Blog | Friday, September 5, 2014

Should doctors be 'political' in the office?

Our nation is highly polarized today, and often bitterly so. Democrats rail against the GOP. Pro-lifers face down pro-choicers. FOX News disses MSNBC. Isolationists push back against expansionists. Traditionalists disdain the politically correct. Free marketers duel against government advocates. Carnivores deride the gluten-free crowd. Martin Bashir trashes Sarah Palin, 2 proxies in a culture war.

There’s a philosophical divide among physicians also. Would you prefer a liberal physician or a conservative practitioner? I’m not referring here to fiscal policy or legalizing recreational marijuana use. Consider the following hypothetical scenario and the 2 physicians’ approaches from opposite sides of the medical philosophical spectrum. Which physician would you choose?

The Patient: She is a 50-year-old female with chronic fatigue syndrome (CFS). She is only able to work part time because of her condition. She has consulted with an internist, an infectious disease specialist and a naturopath, but her fatigue persists.

A new treatment for CFS has just been launched by a reputable herbal supplement company. Two well-designed studies suggest symptomatic improvement in afflicted patients after 6 months of treatment. As the product is an herb, there is no formal Food and Drug Administration (FDA) oversight.

Physician #1: ”I’m reluctant to recommend this product, despite the optimistic preliminary results from 2 medical studies. These studies were funded by the herb company and there may be bias present. Moreover, it is very typical in medicine for initial results to be favorable, with unforeseen side effects and complications emerging later when after more widespread use of a drug. I’m concerned that the FDA had no role in validating that the drug is safe and effective for its intended use. Additionally, there is evidence that the active ingredient in the product disrupts the immune system, which may have serious future consequences that may not become manifest for several years or longer. While CFS is decreasing your quality of life, your condition has been stable and will never threaten your life. I recommend holding off until we have an FDA approved medicine for CFS or the herbal supplement has been used long enough that we have a better sense of its safety and efficacy.”

Physician #2: “I recommend that you try this new herbal product. It is completely natural and showed promising results in 2 medical studies. Importantly, no serious side-effects developed in either study. Of course, we have no long term data on safety, but the vast majority of herbal supplements on the market are safe. No other treatment thus far has been successful for you, and your condition is adversely affecting your professional and personal lives. The choice is to try something new or to continue suffering as you have been. Try it for 6 months and then we’ll reassess.”

So, that’s my herb blurb. This is a common situation in the medical world where medical advice must pass through the prism of risks and benefits. These analyses are limited when the risks and benefits are unclear or disputed. Treatment acceptance also depends heavily on the patient’s risk tolerance. What if the herb referenced above had a 5% risk of cancer? What if the herb needs to be taken indefinitely? Clearly, when the disease poses a serious medical threat, the patient may be willing to accept greater risk of new or investigational therapies.

So, which of these physicians would you choose for yourself? Are you a medical liberal or a conservative?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.