I’m a Doctor Now and I’m Upgrading to a New Blogging Site

October 16, 2015
Reinventing Primary Care

               Reinventing Primary Care

I still get a lot of daily views on this shabby old blog site from my medical school days. This site was what laid the foundations to a future in online content marketing. Lessons were learned. Don’t invest TOO much time in research and writing. Now I’ll be quicker and swifter, making more videos personally. Focus will be on medical topics. In particular, my specialization in medical marijuana, which I hinted at my early interest in this field years ago by writing about it. 

So join me over at Nature’s Way Medicine. It’s a company devoted to integrating primary care medicine with medical marijuana for patients who need it. Between updates and posts, patients will be getting treated in my Wilmington, Delaware office, where I will provide medical marijuana consultations alongside their primary care.

That last marijuana post didn’t make the cut at Science-Based Medicine the way my CAM in Obamacare article did, but who knows, maybe in the future I’ll have the chance to share my impressions, research, and personal opinions on a topic I know back then was discussed without much optimism.

For additional updates, check out our Facebook Page, Twitter account, and Youtube channel.

Thanks for reading everyone. Now let me bring you to a new era of blogging by DOCTOR Roman, MD.

See ya’ll there!


The Current Legalization of Marijuana is Unethical

May 15, 2010

Marijuana has been both steadily decriminalized and legalized for medical purposes in the United States since the Compassionate Use Act of 1996, where Californians voted to allow the use of marijuana with the guidance of a physician for the alleviation of symptoms for various medical diagnoses. Since that time there has existed a battle between the federal and State governments stemming from the federal governments blunt opposition towards the substance. Nevertheless, other States have since followed California’s lead and have also legalized its use for medical purposes.

Whether or not marijuana has therapeutic effects is becoming more evident with the coming years. Clearly, it has physiologic effects on both the mind and the body. Its active ingredient, tetrahydrocannabinol (THC), is a cannabinoid that exerts its effects on the brain through its binding to cannabinoid receptors. Cannabinoids are neurotransmitters, and like other neurotransmitters can be used for therapeutic effects. For example, the neurotransmitter dopamine  is used to treat Parkinson’s disease (in the form of L-Dopa), which is caused by a deficiency of dopamine within the brain, and opiods, such as morphine, are used for analgesic properties. THC’s neurotransmitter effects show potential for future therapies and the molecule could help create similar drugs with different properties.

Tetrahydrocanabinnol (THC)

Although there exists this potential for marijuana to be used pharmacologically, we still do not know enough about it for it to be ethically made legal. All FDA-approved drugs that go on the market are tested through Phase I, II and III clinical trials before they are approved for release. These phases are extremely important as they help determine not only side effects but also dosages and other vital information required for optimum benefits and minimum risks. Without this sort of knowledge, patients can be harmed from over or under-usage, unexposed side effects, or potential adverse combinations with other pharmaceuticals.

These sorts of clinical trials, and large long-term studies have never been performed for marijuana. Ultimately, the federal government is to blame for this. As I write this, marijuana is a Schedule I substance according to the Controlled Substance Act that came into effect in 1970, along with heroin, cocaine, peyote and a multitude of extremely detrimental substances. Schedule I substances are defined to have “no current medical use.” If the United States government is to remain consistent with their legislature, they should surely drop marijuana to a Schedule II drug because research has shown it to have a multitude of potential health benefits, as well as side-effects.

The problem with marijuana being a Schedule I substance is that drugs of this legal caliber have a much stricter set of rules and circumstances for clinical testing. It is much more difficult for a research institution to study the effects of a Schedule I drug than it is for it to study a completely new drug synthesized in the laboratory. By definition, the same laws for researching heroin apply to researching marijuana, but researching a cholesterol-lowering drug or an anti-depressant is legally much easier. What this ultimately leads to is an inability for academia to research marijuana and study its effectiveness and proper dosages.

To counter the federal governments rigid stance on marijuana, 14 States have broken accordance with federal laws and allowed marijuana to be legal for medicinal uses anyway. This has created a sticky situation where the federal government is inconsistent with its own laws by refusing to reclassify drugs as new evidence deems them therapeutic, and individual States counteract this with their own inconsistency by allowing drugs with inadequate research confirming their efficacy to be medicinally legalized. Two wrongs don’t make a right. On top of all of this is the indecency of physicians who prescribe marijuana with inadequate clinical evidence to do so.

The lack of proper research on medical marijuana is evident through the completely different dosages that individual States recommend for their patients. A recent New England Journal of Medicine article about this very same subject has detailed information about the inconsistencies of marijuana dosing between different States. For example, Alaska allows patients a maximum of 1 ounce per month but Washington State allows 24 ounces and as high as 15 personal plants. Furthermore, the potency and quality of the plants themselves are undetermined and unregulated. Obviously, such guidelines are not based on any resounding proof or evidence of efficacy but rather politics alone. This exemplifies a completely unscientific approach that is necessary in modern medicine.

As of right now, medical marijuana is an alternative medicine that puts not only the patient and the doctor, but entire States, on thin ice legally. More importantly, however, if marijuana is to be used as a prescribed medicine it has to be researched as intensively as other drugs on the market. To do this requires a change in its classification from a Schedule I to a Schedule II drug by the federal government. Until then, its usage for medical purposes will continue to be unethical and potentially dangerous to patients.


The New Craze in English Soccer: Horse Placenta!

March 9, 2010

The skeptical movement in America has grown substantially in the last few years. I shouldn’t even say that it’s grown but rather that it’s exploded onto the scene. Europe, on the other hand, is having a slow start.

funny-horse

Last fall, news broke in the English Premiere [Soccer] League (EPL) of a radical new treatment involving several high-profile players. At least 12 players had seen an alternative medicine proponent, Marianna Kovacevic, to undergo a procedure to cure a variety of injuries in her homeland of Serbia by using a special gel created from horse placenta. That’s right… repeat after me… HORSE PLACENTA!

Before going into the technicalities, it should be noted that this was a complete media fail. Coverage was hardly skeptical and I was especially disappointed by the UK’s reporting on this matter since so many of their citizens are die-hard fans of the teams these players are on, as well as the players themselves.

Robin van Persie, for example, was named Barclay’s Premiere League Player of the Month last October and plays for Arsenal Football Club, the third richest soccer club in the world. One would think that with so much money on the line, all reliant on the performance  of a few players, the care and advice given to these players would be the best in the world. Think again.

It’s no secret that EPL soccer players can seek unusual treatments to cure their rather typical sports-related injuries. Wayne Rooney, currently the top goal scorer, used a hyperbaric oxygen (HBO) chamber to heal a fractured metatarsal in 2006. This alternative modality of treatment is not established to be effective by the scientific community. Such alternatives are not only supported by the players themselves, but also by the teams they work for.

Robin_Van_Persie_633567237313281250

Rumor has it that Manchester City Football Club had contemplated hiring Kovacevic to formally treat their own players. Rafael Benitez, manager of Liverpool Football Club, also fell for the act hook line and sinker. He sent 6 of his own players to Serbia for the controversial treatment. Is this why his top-four team has dropped in ranking so much this year? Ouch! Obviously not, but such management of his players’ health causes me to question his common sense.

Marianna Kovacevic claims that her horse placenta treatment speeds up the recovery of injuries by using stem cells present inside of it to increase the healing process. This sort of scam is not new. Quacks like Dr. Huang from China have been selling bogus stem cell treatments for years. Stem cells are a very sexy topic in medicine because of the immense potential they have for curing disease. The key word there being potential, as there are yet very few applications for stem cells in medicine and absolutely none in the sports medicine department.

How does Kovacevic use these stem cells to cure torn ligaments and broken bones, you might ask? Don’t expect to get an answer. Kovacevic has clouded her methods in mystery and refuses to explain her technique. This sort of ambiguity is a red flag and is common in the alternative medicine world. That’s OK, because Liverpool’s own Yossi Benayoun leaked a vague description of the treatment and explained that,

“Nothing went into the muscle itself. It was just a case of massaging the liquid on to the skin around the affected area.”

Well that’s a relief. At least she isn’t injecting foreign material into the tissue. This could lead to infection and more inflammation as the body’s natural response to foreign material is to attack it with an immune reaction. So how could stem cells on the surface of the skin affect the damaged tissue deep beneath? They can’t!

Assuming somehow the cells could travel across the skin and subcutaneous tissues to reach the ligaments or bones, which if they could would mean we would have a constant bombardment of microbial pathogens seeping into our blood, there still is no explanation for how these cells would help us heal. For one, horse placenta is completely foreign to our bodies. Cells from another species contain too many ‘unusual’ markers on their surfaces to be accepted by our immune systems.

Even if they weren’t destroyed immediately by the host’s immune cells, the stem cells wouldn’t just start multiplying and transforming into whatever tissue surrounds them. That would require a special environment and exact cell signaling molecules, one of the many hurdles for stem cell researchers.

Dusan Petrovic, a Serbian player and former patient of Kovacevic, explained that her treatment involved,

“a combination of electricity and the miracle gel that is her exclusive product. The electric current goes through a stick holding the gel, which is applied to the injured spot.”

Kovacevic adds electricity to the lure! If electricity could heal sports injuries, wouldn’t every famous player be attached to an electric current after breaking a leg or spraining an ankle? This additional electricity only adds to the placebo effect that these players are experiencing because it is a well known fact that the more invasive and technical a treatment seems, the more inclined the patient is to feeling an improvement in their symptoms.

If anything, I propose that traveling to rural Serbia for a factitious cure by a non-professional would only aggravate a sports injury. Musculoskeletal injuries are meant to be stabilized to let the body use it’s well known and documented ability of healing itself without any disruptions. Otherwise, there will be more inflammation, which is supposed to be suppressed as much as possible to prevent the build up of scar tissue. Ice also helps prevent inflammation. Not electricity with animal placenta and amniotic fluids. For me, it’s repulsive to even think about.

But why is this placenta treatment so popular amongst these extremely valuable players? The answer lies in the susceptibility of our minds to unconsciously cherry pick positive results. For the same reason that people think vitamin C cures a cold, soccer players believe that placenta treatment could cure breaks and tears. Anecdotal evidence runs rampant in all societies. Misinformation spreads because people claim efficacy for treatments without considering their own bodies’ abilities to heal. A placebo effect leads to a belief that a false treatment works, which is then propagated through anecdotal evidence to other people, and they too start to believe in the nonsense.

I haven’t read much about Kovacevic recently. Last I heard, she has gone into hiding from allegations by the Serbian Health Commission of fraud and illegally treating patients without a license along with tax evasion for charging different amounts depending on the profile of the player. This will only add to her martyrdom for her believers. To them, she is another guardian of alternative healing from the evil conspirators of modern western medicine.

This whole story in general is not surprising to me at all. Like I said, it’s not uncommon for high profile players to search for miraculous cures to speed their recoveries. The thing that struck me the most, however, was the complete lack of skepticism to all of this. Effectively, the incompetent UK media reported of a Serbian housewife electrically shocking horse placenta fluid onto some of it’s most cherished athletes without mentioning a hint of wrong doing. Dropping the word ‘controversial’ into a long article does not suffice to create a balanced story.

Even now there are only a few skeptical posts about this on the internet, after a whole media-storm of coverage last fall. I think that the lack of skepticism on this subject should be brought to notice by the public at large so that reporters can do a better job of doing their homework when covering such stories in the future. Also, the medical staff of sports teams and doctors in general should be more outspoken about such pseudoscientific treatments and should not allow their patients to undergo these sorts of bogus therapies. This is especially true in Europe, where I personally believe skepticism is not abundant enough.

And come on! Horse placenta for sports injuries? Seriously???? Some people need more common sense!