Why Doctor Oppenheim Isn't Rich

The better we conventional doctors handle a problem, the less you’ll read about “alternative” treatments. Your local health food store doesn’t sell an herbal remedy for appendicitis. Don’t laugh. Until a century ago victims died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. This is one of many genuine medical miracles we take for granted. Some of us remember the herpes panic of the late seventies. The AIDS panic that followed overshadowed it, but Time magazine and Newsweek published cover stories on herpes, and the New York Times described it as the twentieth century bubonic plague. Alternative remedies were everywhere, not a few sold by entrepreneurial doctors. Then a good drug appeared, and the market for herpes cures dried up.

On the other hand, doctors don’t do so well treating obesity, arthritis, aging, or senility. If you want a superb treatment that conventional doctors ignore, check the internet or a bookstore. You’ll find plenty.

Many alternative healers are M.D.’s like me. They have names like Deepak Chopra and Andrew Weil and Mehmet Oz. They agree that scientific medicine has much to offer but insist that it is merely one of many routes to healing. 

They assert that it’s equally important to tap our spiritual energies, maintain a healthy optimism, promote natural healing with balanced and pure nutrients available through their web sites, and keep an open mind to cures wrought by eastern religion, nonwestern medicine, and pioneering researchers ignored by the establishment.

It is my belief that this is not true and that they are quacks. In my opinion (my lawyer insists that I add this). But as someone convinced that science is the road to truth, I’m obligated to present evidence. So….

I write an obscure blog. Weil, Oz, and Chopra write bestsellers. My books never sold much (I’ve written five, all commercially published). There are no ads on my blog. Weil, Oz, and Chopra have plenty. They sell wonderful stuff on their web sites. They appear on TV all the time. No one asks for Doctor O.

It doesn’t look good for me. 

Three More Great Sins of the Medical Profession

 4. Doctors order too many tests and prescribe too many drugs.

Correct. We love tests, but so you. Most patients with a painful injury assume they need an X-ray, but they don’t.  Those with a high fever (“flu”), sore throat (“tonsillitis”), cough (“bronchitis”), or stuffiness (“sinus infection”) assume they need an antibiotic, but they usually don’t. Doctors hate to disappoint patients, so they lean over backwards to “do” something like order a test or prescribe.

 5. Doctors order too few tests and prescribe too few drugs.

We can’t win.  Some clinic directors and insurance plans restrict the tests and drugs we can order. This infuriates doctors as well as patients, but the sad fact is that experts set up guidelines to discourage useless tests and wrong or unnecessarily expensive drugs. They sometimes work.

6.  Doctors ignore alternative and folk medical practices.

I notice enthusiasts treat folk medicine with respect, but no one advocates folk dentistry...  It turns out that many alternative practices work but less dramatically than advocates claim.  Acupuncture definitely relieves pain. Unfortunately, its action is unpredictable and not always complete. Despite vivid reports, Chinese surgeons rarely use it for anesthesia. Chiropractic manipulation relieves some backaches for a limited time.

Three Great Sins of the Medical Profession

Critics regularly denounce us for certain practices. These denunciations are more or less correct, but they miss the point.  Examples -

1. Doctors give treatments that relieve symptoms but don’t cure the underlying problem.

Right, but sometimes this is the best we can do. The cure for severe menstrual cramps is menopause, hysterectomy, or pregnancy. Drugs only relieve the pain, but patients appreciate it. No doctor cures migraine, asthma, emphysema, osteoporosis, or the flu, but we relieve a great deal of misery.

2. Doctors don’t pay much attention to diet, liquid intake, rest, and other natural treatments.

We don’t, and it’s the right thing to do.  Diet, rest, etc. help prevent disease but don’t do much once you get sick... A perfect example were tuberculosis sanitariums, the oldest government supported medical program. They began appearing in the nineteenth century. Patients received nutritious food and plenty of rest in a healthy, rural environment. They were discharged (sometime after years) when their TB became inactive. No one was cured, and many relapsed. When drugs appeared after 1945 sanitariums closed. Nowadays doctors encourage TB patients to adopt a healthy life-style, but they’ll get better if they don’t – provided they take their drugs.

3. Doctors spend too little time explaining how to relieve stress.

Perhaps....  Stress makes everything worse but doesn’t cause anything. Seeing a doctor for stress results from what I call the “medicalization of society” - the notion that life’s difficulties (a hateful job, unsatisfying sex life, shyness) represent a medical problem. There’s no harm in this; a good doctor can listen sympathetically and make sensible suggestions which require no medical training.

More Guests I Didn't Help

A travel insurer asked me to see nine sick hotel guests. My first thought was food poisoning, but their symptoms turned out to be coughing and sore throat.

I love multiple visits at the same hotel, but I wouldn’t love these. I visualized the scenario: a large group arrives for an expensive vacation where many fall ill, and in America you need a prescription for an antibiotic. Luckily, they tell themselves, we have travel insurance. The doctor will come and give us our Amoxicillin, and we’ll be fine.

My philosophy on antibiotics is that I prescribe them if they’ll help, and I don’t prescribe them if they won’t. This puts me at odds with doctors around the world not excluding the US.

When I see victims of a respiratory infections (fifteen percent of a family doctor’s business) I do my best. Almost all seem satisfied, but a few make it clear that I have failed them.

Luckily, there was a nearby walk-in clinic where these guests would get their antibiotics.

A Guest I Didn't Help

A flight attendant at the Airport Holiday Inn was suffering an allergy attack. She couldn’t fly because of the congestion, and her airline required a doctor’s exam and note. This is a common request which I fulfill regularly, but I couldn’t fulfill hers because she was American.

When a British Air, Virgin-Atlantic, Emirate, Singapore, or Cathay-Pacific crew member falls ill, the local supervisor calls a national housecall service who calls me, and the airline pays. US airlines never do this. Their employees are on their own in a strange city with no transportation and their American insurance which is deeply suspicious of housecalls. 

I occasionally make a charity visit to an American flight attendant too sick to leave the room but not sick enough for the paramedics. Mostly I refer them to an urgent care clinic.

Caring for Celebrities

Searching my housecall database (over 18,000 visits) for “celebrity” turns up 92 hits although that includes wives and children.

You recently read about my encounter with a famous person. I mentioned him by name because I was never his doctor, but I’m sure you don’t expect stories about celebrities I cared for. Unfortunately, literary agents do expect it. News that it’s forbidden has proven the kiss of death for my memoirs.

Most celebrities are nice, but over forty years I’ve cared plenty of misbehaving luminaries including several who died under dramatic circumstances. Agents have assured me that “you can’t libel the dead.” This turns out to be a legal fact, but the dead’s loved ones have been known to sue after reading unflattering remarks.

Why You Get Sick, Part 2

You do get sick because:

        1.  No one is perfect.  The healthiest human is full of clumsy design defects.  Our back muscles are too weak, so even normal activity can injure them.  Human veins are too flabby to resist a normal blood pressure; that’s why we get hemorrhoids and varicose veins.  Roughage may be good for you, but humans can’t digest some carbohydrates.  That’s why a high fiber diet causes gas.

        2.  Your “resistance” is too strong.  Don’t blame a fever on that infection you caught.  Your body itself generates extra heat whenever an invader is present.  Some experts claim fever is good for you, but the evidence is thin.

        The human immune system is too strong for its own good - and trigger happy!  Allergies occur when it tries to defend you against an innocent pollen, drug, or food.  Even worse, it may decide one of your own organs is the enemy.  Thyroiditis, the most common cause of thyroid deficiency, is an “autoimmune” disease.  An overactive immune system may also assault the heart (rheumatic fever), liver (autoimmune hepatitis), kidney (glomerulonephritis), joints (rheumatoid arthritis), or skin (eczema, hives).

        3.  Nature plays no favorites.  It assumes germs and viruses have as much right to exist as you.  Catching the flu, for example, is not a sign of weakness.  Most healthy people exposed to a new flu virus get sick.  Then they recover, but this is not a defeat for the virus.  Multiplying during the illness, many escape into the air to infect others.  The flu virus normally infects a victim for a week or so, then moves on.  That’s the role it plays in nature.  Your role is to get the flu now and then.

        Medical science works to give humans an advantage in this competition, and we’ve done pretty well.  But nature is impartial.