Archive for: February, 2010

Quackery, pure and simple

Feb 13 2010 Published by under Absurd medical claims, Medicine, Texas nurse case

What constitutes quackery depends very much on how quackery is defined. If part of that definition is making false or unsubstantiated claims about a medical product you are selling, then Dr. Rolando Arifiles is a quack.

Dr Arafiles and his cronies in the Winkler County government may not realize is that this "internet" thing works both ways. It may increase your ability to sell fake cures, but it also opens you up to being discovered. Of course, increasing your profile by abusing the legal system to quiet critics doesn't help.

The FDA and FTC aren't too happy about the proliferation of fake flu cures coinciding with the H1N1 pandemic. They are so unhappy that they are making a special point of going after people preying on the public:

"Products that are offered for sale with claims to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus must be carefully evaluated," said Commissioner of Food and Drugs Margaret A. Hamburg, M.D. "Unless these products are proven to be safe and effective for the claims that are made, it is not known whether they will prevent the transmission of the virus or offer effective remedies against infection. Furthermore, they can make matters worse by providing consumers with a false sense of protection."

The Quack Miranda Warning is no protection against this sort of malfeasance.

So, in case this site goes down the memory hole, I grabbed a screen shot. According to my sources (OK, and Arifiles' own LinkedIn profile), Dr. Arifiles is the owner of the Healt2Fit website.

arifiles1.JPG

See the circled bit?  The part where Arifiles claims that his colloidal silver gel is FDA approved for swine flu?  That's not OK.   

It would probably be unfortunate for him if the FTC or FDA were to hear about this.  It might take away some of the precious resources he needs to help him fight the civil suit filed against him

16 responses so far

You may be judged by those who you call "friend"

Feb 13 2010 Published by under Texas nurse case

I love writing about quackery and other medical shenanigans, but there are some activities and organizations that are so distasteful that I can rarely force myself to write about them. One of these is the Association of American Physicians and Surgeons (AAPS). This is an organization that has supported the lie that abortion leads to breast cancer, has defended child abuse by attempting to "debunk" shaken baby syndrome, or worse, blame it on vaccines, and fought for treating mental health as moral failing rather than a real illness. And that's just a sampling.

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4 responses so far

A lurker in the forest

Feb 12 2010 Published by under Medicine

Human papillomavirus (HPV) is a fascinating little bugger. Certain strains can interfere with tumor suppressor genes leading to cancer, especially cervical, anal, and some mouth cancers. Other strains cause genital warts. The vaccine offered in the U.S. (Gardasil) protects against the two strains that cause most cancers and against two strains causing warts. The vaccine has the potential to change the way our population is affected by these diseases.

But we are still learning more about this virus. We know that HPV can be transmitted even without visible lesions. But where are these viruses hiding? A recent study in the Journal of Infectious Diseases may have found one reservoir.

Researchers in Slovenia looked at some of the old data on HPV which suggested that pubic hair follicles might contain HPV. To investigate this further, they rounded up 53 Slovenian males with genital warts, and 53 males without warts to serve as controls. They then sampled the warts and plucked hairs from the scrotum, pubic area, and from around the anus.  They used PCR to find and identify HPV DNA from the samples.  

HPV infections and HPV-related cancers are sexually transmitted, and are strongly affected by the immune system, and HPV-related cancers are particularly common in people with HIV, so the study subjects were screened for the presence of HIV and other immune diseases.  

The researches found significant differences between the two groups studied.  Nearly 70% of subjects with warts had HPV isolated from hair samples, compared to about 13% of controls.  Strains in the hair matched the strains from the warts present.

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8 responses so far

Texas nurse acquitted!

Feb 11 2010 Published by under Texas nurse case

Good news out of Texas. Anne Mitchell, the nurse who filed an anonymous complaint about a doctor with the Texas Medical Board, was acquitted of felony charges.
Mitchell brought her concerns about Dr. Rolando Arifiles to her hospital administration, and when she got nowhere, she felt forced to bring her patient safety concerns to the state medical board. The local sheriff, a friend and possibly business partner of Arifiles, used is investigative super-powers to figure out who filed the anonymous complaint, and had her indicted for misusing state information (the medical record numbers of the patients).
The jury took about an hour to acquit Mitchell. Give the damage to her career, hopefully her civil suit against the gangsters who misused their offices to harass her will succeed.

24 responses so far

CardioFuel---another magic pill

Feb 10 2010 Published by under Absurd medical claims, Medicine

I get a lot of email asking me about various alternative therapies and supplements. A recurring theme on this blog has been the hyperbolic claims of alternative practitioners and supplement makers, and while I can't answer every email, I can at least address some of them in the blog. Supplements are often marketed using unsupported health claims to which is appended the Quack Miranda Warning, essentially allowing the makers to say that the pill will have such and such a benefit, while simultaneously denying any responsibility for the claim.  Since the FDA isn't examining these claims, it's worth while to ask our own questions.

The latest email concerned a product called CardioFuel. Let's take a closer look at this stuff.

According to the distributor:

CardioFuel is the most profound energy producing supplement on the market today! It does something like no other can: Increase energy at the most basic metabolic level, by increasing ATP (the biochemical energy unit of transfer) production. More ATP means more energy reserves to overcome chronic disease, beat the competition, and handle the everyday stressors of today's fast paced world!

So to be taken seriously, there should be evidence that this product: 1) increases ATP, 2) increases "energy reserves", and 3) helps overcome chronic disease and "the competition".
First, it is not possible to directly measure ATP in a human being under normal clinical conditions, so any claims about this must be an inference from markers of ATP metabolism, or a guess. We'll see what the literature says about this below.
Second, we need an operational definition of "energy reserves". Does this mean fat stores? Glycogen stores? These things are measurable to an extent.  Finally, we can do a literature search to see if CardioFuel or an acceptable analog has been tested for its effect on relevant outcomes.

First, what is ATP?  
ATP is adenosine triphosphate, a biological molecule with many functions, among them the transfer of energy.  ATP is produced in several ways, most famously in the Krebs cycle, a complicated biochemical process which premeds are mercilessly forced to memorize.  ATP contains three phosphate bonds, and the third bond contains a great deal of energy, energy that the body uses to fuel many biochemical processes.  Each molecule of ATP contains a d-ribose moiety, a simple sugar upon which the molecule is built.  One of the claims being made by the CardioFuel folks is that if we ingest more d-ribose, we can make more ATP and be more "energetic".  
First, ATP synthesis, like most biochemical processes, is subject to feedback regulation; ATP production and its byproducts feed back to reduce further ATP production. Second, it is not clear to me that simply providing more of this particular substrate would significantly boost ATP production.  But with my limited knowledge of biochemistry, it seems like an interesting question to investigate.  

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19 responses so far

More on injustice in Texas---now with quackery?

Feb 10 2010 Published by under Absurd medical claims, Medicine, Texas nurse case

There have been some disturbing rumors circulating about Dr. Rolando Arafiles, the Texas doctor who enlisted a local sheriff to harass and ultimately prosecute local nurses. The nurses filed anonymous complaints with the state medical board about Arafiles' practices, and one of them is now in court facing felony charges for doing her job.

One of the complaints that nurse Anne Mitchell registered was regarding Dr. Arafiles alleged that he was hawking supplements to patients. While this is not necessarily illegal, it is ethically questionable, and if the patients were in the ER and not under his care, that would be a bad thing indeed.

Now, my initial stance on supplements is usually negative, but since further specifics weren't available, I withheld judgment, at least in writing. But now Arafiles' own words show us just how scary this guy is (and to thicken the plot further, court filings allege that the sheriff in this case is actually in the supplement business with Arafiles---a whopping conflict of interest).

Blogger Mike Dunford of The Questionable Authority has done the legwork to uncover some of these disturbing connections.  Among some of the most disturbing revelations:

Dr. Arafiles has appeared on infomercials on "God's Learning Channel" about so-called Morgellons syndrome, a form of delusions of parasitosis.  Arafiles has aligned himself with Randy Wymore and Marc Neumann, two big boosters of this non-disease:

 

Arafiles appears from this video to be one of the doctors who tells patients what they want to hear, instead of the truth.  But even more cynically, he tells patients they have this non-disease, and then sells them worthless "cures" such as colloidal silver.

His medicine show on God's Learning Channel continues on his commercial website  where he sells colloidal silver for everything from Morgellons to diabetes.  This last is particularly horrid, as nearly 10% of adult Texans have been diagnosed with diabetes, and effective treatments are readily available.  He even hawks "water alkalinization systems", helping perpetrate one of the stupidest medical myths after homeopathy.
This is one of the worst cases of outright quackery (at least, in my opinion) that I've seen from a licensed physician. He appears to make up diagnoses for patients, and then conveniently has just the right (unproved, profitable) cure to sell them.  This is no Pharma Shill gambit---when I prescribe medication for diabetes, it often costs a patient pennies a day and I do not profit from it, other than to see my patient get better.  When a doctor either invents or plays up a disease, and then profits from selling the cure, this is the most cynical, unethical, and immoral form of abuse.  
In this small Texas town, a nurse is now being subject to a malicious prosecution brought by a huckster and his partners who are not only using law enforcement to advance their business needs---they are the law.  There is nothing here that doesn't stink, and it keeps getting worse by the day.

5 responses so far

A travesty in Texas

Feb 08 2010 Published by under Medicine, Texas nurse case

There's a prosecution going on in Texas that sounds so corrupt, and could have such a chilling influence on the pursuit of quackery nationwide, that it cannot be ignored. I urge you to read the story in the Times, but here's a brief recap.

In Kermit, a small Texas town, two nurses at local hospital became concerned about the practices of one of the physicians, Dr. Rolando G. Arafiles, Jr. Among the alleged practices were the improper peddling of herbal medicines to hospital patients, and the performance of (sometimes unorthodox) surgical procedures without the appropriate privileges to do so. Anne Mitchell, RN, the nurse against whom charges are still filed, went to the hospital with her concerns and was fired, an act for which state reprimanded the hospital. Given the lack of response from the hospital, she went to the state medical board. When Dr. Arafiles found out that there was a complaint against him, he went to a local sheriff buddy of his, who tracked down the confidential report to the state medical board, and used the information in it to deduce the identity of the filers.

And then he charged them with a crime.

The alleged crime was a trumped up bullshit charge for misuse of state data---which is impossible, since the nurse used the hospital data to refer cases to the state medical board. I'm not a lawyer, but it's hard to see what could possibly be wrong with what Mitchell did.

In fact, the nursing code of ethics specifically requires nurses to advocate for patients, including going to higher authorities when necessary.

There is no "rule" that a code of ethics must square with all laws. In this case the ethical code probably does agree with the law, at least the spirit, and probably the letter.

Reading about the actions of these local officials is like watching Blazing Saddles---it's a small town, with a few people in control of everything, and willing to contort the meaning of the law into any shape they wish. If it weren't for the real people involved, it would almost be funny.

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23 responses so far

More on narcotic contracts

Feb 04 2010 Published by under Medicine

I recently raised some questions about narcotic therapy contracts and my readers raised even more issues. Some of these questions deserve further discussion.

First, despite the examples I gave, when I'm speaking about narcotic contracts I am talking about people chronically on narcotics. I don't normally use contracts for people with self-limited problems. That doesn't mean these patients aren't susceptible to the same problems as long-term users of narcotics, but the thinking is (based on what data, I don't know) that people with a clear, self-limited, anatomic problem, such as a kidney stone or broken hip, are less likely to develop a substance use disorder (depending of course on their baseline susceptibilities to such problems). This assumption may be complete and utter bullshit, and certainly there are people who become addicted after using narcotics for self-limited problems. Still, it seems (from crappy, anecdotal experience) that it's people with vague, chronic pain that end up causing health care providers the most problems.

Second, despite reservations I may have, and other cogent points made by my readers, I'm not about to stop using this tool. It may be a blunt instrument, but it's what we've got for the time being.  Even though we may recognize that these contracts may do more to protect providers than patients, and that narcotic use is not entirely volitional, these contracts serve an important purpose.  They recognize that narcotics are not like other drugs.  While someone may be dependent on insulin, they do not engage in illegal behaviors to obtain it, and they do not end up using it for that yummy insulin high.  They do not grow to crave it.  

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40 responses so far

Nursing students dressed in white

Feb 04 2010 Published by under Medicine

Medicine has traditionally been full of hierarchies. Employees' uniforms make their role easy to identify: one color for radiology techs, another for secretaries, etc. When I was a resident, medical students wore short white coats, residents long blue coats, and attendings long grey coats.
Medicine is also a traditionally male-dominated field, and despite the fact that a small majority of medical students are female, the higher academic and administrative positions are still male-dominated.
Nursing, on the other hand, is traditionally female. Nurses, despite their indispensable role in health care, are traditionally subordinate to doctors, a role made explicit by doctors giving "orders" and nurses following them.
Nurses have taken on a much more complex and diverse set of roles over the last several years. Critical care nurses and nurse anesthetists are some of the most highly trained and highly skilled of medical professionals.
So how come nursing students wear white, see-through scrubs?

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25 responses so far

More on Lacks ethics

Feb 03 2010 Published by under Medical ethics, Medicine

I'm heartened by the discussions of medical ethics arising out of The Immortal Life of Henrietta Lacks. From reading and listening to interviews with writer Rebecca Skloot, and from my brief conversations with her, I know that medical ethics were very much on her mind during the ten years it took her to create the book. If you read the book, you will see that she was also very concerned that she not be just another exploiter of the Lacks family. That's one reason comments such as this one are disturbing----and at the same time not really disturbing at all. It helps to highlight the amount of distrust the scientific community has managed to bank.

(As a reminder, Henrietta Lacks was an African American woman who died of cervical cancer in the 1950s and whose cancer cells, taken without her explicit consent, became one of the most important tools of modern biology.)

We've all benefited from research made possible by Henrietta Lacks and countless others whose names have been forgotten. The amount of distrust we've banked with the public over the years is considerable, and will take a long time to mitigate. But there are many reasons to try to improve our trust balance sheet, not the least of which is our own self-interest. 

But let's back up a bit and get a little deeper into how we understand medical ethics.

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10 responses so far

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