Because if you're going to make health claims and claim to treat patients, you should be held just as accountable as any physician:
A Carson City "anti-aging" doctor has pleaded guilty to malpractice for failing to diagnose an elderly patient with the cancer that ultimately killed him.
It is Dr. Frank Anthony Shallenberger's second discipline by the Nevada Board of Medical Examiners in 12 years.
Shallenberger's plea last week regarding patient David Horton's care came on the heels of the board's dismissal of another family's complaint related to Shallenberger's treatment of their sister, Ellen Gallagher, of Sacramento, who died on Labor Day 2006.
Get a load of the treatments used:
In February 2000, Horton complained to Shallenberger of rectal bleeding and abdominal pain -- symptoms of colon cancer. But the medical board complaint said Shallenberger told Horton, formerly of Carson City, that he suffered from hemorrhoids and advised him to use suppositories and take baths in witch hazel."At no time from the initial presentation of (Horton's) medical symptoms did he examine the patient, order a test or record in the medical records why those actions weren't taken," Cousineau said.
"If you ask a beginning medical school class what is at the top of your list for a 75-year-old man with rectal bleeding and abdominal pain, it's colon cancer," said Horton's daughter-in-law, Dr. Katherine Gundling, an internist who heads the allergy and immunology clinic at the University of California, San Francisco.
"You rule that out first and worry about the rest later," she said. "Shallenberger's treatment was unbelievable."
I can't emphasize how much just how bad this is. In a person over 50, rectal bleeding must be presumed to be colorectal cancer until proven otherwise by colonoscopy. Period. It's not even arguable that cancer has to be ruled out in a patient presenting with these symptoms.
Even more unbelievably, Horton went back Shallenberg after his diagnosis for further treatment, which shows the power incompetent practitioners can still sometimes hold over even patients whom they've messed up badly.
More like this
"At no time from the initial presentation of (Horton's) medical symptoms did he examine the patient...,"
Unbelievable.
From the evidence, "Doctor" Shallenberger would have been just as ignorant after examining the patient as before. Usefulness of information is partially dependent on the skills of the observer. How dreadful.
Given his training, he might not have know how to examine a patient, or even that it was an option.
"But the medical board complaint said Shallenberger told Horton, formerly of Carson City, that he suffered from hemorrhoids and advised him to use suppositories and take baths in witch hazel."
Imagine to the great relief of this patient who likely was more than a bit worried about his symptoms, that all he had was a case of bleeding hemorrhoids.
Either he's just a lousy doctor or he's a lousy Dr. whom doesn't like giving bad news to patients.
This case exemplifies why I feel that advertising with the title of "Dr." should be reserved for MD/DOs or PhDs with real training to see patients (psychologists, for example). In my Yellow Pages (yes, I still look at the hardcopy), there are any number of non-MDs using the title of Dr. in advertising their practices. The lay public may not necessarily recognize the distinction between the different types of people who call themselves Dr. and even without the use of Dr., "N.D." looks like "M.D.". This case is a very sad reminder of why we have mandatory medical licensing. Even in the 13 states that "license" naturopaths, there is no assurance that such a case would be avoided.
I like the phrase, "clash of medical belief systems". It's a classic.
I've got more on this:
http://themachoresponse.blogspot.com/2007/09/gambling-with-your-life.ht…
Pay special attention to the last link ("one of the five worst medical boards in the country") it's a doozy, put together by Susan Gallagher, whose sister was killed by Shallenberger.
I agree with Abel Pharmboy. I live in Toronto, Ontario Canada, and on my walk to work, I pass through the fashionable artsy area every day. There are a great many clothing stores & yoga studios, and naturopathic clinics above them. A-frame sandwich boards on the street are a popular sight.
And each one of them has "Dr." names with a huge number of N.D., R.R.T. (I think this is registered reiki therapist or something) etc. There are all these initial/credentials that look complicated and impressive to a lay person.
For people who want to believe they've found the magic bean, the magic bean seller obfusicates and confuses and leaves them with just beans.
Is Dr. Shallenberger a naturopath? He's licensed by the Nevada Board of Medical Examiners and the Nevada Board of Homeopathic "Medical" Examiners. The NVBHME purportedly permits its licensees (all 20 or so of them) to prescribe Laetrile and engage in other foolish quackery.
For its part the NVBME seems reluctant to discipline dually licensed physicians, largely it seems because physicians claim they were practicing homeopathy, over which the medical board has no jurisdiction, or so it claims. How convenient.
Another shameful story of incompetence and pitifully inadequate licensing and regulation of quacks.
But sadly, we've been here before - e.g. on the story Orac did back in June about the ND who managed to kill someone with Woo-fave chelation.
http://scienceblogs.com/insolence/2007/06/another_clean_kill_by_chelati…
According to his "rap sheet", the ND in that story was doling out meds for ischemic heart disease, something he wouldn't have had a clue how to manage medically.
It seems pretty clear that "regulation" of NDs/Naturopaths actually provides little meaningful safeguarding for their customers / "patients". The odd case that reaches their regulatory board only seems to highlight the iceberg of the deluded (the practitioners) bilking and occasionally killing the gullible.
Athena is indeed onto something; he is not a ND. I'm not sure whether this makes it better or worse: Shallenberger actually got an M.D. at University of Maryland but then also got a H.M.D. (homeopathic medical doctor). How one can subscribe to dose-response pharmacology and homeopathy requires mental gymnastics that are beyond my comprehension.
Reading more about the article Orac cites, Shallenberger was, as Athena points out, a dually-regulated doc since Nevada is one of three states that has a separate medical board to regulate homeopathic "doctors." But according to this system, the Medical (M.D.) Examining Board cannot discipline physicians for homeopathic "care" and the homeopathic examiners cannot regulate docs for their allopathic care.
The Gallagher family contends that Shallenberger was hiding behind his homeopathic license to avoid discipline:
"The sisters said Shallenberger ordered a treatment plan for their sister before he examined her or her medical records. They say he ordered a catheter to be inserted into her heart so he could infuse her with controlled substances, and then provided no follow-up care when she returned to Sacramento.
***
But the Gallaghers said their sister's treatments involved injections of human growth hormone, change in diet and plans for stem cell therapy and hyperbaric oxygen treatments -- none of which are considered homeopathic in nature.
***
But the medical board said its hands are tied when it comes to disciplining dually licensed doctors who claim bad medical practice was instead homeopathic treatment. Nevada, Arizona and Connecticut are the only states in the country that have regulatory homeopathic boards."
What a great defense -- the state Med Board can't regulate because he's also registered with the state board for Homeopaths. So he can inject "controlled substances" into her heart, and perform other "treatments" that aren't even recognized as homeopathy (or medicine), but the state Med Board still concludes it can't take action.
Meanwhile, because he's a "Doctor" lay persons will still believe in him and he can still "practice", and until he kills someone so that a prosecutor looks into the matter, no action is taken.
That really is utter Alice Through The Looking Glass stuff.
One reason why Complementary Medicine is slightly less deranged in continenetal Europe than in the US or Great Britain is that it is more-or-less sensibly regulated AND that it is often done by such "dually licenced" people (like MDs who have also done a Diploma of some sort in acupuncture or homeopathy).
The rationale there is that the docs use their "conventional" training to see if your ailment is one amenable to "CAM therapy" - and to tell you it's not, and recommend conventional investigation and treatment, if that is what your symptoms indicate.
The idea that a doctor can't be busted for Gross (conventional) Medical Negligence and lose his medical licence for such flagrant incompetence because he was "only thinking and acting with his homeopathic hat on" requires a level of Doublethink that has left me speechless. Truly beneath contempt, as well as ridiculous.
No doubt this was worked out by a lawyer. I can't think of any other possible explanation for such a crazy loophole.
@ Dr. Aust,
How do you sensibly regulate fraud; except, by banning it?
Given that David Horton was a lobbyist for quackery, I have zero sypmpathy for him. He was hoist on his own petard. However, I do have sympathy for his children who as medical doctors must have known from the beginning what was wrong with him and felt totally frustrated and powerless knowning what could have been done.
I'm an engineer with zero biology beyond hihg school and I knew that blood in the stool was a sign of colon cancer especially after 50. This bastard shuold be charged with criminal negligence causing death or whatever the Amercian equivalent is. What is his defence - "my homeopathic training made me stupid"?
Dr. Aust,
Just a word about "why Complementary Medicine is slightly less deranged in continenetal Europe than in the US or Great Britain is that it is more-or-less sensibly regulated AND that it is often done by such "dually licenced" people (like MDs who have also done a Diploma of some sort in acupuncture or homeopathy).":
My mother-in-law was killed by a homeopathic "MD" in France (he also managed to woo my woo-woo wife) and the results were exactly the same from those in charge of oversight - He's a homeopath and there's nothing they can do - or nothing they choose to do. (I was never clear about the distnction.) Since I was "only" a husband, and son-in-law, there wasn't much, legally, I could do but get a divorce once I figured things out. It's maddening, and heartbreaking, still.
I've spoken with David Horton's son, Robert, and, like me, he's working hard to "do something" while trying, equally hard, not to let this subject take over his life. The irony in his case, though, is that he's trying to undue his dad's life's work - and his dad was good at what he did - as we can all see. He said he only won his case (he got an undisclosed settlement) by leaving out all aspects of the woo and focusing exclusively on the malpractice elements. Which, when you're in this situation, seems insane because it's the belief system that drives all this: As you said, "the deluded,...bilking and,..killing the gullible."
I discovered the same thing in my divorce: bring up the woo elements and you might as well be woo yourself. Personally, I don't get it. My wife's mother was killed - and my wife was taken advantage of sexually - but, because of the way the laws work, I was forced to abandon all concern for my wife and mother-in-law (divorce is adversarial) in order to do what was in my own best interest under the crazy circumstances. When, in my mind, getting the bastard that did this (and making sure he's stopped) was what was most important. It's crazy, and crazy-making, as anyone that's followed my posts can tell.
BTW, like Shallenberger, this respected french "doctor" is still "practicing" his highly-personal form of "medicine" undisturbed. Here's his info:
Robert Wohlfahrt
7 Quai 24 Novembre, 67160 Wissembourg
Phone: 0388941697
physicians: general medicine orientation homeopathy
Sorry to hear the story, Robert.
The idea (according to my wife, who trained in medicine in Germany) was that any "Heilpractiker" (health practitioner) there has to have a state licence to set up shop. If they do something they are not allowed to (like say they can "cure" cancer instead of telling the person to see an oncologist) they should lose their licence and be out of business permanently. If they keep trading without a licence, they are committing several different crimes and can be fined or jailed.
If the person also has a medical degree, like in the story on this post, they unequivocally ought to be erased from their (conventional) medical register for gross negligence as well as from their "alternative" register.
Sadly, it is not an ideal world, and stories like this one and yours are all too common. But is it better to have absolutely zero regulation of these people at all, like in the UK? I don't think so. I'm for regulation and licencing, but it has to have the teeth to bust the incompetent ones properly when they screw up, as happens (and should) to conventional physicians.
Re Joe's point, the CAM lot should stick to "treating" things where there is evidence for efficacy of what they are doing (very little) or where they do no harm, basically chronic minor ailments. This stuff makes up a vast amount of conventional doctors' workload in UK family practice, and in things like Occupational Medicine. Another use for CAM I can live with is providing "makes you feel better" add-ons to real treatments. It is not uncommon to find cancer hospitals in the UK offering various CAM therapies to the patients who have just had their chemo... and if aromatherapy, or massage, makes them "feel" a bit better under such circumstances, I can live with that. Just don't lets kid ourselves it is treating their underlying disease, as opposed to their feelings, including their feelings about their health / disease.
Dr. Aust,
"Complementary and Alternative Medicine" is a marketing term, it does not identify anything "medical." There are only rational/proven medicine, experimental medicine, and fraud. Most of "CAM" is fraud.
The specific methods you mention (massage, aromas) just like candlelight and soft music have long been used by healthy people who want to relax. The purveyors have simply stepped-up to feed at the "CAM" trough. The price of a fragrant room is trivial (if there is a charge for this service, it should be a crime) and a masseur has a right to charge a reasonable, hourly rate.
Doctors who charge for irrational/unproven methods are defrauding people. I stand by my assertion that the only responsible regulation for fraud is criminalization.
Shallenberger and many other charlatans have remained in business in Nevada as a result of the combined incompetence of the medical board and the legislature. Your can read all about it on my UMass faculty web site:
Snake Oil Salesmen Hit Jackpot in Nevada:
http://faculty.uml.edu/sgallagher/NIRB.htm
What's happening is criminal, but state officials have so far turned a blind eye.
Complementary medicine is an adjunct to traditional medicine. Step one for any condition, is the family doctor. If a condition cannot be diagnosed and if the family doctor cannot refer to an appropriate specialist, the patient can then go to the Naturopath. I have witnessed patients not even following the natural route, and simply describing a condition to their pharmacist and asking what would be good for it. It is the duty of all adjuncts to encourage seeing the family doctor first.