Covid Compassion Fatigue

Haven’t posted for quite a while as we all have been suffering from Covid fatigue.  I’m wondering if we former flexies have any different perspective than “regular” doctors on the topic.  I’m having a very difficult time caring for unvaccinated patients as I really want to blame them for their own illness.  In my hospital we have closed down the Pediatric Ward so that it could be filled with Covid patients.  Now if you have a sick kid that needs hospitalization in my county you have to get an expensive ambulance ride to Orlando over an hour away – even for something as simple as phototherapy for neonatal jaundice.  I want to blame these unvaccinated people for causing harm to the rest of our community.

How do the rest of you all feel?

Tired M.D.

Drug Pushers in Nursing Homes

This report out from CNN

It’s a long story but sadly a repetitive one.  It has all the elements of a modern pharmaceutical success story (if you are a investor).

  1. Find some old generic drugs lying on the shelf not being used too much anymore
  2. Combine 2 of them into a “New” drug
  3. Find a rare “disease” to treat
  4. Fund a small study showing it sort of works, possibly, maybe.
  5. Hire a bunch of good looking sales reps to court doctors into pushing the drug
  6. Have the doctors overdiagnose the aforementioned rare disease
  7. Hire the doctors and pharmacists to give talks about how you can prescribe this “new” medicine for all kinds of “off label” problems too
  8. Sell your small company to a mega company for billions
  9. Quit before the FDA and News media catch on to  your scam


This particular version involved an old, almost never used, cardiac drug called quinidine and a cough suppressant called dextromethorphan.  Quinidine was a crappy heart drug that we used years ago when we didn’t have anything better.  It was supposed to stop heart arrhythmias but often made things worse and had a lot of interactions with other drugs.  Dextromethorphan is the right handed molecules of an opioid type molecule that really doesn’t work that great for coughing anyway but does have a nice sedative effect.  That’s probably why Nuedexta “works.”  It’s probably just a sedative!

The rare disease they decided to push is REALLY rare.  I’ve NEVER seen a case and I’ve been doing this for 25 years!  Pseudobulbar affect even sounds fishy!  Maybe a “pseudo” disease?  The company states there are 1.8 million patients.  I find that hard to fathom. OK maybe there are a few real cases but not enough to warrant medicare spending tons of cash ($9,198/yr) on a barely palpable effect other than sedation.

Moral of the story is if your friend/relative is in a nursing home and you want to be their advocate, get a real doctor that you trust to look over the med list and get out the pharmacologic pruners.  Just because a wandering, company funded psychiatrist is trolling the halls with a prescription pad and a kickback scheme doesn’t mean you have to take it.


Scarred for Life

So yet another ugly story about a doctor doing surgeries and procedures on healthy people.  This time another cardiologist.

Just gets added to the list of scofflaws.  Occasionally they even go to jail!

The case of Farid Fata, an oncologist in Detroit is one of the ugliest.  An oncologist who gave healthy people chemotherapy!

The subtitle of my provocative Blog Title,

“Your Doctor is Killing You”


“and he doesn’t even know it.”

In these cases they did know it – and did it anyway.

Be careful out there in the American Medical “system.”  It’s the wild wild west and there’s gold in them there patient’s pockets!

Dr. Nick

Even the Good Guys are Confused!

Great op/ed piece today in NY Times by Timothy Egan titled

“What to Be Afraid Of”            

Only one problem:  Timothy threw out an anecdotal fear-mongering medical myth himself!

He rightly points out that terrorism kills few people compared to most any other risk, but then states.

“Consider the various threats to life. The sun, for starters. The incidence of melanoma, the most lethal form of skin cancer, has doubled in the last 30 years. More than 9,000 Americans now die every year from this common cancer. I also lost a friend — 30 years old, father of two — to malignant melanoma.”

To quote Vizzini  “You fell victim to one of the classic blunders – The most famous of which is “never get involved in a land war in Asia”

(And then me)  “the second, only slightly less well known, is to confuse INCIDENCE with MORTALITY.

Egan then goes on to throw in a sad, but totally inappropriate anecdotal report of a young friend of his dying. Classic scare tactics/fear mongering.  Shame on you Timothy!

We have started screening EVERYBODY for skin cancer.  Lot’s of dermatologists have nice boats.  The INCIDENCE of melanoma has skyrocketed, but the death rate hasn’t changed.  The CDC just published an M&M on the topic.

Click to access mm64e0602.pdf

Here’s the conclusion quote in a nutshell:   “From 1982 to 2011, melanoma incidence rates increased while mortality rates remained constant ”

Melanoma Incidence vs Mortality

Melanoma Incidence vs Mortality

I don’t know why the incidence of melanoma is going up but the death rates are not.  Certainly we doctors would like to claim that it’s because we’re saving so many lives after we find the melanoma but I’m simply not sure.  Are we causing more harm than good by keeping kids out of the sun?  Are women getting osteoporosis and vitamin D deficiency because they are afraid of the sun?  Lot’s to think about but know this; your chance of DYING from melanoma hasn’t increased.  You are more likely to die from lots of other things.


Dr. Nick

Peanuts – Oops!

Well we changed our mind again!

Excellent article in the prestigious New England Journal of Medicine shows that feeding children peanuts early in life DECREASES peanut allergies.  This goes against not only common wisdom, but against what, until recently, was the official American Academy of Pediatrics recommendation!  In 2000 we recommended that parents NOT feed children peanuts until age 3 to help prevent development of allergies.  Later on that recommendation was retracted, as it became clear that it had been made without good evidence to support it.  Now this study concludes:


The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. 

So, not only did we get it wrong, we probably violated the old “primum non nocere” (Firstly cause no harm) by creating MORE kids with peanut allergies.  Did some of them DIE?  Hard to know but just another example of how you need to ask your doctor WHY you should do something and whether they have GOOD evidence to back it up.

The good news is that we are getting better about making sure we have that good evidence before we make broad proclamations.  The bad news is a lot of the old stuff is still out there.  Dietary advice in general is suspect.  Follow Dr. Nick’s easy diet:


Definition of food:

A)  If it wasn’t food 100 years ago it’s probably not food today

B) If you have to read the label to know what’s in it, it’s not food.

Dr. Nick

George Du Toit, M.B., B.Ch., et. al. for the LEAP Study Team

N Engl J Med 2015; 372:803-813February 26, 2015DOI: 10.1056/NEJMoa1414850

Superbug linked to 2 deaths at UCLA hospital; 100 potentially exposed

An article in the Los Angeles Times today outlines another problem – inadvertent consequences of medical technology.  Apparently they have some fancy scopes they use to perform ERCP’s (Endoscopic retrograde cholangiopancreatography – say THAT three times fast!).  Well that fact that the procedure can CAUSE pancreatitis is one thing, but now it wasn’t adequately sterilized and gave 100 patients “CRE.”  Now you should know that we like to name our REALLY nasty infections with letters.  It usually starts with the antibiotic that DOESN’T work anymore and then the bacteria.  In this case “carbapenem resistant enterococcus.”  We also have “VRE” (vancomycin), “MRSA,” (methicillin resistant staph aureus) and my favorite:  “MDR” for MULTI drug resistant.

UCLA claims they cleaned the scopes according to manufacturers recommendations, and I believe them.  Nonetheless, we killed two more in L.A.

Dr. Nick

16,000 Dead from Doctors!

Well ok, maybe a bit over the top but check out this article:

Opioids (aka narcotics) are WAY over prescribed.  So much so that 16,000 people died of overdoses in 2012.  That’s more than died from homocides!  It’s half as many as all firearm deaths.  I often pull out my prescription pad and tell people it’s more powerful than a gun and it is.

It’s just crazy how often I see this in the hospital.  Some little old lady has seen 5 different doctors and is on methadone for chronic pain, Soma (carisoprodol ) for muscle spasms, Xanax (alprazolam) for anxiety and Ambien (zolpidem)  for insomnia!  Then I’m asked why she has AMS (altered mental status).  DUH!

Accidental Polypharmacy Overdose  is now one of my most used admitting diagnoses.

Is your mother, brother, sister or aunt getting overdosed by the medical system?  Get them to stop before they die!

Dr. Nick

History comes back to haunt us.

Interesting story today reporting that the National Health Service in Great Britain has determined that it’s MORE DANGEROUS to have your baby in a hospital than at home!  At least for uncomplicated births your chances of having something bad like an infection or an unnecessary procedure are HIGHER in a hospital than at home with a trained midwife.  As a pediatrician I always thought people who had these home births were nut jobs, but maybe I was just expressing my bias and didn’t have any real data to support my contention.

Here’s the link:


The story really goes back to the 1840’s when an unfortunate, brilliant soul named Ignaz Semmelweis discovered that Obstetricians in Vienna were killing women and babies at a high rate by failing to sanitize their hands after examining cadavers.  They would then examine pregnant women and contaminate them causing “puerperal fever” and DEATH.  Semmelweis was chastised and essentially chased out of town.  He went to Hungary were he repeated his experiment (high tech at the time – washing your hands with chlorine) and replicated the impressive results.  It all ended badly for him anyway as he died at 47 in an asylum.


Click to access whoseajphv1n4p477.pdf


Once again – if you go into the hospital make sure those doctors wash their hands!


Dr. Nick

Doctor who discovered PSA test talks about Prostates

The PSA (prostate specific antigen) test has become a rite of passage for men crossing the border into middle age.  The hunt for cancer in the primary care office is, unfortunately, being pursued vigorously all over the country.  Dr. Ablin outlines his concerns in this op/ed piece:

The various “authorities” still recommend different types and frequencies for screening for prostate cancer.  Personally, I’ve been screened twice:  the first time and the last time!  That was when I turned 40 and had a DRE (digital rectal exam).  Since then the data has shown that the “educated finger” is worthless. By the time you can feel a prostate “bump” you already have trouble brewing.  Worse were all the false alarms and unnecessary biopsies that were done.  I will forgo the PSA test as I cross into my 50’s.

Tell me what you think.

Dr. Nick

Drug Maker Gave Large Payments to Doctors With Troubled Track Records

Surprising?  Not really.  Humans respond to incentives and doctors are human.  Nonetheless stories like this add fuel to my controversial title.  According to “To Err is Human,” Doctors and Hospitals kill 44,000 to 98,000 people a year.  That’s 4-8 times the number of gun deaths more than twice the number of car accidents.

Be careful out there! (in the hospital).  Make sure every single person who walks into your room washes their hands.  INCLUDING THE DOCTORS!

Dr. Nick

NY Times Story

To Err is Human

Homicides/gun deaths in the US

Motor Vehicle Deaths