Medicine • Philosophy
Every trouble in medicine begins when physicians serve the State rather than patients.
Below is my closing statement for the recent debate on brain death in which I participated. It starts with a reference to the fact that a declaration of brain death often requires that the examination be performed by 2 or more physicians.Continue reading “A lethal license to deceive”
I was invited to participate in a debate on “brain death” at the annual meeting of the Catholic Medical Association in Orlando this past week. The question was: “Are neurological criteria for the determination of death acceptable in Catholic health care?”
On my side was my friend Pete Colosi, and we argued the negative (i.e., that brain death is not true death, and harvesting organs from people who have been declared brain dead is homicide).
This topic is very dear to me. I have published 2 scholarly papers on brain death, refuting some of the more salient philosophical arguments that have been advanced to push the idea that brain death is true biological death. The most accessible of the 2 can be found here.
Below is my opening statement for the debate. I didn’t know if the audience would be familiar with the topic, so I tried to give a simple overview. I am adding a couple of footnotes here to expound on some key points.
[As this goes to press the Biden administration is proposing a sweeping vaccine mandate that may affect an estimated 100 million Americans, making the following considerations all the more relevant]
Dear_________,
I received your message detailing your concerns about receiving a COVID vaccine and requesting a medical exemption. I understand that your employer is now mandating a vaccine unless you can obtain such an exemption (or perhaps a religious one). I find your concerns perfectly legitimate but, unfortunately, they do not justify a medical exemption.
As you’ve noted yourself, there is no evidence that a history of prior myocarditis or prior atrial fibrillation increases the risk of getting myocarditis from the Pfizer or Moderna vaccines. And even if there was such evidence, then the J&J vaccine would be the alternative immunization to address that particular concern.
I also understand that your worries go beyond the possibility of having another bout of myocarditis (however small the chance may be). You have serious misgivings about these vaccines because you’ve lost confidence in the medical profession, the pharmaceutical industry, or the public health authorities (or perhaps all three).
Who can blame you? Can anyone deny that self-interest is all too often a prime motivator in healthcare—even in public health—and all too often at the expense of patients or the public? Abuses of confidence by doctors and hospitals, greediness in the pharmaceutical industry, and ideological or political pressure in the public health sector are all plainly evident and warrant at least some degree of skepticism. Your distrust is not paranoid, it is actually rational.Continue reading “Letter to a patient seeking a medical exemption to the COVID vaccine”
By now, everyone and their mother has seen the censored Breitbart video of “America’s Frontline Doctors” standing in front of the Supreme Court and vaunting a hydroxychloroquine cocktail as “a cure” for COVID. To many, the overtly political display seemed over-the-top and proof that the stuff could only be snake oil. It also didn’t help that the doctor who promoted its benefit with the most swagger had apparently made prior claims about the demonic origin of certain diseases.
But I will take sides here and defend those who wish to prescribe that cocktail, that they may be able to do so without fear of ignominy. If my arguments are taken to be political, so be it.
(This is the second part in a series on shared decision-making. Click here for part 1)
I recently attended a cardiology conference where a speaker proudly presented a case of shared decision-making. It involved a young female athlete who had survived a cardiac arrest and was diagnosed as having an anomaly in her heart conduction system, putting her at risk for arrhythmia during exercise.
She had received an implantable cardioverter-defibrillator and the decision in question had to do with whether she could resume sports activities or not. The guidelines issued by the American Heart Association recommend that activities be strictly limited in intensity, but the evidence to support that recommendation is scant.
The cardiologist told the audience that he and the young woman met several times and had long conversations. He got to know her very well. He took the time to explain to her everything that medical science has revealed about the potential risks of a future cardiac arrest under the circumstances. Together, they imagined various scenarios of what might happen if one course of action or another was taken, and what impact the athlete might personally experience in terms of overall quality of life.
Finally, they jointly agreed on a decision.Continue reading “The case against shared decision-making – 2”
We just did a fantastic interview with the legendary G. Keith Smith, MD, co-founder of the Surgery Center of Oklahoma.
Early in the interview, Dr. Smith speaks of the motivation that pushed him and his partner, Dr. Steven Lantier to divest themselves from the government-insurance-hospital system back in the late 1990s: They wanted to stop enabling what Smith identified as “financial serial killers,” so-called non-profit institutions that end up charging astronomical prices for healthcare yet have no qualms about bankrupting defenseless patients who are unable to pay those prices.Continue reading “How to rid medicine of its cronyism”
On November 13, 2017, an epidemic of hypertension broke out and could rapidly affect tens of millions of Americans. The epicenter of the outbreak was traced back to the halls of the Anaheim, CA, convention center where the annual meeting of the American Heart Association was taking place.
The pathogen was released in a special 488-page document labeled “Hypertension Guidelines.” The document’s suspicious content was apparently noted by meeting personnel, but initial attempts to contain it with an embargo failed and the virus was leaked to the press. Within minutes, the entire healthcare ecosystem was contaminated.
At this point, strong measures are necessary to stem the epidemic. Everyone is advised not to click on any document or any link connected to this virus. Instead, we are offering the following code that will serve both as a decoy and as an antidote for the virulent trojan horse.Continue reading “How to stem the incipient epidemic of hypertension”
Here’s the typical story we come across every day:
Jack was overweight and had a terrible cardio-metabolic profile. Jack changed his diet: he eliminated X, Y, Z and added more A, B, and C. He’s now lost 30 pounds and he feels fantastic. His numbers are also perfect: his HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range.
Todd was overweight and had a terrible metabolic profile. Todd changed his diet but he did not eliminate X, Y, or Z. In fact, he did the opposite. He increased his intake of X, Y, and Z but eliminated A, B, and C. He’s now lost 30 pounds and he feels fantastic. His numbers are also perfect: his HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range. Continue reading “You eat as you are”
A recent tweet from JAMA, the journal of the American Medical Association, urged me and other doctors to “include nutrition counseling into the flow of [our] daily practice.”
Along with the tweet came a link to an article that outlines “relatively small” dietary changes, based on the latest Dietary Guidelines for Americans, that can “significantly improve health.”
My response to the tweet was swift and knee-jerk. I will not do it. I simply will not. I refuse to follow dietary guidelines or recommend them to my patients.
“What are you saying?!” “Are you the kind of self-interested doctor who only treats disease and cares nothing about prevention?!” I imagine my outraged critics erupting in a chorus of disapproval.
Is my reaction unwarranted? After all, the recommendations themselves seem sensible enough: Eat fast food less often; drink fewer sugary sodas; consume more fruits and vegetables. What’s not to like?
I don’t know. Perhaps it’s dietary guideline fatigue.
For more than 40 years, the nutrition experts have instructed us with guideline after guideline, food pyramid after food pyramid. But what have they got to show for? The obesity epidemic followed the introduction of dietary recommendations, and some doctors even blame those recommendations for causing the epidemic!
The blame may be far-fetched, but there’s something un-natural and perhaps even unhealthy about dietary guidelines.Continue reading “I refuse to tell you what to eat”
[I was kindly asked to provide an article for Courrier du Medecin Vaudois, the French language journal of the medical society of the canton of Vaud. The article was published as part of an issue on the theme of ‘America First against Obamacare.’ Below is an English version of the piece.]
On the surface, the news from America about health care seems rather grim: cost and dissatisfaction keep rising, reforms are stalling, and, for some, even life expectancy may be declining. If that wasn’t bad enough, President Trump issued a tweet on March 25 predicting that “Obamacare will explode.”
For a small but growing number of doctors and patients, however, the future is surprisingly hopeful. Continue reading “Good health care news from America”
