"hCG" Redux

I've seen much more of the "hCG" nonsense since my previous post.

I had a (very tall and obese) 11 year-old boy brought in by his father's female friend to receive my stamp of approval for "hCG" drops and the 500 calorie diet. She hoped to recruit me in her war against his mother (who refused the scheme, thinking it crazy).

Hal Dall, MD: "It's not appropriate, 500 calories are too few for a growing child".

Ms. Fireworks: (at 100 db) "Why do you want him fat?!? Do you want him dead? His mother is killing him"! etc. [rant]

HDMD: "He needs a balanced, moderately low calorie diet. 500 calories is too low".

Ms.F: "You want him fat? Why do you want him to get fatter?" etc. [rants more]

HDMD: "He'd lose weight on a balanced low calorie diet, and I'd be happy to refer him to a dietician for it".

Ms.F:(at 110 db) "That won't work!! He needs the "hCG"! He can't lose without it! His mother feeds him toasted cheese sandwiches! Is THAT the diet you want for him? Toasted cheese sandwiches? ...[rants longer and louder]

After a sharp exchange she accused me of child abuse for not giving approval to her scheme and she stamped out of the office.

I've not encountered the lady again, but the boy has since dropped from BMI 34 to 30.1 in the 8 months since his mom instituted a 1800 kcal diet with consistent exercise.

Expensive Ingredients

Recently a long-time patient asked my opinion of the 'new' weight-loss method becoming popular in our town. She has lost and regained hundreds of pounds over the years, trying various diets without long-term success. She did best with Weight Watchers, but a successful friend convinced her to try the "HCG" diet.

I scanned the pages of propagandvertising (the usual pseudoscientific rationale) and instructions she had been given. The diet was primarily very-low calorie (500 kcal/day) with periods of low calorie (1800 kcal) and had a long list of forbidden foods. No surprises there (as I told her, who won't lose weight on 500 Kcal/day?). In addition "HCG" drops are the magic ingredient- to be taken sublingually in 23 day cycles. HCG drops??

"Can I see the bottle they sold you"?

"Here it is. I paid $40 for it".

I look at the front of the label. " hCG". "homeopathic". I turn the bottle and see this on its side:

I turned the label toward her and she read aloud "Ingredients: Water."

"What! I paid $40 for WATER?!? How dumb was THAT"?

MMR Derangement Syndrome

BMJ published the first article in a series documenting how Andrew Wakefield falsified data to publish a purported link between the MMR vaccine and autism. Please read the article and commentary  in full (and future installments as they are published).

A summary from the BMJ article:

How the link was fixed

The Lancet paper was a case series of 12 child patients; it reported a proposed “new syndrome” of enterocolitis and regressive autism and associated this with MMR as an “apparent precipitating event.” But in fact:

Three of nine children reported with regressive autism did not have autism diagnosed at all. Only one child clearly had regressive autism

Despite the paper claiming that all 12 children were “previously normal,” five had documented pre-existing developmental concerns

Some children were reported to have experienced first behavioural symptoms within days of MMR, but the records documented these as starting some months after vaccination

In nine cases, unremarkable colonic histopathology results—noting no or minimal fluctuations in inflammatory cell populations—were changed after a medical school “research review” to “non-specific colitis”

The parents of eight children were reported as blaming MMR, but 11 families made this allegation at the hospital. The exclusion of three allegations—all giving times to onset of problems in months—helped to create the appearance of a 14 day temporal link

Patients were recruited through anti-MMR campaigners, and the study was commissioned and funded for planned litigation

The original paper fueled anti-immunization sentiment, and contributed to decreasing immunization rates and increasing infection rates across the Western world. Although the original paper was retracted last year by the Lancet, and Wakefield was stripped of clinical privileges in Britain, he remains a star of anti-immunization groups.

For his fraud, Wakefield gained fame and filthy lucre (including over $600000 from the legal firm). He remains unindicted, free to peddle his ideas here in the US.

The rest of us have paid a heavy price for these lies, in distrust and alienation between parents and doctors. In millions spent trying to disprove a fantasy. In children with preventable illness and untimely death. 

Homeopathic ER

H/T to Dr. Val and GruntDoc.

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Patient Autonomy vs. Doctor Autonomy

My last post dealt with the simple question of responsibility for one's own health. This follow-up is about one type of conflict which arises as a result.

A person called our office requesting to become a new patient. He wants be referred for hyperbaric oxygen therapy (HBOT) for an old stroke. He also stated that he is happy to stay with his regular doctor for everything else, but wanted to see me since he had heard I use alternative medicine. [note: I have that reputation as I do not argue with my patients over such "woo" unless I believe it to be harmful] 

I declined the invitation. 

The person later that day showed up at the Office front window and argued for 10 minutes with my receptionist about my decision. He only needed a referral to a nearby HBOT center and promised he would take little of my time. Oh, he also wanted to discuss other alternative therapies with me.

He had found a HBOT place in California, but didn't want to pay for the trip, motel, etc. Could he make an appointment so that I could convince the nearby HBOT center (2 hours away, only treating chronic wounds) to treat him for the stroke? "What kind of wound do I need?" 

I continued to decline, and he left unsatisfied. 

An individual has the right and responsibility for their own health. If unsatisfied with one doctor or practitioner or course of treatment, s/he is at liberty to find others to provide the health care sought (providing it is legal).

This man exercised his freedom finding a place for his desired legal treatment from the internet, but wanted a cheaper, more convenient outlet. I exercised my freedom by declining to be involved. He felt I was wrong to do so, that it is my job to help him obtain the health care which he has decided he wants, in the manner desired.

The patient has autonomy (self-rule) to make their own health care choices (within the law).

The doctor has autonomy to make his/her own practice choices (within the law). This includes the mode of practice and under the circumstances s/he decides.  

The self-rule of the patient does not give the right to rule over the doctor.

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