Death by homeopathic surgery

Normally, when I hear such a term as “homeopathic surgery” or of homeopaths doing surgery, I get the irresistable urge to make jokes about it, such as wondering if homeopathic surgery is surgery diluted down to the point where not a single cell in the body is injured or whether homeopathic surgeons make ultra-tiny incisions. Actually, that second quip risks confusing homeopathic surgeons with laparoscopic surgeons, and I’d never do that. I respect laparoscopic surgeons. Laparoscopic surgery is very difficult, and I have the utmost respect for my colleagues who can do complex operations through four or five tiny incisions, using long skinny instruments and a video camera. Unfortunately, via the Skepchick, I’ve learned of a combination of homeopathy and surgery that is no joke:

A homeopathic doctor was suspended Tuesday for his role in a botched liposuction operation earlier this month that resulted in the death of the patient.

A state regulatory board deemed Dr. Greg Page a “clear and present danger to the public.”

Page performed the liposuction procedure on July 3 at the Anthem office of Dr. Peter J. Normann, whose practice was restricted by the state in May after two other liposuction patients suffered cardiac arrest on the operating table and died.

Normann, who provided follow-up care in the July 3 surgery, was suspended last week, and both doctors are awaiting hearings with an administrative judge, who can revoke their licenses or reinstate them.

Page’s suspension by the Arizona Board of Homeopathic Medical Examiners followed a half-hour executive session and an hour of questioning. Page took part by phone.

This case, of course, raises a number of disturbing questions, the first and foremost of which is: WHAT WAS A HOMEOPATH DOING ANYWHERE NEAR AN OPERATING ROOM WITH SURGICAL INSTRUMENTS AND A HUMAN PATIENT ON THE TABLE?

Sorry, as a surgeon, I had to vent for a moment. This story is so amazingly tragic, but, even worse, it reveals something that I didn’t know about the state of Arizona:

Under state law, homeopaths may do “minor surgery,” and Dr. Bruce Shelton, president of the Arizona Homeopathic and Integrative Medical Association and former president of the Homeopathic Board, said whether liposuction can be considered minor surgery “is a huge gray area.”

“In my opinion, it (liposuction) is best left to plastic surgeons,” he said.

Ya think? That’s about as good a “well, duh!” statement as I’ve ever heard.

I’m flabbergasted that Arizona state law allows homeopaths anywhere near a patient with a scalpel, even if it’s just to remove a mole. They have zero training in surgery and zero appreciation of the complications that can occur as a result of surgery. Most plastic surgeons do a complete five year general surgery residency, followed by a two or three year fellowship to attain their skills. There are pathways that can shave a couple of years off of that process, but in the end there’s no way to be a fully trained, Board-certified plastic surgeon without at least five or six years of residency and fellowship training after medical school. Indeed, I know that part of the process of being Board-certified in plastic surgery includes a portfolio of case reports, complete with before-and-after photos. Moreover, there’s more than a little art to plastic surgery, given that the idea is to make the end result look as aesthetically pleasing as possible. As we say in surgery, you can teach a monkey how to operate. It’s knowing when and why to operate and knowing what to do when complications ensue that are hard to learn.

Why on earth would homeopaths even want to do surgery anyway? After all, we so often hear them criticizing “conventional” medicine for “cutting,” “burning,” or “poisoning,” particularly in reference to cancer treatment. Yet, here we have a homeopath cutting away. Moreover, he’s cutting away in the service of a cosmetic effect. Besides, wouldn’t the homeopathic treatment of excess fat involve the tried and true homeopathic principle of “like cures like,” you know, like taking a bit of fat from a piece of meat and then diluting it 100-fold 20 or 30 times to produce a 20C or 30C solution (which would have not a single molecule of fatty acid or cholesterol left in it) and then having the patient drink it? This homeopath seems to have fallen into something that is profoundly against homeopathic principles, at least as they are stated so frequently in the homeopathic literature that I’ve perused and by homeopaths who get all up in arms whenever I criticize homeopathy for the blatant quackery that it is.

Yes, I said it. Homeopathy is quackery. Period. I’m tired of being politically correct and dancing around it with words like “dubious” or “unproven.”

What’s even more depressing is looking at the confederacy of dunces who are “investigating” the incident, namely the Arizona Board of Homeopathic Medical Examiners, whose skill at getting to the bottom of this would embarrass Inspector Clouseau:

Dr. Garry Gordon, a member of the homeopathic board who practices in Payson, focused his questioning on the medications Page used during the procedure. Page said there was nothing out of the ordinary, but acknowledged that he did not know whether the patient had taken pre-surgical vitamins and minerals, as normally required.

No one on the homeopathic board asked whether liposuctions fall within the range of procedures that a homeopath is licensed to do. Chris Springer, executive director of the board, declined to comment on the matter because she is not a doctor, and the three doctors on the board also declined to comment.

That’s right. He seems to be saying that, if the patient had just taken her presurgical vitamins, she wouldn’t have died. I’ve seldom seen thinking so divorced from reality. Only in homeopathy-world could there be such medical idiocy stated with a completely straight face.

Sadly, though, when it comes to liposuction, it’s not necessarily just homeopaths who fall into the trap of thinking it’s just minor surgery. It’s not, especially when it takes 5 hours, as this case reportedly did, and when apparently a lot of fat was removed. Besides complications of unsightly contours that can result from removing fat carelessly without the eye for “sculpting” that good plastic surgeons doing the procedure develop, there can be life-threatening complications, including fluid imbalance, skin necrosis, serious infections, and fat embolism. Here’s what happened to the patient:

The patient that Page treated who died, identified only as LR, was a 250-pound woman who was having liposuction done on her thighs. It took about five hours, and Page left the premises an hour later, about 7 p.m., the medical board report said.

Normann stayed behind while the patient awaited a ride. He tried to rouse her from sleep at 9:50 p.m., was unable to do so, and 911 was called at about 10:10 p.m. The patient later died at the John C. Lincoln Deer Valley Hospital.

Page, a licensed homeopath since 2005, told the homeopathic board he considered the patient fine when he left.

“She was in a condition where I would have discharged her to her ride,” he said.

In other words, she was just “fine” until she keeled over dead.

I have to wonder: Did these incompetent boobs still have the patient hooked up to an IV? Were they monitoring vital signs? Urine output? It’s not surprising that Page would think the patient was “OK,” given that he had become a homeopath and thus had probably become used to assessing patients based on bullshit, but Dr. Normann should have known better. What was he doing to monitor the patient? What did he do between 7 PM and 9:50 PM? From the sketchy information here, my guess is that the patient probably died of fluid imbalances or a fat embolism. One has to wonder whether these clowns even knew that such complications were possible or that the mortality rate from liposuction procedures can be as high as 20 to 100 deaths per 100,000 liposuction procedures (making the very highest estimate for mortality 0.1%). Moreover, the highest risk is generally seen when large liposuction procedures are done at outpatient centers. I realize that a lot of nonhomeopathic incompetents who think liposuction is easy and know it’s lucrative have killed patients doing it (witness Dr. Peter Normann, Page’s nonhomeopathic enabler, who, according to the story had had two previous patients die of cardiac arrests while on the operating table for liposuction and apparently contracted Dr. Page to do liposuction for him). For example, I’ve heard of dermatologists trying to make a little extra dough doing liposuction and not realizing that it can have complications far worse than just cutting off skin lesions. However, I never thought that homeopaths would be interested in doing such surgery. It doesn’t fall within the purview of what homeopaths normally represent as homeopathy. Indeed, doing surgery seems inimical to the very concept of homeopathy. On the other hand, the concept of homeopathy is quite fluid, given that homeopaths frequently embrace all manner of woo other than homeopathy and incorporate it into their practice, making it sometimes difficult to tell what is and isn’t homeopathy. Even so, surgery always seemed out of bounds for homeopathy.

Of course, the utter absurdity of this case is to contemplate on what basis the homeopathic board would adjudicate and decide whether a violation of its standards has occurred. After perusing the statutes governing homeopathic practice in Arizona, I’m dumbfounded at how broad a scope of practice homeopaths are allowed there. It’s truly depressing (and unintentionally hilarious in places) reading. For one thing, apparently homeopaths are allowed to prescribe controlled substances! Looking over the website and seeing that homeopaths have to pass written and oral examinations to be licensed in Arizona made me profoundly curious about what, exactly, is on the examination. (Certainly, I’d love to add a question to ask a homeopath to calculate how many molecules of active substance one could find in a 30C homeopathic dilution.)

I once said that I thought, on the whole, that state regulation of professions such as homeopathy and chiropractic was probably better than no regulation at all, even though the regulatory bodies that regulate such “alternative” medical practices inevitably come under the sway of the very same dubious practitioners that they are supposed to regulate. This case makes me wonder if that assessment was incorrect. Either way, if I lived in Arizona, I’d be writing the Governor and my legislators demanding that this travesty of a “board” be disbanded. Whatever the faults of my own state in regulating medical professionals, I’m really glad that I don’t live in Arizona.

ADDENDUM: More on legalized quackery in the State of Arizona.