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Another preventable death thanks to alternative medicine

What is it about Florida and quacks? It’s as though it’s the Wild West there when it comes to regulating the practice of medicine. There, quacks can get away with almost anything, or so it would seem. After all, Brian Clement, who isn’t even a doctor and isn’t even really a naturopath either, has been practicing his quackery for decades, even going so far as to travel to Ontario to look for new marks among the indigenous peoples and to Europe and the UK, leading to at least one preventable death and to a young mother with incurable breast cancer to waste her precious remaining time and effort pursuing dubious treatments before dying. The sorts of treatments administered by Clement’s Hippocrates Health Institute include various detoxification schemes, juice fasting, wheatgrass enemas, “bioenergy” treatments, ozone pools, far infrared saunas, and much more. yet, for some reason, even though the State of Florida has tried to shut Clement down, it’s failed.

Clement, unfortunately, is not alone. I just learned of another quack in Florida. This time, the quack is a real doctor with a real MD, which makes it all the worse in my eyes, because real doctors are regulated by real state medical boards, who can take away their medical licenses. Of course, as I’ve discussed many times before, medical boards seem inexplicably reluctant to take that step, even for obvious quacks. I tend to think that the reason consists of a combination of fellow physicians’ “there for the grace of God go I” attitude towards other physicians and, more importantly, a lack of resources, particularly in states controlled by governments with a lot of anti-regulation legislators and governors. That latter problem contributes to medical boards prioritizing straightforward cases, such as docs impaired due to substance abuse or docs who diddle their patients, over shutting down quacks, which is harder to do because it’s harder to prove that something is quackery that is a danger to the public than it is to show that an impaired or sexually inappropriate doctor is. You almost can’t blame them in a way. Their charter is to protect the public, and they have to decide whether to put away several impaired doctors or to shut down one quack.

Here’s one they’re trying to shut down now in Florida, Dr. Kenneth Wollner, and what he is accused of doing:

Stephanie Sofronsky was just 23, close to graduation from Florida Atlantic University, when she learned she had lymphoma.

She didn’t want to believe it. So she sought a second opinion from Moffitt Cancer Center in Tampa and a third opinion from Mayo Clinic in Jacksonville, state records show. Moffitt double-checked with the National Cancer Institute.

All confirmed that Sofronsky had Hodgkin lymphoma, a cancer that attacks white blood cells. They said she had an 80 percent chance of beating it with chemotherapy.

Hodgkin’s lymphoma. Why is it always Hodgkin’s lymphoma? OK, it’s not always Hodgkin’s lymphoma, but it frequently is. What’s so frustrating about seeing young people with Hodgkin’s lymphoma choosing quackery instead of effective medicine is that Hodgkin’s lymphoma is so treatable for cure. Indeed, even stage IV Hodgkin’s lymphoma can be cured about 65% of the time. Sofronsky must have had stage III Hodgkin’s because the story says she had an estimated 80% chance of beating it with standard treatment. Remember, Hodgkin’s disease is usually treated with a combination of chemotherapy and radiation therapy.

Of course, the problem is the chemotherapy. Of all the treatments for cancer, chemotherapy tends to be what scares people the most. It’s understandable. Take breast cancer, for instance, which I treat surgically. Most women operated on for breast cancer undergo fairly small operations, but even for those who undergo mastectomy, the recovery is generally within a month and the pain not long lasting. Chemotherapy, on the other hand, goes on for months and can in some cases make the patient feel worse than any surgery. It also doesn’t help that there is a narrative that chemotherapy is so toxic that it kills people before the cancer can, and ineffective, to boot, a false narrative fed by online anti-medicine cranks like Mike Adams. When someone whose outlook has been influenced by such a narrative hears the pitch from someone like Dr. Kenneth Woliner, who bills himself as an “integrative medicine specialist” in Boca Raton.

The decision of Administrative Law Judge Mary Li Creasy, who held two days of hearings in February and issued her opinion in late April, is chilling reading. It turns out that Sofronsky was originally diagnosed with peripheral T cell lymphoma, but after a second opinion a diagnosis of Hodgkin’s lymphoma was settled on. She went for a third opinion from Dr. Vivek Roy, who confirmed the diagnosis of Hodgkins lymphoma and recommended standard chemotherapy. Initially, Sofronsky appeared as though she were going to pursue standard of care for her Hodgkin’s lymphoma (HL), but then:

40. A few days before S.S.’s appointment with Dr. Rothschild, M.S. asked Respondent if it were possible that a “toxic something” was causing all of S.S.’s symptoms, including her swollen lymph nodes.

41. Instead of telling M.S. that S.S.’s symptoms, including her swollen lymph nodes, were more likely caused by her untreated cancer, Respondent suggested that S.S.’s house be tested for mold.

42. On July 5, 2011, S.S. presented to Respondent for a “check-up” and to discuss the little bit of mold that was found in her home. During the appointment, S.S. mentioned to Respondent that she met with Dr. Rothschild to discuss chemotherapy for her HL.

43. Respondent reiterated to S.S. that cancer was “low on his list” of possible medical concerns. Respondent indicated that S.S.’s tests showing she had increased lymphocytes9/ were not indicative of cancer, especially since he did not see any “Reed- Sternberg” cells.10/ Respondent insinuated that oncologists often overreact to the presence of lymphocytes and recommend chemotherapy before making an actual diagnosis. Respondent further insinuated that Dr. Rothschild may not be a competent oncologist.

44. Respondent recommended S.S. pursue her “mold allergy” issues and referred her to Daniel Tucker, M.D., a local allergist.

45. Respondent also provided S.S. with a letter addressed to Dr. Rothschild wherein he emphasized that “mold could be causing all of [S.S.’s] symptoms and exam findings.”

So basically, Sofransky decided to abandon standard of care treatment that had a high probability of saving her life in favor of Wollner’s rejection of the diagnosis made by pathologists at an NCI-designated comprehensive cancer center (Moffitt) and subsequent claim that all her symptoms were caused by “allergies” and other issues—anything but the cancer.

The last nearly two years of the narrative are painful to read about. Sofronsky kept developing new symptoms, all of which were consistent with progressing lymphoma, including complaints of back pain, more lymph node swelling and pain (which Wollner treated with low dose Naltrexone), leg swelling, increasing abdominal pain and swelling (which Wollner attributed to an allergic reaction), and weakness. Finally, she collapsed and died three days after a visit to Wollner’s office for a complaint of “pain and severe swelling in her legs,” which was almost certainly caused by growing lymph nodes in her pelvis pressing on the veins draining blood from the legs.

Even after the autopsy conclusively showed that Sofransky had died of complications of Hodgkin’s lymphoma (to which Wollner responded that the patient had never been diagnosed with Hodgkin’s lymphoma), Wollner remained in denial:

84. Despite having reviewed S.S.’s radiographic, pathology, and oncology consultation reports indicating that S.S. had HL,15/ and having treated her symptoms indicative of progressed HL for nearly two years, Respondent refused to believe that S.S. had HL, choosing instead to believe that she presented “more like a [chronic fatigue] patient allergic to mold than a lymphoma patient.”

85. It was not until Respondent received the final autopsy report, several months after S.S. died, that Respondent was finally “satisfied” that S.S. had HL all along.

I took a look at Wollner’s website. He actually presents a rather interesting conundrum—not to me, mind you, but to promoters of the specialty of “integrative medicine,” or, as I like to call it, integrating quackery with medicine. His practice does not take insurance and bills itself as offering concierge medicine with:

  • Second opinions for “Difficult-to-Treat” medical conditions
  • Functional Medicine. Find and treat the cause of your condition not just cover up the symptoms
  • Nutritional IV Therapy
  • Bio-Identical Natural Hormone Replacement Therapy for Menopause
  • Individualized Treatment of Thyroid Disorders using all medications including Armour Thyroid and Nature-throid
  • Effective Weight Management for Men, Women and Children
  • Medical and Nutritional Therapies for Chronic Fatigue, Insomnia, Hair Loss, Diabetes, High Cholesterol and other medical conditions
  • Effective Pain Management for Fibromyalgia ,Arthritis, Back and Neck Pain using Trigger Point Myotheraphy
  • Holistic Therapies for Osteoporosis using diet, exercise and vitamins

I guess that second opinion for Sofransky’s “difficult to treat” medical condition didn’t work out so well. Of course, Sofransky wasn’t that difficult to treat. She had Hodgkin’s lymphoma, and even if she had actually had a peripheral T cell lymphoma, both diseases have pretty straighforward treatment protocols. Be that as it may, the above doesn’t describe everything. Wollner treats candida infections, for instance, in a manner that naturopaths do when blaming a vast panoply of vague symptoms on “chronic candida infection.”

On his website, Wollner touts the following credentials:

  • American Board of Family Medicine (ABMS) – July 2000, Re-certified August 2007 and 2013; valid through Dec 31, 2017
  • Board Certified Integrative Medicine (ABPS) – Certified February 5, 2015, valid through December 31, 2023
  • American Board of Integrative Holistic Medicine – Certified 1997; Recertified November 2013
  • Institute for Functional Medicine Certification Program – Certified November 2013
  • U.S. District Court for the Southern District of Florida – Qualified as an expert witness, October 11, 2013.

Well, that last one is good to know.

Remember how I discussed the board certification in integrative medicine, how it was Andrew Weil’s attempt, in collaboration with the American Board of Integrative Holistic Medicine, to bring respectability to the specialty? Here’s the problem. “Integrative” medicine “integrates” the very practices that Wollner used on Sofransky. Oh, sure, the academic integrative medicine specialists in their ivory towers of academia will deny that integrative medicine encompasses anything that isn’t evidence-based, and maybe in university academic medical centers integrative doctors can delude themselves into believing that’s true even as they recommend acupuncture, reiki, traditional Chinese medicine, functional medicine, naturopathy, and even high dose vitamin C for cancer. And maybe at academic medical centers, there is even a modicum of quality control. However, when you get out into the community, what you’re dealing with when it comes to integrative medicine are docs like Dr. Wollner.

Indeed, the story about this case is even more damning, as it points out:

Dr. Stephen Silver of Boca Raton, the only integrative medicine specialist who testified. He said Woliner’s treatment was appropriate.

And:

Neither of the two expert witnesses for the state was qualified to judge Woliner’s handling of the case because neither of them practices or is trained in integrative medicine, the attorneys argue.

The irony is rich. Wollner’s defense was an “integrative” doctor who said his treatment was appropriate and to criticize the state’s two expert witnesses for not being trained in integrative medicine. That’s what we’re talking about in the community far more often than the integrative doctors in ivory tower academia would like to acknowledge.

Patients like Stephanie Sofransky pay the price.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

41 replies on “Another preventable death thanks to alternative medicine”

Ah, more carpet bombing and damnation of everything unapproved, for some young unfortunate soul. Damnation including ye olde vitamin C, which is not a single entity in cancer treatment.

Now I don’t believe in vitamin C as a likely monotherapy for most cancer in today’s market. It does appear to favor certain kinds of cell lines, KRAS mutant CRC in recent papers. We have found it useful against in combination with chemo where the chemo without enough vitamin C had repeated marker doublings, almost 40 fold cumulatively over several years, mostly with various treatment slippages. Interestingly, simply continuing chemo and doubling the IV dose drove the cancer marker back down to the normal range in 6 months.

)ver 60 years (figure Klenner’s hospital experience in the 1950s) and we can’t get straight research, collocation of results, reporting or collaboration on the collective experience base of IV vitamin C because of an atmosphere of oppression, fear and ridicule that restarts the learning curve to near zero with each generation of doctors.

Wow. I was confused about some details and checked the links to the news story (‘ what he is accused of doing’) and the Judge’s decision. Orac left out a lot of stuff. Most importantly, from the WLRN article:

The case may raise the profile of “integrative medicine,” a newly-recognized specialty sponsored by the American Association of Physician Specialists, a Tampa-based group. Woliner’s website says he is certified by that group’s American Board of Integrative Medicine. James Marzano, director of public relations for the association, declined in an e-mail to comment, saying the Woliner case “has nothing to do with board certification.”

It is highly unusual for a single incident of alleged malpractice to end in a revoked license, even if the patient dies. But this incident doesn’t fit the pattern for malpractice complaints, which tend to involve a late diagnosis or an error in treatment. In the Sofronsky case, hearing officer Creasy said, Woliner knew the diagnosis and chose not to believe it, or at least failed to follow up.

Woliner’s current attorneys, George Indest III and Lance Leider of The Health Law Firm in Altamonte Springs, have filed numerous objections to Creasy’s legal conclusions and are expected to mount a fierce defense. In written motions, they argue:

— Sofronsky was a mentally competent adult who had been advised of her cancer diagnosis by at least five cancer specialists. “Dr. Woliner cannot be held responsible” for her failure to take their advice, they wrote.

— The hearing officer erred in calling Woliner Sofronsky’s primary care physician, who would have been required to refer her to an oncologist and counsel her to go through with the chemotherapy. They argue that as an integrative medicine specialist, he was not her primary care physician. “Dr. Woliner was engaged to investigate Sofronsky’s thyroid issues, not to diagnose or treat her cancer,” they wrote. Even though he was trained in Family Medicine, Woliner was no longer practicing that specialty, his attorneys say. He was practicing “integrative medicine,” and thus could only be reviewed on that basis.

— Neither of the two expert witnesses for the state was qualified to judge Woliner’s handling of the case because neither of them practices or is trained in integrative medicine, the attorneys argue. One was Dr. Roy Ambinder, a cancer specialist in Altamonte Springs, and the other was Dr. Charles Powers, a Family Medicine specialist in St. Cloud. Both said Woliner’s treatment amounted to malpractice. But Woliner’s attorneys said the hearing officer should have listened to defense witness Dr. Stephen Silver of Boca Raton, the only integrative medicine specialist who testified. He said Woliner’s treatment was appropriate.

Second, Orac has just touched the surface of the chilling stuff in the narrative detailed in the judge’s decision. IMHO, the comparison of Woliner to Brian Clement isn’t exaggerated at all. It sure looks like he just slo-motion murdered Stephanie Sofronsky for the pupose of draining her mom’s bank account.

i have lots of questions — I don’t really understand how these license challenges work (also not clear to me re: Bob Sears)… Nor do I understand the legal ramifications, if any, of board certification, or how the Medical Board license decision might relate to criminal prosecution or civil litigation. And then there are questions about the details of the narrative… But I’m too tired to think or type straight, so I’ll come back after I get some sleep.

@ prn

Ah, more carpet bombing and damnation of everything unapproved,

WTF?
As I read it, Wollner is guilty of misdiagnosis, going all the way into gross medical incompetence and negligence.
Mold allergy, indeed. I suspect Wollner had a fungus for a brain.
Whatever Wollner prescribed to the poor girl is next-to-irrelevant. It’s certainly not about “damnation of everything unapproved”. It starts with making a proper diagnosis and checking your initial assessment when the patient doesn’t improve, instead of doubling-down on unnamed “allergies”.
A regular doc does this, he should be disbarred and send to the street. I mean it.

You read this article, and all you can do is whine about your freeling ascorbic acid.

Not a single word about Wollner or the poor girl.

You are not better than him. Just like him, an obsessed prick with a pet theory of a cure-all panacea.

Go away.

Dr. Stephen Silver of Boca Raton, the only integrative medicine specialist who testified. He said Woliner’s treatment was appropriate.

By the standards of Integrative Medicine, treating HL with benign neglect is “appropriate treatment”.
Woliner’s attorneys have damned the whole scam so thoroughly, we can all go home now.

Comment #1 is just plain wrong, and using one of the oldest tropes in quackery’s book:

Vitamin C and chemo is not an effective combination treatment – the latter is, and your vitamin dosage is virtually irrelevant. But by piggybacking nonsense onto legitimate medicine, claims like yours can be made. Show the statistically significant correlation instead of fuzzy logic, please.

“Neither of the two expert witnesses for the state was qualified to judge Woliner’s handling of the case because neither of them practices or is trained in integrative medicine, the attorneys argue.”

This is rich in irony, seeing that “Respondent (Wollner) indicated that S.S.’s tests showing she had increased lymphocytes9/ were not indicative of cancer, especially since he did not see any “Reed- Sternberg” cells.”

One gathers from this statement that Wollner fancied himself a pathologist, looked at slides(s) and concluded that there weren’t any Reed-Sternberg cells, so it wasn’t Hodgkin’s lymphoma.
The problem here is even if Wollner knew what he was looking for, not all Hodgkin’s cases contain classic Reed-Sternberg cells.

Hematopathology is a challenging enough subspecialty for those trained in it. Wooncologists should stick to sniffing out mold.

Decades of science to be able to treat condition like this… Stupid people ignoring the truth, killing 23 years old women to make some money. Getting away with it, indeed. I really wonder how those quack can sleep, this is so sick.

By the standards of Integrative Medicine, treating HL with benign neglect is “appropriate treatment”

Yep, that “integrative medicine” expert witness did the specialty no favors with that testimony.

This is rich in irony, seeing that “Respondent (Wollner) indicated that S.S.’s tests showing she had increased lymphocytes9/ were not indicative of cancer, especially since he did not see any “Reed- Sternberg” cells.”

One gathers from this statement that Wollner fancied himself a pathologist, looked at slides(s) and concluded that there weren’t any Reed-Sternberg cells, so it wasn’t Hodgkin’s lymphoma.
The problem here is even if Wollner knew what he was looking for, not all Hodgkin’s cases contain classic Reed-Sternberg cells.

One wonders if Dr. Wollner was too used to doing live blood analysis to have seen the features of lymphoma. (I have no idea of he does live blood analysis, but it wouldn’t surprise me.)

I can’t help but note that there was no disagreement between the pathologists at different cancer centers over whether this was a lymphoma. They just disagreed over whether it was a peripheral T-cell lymphoma or Hodgkin’s disease. There’s no doubt that it’s a lymphoma. Dr. Wollner disagreed, despite having no qualifications to do so, and instead treated the lymphoma as though it were an allergic reaction. Even as the patient’s lymph nodes got bigger and she developed more signs and symptoms of progressive lymphoma, he “stayed the course”—until the patient died.

Dangerous things happen when people fancy themselves pathologists without the requisite credentials and training. Had a run-in on Twitter with a former phlebotomist/lab tech that fancied herself a pathologist yesterday.

@Orac, as a man who formerly killed people for money as an occupation – that is what a soldier’s job is, *I* can’t see how that man can sleep at night.*

But, comment #1 and the rest of the story do help build an alarm bell filter. Screeding on about megadose vitamin C, big warning flag. “Blame the mold” in an absence of evidence of allergy in blood films, excellent new alarm flag.
Something that recent life experience in the mystifying case of my wife’s blood work outlines. RBC’s, always elevated, CO2 always elevated, oh, she’s a smoker (yeah, we know where the punch line is going, we just have to get around to checking CO levels). Neutrophils will elevate randomly. Eosinophils also are currently elevated. She also coughs periodically, consistent with asthma, with a sister with asthma.
Our *real* doctor prescribed a highly effective inhaler for her. A quack will go for all manner of exotic things, likely (one current trend that has been ongoing for a while, mold).**
Usually, the blame goes to “black mold”.
Interestingly, I’m highly allergic to one species of “black mold”. Allergic as in, a one square infested area sends me outside vomiting, gasping around massive amounts of mucus and feeling rather faint.
Fortunately, that specific species is common in the wild and rare in any home environment, as it needs highly specific conditions under which to grow. Let’s face it, common household “critters” are ones we usually tend to tolerate or only have mild symptoms from (dust mites, common mildew, etc).
So, let’s add an additional flag, zebra hunting. A “doctor” who look for zebras whenever he or she hears hoof beats.
No, horses are more common than zebras, many zebras are endangered, others, extinct.
Alas, the horse’s ass seems to be thriving off of those who are ill.

*OK, I also got to help run rural clinics, help build schoolhouses and even help fix sanitation issues in some really, really remote areas.

**I’m of the suspicion that some of her constellation of issues are unrelated to her severe degenerative disc disease and advanced osteoporosis, but related to incipient liver failure.
Decades of higher than necessary APAP loads, plus ignored bilary obstruction from gallstones (dismissively regarded as sand) resulted in cirrhosis that is scheduled for biopsy. To ascertain from the blood work and diagnostic imagery, I suspect it won’t be good.***
Woe unto the woo peddler that tries to ply their wares with us. Those ‘gators down the road are hungry.

***She’s taken to falls of late – a lot of falls. To the point when, when I identified an apparently trustworthy homeless couple trying to earn money doing odd jobs, well, they’re living with us, worried about her as well. We also have a superpower, that of having people tell their honest life story to us, both good and bad. They’re a couple where the male made a few bad life choices, the legal system destroyed the rest of his life potential, as this area punishes convicted people for life with deprivation of rentals and purchases, as well as employment difficulties.
An area that I actually wanted to address when employment forced us to move here. One entity of life has odd, both way biting teeth: serendipity, it can and will insist. 😉

P.S.; As for humor, do look up your local EMT population and ED population to begin to understand. The oncology treatment population tend to be a bit grimmer than we, who have a humor type that’s as mercurial as the EMS situation in general reality.
Besides, we always love friends from outside of work.
While we do understand the oncology community, I’ll admit a massive gap in comprehending the minds within the NICU community. But then, that job would utterly destroy us. But then, I’d distract from the tangent already introduced, with my apologies. Really bad week.
Had to unload, but also remain on topic, primarily.

I’d create my own blog, but I’d get sued, as it’s be called, “Life Stinks – see Mel Brooks”.
Maybe I could get away with calling it, “Pepto’s blog”?

Overlapping with Dangerous Bacon’s point, but still worth spelling out explicitly: if the specialists here are not qualified to speak on integrative medicine because that’s not their specialty, Wollner was not qualified to speak to a diagnosis of cancer and should not have tried to challenge the experts on that.

They can try to have it both ways, but Amy competent administrative or regular judge should reject that.

But, comment #1 and the rest of the story do help build an alarm bell filter. Screeding on about megadose vitamin C, big warning flag. “Blame the mold” in an absence of evidence of allergy in blood films, excellent new alarm flag.

Add to these warning flags the following:

[Wollner’s] practice does not take insurance

I’ve noticed a pattern that several of the practicing doctors at whom Orac has directed his Respectful Insolence do not accept insurance: Bob Sears, Jay Gordon, Stanislaw Burzynski, and now Kenneth Wollner. It’s almost as if they fear (reasonably so, IMO) that an insurance provider would disallow many of their treatments, and they want to make sure they get paid.

How does a competent doctor mistake lymphoma for mold allergy?

Well, I wouldn’t know obviously, but I don’t think that’s the relevant question. What does it say when a licensed MD, board certified in Family Medicine, knowing that his patient has been diagnosed with lymphoma by the U of Miami, Moffit, NCI and Mayo, suddenly decides to attribute her severe symptoms to a mold allergy, and persists in treating her for ‘allergies’ for two years as her condition continues to decline, despite the fact the allergist to whom he referred the patient diagnosed only a mild mold allergy and recommended only “a series of life-style modifications to reduce her mold allergy symptoms”?

This wasn’t your classic misdiagnosis, just mistaking symptoms on one thing for another. Wollner began treating Sofronsky in March, 2011. He didn’t come up with the allergy ‘diagnosis’ until late June, AFTER he had received PET scan results from Mayo “indicating that S.S.’s malignancy progressed to her pelvic region.” AFTER Dr. Roy from Mayo affirmed the HL diagnosis, recommended chemo, and had Sofronsky schedule an appointment with the hematologist (Rothschild).

Misdiagnosis? Or just pulling something/anything out of his ass to keep Sofronsky from starting chemo, and instead keep coming to his cash-only practice for ‘treatment’ of her advancing illness. And how do you call it ‘misdiagnosis’ of allergy instead of lymphoma when Wollner gets the info that the actual allergist didn’t even put Sofransky on antihistamines, much less immunotherapy?

Read items 20-85 in the decision, and give me your IANAL opinion: Does this look more like a petition to revoke a medical license, or an indictment for first degree murder?

This wasn’t your classic misdiagnosis, just mistaking symptoms on one thing for another.</blockquote?
This isn't a classic misdiagnosis, this is mistaking one's wife for a common canine.
This is either the most pure and distilled case of medical incompetence or malfeasance.
In the former case, were this a family member of mine, we'd not be in court, he'd be missing, with some 'gators well fed.

It *really* is that simple and I'm being very, very honest.

This wasn’t a misdiagnosis, it was a clear path to empty her bank account and tap any insurance coverage she had.

Had a run-in on Twitter with a former phlebotomist/lab tech that fancied herself a pathologist yesterday.

That would be Australia’s favorite florist, Angela Coral Eisenhauer? Yes, she habitually over-represents her credentials.

I am in the panhandle of Florida. This is truly the wild, wild West. All of my personal physicians are callous, unpleasant burnouts who know most of their patients have neither the resources nor education to challenge the mediocre quality of their care. It is sad, depressing, infuriating. I have spent thirty years in academic medicine and know a bad doc and a burnout when I see one, and there is almost almost nothing I can do here. I feel totally helpless to help people who know less than I do about the deficiencies of care here. There is a dead end for what I think I can do. Totally maddening and very, very upsetting.

To add to the original post…..This state board is totally, totally corrupt. I can’t post evidence for that to someone else’s blog. They are failing good docs and the public in outrageous ways.

@shay simmons

Ding! Ding! Ding! We have a winner.

I took her at her word at first, but then decided I should probably check to verify her claim. Color me oh so surprised when I discovered that she misrepresented herself, after misrepresenting a study, my comments, Dr. Boonstra’s comments…

At any rate, that’s neither here nor there.

” Usually, the blame goes to ‘black mold'”

So true.
Although I haven’t heard as much recently ( at those sinkholes of altie lunacy I survey**) very much about either black mold or (( shudder)) yeast/ candida.

I suspect that once they get someone in their offices, the big guns come out: mold, yeast, parasites, adrenal insufficiency, vitamin deficiency ,lack of magnesium, low qi, ad nauseum.

A few months ago, one of my gentlemen sent me to a ( supposedly) famous acupuncturist at his expense, about which I’ve related @ RI::
to make a long story short, after 3 sessions of manual manipulation ( 3 times), needles (n 3 times) and (((( double shudder)))) cupping ( once was enough!), she suggested that I had low qi and needed ‘supplements’.

From what I’ve observed, woo- meisters attack illness by attributing most symptoms to single causes ( like inflammation or toxins or the aforementioned) and then, use multiple treatments to ameliorate these causes- including dietary injunctions/ cures.

All of which yields profit .

** they’re too busy with politics

Todd – true. But it’s amazing how readily the anti-science crowd discounts the value of professional training and experience (as evidenced by some mothers’ group now TESTING VACCINES FOR GLYSOPHATE OMGMERCKMONSANTO!)

@shay

They claim the respectability of titles and expertise, but then denigrate the same titles and expertise as meaningless and unnecessary. Like everything, they’re good when they enable the frauds to grift their marks, but worthless when it goes against them.

@Orac

Saw that she’s in a pique over your not replying to her email.

@sadmar: I have to agree with wzrd1 here. This was indeed a misdiagnosis of a nature that qualifies as malpractice, and that was explicitly one of the issues before the judge here.

The position taken by Dr. Silver, the expert witness for the respondent, is quite brazen. From the judge’s opinion:

89. Stephen Silver, M.D., testified on behalf of Respondent and opined that Respondent’s role in S.S.’s care was as an out-of-network, adjunct holistic doctor, more comparable to an acupuncturist or Reiki specialist than a medical doctor. Dr. Silver suggested that Respondent should not be held to the same standard as other family medicine doctors providing primary care services.

The judge, to her credit, rejected this position. But even if she hadn’t, Dr. Woliner would have been explicitly labeled as the equivalent of an acupuncturist or Reiki practitioner rather than an M.D. The latter, as regular RI readers know, is one of the more ludicrous forms of woo out there, rivaling homeopathy in the obviousness of its nonsense.

‘how the anti-science crowd discounts the value of professional training and experience’ – shay simmons

Absolutely.

Since 2008-9, I’ve noticed that amongst the woo-ready on the net, the suspicion of SBM/ doctors/ psychologists
has mushroomed into dismissal of experts in general
( contra the ‘cult of the expert’- prn.fm) :
scientists are wrong, economists are wrong, the media is wrong ( big one!), bankers are wrong, politicians are wrong,
historians are wrong, educators are wrong… you name it!-
It’s RONG! ( see Natural News, AoA, TMR)**

And in their place, we get the usual suspects and alt media [email protected] ( see the news re Alex Jones) as well as
so-called political anti-elitists.

I enjoy being an elitist. Don’t you? Perhaps we’re all devils and smell of sulfur.

** where do these people go when their car breaks down?

Sofronsky kept developing new symptoms, all of which were consistent with progressing lymphoma, including complaints of back pain, more lymph node swelling and pain (which Wollner treated with low dose Naltrexone), leg swelling, increasing abdominal pain and swelling (which Wollner attributed to an allergic reaction), and weakness.

The usual rationale for the very *existence* of ‘Integrative Medicine is that Conventional Allopathy is reductionist and only about Treating the Symptoms while Ignoring the Underlying Disease.

Someone has to make a joke about the name ‘concierge medicine’…
Don’t look at me like that.
I have to leave so I can’t.

Dr. Silver suggested that Respondent should not be held to the same standard as other family medicine doctors providing primary care services.

“I’m playing a doctor, I want to have the same prescription privileges as a real doctor, but please don’t held me accountable like a doctor when things go wrong”

I hate humans so much.

were this a family member of mine, we’d not be in court, he’d be missing, with some ‘gators well fed.

Awww, Wizrd1; I always took you for a “went to shit and the hogs ate him” kinda guy.

It’s scary how much the “integrative medicine” speciality has become legitimized. A Texas quack named V. John Gonino was accused of various wrongdoings. In 2013, he and the TMB entered into a Mediated Agreed Order in which he basically got a slap on the wrist.

Part of the order required him to “attend and participate in a nationally or internationally recognized conference for integrative medicine which includes 17 hours of CME”. So his punishment was to attend a conference to learn to be a better quack?

I was the equivalent of one of your Corpsmen in the Royal Navy and was trained quite well in basic diagnostics; as most of the ships I served in I was working independently.

I had a couple of personal ‘Directives’ I tried to follow.
If my patient showed little or no improvement after 3 or 4 visits; Get advice.
If I really had no idea what was wrong; Get advice.

I suppose what I’m saying is, “Know your limitations”.

But then, I wasn’t in it for the money.

Maybe mammography should be moved from conventional medicine to integrative medicine?

If you think that’s the message of that study, you missed the point.

It doesn’t improve patient outcomes. It appeals to their health paranoia. It requires this big fancy machine. There’s some pain involved (they really squeeze your boobs to take the pictures). And you can charge lots of money for it. That sure sounds like integrative medicine to me!

@ Wzrd1
So sorry about the troubles you’re having with your wife’s illness. It’s a reminder that we have more to do than attack quackery — our healthcare delivery system just doesn’t handle difficult to identify chronic disease well at all, and it’s far to easy for ‘regular joes and janes’ to fall through the cracks.

This is either distilled incompetence or malfeasance. In the former case, he’d be missing, with some ‘gators well fed.

So if incompetence goes to the gators, what happens to him if it’s malfeasance?

@sadmar;

our healthcare delivery system just doesn’t handle difficult to identify chronic disease well at all, and it’s far to easy for ‘regular joes and janes’ to fall through the cracks.

It didn’t help not having health insurance when I was caring for my father during his final years of his life. He needed 24/7 care.

So if incompetence goes to the gators, what happens to him if it’s malfeasance?

A very, very unpleasant time with me, then the gators get what’s left.
I’m very protective of my family.

@ Wzrd1
I second sadmars’ sentiment.

RBC’s, always elevated,… Neutrophils will elevate randomly. Eosinophils also are currently elevated.

When I do a little medical google sleuthing, I somehow have every malady under the sun. Still, you might check out this sight and see if anything rings a bell:

Eosinophils can also be high in
diseases that cause an increase in myeloid tissue… One such condition in which there is an increase in myeloid
tissue is polycythemia vera. Polycythemia vera is a condition of unknown cause in which there is a
long-term increase in red blood cells and other types of cells.

http://www.medfriendly.com/eosinophil.html

Esonophils are usually associated with allergies or parasites and various skin conditions.

Ohh, and Mitragyna speciosa for all forms of pain, especially herniated disks.

I’m sure one of the things coming into play that is permitting the spread of quackery and, as we see in some cases, providing licensing/legal cover, is the relatively recent activist and political/funding driven “choices” and “patients first” philosophies and campaigns.

Most of the time when i read about this or that being about patient “choice,” or “putting patients first”, or letting patients “take control” it’s public relations cover for one of two things: Quackery or budget control. Actually … three things, as the two can be combined in some cases. When I refer to “budget control” I refer to all forms of controlling health care expenditures by, for example, cutting or reducing existing costs or limiting increases in costs.

So, for example, hospitals can generate good (if not great) PR and media attention by, for example, announcing the addition of quackery-based “alternative” services (e.g., acupuncture, homeopathy, or something “wellness” or “holistic”) to their cancer program. I think in order to ride the line between something like the concept of “what harm can it do” and complete lunacy such alternative practices are limited to “symptom management” – often treatment side-effect management (e.g., nausea from chemo) – rather than using such alternative practices as any sort of legitimate part of the actual cancer treatment plan. I think many hospitals would find their oncologists ready to walk out if, for example, alternative medicine practitioners/considerations had to be part of case management conferences.

On the other hand, the “patients first” and “patient choice” game can be used to help contain or control budgets and reduce or eliminate the need to take any effective, and more expensive course of action. In Ontario, Canada, for example, the provincial Ministry of Health can expand telemedicine programs under the guise of putting patients first, patient choice, bringing care “closer to home,” etc., at a much lower cost than actually providing a lot of services where they are actually needed. Don’t get me wrong, a variety of telemedicine consults are much preferred to having the 10 scheduled patients each separately having to travel 100, 200, 500 km to the nearest consulting specialist, but the “gold standard” really does remain those 10 patients, and all the others before/after them, having direct local access to a relevant specialist in person. Of course, it often isn’t just a case of getting 1 or 2 of certain specialists to move to (or even visit) whatever city/hospital – many specialists/specialties are not going to be willing to move or even visit unless there are local technicians, diagnostics, operating or procedure room time, hospital privileges, designated inpatient beds, designated budget, staffing, etc. So it is still cheaper for funding agencies to add on more staff and a few more beds, for example, to an existing program – and have dozens of patients travel TO it – rather than create new programs where needs exist and start-up costs can be high.

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