity of a critic does not constitute a valid argument.
First, the comments posted here insulting Osteopathic physicians are mind-numbingly ignorant, especially in this day and age. They say lots about the individuals posting them, and absolutely nothing about the Osteopathic profession.
Osteopathic medical students learn all their allopathic counterparts must learn–plus about 25% more. Their board exams are twice as long. And while I refuse to disparage my MD brothers and sisters, Osteopathic physicians not only practice every specialty of medicine, we also regularly score much higher when compared to MD’s for patient satisfaction. Perhaps that is because we tend to practice in a more holistic and family-oriented manner. We are also more likely to seek cures, and less to simply write prescriptions. But there are certainly good physicians, and bad ones, on both sides.
In the United States over the last 20 years or so, osteopathic medicine has ceased to be an alternative and has more or less merged with the MD community. Many if not most DOs complete MD residencies and take MD boards. Crisler is quite correct that to disparage DOs as a class is ignorant and unfair. The rest of his statements about satisfaction, etc. are not meaningful.
Everything we do at my office has been rigorously scrutinized by legal counsel and regulatory body. Therefore there is absolutely nothing unethical, immoral or illegal about anything we do. My profile is far too high to be doing anything I shouldn’t.
For the record, I have never prescribed an anabolic steroid, not even once. Further, I am proud of the fact you could not produce example of a physician doing more to fight the spread of anabolic steroids over the years. There are literally tens of thousands of words published by me on the Internet, portions of every lecture I have given, and countless hours counseling patients regarding the hidden dangers of excessive hormonal manipulation. I also regularly assist Law Enforcement as they crack down on dopers and Doper Doctors. That is why this blog is so profoundly ridiculous.
I am happy to hear that Dr. Crisler has not prescribed any anabolic steroids (other than testosterone, I assume). The rest of this statement is meaningless. Ethics are not determined by legal counsel and regulatory bodies but by a profession as a whole. But if Dr. Crisler has put himself out there on muscleboards.com and other venues as strongly anti-steroid, that’s very commendable.
And very single patient I have has either been seen by me personally, or served on a consultation basis, as is done every day all over the country. Some of the verbiage from my website is meant merley to facilitate that process, whether you understand it, think it’s “weird” or not. By the way, thinking something is “weird” is certainly not excuse for libel.
I’m not sure what this means. When I send a patient to a consultant, the patient sees the consultant—in person. That is the standard which as far as I know all doctors follow. I may from time to time curbside a colleague to ask them a question about a patient, but this is not a consult and cannot be billed as such. And the fact that your practice appears—in my opinion based on what you as a public figure has put out there on the internet—to vary considerably enough from most other doctors’ practice to constitute something “weird” is not libelous but a matter of opinion.
Do you treat patients for the COPD and emphysema that smoking brings? Well then, by your logic, you support tobacco use! These steroid guys will one day finally quit. And on that day I want them to be in the best state of health possible. That way they will be less a drain on our precious medical resources. Of note, while I do not care if a single steroid user ever darkens my door again, I only have a small handful of patients using these days (again, with Controlled Substances not of my doing). In fact, it was precisely the clinical experience gained treating those guys which taught me how the Endocrine system works, as one must come to know the excesses of a thing to truly understand its middle ground.
I have no idea what you are talking about.
I have never called myself an “expert”. That is for others to decide. I am but a simple country doctor. So I am not an Endocrinologist, but I have personally trained literally hundreds of them, from all over the world. I consult for them on a regular basis. And I have a large number of physicians as patients. Hey, I must be doing something right! LOL
When I wrote that you were a self-proclaimed expert, I based that on the statement on your website that, “Leading TRT expert Dr. Crisler is now available for consultations, lectures, advanced physician training, conference hosting, interviews, and more.” Perhaps I read it wrong.
When you say that you have personally trained “hundreds” of endocrinologists, I searched in vain to find what endocrine fellowship program you have been leading or taking a leading role in. Endocrinologists are medical specialists who, after completing a residency program, then complete a 2-3 year fellowship in endocrinology.
Not to disparage Endocrinologists [hundreds of whom you've trained? --ed], but my colleagues who think they should be relied upon to expertly treat hypogonadism are in for an eye-opening experience. For it seems the Endocrinologists are the least likely to properly manage sex hormones. For instance, ask one how to properly manage estrogen in men. You response is likely “estrogen is not important in adult males”. The truth is estrogen is part and parcel of nearly everything that kills a man, outside of trauma. That I why simply optimizing the 40 or so estrogens in our bodies can turn a man’s life around. The evidence is out there, in droves. So why do they jealously maintain the position they do?
Do you have any evidence to support your blanket condemnation of the profession of endocrinology and all those who practice it? If so, I’d love to see it.
That is why they don’t know how to use aromatase inhibitors, such as Arimidex (anastrozole), stating it is “only for female breast cancer patients. So why are there between 100 and 1,000 times more men than women on it? Astra Zeneca is laughing all the way to the bank. They also will not use HCG to its best advantage, even though minimal thought is required to understand same. Or they will prescribe it at 10 times the effective dose, which is counterproductive in several important ways.
For any of you wishing to see just a portion of the 20,000 scientific studies supporting what we do, I invite you to the American Academy of Anti-Aging website www.WorldHealth.net
Once again, I have no idea what you are talking about. If you are in a position to present some great new medical knowledge that would revolutionize our practice, where are you papers, where is your research? Show us the data! And as to the anti-aging stuff, well, that’s fringe and has not managed to get the rest of the medical community to give it recognition yet. There is a reason the American Board of Medical Specialties is a bit picky about accepting any group coming along claiming a new medical specialty.
So what is an “expert”? Is it the head of some mucky-muck medical department? Those of us within the field notice those positions do not come from superior medical technique; but rather as reward for proficiency in paper-pushing and meeting-calling. Some of the finest clinicians I have seen are so because they exclusively value the health and happiness of their patients. It is their commitment to perfecting their art which brings their increased success rates. It’s what they do with their patients, not some shingle on the wall.
…wait for it…
Students of medical history know it was the top “experts” of their day who bled our first president to death, because blood was considered poisonous. And Dr. Joseph Lister was attacked by the top Surgeons of his time for daring suggest they wash their hands, and change their blood-soaked gowns between procedures. Remember when medical “experts” told everyone to stop eating margarine, because saturated fats clearly increase the risk of cardiovascular disease, and to eat margarine instead? They NEVER gave a thought to what trans fatty acids do to us. We now know they are literally toxic to our bodies.
In my second year of practice I had the honor of delivering a lecture at The Royal College of Physicians, in London. The topic was my TRT protocols. In the museum portion of the building was a display case, for the purpose of poking fun at physician ignorance and arrogance. There was a lock of Dr. William Jenner’s hair, the physician credited with inventing the vaccination. Included were letters from some of the top “experts” of the day, demanding Dr. Jenner not only dismissed from the Academy, but drawn and quartered as well!
Bingo! “Medicine has been wrong before!” “They denied Galileo and Semmelweiz!”
Look…dude…a negative argument about others does not constitute an affirmative argument about your own practice. It’s rhetorical smoke and mirrors.
Patients are much more interested in being healthy and happy than they are the shingles on a doctor’s wall. That is why a patient sitting in front of my desk may have already been to half a dozen other doctors, including Urologists and several Endocrinologists. They know I will solve their case, and so I do. It’s a matter of knowledge and experience, and I probably have as much experience in this area as any physician in the world. It’s all about being able to deliver effective medical treatment. Hey, if simple country doctor can figure this stuff out, why can’t everyone else?
I would agree with you that patients just want to be well, or at the very least be listened to. Once again, you haven’t actually made an affirmative argument for your methods.
The host of this blog obviously has no idea how low the Standard of Care is with respect to, for instance, treatment of adult male hypogonadism. That is why, even with the increased risk of cardiovascular disease, cancer, diabetes, osteoporosis, depression, dementia, and sexual dysfunction low (even low-normal) testosterone levels bring, half of them put on TRT go off from it. The physician simply does not know how to manage it properly. So when he asks why anyone would travel to see me, when there are perfectly good doctors in their own area, it just show he knows nothing about the state of the art in treating this insidious and rampant (about half the men over the age of fifty) disease. Maybe this is why I have patients in 48 states and 20 foreign countries?
There are perfectly good Heme/Onc and Cardiologists all over the country. So why do patients travel to the Mayo or Cleveland clinics, or M.D. Anderson? Ummm…is that “weird” too?
Peer-reviewed, validated guidelines for the treatment of male hypogonadism do in fact exist. Whether you and your patients feel that your unpublished results are better is largely irrelevant to the greater world.
This profound ignorance of how TRT works also leads many physicians to deny their patients the testosterone they need and deserve, because , for instance, “TRT will cause prostate cancer”. Find ONE shred of evidence to support that position! And where is it okay for doctors to tell patients things which are exactly the opposite of the truth–purposefully damaging the patient in the process? Rest assured, those opposed to TRT WILL be getting on board. The literature is so abundant it will become malpractice in the future to NOT screen testosterone levels. And its ability to turn around a patient’s life means the patients will demand it (or come to me). I suppose when physician income is damaged their ignorance will cease.
To claim that one is on the cutting edge is nice, but once again, your own opinion of your greatness is lacking any objective support. You may, in fact, be onto something very important, but without validating it with objective studies your knowledge is useless to the rest of the world. No reputable physicians, academic, or medical organizations make treatment recommendations based on the unpublished experiences of a single self-proclaimed expert.
As for myself, I sit on the Speaker’s Bureaus of both BigPharma companies that make T gel, the Medical Advisory Board of the Life Extension Foundation, Advisory Board of the Men’s Health Network, and serve on the faculty of my alma mater. My lectures are nearly always packed (you can watch one for free on my website), whether delivered in Las Vegas or the Michigan Osteopathic Association annual convention (where I have taught TRT three times). In fact, I was supported by both BigPharma companies AND an excellent compounding pharmacy–for the same lecture! I donated all proceeds to the MOA, and financed a statewide radio talk show from there, which I co-hosted, spreading the good word about Osteopathic medicine.
Yes, and…? What is the point of this statement? It sounds like an appeal to an irrelevant authority.
As for our office protocols, patients may get their medications wherever they wish. That is pure Consumer Protection, as it should be. We provide the convenience of ordering their compounded medications for them, and have them delivered at exactly the same price as if they took the time and expense of ordering them themselves. And I do not know where the host of this blog practices, but it is extremely common these days for physicians to impose fees to encourage script writing that the time of the office visit.
I will take you on your word that your current prescribing practices are much more ethical than your literature seems to imply. Physicians who accept insurance are usually forbidden from extra fees such as fees for phone calls or prescription writing. As someone who chooses not to accept insurance, you are free to impose whatever fees you wish, both legally and ethically. But to claim that it is normal practice and that the service would cost just as much elsewhere is probably not entirely consistent with current reality.
I cannot tell you how many gentlemen I have labored to save from the Internet Doper Doctors. Kindly do not lump me into that cesspool. In fact, it would be nice to receive some encouragement for this often thankless task.
Finally, I shall place my trust in the Lord as to the state of my soul.
I am happy to hear that you have helped men get off of anabolic steroids. That’s commendable. Of course, lots of docs can do that, so that’s not a unique service as far as I know. Whether your task is “thankless” or not isn’t anyone’s problem but your own. Medicine is practiced for the benefit of the patient, not for the good feelings of the doctor—the latter is a nice bonus when it happens.
As for the immortal soul, mind-body dualism isn’t my thing. I’m more concerned with, as the title said, the “medical soul”.