Bienvenido a Mexico

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HolaAfter a stress free flight with the bonus of extra leg room we touched down in Meh ee co No problems with customs etc and the authorised airport taxi dropped us at our Zona Rosa hotel for the official set rate of 152 MXD. All nice and easy We arrived pretty late at night so we grabbed some tacos from a street stall near the hotel. They were gorgeous but we learnt two things pretty

Up in the mountains but down on our luck

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TahleiIts been quite a while since our last entry. Just a few short days ago we were thinking how nothing has gone wrong for us lately and we therefore had no stories to tell. Generally having a good time does not for an interesting blog make. However all of a sudden we were hit by a streak of bad luck and the last couple of days nothing has been going our way so now well have plenty to say B

BFN Tours

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Hi AllFinally made it to the glorious tip the last three days have seen us cover about 800kms of red dirt along the Peninsular development Road aptly named as it sure needs a hell of a lot of development. We have discovered that the road signs when there is one have a whole new meaning up this way ie DIP mean Doom Impending Pit as they are car swallowing depressions that your car may not eme

Queenstown Arrowtown

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A new day sunshine petrol in the tank and a leisurely pace and Arrowtown is quite a lovely place to visit. Its a historic mining town with trendy shops and restaurants. There is a park with restored mining houses of Chinese miners who came for the gold rush. The town has a 'western' feel and Queenstown is much like Whistler or Banff. Both towns have artsy small theatres that promote altern

Less than 12 hours

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HI this is Kevin. We are going to leave on vacation at 5 in the morning tomorrow. I cannot wait because we are going to Purdue first. It is going to be the best day of my life. We each get 20 for vacation and we get to spend it all and when we run out we run out and we can't buy anything else. I have 40 to spend because of the Super Summer Challenge. I'm going to see Mark Luke and Ava.

British Museum and Greenwich

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Desde que llegue a Londres los pronosticos eran lluvias cada dia. Afortunadamente los 2 primeros dias fallaron y pude salir en bicicleta.Hoy decidi tomar el bus y efectivamente por fin aparecio la lluvia. Me salve de una lavada segura ...Hoy visite el British Museum. Hice un tour por la salas de Egipto Siria Grecia y Roma.Hay muchas salas pero estas son la mas importantes. Egipto fue la mejor ..

Mekong Delta today

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Motor cyclists should NOT drive like that at 630 in the morning when they have a tourist on the back who's holding 2 backpacks haha PI took the bus at about 6am from Kha's place my couch surfing host to the city center as I needed to be at the Sinh Cafe in time for my Mekong Delta tour. On the bus I met a nice Vietnamese girl Ngoh Ha was her name. Talking was a little difficult but I'm expe

Soy friolenta

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I realize I've kinda fallin' off the blogging bandwagon. I'm sorry that it's been two weeks since I've written anything. The entry about my church that I just posted has been in the works for a long time so it's good to finally get that out there. Perhaps it's productive procrastination I've always been good at that. Since I still have a sermon to finish I suddenly find time to catch up on

Day 33 July 18 2010 Gulkana Glacier enroute to Glenallen AK

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Pulled out of SantaLand RV Park today headed towards Glenallen AK. Along the way we stopped to wash the motorhomes of a little of the Alaskan highway system . We did see a little sneaux fall up in the mountains along the way. Our chosed stopping point allowed us a wonderful view of the Gulkana Glacier directly out our front windshield. The view was unreal looking up the valley tundra up a

Guest commentary: The Jackson Lab Biomedical Research, Clinical, and Education … – Naples Daily News

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Morning Sentinel
Guest commentary: The Jackson Lab Biomedical Research, Clinical, and Education ...
Naples Daily News
USF is one of the most rapidly growing, entrepreneurial and forward-looking medical programs in the country. The first to integrate its medical school with ...
Maine firm picks Florida lab partnerThe News-Press
University of South Florida to Partner with Jackson Labs in Research ParkThe Ave Herald

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Plastics Linked to Inflammation in At-Risk Babies – EndoNurse

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Plastics Linked to Inflammation in At-Risk Babies
EndoNurse
Anna M. Vetrano, PhD, adjunct assistant professor in the Department of Pediatrics, led a UMDNJ-Robert Wood Johnson Medical School team that conducted an ...
UMDNJ to raise tuition as much as 21 percent for some studentsThe Star-Ledger - NJ.com
UMDNJ hikes tuitionPhiladelphia Inquirer
Official: Newcomb project needs pushVineland Daily Journal
Natural Products Marketplace -Cosmetic Dentistry Guide (press release)
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Med school, University of Scranton to offer dual degree program – Scranton Times-Tribune

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Wilkes Barre Times-Leader
Med school, University of Scranton to offer dual degree program
Scranton Times-Tribune
The medical school and the university signed a memorandum of understanding to offer a dual degree program in medicine and health administration, ...
Medical College and The University of Scranton team up for joint degree programWilkes Barre Times-Leader
Dual Degree Program Announced in ScrantonWNEP-TV
University, medical college team up to offer region's first dual degree programsStandard Speaker

all 5 news articles »

Harvard Medical School Bolsters Conflicts Policy – Newsinferno.com

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TopNews Arab Emirates
Harvard Medical School Bolsters Conflicts Policy
Newsinferno.com
Over the past several years, states, medical schools, medical societies, and other entities have passed regulations requiring doctors to disclose their ...
A Tougher Conflict Policy at Harvard Medical SchoolNew York Times
Harvard Medical School Frames New Guidelines for Its FacultyTopNews United States
Harvard puts tighter limits on medical facultyBoston Globe
MedPage Today -TopNews Arab Emirates -PRWeek
all 39 news articles »

Taking On Homeopathy in Germany

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Homeopathy is having a bad year. From a scientific point of view, it has had a couple of bad centuries. The progress of our scientific understanding of biology, chemistry, and physics has failed to confirm any of the core beliefs of homeopathy. Like does not cure like (this is a form of superstition known as sympathetic magic, with no basis in science). Diluting substances does not make them stronger – a notion that violates the chemical law of mass action and the laws of thermodynamics. And countless clinical studies have shown that homeopathic preparations are nothing more than placebos. That homeopathy cannot work and does not work is settled science, as much as it is possible for science to be settled.

Despite the science, homeopathy has persevered through a combination of cultural inertia and political support. But in the last year there are signs that this trend may be reversing. In the UK The House of Commons Science and Technology Committee (STC) released a report, Evidence Check 2: Homeopathy, in which they conclude that homeopathy is failed science and should be completely abandoned – no further support in the NHS and no further research.

Following that the British Medical Association has openly called for an NHS ban on homeopathy, calling the practice “witchcraft.”

Now German politicians are starting to echo the same sentiments.

Karl Lauterbach, the centre-left Social Democrats’ chair on the Bundestag health committee, told German news magazine Der Spiegel that insurers should be “prohibited from paying for homeopathy.”

and

According to Spiegel, Rainer Hess of the Federal Joint Committee for doctors and insurers also characterized the current situation as “extremely unsatisfactory.”

The common thread in the UK and Germany is rising health care costs, which is creating the political will to oppose worthless interventions like homeopathy. Up until now systems like homeopathy which are not science-based have received political support from individual believers and promoted largely through the notion of “health care freedom.” But the political climate is changing, and suddenly paying for interventions that do not work seems unnecessarily wasteful. This creates an opportunity to focus attention on interventions like homeopathy.

In Germany, as in the US, homeopathy has received support from individual politicians. According to the cited news article:

“There have already been many attempts to drop protective provisions on such remedies, but influential politicians have consistently prevented this from happening,” Hess said, adding that despite hundreds of medical studies failing to clearly prove the benefits of homeopathics, insurers are still made to pay for them.

It sounds like Germany has had their own Tom Harkin and Orin Hatch to contend with. Political support for homeopathy in the US actually goes back much further. In 1938 Senator Royal Copeland from New York, a homeopath, managed to insert into the new FDA regulations automatic approval for homeopathic products. This situation continues to today – homeopathic products do not require any testing for safety and efficacy.

It is good to hear that politicians in Germany are now openly discussing not only removing the protections that force insurance companies to pay for homeopathy, but actually banning insurance companies from paying for it. This would be similar to the BMA proposed ban on NHS support for homeopathy.

In both cases no one is proposing that homeopathy itself be banned. If an individual wants to pay for water in the mistaken belief that it is an effective remedy, they are free to do so. However, the seller should not be free to make misleading or fraudulent claims – but that is a different type of regulation. What is now being discussed in Germany and the UK is simply preventing public money from being spent on treatments which have already been proven not to work.

I would like to see these efforts spread to the US. We are facing our own health care crisis here, with a new focus on cost-effective medicine. Amazingly, Harkin was able to hijack efforts to deal with the situation (through “Obamacare”) to increase public support for unscientific medicine. This trend needs to reverse – and homeopathy seems like the low-hanging fruit to me.

With homeopathy the science could not be more clear, and recent exhaustive reviews, like Evidence Check 2: Homeopathy, have shown that it simply does not work. It should therefore be an easy political position to take, that our limited health care dollars should not be spent on ineffective medicine.


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The China Study Revisited: New Analysis of Raw Data Doesn’t Support Vegetarian Ideology

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Over a year ago I wrote about The China Study, a book by T. Colin Campbell and his son based on a huge epidemiologic study of diet and health done in China. The book’s major thesis is that we could prevent or cure most disease (heart disease, cancer, diabetes, autoimmune diseases, bone, kidney, eye and other diseases) by eating a whole foods plant-based diet, drastically reducing our protein intake, and avoiding meat and dairy products entirely.

I noticed a number of things in the book that bothered me. I found evidence of sloppy citations, cherry-picked references, omission of data that contradicted the thesis, and recommendations that went beyond the data. I concluded:

He marshals a lot of evidence, but is it sufficient to support his recommendation that everyone give up animal protein entirely, including dairy products? I don’t think so.

The China Study involved 367 variables and 8000 correlations. I said I would leave it to others to comment on the study design and the statistical analysis, and now someone has done just that.  Denise Minger devoted a month and a half to examining the raw data to see how closely Campbell’s claims aligned with the data he drew from; she found many weaknesses and errors.

Campbell says

Plasma cholesterol… is positively associated with most cancer mortality rates. Plasma cholesterol is positively associated with animal protein intake and inversely associated with plant protein intake.

The data do show that cholesterol is positively associated with various cancers, that cholesterol is positively associated with animal protein, and that cholesterol is negatively associated with plant protein. So by indirect deduction they assume that animal protein is associated with cancers and that reducing intake is protective. But if you compare animal protein intake directly with cancer, there are as many negative correlations as positive, and not one of those correlations reaches a level of statistical significance. Comparing dietary plant protein to various types of cancer, there are many more positive correlations and one of them does show strong statistical significance. The variable “death from all cancers” is four times as strongly associated with plant protein as with animal protein. And Campbell fails to mention an important confounder: cholesterol is higher in geographic areas with a higher incidence of schistosomiasis and hepatitis B infection, both risk factors for cancer.

Campbell says breast cancer is associated with dietary fat (which is associated with animal protein intake). The data show a non-significant association with dietary fat, but stronger (still non-significant) associations with several other factors and a significant association with wine, alcohol, and blood glucose level. The (non-significant) association of breast cancer with legume intake is virtually identical to the (non-significant) association with dietary fat. Animal protein itself shows a weaker correlation with breast cancer than light-colored vegetables, legume intake, fruit, and a number of other purportedly healthy plant foods.)

He indicts animal protein as being correlated with cardiovascular disease, but fails to mention that plant protein is more strongly correlated and wheat protein is far, far more strongly correlated. The China Study data show the opposite of what Campbell claims: animal protein doesn’t correspond with more disease, even in the highest animal food-eating counties.

These are just a couple of examples. Minger found many more, which she describes in her long article, complete with impressive graphs. Her exposé is well worth reading in its entirety, if only as a demonstration of how to think about epidemiologic data.

Minger goes on to reveal gaping logical holes in Campbell’s own research on casein, a milk protein that he believes causes cancer. He showed that casein was associated with cancer when given in isolation to lab animals, but he projects those results onto humans and onto all sources of animal protein. Other animal proteins have been shown to have anti-cancer effects, and the results of a normal diet containing multiple protein sources are likely to be very different from his casein-only studies.

Minger concludes

 I believe Campbell was influenced by his own expectations about animal protein and disease, leading him to seek out specific correlations in the China Study data (and elsewhere) to confirm his predictions.

She is being polite.

This is a cautionary tale. It shows how complex issues can be over-simplified into meaninglessness, how epidemiologic data can be misinterpreted and mislead us, and how a researcher can approach a problem with preconceptions that allow him to see only what he wants to see. The China Study was embraced by vegetarians because it seemed to support their beliefs with strong evidence. Minger has shown that that evidence is largely illusory. The issues raised are important and deserve further study by unbiased scientists. At any rate, one thing is clear: the China Study is not sufficient reason to recommend drastic reductions in protein intake, let alone total avoidance of meat and dairy foods.


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The Texas Medical Board acts in the case of the Winkler County whistle blowing nurses

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I can’t speak for anyone else who blogs here at Science-Based Medicine, but there’s one thing I like to emphasize to people who complain that we exist only to “bash ‘alternative’ medicine.” We don’t. We exist to champion medicine based on science against all manner of dubious practices. Part of that mandate 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.

If there’s one area that SBM needs to do better in, it’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:

A brief recap of the Winkler County nurses case

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.

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 alone, although I’d probably recommend that Arafiles have 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. If, on the other hand, he were also treating it with vancomycin and/or “lancing” the boil, then, although the olive oil didn’t add anything, it’s probably didn’t do any harm or interfere with the treatment of the abscess, either. I e-mailed a representative of the Texas Nurses Association a request for the full complaint, but did not receive it in time for this post; perhaps I’ll post an addendum when I have the full text of the complaint.

A strange set of charges

Upon perusing the list of charges brought by the TMB against Dr. Arafiles, I find 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):

Alkalinizer

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

alkalinizerclaims

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

ArafilesQuackMiranda

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

ArafilesH1N1

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.

More than a case about a single doctor

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.

ADDENDUM: A copy of the formal complaint against Dr. Arafiles can be found here.


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