Scott Gottlieb’s smoking hot idea- stupid or brilliant

Scott Gottlieb, MD is the commissioner for the FDA. His FDA bio claims he’s a “medical policy expert, and public health advocate.” Gottlieb has announced that he plans to lower nicotine levels in cigarettes to minimally or non-addictive levels.

Let’s look at this:

  1. There’s no evidence that there’s such thing as “minimally, or non-addictive levels” of nicotine. Maybe if a cigarette was created with no nicotine it might be possible. But nicotine is still nicotine. And, it’s still addictive.
  2. The components of tobacco that cause disease aren’t nicotine. It’s the rest of the smoke.
  3. On fairly predictable side effect of lowering the addictive component is that smokers will consume more cigarettes. Thus they will be exposed to more carcinogens. (Does anyone believe that alcoholics drink less beer with lower alcohol content?)
  4. More cigarettes means more sales for tobacco companies.

Gottlieb’s well-intended, yet potentially misguided plan is standard Washington short-sighted “ready, fire, aim.” It’s telling that no tobacco company has protested.

There’s a better more effective way. STOP the all tobacco subsidies in all forms. The federal government supports the production of tobacco products. Raise taxes on all tobacco products. Those are two easy, proven ways to reduce consumption. Neither of them will result in an increase in consumption.


Our favorite board and Jean Barker

The Mississippi Medical Board remains an easy target. Recently the former executive director wrote an op-ed piece for the Clarion Ledger. The piece apparently provoked one of “Mississippi’s finest” to respond.

Dr. Jean Barker of Greenville, MS wrote a letter to the editor ( Let’s set some context. Barker has no public record according to the board’s website. So no one would have know about her experience at the board except that this “medical genius” outer herself.

Her letter speaks for itself and speaks volumes about Barker in myriad ways. For instance Barker admits:

  1. “failed to call another GYN doctor when the doctor I consulted did not come in.” Barker omits the fact that she didn’t call the on call physician but called another physician.
  2. [the patient]” was not dying, just in pain. Barker omits that the patient said she felt like she was going to die and Barker’s response was “you don’t look like you’re dying.” Barker then told the patient she should go to Jackson if she thought she needed care.
  3. Barker says she was “called four times before that board including an examination for mental stability.” But Barker omits the fact that her behavior was frankly bizarre. Further, no one would have known the board was worried about her mental stability if she hadn’t behaved like she needed to be evaluated and hadn’t announced it in a local newspaper.

Should Barker have a license? Who knows. The worst medical board in the US seems to think so. Should she have patients? That’s an entirely different question. I wouldn’t let her treat me.

Larry Nassar

Larry Nassar is a predator. The massive number of accusers have pointed fingers Michigan State, coaches, and even parents.

The one group that no one has looked at is the Michigan Medical Board. In fact it took the board until January of 2017 to revoke Nassar’s license (see order here). Unfortunately, the Michigan board’s incompetence is fairly common. Doctors protect doctors (I know you’re shocked by that revelation).

In my last post I wrote about Meisam Moghbelli, a physician and cyberstalker. The Mississippi Medical Board charged Moghbelli- and slapped him on the wrist despite tearful testimony by the victim. The Ohio Medical Board has taken no action against Moghbelli. He remains happily “practicing.”

In the next issue we’ll look at other physicians protected by medical boards.

Meisam Moghbelli, MD

Mississippi has a long history of being the worst at everything that’s good and first at everything that’s really awful. But licensing a cyberstalker is a novel low point. But Mississippi is not alone.

“Dr.” Moghbelli practiced cardiology in Mississippi until he was summarily fired by The Hattiesburg Clinic for- you guessed it- cyberstalking. From there he fled to Ohio where he was given a license.

In fairness, the Mississippi Board did issue a summons and have a hearing- then it sent a bona fide cyberstalker back out into practice without so much as a restriction. But he claimed he was sorry! You can see the summons (moghbelli summons) and the wholly inadequate consent agreement (moghbelli order).

Moghbelli remains in Ohio where is seems to be practicing at University Hospitals in Cleveland and Lima Memorial. Those places are either desperate for physicians or they needed someone who’s computer savvy…


Aimee Lutkin writes: The Difficulty of Completing Medical Residencies While Starting Families Is Holding Women Back In Medicine. In her piece she cites a Bloomberg article: Why Having a Baby Pushes Women Out of Medicine.

Both articles acknowledge medical training is hard. Yet both suffer from a fundamental flaw- students and physicians make choices. I’ll use one of the Bloomberg examples:

Like many medical residents, O’Brien forwent maternity leave, against the advice of her doctor. She’d already been accepted to a fellowship with a strict start date; she couldn’t extend her training any further. Instead, she used up all her days off, sent her newborn to day care, and returned to work, often ducking into a shower stall mid-surgery to pump breast milk.

Readers should understand that FMLA (Family Medical Leave Act) applies to residents. So O’Brien was eligible for up to 12 weeks of leave. Let’s look-

forwent maternity leave- choice

accepted fellowship- choice

newborn to daycare- choice

Don’t get me wrong, I have enormous respect for anyone brave enough to have kids while in training. I think it’s admirable for someone to put they’re family’s actual needs ahead of other personal goals such as long-term revenue and professional advancement. But it’s at least disingenuous to expect that you can “have it all.” O’Brien made her choices. Everyone of them. Oh, one other choice not included in the Bloomberg article- why didn’t the father of the baby stay home and provide care?

Children change everything. I got married as a resident and my wife (also a resident- surgeon no less) made the specific choice to delay kids until we finished and got new jobs started. Are we “older” parents, yes. But our kids had the benefit of a stable home and income and we were able to have control over our lives that would have been impossible while in training.

O’Brien and her ilk want the world to bend to her needs. It won’t. The O’Briens in medicine need to learn to accept their consequences of actions and live with them. I admire the women and men who can manage families while in training. The behaviours of “O’Briens” make all of us look like whiners.

Pseudo Medicine

Harriet Hall, MD writes a wonderful review of Life-Changing Foods: Save Yourself and the Ones You Love with the Hidden Healing Powers of Fruits and Vegetables by Anthony William who calls himself the Medical Medium. The review is a great read wherein an actual physician excoriates sheer quackery of an unambiguous huckster.

The whole review is a delightful read but it’s summed up:

Either Anthony William is a deliberate charlatan cynically making stuff up for profit, or he is a self-deluded believer who interprets his inner voices as real communications from the spirit world and is reinforced by cold reading and confirmation bias. Either way, it would be foolish to rely on him for health advice.

I usually reserve this blog for doctors who are some combination of lazy, stupid, corrupt, or other derogatory adjectives. In this case Dr. Hall has done a marvelous job.

One of the high points of William’s website is the “endorsements.” Probably not surprising that Gwyneth Paltrow endorses him:

“While there is most definitely an element of otherworldly mystery to the work he does, much of what Anthony William shines a spotlight on—particularly around autoimmunedisease—feels inherently right and true. What’s better is that the protocols he recommends are natural, accessible, and easy to do.”

OK, that seals it for me. I know I want his advice- not.


Just when you thought it might be safe to return to the waiting room. It’s not.

GOOP the pure junk science website offers a wide array of not-medically-valid-possibly dangerous pseudo-treatments for non-diseases. It has been widely derided for the sheer magnitude of the absurd claims. Entirely on the defensive. some of the GOOP “doctors” decided to speak out trying to resurrect their credibility. They failed, in my book. They failed for three reasons:

1) Who they are, what they’ve done, and what they’re credentials are is unrelated to their scientific and medical credibility on any given topic. It’s a common logical fallacy know as “appeal to authority.”

2) They have conflated absence of evidence with evidence of absence. Whether such  junk devices and science are actually dangerous takes only a single reported occurrence. Proof of safety is, in contrast, elusive.

3) These sites are cluttered with endless “testimonials.” While these may make entertaining reading it’s important to remember that non-randomized, non-blinded, uncontrolled, combined anecdotal experience is not data, no matter how much of it you get.

Scientifically implausible medical “therapy” needs credible evidence not simply testimonials.

But how does this persist? Basically, mainstream medicine allows it. Even large, well-known institutional providers are getting into the “alternative and complementary medicine” act. This occurs at a time when physicians themselves acknowledge that 20% of “mainstream” healthcare is without meaningful patient benefit. Since this study involves AMA members (members of a protectionist trade guild) one might expect the 20% figure to represent a floor rather than a ceiling on the amount of unnecessary care delivered.

But it’s not just the trade guilds. State medical boards also implicitly promote charlatanry. Looking just at Mississippi (the recognized worst medical board in the country see also here and here) we find such things as “low pressure hyperbaric oxygen” therapy- which despite the testimonials lacks any scientific basis and stem cell “research”– another “therapy” lacking in meaningful scientific basis and foisted on the public as “research.” Yet, in the case of stem cells it lacks any of the traditional characteristics of medical research- no real theory (unless let me have you money is a scientific theory). No real systematic collection of analysis of data. No real selection of patients in a manner that might permit reasonable stratification to determine if anyone actually benefited. In the case of the cited stem cell “clinic” the physician is a non-board certified former surgeon.

The bottom line- you can’t depend on other doctors. You can’t depend on medical boards. You simply need to be diligent, ask questions, and realize that you- the patient- are little more than a revenue center to most doctors.