Club Med

There is a famous quip that most medical students have heard at some point prior to graduation, usually in response to their anxieties about surviving the rigors of medical education. It goes something like this: "What do they call the medical student who graduates last in the class? (Answer) Doctor!" I remember hearing this humoresque while a medical student myself and feeling something sinking in my stomach at the time. I suppose the intention had been to quell my worries, but instead I was left feeling that the system was rigged to shepherd through even the worst of us. Was this some kind of hubris on the part of the medical school admissions committee? Were they simply unwilling to admit that at least in some cases they had made a mistake? While we were on the one hand being trained to respect the gravity of the task before us, taking, as we were, others' lives into our own hands, on the other hand, there seemed to be a reluctance to acknowledge that action might be required to protect patients from those who did not meet certain safety standards. Where was the bottom line? Or wasn't there one?

Stanley Wolfe, a physician who writes for Public Citizen, and edits the newsletter "Best Pills, Worst Pills," which recently published a predictably poorly argued and researched piece critical of homeopathy, has latched onto the weakness in medical self-regulation. He regularly publishes in his newsletter, in truly absurdist over-reactionary style, a list of the disciplinary actions by the departments of health in each of the 50 states, rank ordering them so that the "best" states have the most disciplinary incidents of physicians. By his cockamamie logic, the states with the best medical climate have the most disciplinary actions. The more the better! His assumption appears to be that bad medical practice is more or less uniformly spread amongst the various states, and that those states that have more disciplinary incidents are necessarily more vigilant about keeping the profession clean of the bad eggs than those states that have fewer incidents. Of course, this is just an assumption. It is possible that some states have more errant physicians and that some health departments have overly punitive health commissioners or regulatory boards. But forget about this, Dr. Wolfe presumably would say.

Nonetheless, the difficulty that the medical profession has regulating itself has become an embarrassing showpiece for the media, usually rising to our attention when some egregious action by physicians of great sensational import fly onto the media's radar screen. What I first tasted in medical school, I now see, was the immense clubbiness of the medical profession. The reluctance to take regulatory action against its members was just one example of this clubbiness. It was also visible by the negative attitude that the medical profession had towards competing health care fields. Polite tolerance seemed to be the most that most of my mentors could muster up towards osteopaths, chiropracters, and even in some cases nurses or allied medical professionals. At times polite tolerance gave way to dismissiveness or even supercilious disdain. It was clear that they were not part of the club. Evidence, argumentation, and open discussion were not considered to be germane, since these outsider's approaches were so manifestly misguided, if not outright dangerous or harmful.

In a recent book on Lyme Disease, Cure Unknown, by Pamela Weintraub, this clubbiness is revealed in an even more sinister form. Physicians who have specialized in treating Lyme Disease over the past two decades have often faced vilification and even legal indictment by their colleagues for practicing in ways that were outside the accepted standards. Some of them were forced by medical authorities to stop treating patients diagnosed with Lyme Disease or close down their practices. Weintraub details how some of those physicians who led the attack against the so-called "Lyme doctors" often had conflict of interests, having fiduciary relationships with insurance companies, who had a stake in limiting treatment, or who had monstrous speaking fees because of their reputations as experts in Lyme Disease.

To me, this is a frightening scenario, where the medical profession goes to the darkest aspects of clubbiness: attacking those who would differ from the accepted standards, regardless of the merits of those standards. In the medical profession, the "standard of practice" is considered to be the basis of good practice, and is the legal guidepost by which malpractice is often determined to have occured or not. Like in organized religion, there is a certain orthodoxy in the medical establishment which does not admit to faults or dissent. Those who are seen as heterodox are guilty of a kind of heresy -- the heresy of non-adherence to the standards. Such heretics must be disciplined or expelled.

While this Inquisition-like attack is not a common occurence within the medical profession, it is frightening to one such as myself who has embraced a number of non-traditional treatments into my practice. While I have studied both homeopathy and Bowenwork in an effort to bring more to my patients than I have been able to with conventional treatment alone, this would appear to matter little to those who are on witch hunts. Nor would evidence that would suggest that these treatment modalities are safe and effective. That these treatments are not part of the club appears to be the more decisive factor. Getting into a club, as it turns out, is easier than getting out.