Beware, North Carolina. Beware. Dr. Rashid Buttar is free to practice medicine.

Beware, North Carolina. Beware. Your law has become quack-friendly to the point where doctors can do almost anything.

Why, you may reasonably wonder, am I saying this? The answer is what appears to be the end of a long and painful story of cancer quackery and anti-vaccine celebrity that has tainted North Carolina for years now. Do you remember Dr. Rashid Buttar? Regular readers know who he is, as he’s been a recurring character on this blog since the very beginning. Most recently, he figured prominently in the case of Desiree Jennings, the young woman who claimed that the flu vaccine caused a case of dystonia but was almost certainly suffering from a psychogenic disorder. Unfortunately for Ms. Jennings, she decided to seek out Buttar for “treatment” of her “vaccine injury. He subjected her to all manner of his usual woo, and–miracle of miracles!–she was miraculously cured!

Before this case, though, Dr. Buttar had been under investigation by the North Carolina State Medical Board for a variety of misconduct involving “unconventional treatments” to which he subjects autistic children and cancer patients, all for lots of money to line his pockets. At the time, over two years ago, Dr. Buttar lashed out at the medical board, characterizing it as a “rabid dog.” Ultimately, the medical board recommended restricting Dr. Buttar’s license to prohibit him from treating children or patients with cancer. Personally, I thought this was too mild a sanction and thought Buttar should have been “struck off” (lose his medical license in British lingo–you know, just like Andrew Wakefield is–hopefully–about to be struck off), but it was a start. Still, how does one justify letting a physician keep his license after he charged dying cancer patients tens, even hundreds, of thousands of dollars for ineffective “cures” for cancer, virtually all of which were based on the idea of treating “heavy metal toxicity”? I was also frustrated that Dr. Buttar could get away with what he got away with for so long unencumbered by regulations, the state medical board, or, apparently, any hint of morality. At the time, nearly two years ago, I had assumed that the story was over. I was unhappy, but at least Dr. Buttar couldn’t victimize cancer patients or autistic children any more.

I was wrong:

Dr. Rashid Buttar, whose alternative medical practice in Huntersville has been under scrutiny by the N.C. Medical Board for a decade, has accepted a reprimand from the licensing agency.

But Buttar, who was facing potential restrictions to his license, instead can continue offering unconventional treatments as long as he asks patients to sign a form acknowledging his practice is outside the mainstream.

“This was a witch hunt from the beginning,” said Buttar, 44, whose practice attracts patients from 42 states and 37 countries. “They were trying to discredit me … but I didn’t do anything wrong.”

The consent order, signed Friday, marks the end of a battle that Buttar had vowed to take to the U.S. Supreme Court. He said he has spent “hundreds of thousands of dollars” defending himself against the board’s allegations that he exploited patients by charging exorbitant fees for unproven therapies that didn’t work and by arbitrarily ordering expensive tests to make more money.

In recent years, Buttar led a successful effort by the N.C. Integrative Medical Society to get legislators to change state law to make it friendlier to practitioners of alternative medicine.

Buttar had lots of money, lots of political connections, and lots of persistence. He was willing to go to the Supreme Court, or so he said. When I heard about this consent order, I wondered why Buttar would agree to such an order rather than pursue his case, particularly in light of his bravado beforehand. After all, thanks to changes in the law, Buttar was actually in a position of far more strength than the state medical board:

Mansfield, the board’s attorney, said a change in state law, which took effect in October, was partly the reason. The law, one of those that Buttar had pushed for, prevents the medical board from disciplining a physician for using non-traditional or experimental treatments unless it can prove they are ineffective or more harmful that prevailing treatments.

Most of the patient complaints related to the cost of multiple treatments rather than to physical harm. In fact, the cancer patients had already undergone chemotherapy, which is known for its severe side effects.

I hate this false equivalency. Chemotherapy can have severe side effects, that is certain. However, it also has the capacity to cure various forms of cancer and to prolong life in the cases of cancer that is not curable. The side effects are usually (although not always) considered to be a price worth paying for the benefits. In the case of quackery such as what Dr. Buttar plied (in my opinion), any harm that occurs is done without hope of benefit. Worse, the law as written handcuffs the medical board. A lot of the nonsense that “practitioners” like Buttar use has never been formally tested, allowing quacks to claim that the board can’t “prove” that their woo is ineffective. It’s a loophole a battleship full of quacks could steam through, and that’s exactly what Dr. Buttar did. In reality, what the standard should be one standard for every treatment in medicine, namely that it should have strong evidence that it is efficacious and safe, not a favored status for “non-traditional” treatments whereby anything goes unless science can prove them to be unsafe or ineffective. As for experimental therapies, they should not be administered outside the auspices of an IRB-approved clinical trial or under carefully regulated “compassionate care” programs. If a treatment is experimental, the run-of-the-mill practitioner not involved in clinical research should not even think of using it.

But back to why Dr. Buttar might have agreed to this consent decree. The answer becomes obvious if you peruse the actual consent order. All it does is to reprimand Buttar and order him (1) to provide informed consent to his patients dictated by the board; (2) to obey all laws, as well as rules and regulations governing the practice of medicine; (3) notify the board if he changes his address; and (4) meet with the board periodically. In other words, Buttar got a slap on the wrist.

But it’s even worse than that. Peruse the attached “informed consent” documents. They are pathetic. That’s the only word I can think of that adequately describes them. Basically, they state that Dr. Buttar makes no claims for the efficacy of anything that he does. Granted, it does point out that Buttar sells his remedies in his office, which is a massive conflict of interest, one that is illegal in most states. It also points out that serious complications can occur from IV treatments. Even so, if I were to use an informed consent like this for surgery, for example, in which I “make no specific claims” that the surgery will do anything for the patient, sane practitioners would demand to know why I was allowed to do this operation. I ask why Dr. Buttar is permitted to practice his woo on unwitting patients.

Not surprisingly, Dr. Buttar is bragging. He’s holding up cases of patients who lived longer than expected under his woo and takes credit for it. He’s issuing self-serving press releases that say things like this:

“To have many of my treatments in a consent order with NO restrictions is nothing less than condoning and accepting these advanced forms of treatment. I insisted on this language and was not willing to accept anything less,” Dr. Buttar said. “My attorneys and I had prepared for this fight for the last 3 years. We were ready to go to trial before a real judge but the NCMB realized they had to avoid scrutiny in a real court of law, and had no choice but to abandon their prosecution.”

Dr. Buttar has committed years of his life to what he believes. He is the Medical Director of the Center for Advanced Medicine and Clinical Research in Huntersville, NC, founded in 1996 with the purpose of giving those with “untreatable” conditions a chance to recover.

[…]

With the NCMB investigation behind him, Dr. Buttar can now focus on the release of his first book, “The 9 Steps to Keep the Doctor Away,” due for release on June 1 and available at all major book stores. It’s another step toward realizing his goal of “making the change the world is waiting for,” a motto inscribed in larger-than-life-sized letters on the walls of his clinic.

Actually, all that Dr. Buttar appears to have devoted his life to is separating patients from their cash. Whenever I hear supporters of “alternative medicine” lament how much they are “persecuted” by the medical establishment, these days I can’t help but laugh. Some “Inquisition”!

One of the most controversial and difficult aspects of trying to make medicine more science-based is the question of how to enforce a minimal standard of care. This standard of care, in an ideal world, should be based on science and evidence, and state medical boards should be empowered to enforce this standard rapidly whenever a practitioner can’t even meet a minimal standard of using treatments based on sience and evidence. Such is clearly not the case in North Carolina, and, sadly, such is not the case in many states. With medicine being regulated at the state level, there are 50 state medical boards, each with different laws governing licensure requirements and standards for disciplining wayward physicians, our current system doesn’t even do a very good job of protecting the public from physicians who practice obvious quackery.

The reasons are many. Most state medical boards are underfunded and overburdened. This chronic underfunding means that state medical boards tend to be slow to react until and unless actual patient complaints are made and there is actual evidence of patient harm. Also, in my experience, state medical boards tend to prefer to go after physicians who misbehave in particularly egregious ways: alcoholic physicians or physicians suffering from other forms of substance abuse; physicians who sexually abuse patients; or physicians who are “prescription mills” for narcotics. These sorts of cases are relatively clear cut. They are easy for the public to understand. Most importantly such cases don’t force boards to make value judgments regarding the competence and practice of physicians to nearly the extent that prosecuting purveyors of unscientific medicine does. Prosecuting someone like Dr. Buttar, who not only has deep pockets and a willingness to use them but is willing to blur those lines with gusto exposed all these shortcomings of state medical boards. Worse, like many woo-meisters, Buttar had testimonials:

Many of Buttar’s patients came to his defense in 2008. Among them was Elrene Thomas of Lexington. When contacted Tuesday, she was pleased to hear that Buttar can continue to practice. A retired nurse, she went to him for treatment seven years ago when she learned her breast cancer had spread to her spine. Instead of going through chemotherapy and radiation again, she tried IV infusions five days a week for months and had hyperbaric oxygen therapy twice a day for several weeks. She paid Buttar’s center $100,000 and said it was worth it.

“I really feel like he saved my life,” said Thomas, 77. “I’m not healthy in that I have stage 4 (cancer), but I’m surviving and I’m doing all these things that he taught me to do. I believe in his treatment.”

$100,000 for IV infusisons over months plus hyperbaric oxygen chamber treatments? And “alt-med” mavens complain that chemotherapy is expensive! Some drugs can add up to $100,000, but many chemotherapy regimens are much less expensive than this. In addition, Thomas’s case says absolutely nothing about whether his methods “work.” As I’ve described again and again, breast cancer can differ biologically so much that there are outliers who can live for years with stage IV disease. In fact, patients with bone-only metastases and estrogen-receptor positive/HER2-neu negative tumors are the patients who tend to be these outliers. (I’d be willing to bet that Thomas’ tumor was ER(+) and HER2(-).) Among patients with stage IV disease, patients such as these have the best prognosis. Thomas can “believe” in this treatment as much as she wants (apparently to the tune of $100,000 and counting), but her belief is meaningless for evaluating whether the treatment works. Mrs. Thomas is simply another patient being taken advantage of for big bucks by Dr. Buttar.

The North Carolina State Medical Board did the right thing to go after Dr. Buttar. He had been practicing too long with impunity, peddling his “Buttar’s butter,” a “transdermal chelation” therapy, and separating desperate cancer patients from tens of thousands of dollars of their cash. Unfortunately, the board didn’t have the intestinal fortitude to take it all the way, no doubt thanks to the changes in the law that made their job of protecting patients from quacks virtually impossible now. In the battle between a woo-meister like Buttar and the medical board, unfortunately the medical board blinked first. It probably had little choice.

If I lived in North Carolina, I’d be very worried right now. Remember, Dr. Buttar is the guy who treated autistic children with urine therapy. If that doesn’t get his license yanked, nothing will.