Non-judgmental Ethics Sunday: What to Do About a Physician Who May Be a Quack

January 15, 2017 by Joshua
in Ethicist, Nonjudgment, Perception

Continuing my series of responses to the New York Times’, The Ethicist, without imposing values, here is my take on today’s post, “What to Do About a Physician Who May Be a Quack.”

I live in an affluent community in New Jersey. I am a scientist with a Ph.D. and have worked for a company that researched Lyme disease. I am very involved with our hospital, where the head of the neurology department is a leading expert in Lyme. I consider myself quite knowledgeable about the disease.

Here is my problem: There is a family-practice physician in our community who is diagnosing Lyme disease in many of my friends and acquaintances (and their families). The doctor attended an Ivy League college and a well-respected medical school, but she has no specialized training in Lyme disease. What is perplexing to me is that most every patient she sees comes back with a diagnosis of a Lyme-related “condition.” Most of her treatments are not covered by insurance, because they have no basis in evidence, and cost her patients $30,000 a year or more. Moreover, the test she uses for “diagnosis” has never been validated and is not used in New Jersey or New York; all her samples have to be shipped to a lab out of state.

Adding to my concerns is that some of these patients saw a Lyme-disease expert first and were told that they did not have the disease. Moreover, the numbers don’t add up — the C.D.C. reports an annual incidence of 29 cases per 100,000 people in New Jersey. I know of more than 12 people who have received diagnoses from this physician alone. I do not know 40,000 people, so the odds are against my knowing 12 people with the disease, even taking into consideration that Lyme may be underreported.

I believe that this physician is taking advantage of the varied and sometimes vague symptoms of Lyme disease to make a lot of money off patients. And this misdiagnosis may be malpractice, as she could be harming patients in the process; patients may have symptoms of another illness that is being overlooked.

I am extremely concerned that this doctor is essentially a quack. I feel very strongly that I need to take action, but I do not know what that action should be. Name Withheld

My response: You didn’t ask any questions, so thank you for sharing.

The New York Times response:

Let me cavil with your statistics. You don’t specify when these people you know received their diagnoses, but let’s suppose you’re talking about a four-year period. To go by the available C.D.C. numbers, the four-year average incidence, for the years preceding this one, is 33.75 per 100,000 in New Jersey. The C.D.C. estimates that the number of Lyme diagnoses each year is about 10 times as high as the number reported to it. So it’s reasonable to raise its yearly incidence rate, which is based on those official reports, by a factor of 10. You don’t know 40,000 New Jersey residents, but let’s suppose you know 1,000 of them. The probability that you would know more than 12 patients who receive a Lyme diagnosis in that period would be around 60 percent, making reasonable assumptions. The likelihood that they’ve been seen by this one physician is lower, of course, but we’re no longer in the realm of the vanishingly improbable.

For all that, you make a persuasive case that this doctor is wasting her patients’ money and that she may be failing to deal with real problems by misidentifying them as symptoms of Lyme disease. Because these treatments are not covered by insurance, though, these people have been put on notice that they are receiving an unsupported therapy. Some, you say, have even been told by experts that they don’t have Lyme disease. If they are being exploited, they are abetting their own exploitation. They’re doctor-shopping, as affluent people occasionally do. Some may be hypochondriacs, others people with vague, genuine symptoms they would like to give a name to. What’s more, this doctor may sincerely believe that the test she’s using is catching difficult cases, that the condition is underdiagnosed and that she’s really helping.

Good intentions are perfectly consistent with your suspicion that she’s doing harm here, in violation of the Hippocratic oath. That’s a bad thing, but alas, I’m not sure you can do a lot about it. You could make your case in conversation with those of her patients you’re acquainted with. Given what they already know, though, my bet is that they won’t take much notice. You could also file a complaint with the New Jersey State Board of Medical Examiners, but your identity may not remain confidential if it proceeds against this doctor. And this would be a hard case to bring if, as I fear, most of her patients are grateful for their Lyme-disease diagnosis.

Our daughter has been dating a young man for five years. She is a senior at a public university. Her boyfriend has completed two years of community college and one semester of private college and recently tried to transfer to her public university. He owes the private college tens of thousands of dollars. The private college won’t release his transcript without full payment, so he couldn’t provide the transcript to the public university, and thus it denied him final admission.

Three months ago, our daughter asked us to help. We offered to give him $10,000, which he was reluctant to accept but then agreed to after our urging and reassurances. Two and a half months went by as we waited for him to raise the rest of the money and negotiate terms with the private college and its collection agency. However, two weeks ago, we withdrew our offer after discussing the issue with our friends and family, who strongly warned us against such a financial entanglement.

My wife, friends and family feel certain that we did the right thing. Their reasoning is that creating a financially dependent relationship in which Mom and Dad’s money can be counted on whenever it is needed is a bad precedent to set for our daughter. Others have said that her boyfriend will eventually be grateful that we did this: If he finds a way to pay off the loan and go to the university, he will value it more and be more proud of himself. Further, my wife says that my daughter should be doing more herself to help him rather than asking us for the money.

I agree with all that, and yet I really feel for her boyfriend as a person, a young man, who has had to deal with many family misfortunes not of his making. He has paid for all his community college himself. He screwed up by going to the private college and not making payments. I don’t see him as the right person for my daughter in the long term. We’ve never felt really close to him. And yet I feel as though we handled this poorly and there may still be another option. What are your thoughts? Name Withheld

My response: I don’t see how giving someone money entangles them. Putting conditions on the money could entangle him. Were you giving, loaning, or what?

How does a gift imply you’ll do it whenever it’s needed? I don’t understand the terms of the offer. If you give it, once you give it, it seems to me, it’s out of your hands.

If you want to attach conditions to the offer, you sound like you’re proposing a deal, not a gift.  If so, I recommend writing a contract instead of assuming obligations he may not understand, agree with, or agree than he accepts them. My point isn’t to bring lawyers in but to clarify what you’re agreeing to. You sound like you’re assuming terms others aren’t.

Personally, I see a lot of the past events as past sunken costs which I wouldn’t factor in to my actions and would look forward instead. If you don’t expect the relationship to last, I don’t see the point in investing in a future you won’t be a part of.

The New York Times response:

It’s worth noting the background problem here: This young man was drawn into debt he can’t afford by the private college that he attended. Taking advantage of vulnerable people — in this case, a young man with ambitions and neither money nor family support — is a paradigm of exploitation. Nor is the college’s decision to withhold his transcript entirely rational, because that reduces the probability that the college will be paid in the end. Our president-elect has said he wants to help with student debt, but the plans he has described so far do not suggest a program that will solve this young man’s problem, and recent Republican orthodoxy runs against plans for college-debt refinancing or forgiveness. I doubt, in short, that there’s relief for him in sight.

None of this is your fault, of course. But I agree that you’ve handled this situation poorly. Making an offer and then withdrawing it was unkind — worse, surely, than never having made the offer. And I’m puzzled at the notion that “creating a financially dependent relationship” is a “bad precedent” to set for your daughter. She hasn’t proposed that she should be able to rely on you whenever she needs to for the rest of her life. She’s asking for help for the man I assume she’s planning to make a life with, so that he can get on with his education. With the right start in their life together, in fact, they’re much less likely to have to ask for help in future.

But the rest of your circle probably wouldn’t feel as they do if your daughter were the one in trouble. I suspect that they’ve misdescribed their objection: What they really think is that it’s not worth investing in a young man if he isn’t going to end up in your family. That’s not a crazy thought, especially given your doubts about him. So I suggest you tell your daughter the truth. And if she stops speaking to you for a while, you can reassure your wife and friends that she won’t be asking for money from you again anytime soon.

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