First, Do No Harm – Open Letter to Doctors

27 03 2020

Primum non nocere is “one of the principal precepts of bioethics that all medical students are taught in school and is a fundamental principle throughout the world. Another way to state it is that, “given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.” It reminds physicians to consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.”  Prescribing medications with a less certain chance of benefit would be in that category.  Prescribing medications that creates a shortage for people who need this medication for serious illnesses would be causing harm. 

It is now news that doctors are now sending in prescriptions for hydroxychloroquine and Z-Paks, even though THERE IS NO CLINICAL STUDY THAT SAYS THIS WORKS against COVID-19, not only for THEMSELVES, but their families, their friends, and their office staff and God knows who else.  You think you aren’t doing any harm, BUT YOU ARE.  You are taking away a valid treatment option for people with lupus and rheumatoid arthritis.  At a press conference, Dr. Fauci even stood up to say, “The information that you’re referring to is anecdotal. It wasn’t done in a controlled clinical trial, so you can’t make a definitive statement about it.”  But there was President Trump is constantly spreading the name of the medication; it even caused a tragedy that didn’t need to happen to a couple in Arizona who decide to ingest chloroquine phosphate that they thought was the compound Trump kept saying over and over and over again.  The man died; the woman said she specifically tried it because it was the name the president said.  But it wasn’t the exact one he was spouting.

According to a report by BuzzFeed who saw this woman’s note, Kaiser Permanente thanked her for her sacrifice since the medication would be used for COVID-19 patients.  See this link for the full story.  Below is the picture.  It came from kp.org so it is a valid text message. 

Lupus and rheumatoid arthritis patients who rely on this medication now cannot access it because of your unethical (at best and perhaps criminal at worst) behavior.  I hope when this is all over they do an accounting with the pharmacies to figure out who called in an unusually high number of prescriptions (comparing all local pharmacy’s data just in case you covered your tracks knowing that it may be scrutinized) to see just how many prescriptions of this drug you prescribed in March 2020 and going forward and compare it to your prescribing habits of this medication for the year prior.  There needs to be an ethics inquiry with loss of licensure to any doctor who did.    

I tend to have lots of side effects.  Kaiser Permanente alludes to the fact that there are “other medications” lupus and rheumatoid arthritis patients can use instead to free up the hydroxychloroquine. Are they telling people receiving this for off-label use hydroxychloroquine may cause macular degeneration because I have to get eye exams every 6 months?  I have been on this medication now for 10 years.  When I called my pharmacy, they said that yes, it was happening in our area (the doctors’ behavior) and yes, they were having great difficulty getting more.  I then, in a heap of tears, fell apart.  I told them the two medications I was given a choice of was hydroxychloroquine or methotrexate to try at the beginning of this process. 

So let’s review:  Doctors, who are scared and are human, but took an ethical oath not to do harm, are now causing harm and I have to choose between not getting hydroxychloroquine which I know works for me and I have zero side effects, to move to a drug used for chemotherapy for breast cancer and all the side effects that would come with since it would be a new drug in my system.  I let my pharmacy know that I would have to call my rheumatologist to come up with a plan. 

The plan would be I could take 1 pill a day to try to stretch my supply for 2 additional weeks, but if by 4/20 my pharmacy is not able to procure it to fill my prescription, then he wants to put me on a drug called Benlysta versus going to methotrexate. 

I looked up that medication.  Once again, I burst out into tears that I am being forced to make difficult choices to make YOU FEEL SAFE.  This is bullshit.  Is this drug benign?  Oh hell no. 


And

You watch….If I am forced onto this medication, I will find out that my insurance won’t cover it and I’ll have to get some sort of “deal” with the pharmaceutical company.  I’ll be the one that gets PML that requires hospitalization.

But let’s talk about the medical industry as a whole. There is what I call the “BRO-CODE.” I worked for a cardiology group a long time ago.  I remember the doctors in the group talking about other doctors and would tell us this one was addicted to drugs or that one was doing XYZ.  I remember asking them, “Why don’t you report them then?”  It was then I learned about the BRO-CODE.  No doctor rats out another doctor even if that other doctor may be putting their patients under that doctor’s care at risk.  It was so wrong.  But I was young and kept my mouth shut.  When doctors would have affairs with their office staff, I kept my mouth shut. When staff took medication samples from the closet (including drugs like Ativan), I kept my mouth shut. I was part of that BRO-CODE….until I started being blamed for things I had not done. I left.

Later when I worked for a medical transcription company, I would hear stories about some of the doctors.  One was Dr. Eric Scheffey of Houston, Texas.  He became a notorious workman’s compensation doctor who performed way too many unnecessary procedures and killed many of his patients and maimed too many more.  He had a $6M mansion, had a private jet, multiple Ferrari’s and a horrible cocaine habit.  Of the ones he didn’t kill, he maimed others and left them in chronic pain forever.  At least four of them committed suicide from their chronic pain they didn’t have until he operated on them. His license was suspended in 2003.  In 2005 it was finally revoked and he was fined $845,000.  Despite reports from colleagues and nurses (one described that he had slurred speech) during surgery, no one actually stopped him or refused to scrub in. He was named “Eric the Red” because of the large blood loss volumes of his patients.  But he continued to be allowed to practice.  Police arrested him after he was higher than a kite on cocaine at a Montgomery Ward store; they found 30 grams of cocaine in his car.   But after a whole bunch of this stuff, he only lost privileges at three of the hospitals.  I often heard stories from the people in the medical records’ department about this man.  I could not believe he was still allowed to perform surgeries at their facility (and another hospital).  This is the BRO-CODE.  When a judge ultimately tried to revoke his medical license, the Medical Board reversed it and gave him a 5-year probation.  But then a district court overturned their decision and let him go back to practice without ANY restrictions.  An appeals court overturned the district court.  But his probation was almost over.  He continued to work and went right back to what he was doing.  Scheffey’s practice had never operated quite so efficiently, relying upon an elaborate network of enablers that included fellow surgeons, nurses, radiologists, anesthesiologists, and a system of insurance and workers’ comp approvals that was easily gamed. The TWCC (Texas Workman’s Compensation Commission), which, in effect, controlled 90 percent of his revenue, not only allowed him to continue but failed to challenge him when he was asking for approval (in one case, for the fifteenth surgery on one patient). Once the TWCC approved it, there was little anyone could do.  He continued to maim and kill people without any checks on him.  This is the BRO-CODE.  His license was FINALLY suspended in 2005.  But he found a way around that with another enabler.  In its 2004 complaint, the state medical board also charged Scheffey with practicing medicine with a suspended license, a third-degree felony punishable by up to ten years in prison. According to the complaint, Scheffey continued to practice medicine even after his 2003 suspension, using his partner Dr. Floyd Hardimon as a front. When the board temporarily suspended Hardimon’s license later in 2003, it did so in part because it found that Hardimon “associated with and aided and abetted [Scheffey] in the practice of medicine after [Scheffey’s] medical license had been suspended.”  In 2005, he was arrested in Aspen, Colorado for practicing medicine without a license.  In 2007, his trial started.  Prosecutors decided to dismiss the charges after three days of testimony.  He never suffered any consequences outside of settlements with the victims or his victim’s families if they had died.

If I find out you are among one of my doctors who have done this, you will have no place in my care team.  I will always wonder if you were putting your interests above what is best for my health and that you were so willing to toss aside your oath to your patients in order to take care of yourself, your family, your friends and your office staff first.  And I will report you to the Medical Board.  Count on that.


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