There was a doctor in a Maryland suburb several years ago who sold narcotics to an undercover agent, was arrested and skipped bail. What, you have to wonder, did his receptionist say when patients called for an appointment?
"I'm sorry, but the doctor is on the lam."
If the patients didn't know where he had gone, at least they knew what had happened to him. But for the majority of doctors disciplined by either their states or the federal government, the patients remain ignorant. Censured physicians don't tend to post the results of their medical board hearings next to their diplomas.
Public Citizen Health Research Group (PCHRG) thought this was all wrong, and that a little more exposure was needed. Two weeks ago they released "6,892 Questionable Doctors," a massive but sketchy list of doctors, podiatrists, chiropractors, dentists and osteopaths who have done wrong in one fashion or another.
So you can look up the doctor who was reprimanded by Maryland for giving "succinylcholine inappropriately to a patient who had exhibited signs of paraplegia for approximately three weeks prior to administration after which patient developed tachycardia followed by cardiac arrest and death; use of drug is contraindicated except within 48 hours after major spinal cord injury." It's not very elegantly phrased, but you get the idea.
There's also the doctor who was suspended and put on probation by Maryland for three years "or until satisfactorily completes pharmacology course." And the Virginia doctor who was disciplined for "indiscriminate and excessive prescribing and for failing to recognize an erotic and/or dependent transference/countertransference patient relationship." And there's the fugitive mentioned above.
As it happens, this area doesn't come out particularly well in the book's state-by-state ranking of "serious" disciplinary actions reported for 1987. Virginia and the District are tied at 27; Maryland ranks 36. West Virginia, on the other hand, either revoked or suspended the licenses of 29 physicians or put them on probation. This is an "action rate" of 8.6 per 1,000 doctors -- more than three times the national average.
Is it possible there are simply more physicians in West Virginia doing things that need to be disciplined, and fewer here?
Responds Sidney Wolfe, director of Public Citizen Health Research Group and one of the authors of the report: "There's never been any evidence that doctors make decisions on where to practice based on how incompetent they are. Furthermore, in every state that has decided legislatively and otherwise to get serious about this issue, the number of disciplinary actions has gone up."
In other words, they've never looked for a problem and then not found it.
When it was released, "6,892 Questionable Doctors" drew flak from the American Medical Association for, among other things, including what they saw as relatively minor violations with big-time stuff like sexual abuse and felony convictions.
Wolfe says he got a complaint from a doctor who was fined for letting his license expire. "The doctor said, 'I don't think that's a disciplinary action.' He thinks it's minor. I don't think it is. It says something about the person's practice."
Even if practicing without a license is the least serious complaint here, there's another problem with the book: It's not exactly user-friendly. The examples cited above were among the more detailed; more often, it says only "fine," "license revocation," "denial of license reinstatement" or "denial of new license." There are lists of violations at the front of the book, but the average reader is going to get little sense of what each action was taken for.
The point of "6,892 Questionable Doctors" is not to encourage these physicians' patients to dump them, but merely to find out more information. If you see your doctor listed, the book recommends contacting the appropriate agency to learn more details.
The scenario Wolfe hopes patients would follow goes like this: Say you've been going to a doctor for 15 years and you learn for the first time from the book that he was reprimanded. You contact the state and they say, yes, two years ago he was disciplined for alcohol abuse. Then you talk to the doctor about it and he says he hasn't had a drink in two years.
"If, having found that, you decide you still have a good relationship with the doctor, and if he is no longer, as far as you can tell, having the problem, then you should continue to go to him," Wolfe says. "But what's wrong with being cautious with the doctor to whom you're trusting your life and health?"
Similarly, "If they see the doctor making a pass at them they may not take it as seriously as they would if they know the doctor has already been in difficulties for that. The same goes for misprescribing. You're coupling what you're observing with something that's been observed by a disciplinary board."
"6,892 Questionable Doctors" costs $30 for individuals, consumer groups and government agencies; $100 for businesses, doctors and lawyers. Only a hypochondriac would need more than his individual state listing, which is available for $10 for the first and $5 for each additional state. Public Citizen Health Research Group, Dept. QD, 2000 P St. NW, Washington D.C. 20036.
Big Fat Attack Phil Sokolof, the millionaire food crusader, has gotten new opponents but kept the same tactics. After all, you don't change a winning approach.
The cause with which the Omaha businessman first rose to prominence in the media -- the use of tropical oils in processed foods -- has been largely won, and most observers give him a share of the credit. While Sokolof's full-page ads declaring "The Poisoning of America" didn't start the ball rolling, they doubtless hurried some manufacturers along.
The importance of tropical oils in reducing cholesterol has been the subject of some debate. If you want to cut down on your saturated fat intake, experts say, the most important thing is to watch your consumption of fatty meat, fried foods and whole milk.
Tropical oils such as palm or coconut are also high in saturated fats, but comprised at their height only a small percent of a typical diet. The bigger problem was that they were hidden: people eating crackers or cereal made with them often thought they were on a strict, low-cholesterol diet when they really weren't.
Regardless of their effect, now that the tropical oils are largely gone, no one seems to miss them very much. Least of all Sokolof, who has turned his attention to an equally big target: the fast-food chains. In April, he ran a "Poisoning" ad in 15 newspapers -- another five turned it down -- focusing on McDonald's, and telling the company via headline: "Your Hamburgers Have Too Much Fat."
McDonald's did something no other company ever targeted by Sokolof had done: It fought back. Former secretary of Health, Education and Welfare Joseph Califano wrote to the newspapers, saying the "assertion that McDonald's is poisoning America is an outrageous lie that no responsible newspaper should have published ... Any further publication without ... corrections would have to be considered malicious."
But even McDonald's concedes the letter didn't have much effect. None of the newspapers admitted an error, a spokesman for the chain says. And when Sokolof last week submitted a new anti-McDonald's ad to five papers, including The Washington Post, they all ran it.
McDonald's isn't crazy about the latest ad, either. "It's so absurd it's getting tiresome," says spokeswoman Rebecca Caruso. At issue is just how much fat the hamburgers have. Sokolof said 21.5 percent precooked. McDonald's says it's much lower: between 17 and 19.5 percent. The New York Times had lab tests done that showed a fat content of 20.28 to 22.50 percent. But this was after cooking, and while Sokolof says it supports his position, it's not necessarily inconsistent with McDonald's either. If the burger loses moisture during cooking it will weigh less, and then the percentage of fat may appear to go up.
Last week's ad also focused on the fact that McDonald's cooks its french fries in beef tallow. The chain replies that they use "a blend of beef shortening and vegetable oil," but say that the breakdown -- which Sokolof asserts is 90 percent tallow -- is proprietary. In any case, the chain says they're testing in 500 outlets a process that allows cooking in 100 percent vegetable oil.
"They're fat factories," Sokolof says, a category into which he puts some of the other fast-food chains that aren't changing their ways. "But they can reduce the amount of saturated fat the public consumes. When you think of 22 million people a day going there, they have an enormous obligation to provide people with healthful food."