Medicins Dentiste Sans Frontieres

Christine Kearney at Reuters reports on this case. I love the last sentence.

NEW YORK (Reuters) - A New Jersey dentist behind a scheme to steal body parts from corpses, including that of British journalist Alistair Cooke, was sentenced on Friday to a minimum of 18 years and a maximum of 54 years in prison.

Michael Mastromarino, 44, in March admitted to leading a $4.6 million operation that stole body parts from funeral homes in New York, New Jersey and Pennsylvania.

The ring dismembered more than 1,000 cadavers in unsanitary conditions, and sold them to doctors who transplanted them into patients.

"I am sorry for the emotional pain I have caused," Mastromarino told the court, repeating an apology he made to victims and relatives of the dead earlier this month.

State Supreme Court Judge John Walsh made no comment as he sentenced Mastromarino, who had pleaded guilty to body stealing, reckless endangerment and enterprise corruption.

"His sick, disgusting and appalling actions all in the name of greed have devastated my family," Dayna Ryan, 44, told the court.

Ryan contracted Hepatitis B when she was a recipient of stolen body parts during a lower spine operation.

As part of the scheme, a team of so-called cutters removed bones, skin and tendons in an unsanitary embalming room, prosecutors said.

"He fully recognized the gravity of what he has done," Mastromarino's lawyer Mario Gallucci said outside court. "He cut some corners and that is why he is here today." (emphasis mine)

Some thoughts:
1. Ewwwww.
2. Some corners? Did he actually use the word "cut?!" He apparently skipped the semester on public relations in law school.
3. What the hell did he want with Alistair Cooke's body? Was he a fan of Omnibus or Masterpiece Theater?
4. Does this make me an Anti-Dentite?

Dr. Feelgood?

The most recent episode of another pop pseudo-psychologist making headlines has got me perturbed. Dr. Drew Pinsky was babbling about how Tom Cruise is mentally ill, due to his involvement in the cult of Scientology. To quote Drew: “To me, that’s a function of a very deep emptiness and suggests serious neglect in childhood — maybe some abuse, but mostly neglect.”

Of course, he then has to retract and apologize. He is the host of Celebrity Rehab on VH1 after all. (Ironic, here, that Cruise, et al, called the Jewish Dr. Pinsky, a “Nazi,” in their rebuttal.)

And then, having learned his lesson real good, Drew comes out with this brilliant piece of work:

“I'm concerned with what's really going on with Angelina Jolie. I've never seen someone remit heroin completely. You're either still on heroin, Oxycontin, or something else. Unless you're dead. Is she still using something? Is she in recovery? If she's in recovery, I don't see any evidence of it, because people in recovery invest themselves in simple, selfless acts of service, not global self-serving acts."

I am irritated for multiple reasons. For starters, this causes me to side with (at some level) Tom Cruise and the scientologists, with whom I personally (not professionally) have a few beefs…..another time on that. The last thing this group needs is to win PR points because some wannabe shrink has to publicly apologize to them. And regarding Ms. Jolie, well…I just think Angelina Jolie is hot. Um…and of course there’s the obvious trashing of medical and professional ethics.

Paging Dr. Drew! Dude, where in your Hippocratic Oath did it state that you should make public diagnoses on people who are not your patients, do not want to be your patients, and are not soliciting your advice? Pinsky is a board certified internist and addiction specialist- which means he went to medical school, specialized in internal medicine and passed a board exam. He is not a therapist, either psychiatrist or psychologist. This is critical, because the untrained pseudo-therapists seem to have difficulty with certain concepts, like confidentiality (Hello Dr. Phil, RE: Brittany Spears), neutrality (Dr. Laura, preaching personal dogma like “don’t marry someone from a different religion.”), doctor-patient relationships, and other medical ethics. Dr. Phil has a PhD in Psychology, but was sanctioned by the Texas Board of Examiners and is not licensed to practice psychology anywhere. He appears to be more concerned with skirt-chasing or dollar-chasing than in actual practical therapy. Dr. Laura Schlessinger has a PhD in Physiology, not in any therapy modality, and uses her title to wax rhapsodically about the “biological error” of homosexuality, rather than focusing on an individual’s emotional need, thus ruining any sense of neutrality in the therapeutic relationship.

Perhaps I’m off the mark, but using a title like “Doctor” denotes some professional expertise; and professional service if you are going to a “Doctor” for advice, treatment, etc. There appears to be no such professional service being transacted here, and the use of “Dr.” is nothing more than false advertising. So, Laura, Phil, Drew and others, if you’re just giving your opinion, drop the whole “Doctor” schtick. And Drew and Phil, stick to the scripts handed to you on TV, and otherwise shut up.

Medical Truths #2

The most important sentence a doctor can speak is "I don't know."

Our medical schools are chock full of high performers (gunners, in parlance), being taught that the right answer is imperative. Differential diagnoses are screened a-la-House, M.D. and the message is to always be right, and always have an answer. I remember students being berated for "guessing with your mouth open," a favorite phrase, of one particular attending. That mindset is reinforced all through training. Primary care doctors are told to be gatekeepers, and that they should have the ability to treat everything. Certain insurance structures (such as capitation) financially punish those doctors who refer out to specialists or order to many tests. And doctors are given a heavy responsibility (patients' health), for which they do not want to be wrong, and thus be a failure.

It's good to know stuff. We want our students and residents to learn by experience and going to find information that will help in the diagnosis. Certainly we all want to have confidence in our physicians. And there are many benefits in gatekeeper medicine. (Having one doctor keeping track of all of a patient's treatments is one.) Illness, though is not so black and white. However, there is very little positive reinforcement for the student or resident when presented with these grey areas, and even less for those in practice.

Patients respect an "I don't know," even though it may be frustrating to hear it. Most do not expect doctors to be superhuman. I recently had a friend of mine (another physician) be told that he had stage 4 cancer by a national expert, only to find that his nodules in his lungs began to shrink with antibiotics were given by another doctor who said "I don't know." He's glad that the doctor didn't.

No semen for you!

I’ve been following the news out of the Supreme Court of (The Peoples Republic of) California, regarding the Oceanside woman suing a fertility clinic for their refusal to provide artificial insemination on the basis of religious beliefs. The article, courtesy of the San Diego Union Tribune, is here.

The case has been won by the woman locally, overturned by appeal in favor of the docs, and has hit the CA Supreme court. The ruling is pending, but sources believe it will be found in the favor of the woman.

Interesting. I was discussing a similar case regarding a photography business in New Mexico that was found to be discriminatory in its business practices. Marshall Art's blog was discussing this article in the American Thinker.

My comments then as to that case now appear quite relevant and I have rephrased them as such in the next several paragraphs:

Per the Federal Civil Rights Act, legally, unless there is a legitimate business reason for such discrimination, then they're out of luck.

Many states have additional legislation more stringent than the FCRA.

This is up for interpretation:

In California, a funeral home was sued by a family trying to keep out "punk rockers" from a service. The funeral home allowed their admission, thinking that under the Unruh Civil Rights Act of California, they could be sued if they didn't.

It is really discrimination--by the fact of refusing service--and in the definition as noted in the law. I am viewing the term "discrimination" as a legal term, not an ethical/moral one; which is logical, as we are discussing the interpretation of a specific law. One is better off asking if the law is moral or right, to address that component. On that, it is difficult, as I think there are specific rights of individuals to conduct business within a specific code of conduct.

The problem exists, in such code, as to where one draws limits. As a pragmatist, I do believe that society has the right to clarify, by law, the specific definitions as to how businesses have to act in providing service.

The question is thus in degree: Should a private business be allowed to discriminate (by refusing business) against a specific group of people purely on the basis of their sexual orientation? The law currently says no for each and every business.

Had the owners of this practice argued that this decision falls outside of a noted code of conduct, and made efforts to refer this couple to a willing provider of services, they probably could have made a viable argument of this being a business decision -as it could have caused them to lose other customers, etc. (It also probably wouldn't have become a court case). The bottom line is: Refusal of service needs to be defined in terms of a business or medical decision, lest it be open for such claims.

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A few additional points and questions:

1. Why was there no suit against the insurance company for not facilitating any other willing provider? There are many instances where physicians may have standards which do not allow comfortable treatment by the physician. An example--treatment of multiple family members by one Psychiatrist is often contrary to professional standards. Shouldn't insurance companies be required to work with clients in these cases?

2. Does the fact that this is a voluntary medical procedure make any difference? Few would argue regarding emergency care, but should a physician have the right to refuse to treat under conscientious objection? Michigan is debating that issue currently. See here.

3. Does this standard apply for other religious groups? There is significant debate in the UK regarding docs of Islamic faith refusing to treat drug or alcohol issues, sexually transmitted diseases, or opposite genders. I am waiting for the day that a Jehovah’s Witness becomes an MD and refuses to treat anyone.

4. These are not the brightest docs to scribble on a pad. There are so many ways around this religious refusal of treatment that I cannot help but wonder if this is not merely a couple attempting to push a political agenda. C’mon! If I’m reading correctly, you agreed to treatment of mediations for this patient, but drew the line at artificial insemination. Huh?! That’s like giving band-aids but refusing stitches.

Doc's Public Service Announcement #1

People with candidate bumper stickers should drive in a safe and courteous manner.

Medical Truths #1

I'm going to try to put out some opinions on how I see the medical field as it is and as it should be. These are truths in the sense of my own personal belief, not necessarily scientific axioms. I will try to keep the initial posts less tome-like, and hope to encourage dialog. With that said, # 1:

Medicine is a science.
The Practice of Medicine is an art.

I notice an increase in the cynicism of the public towards the health care field. I believe there are many political, social, and economic reasons for this. One reason, though, I believe is in the failure of our field to practice this simple truth. We are often blurring the lines of science, by not holding data up to an exacting standard. We are also poor artists. I think that many doctors have a presentation that suggests they are just throwing the drugs out there to see what sticks. Doctors do not often have (or take) the time to explain the science (how the stuff works), and even less time to explain the art (how did we come to this conclusion and plan).

Designer Babies?

From the AP. Link here.

By MALCOLM RITTER, AP Science Writer Mon May 12, 6:25 PM ET

NEW YORK - News that scientists have for the first time genetically altered a human embryo is drawing fire from some watchdog groups that say it's a step toward creating "designer babies."

But an author of the study says the work was focused on stem cells. He notes that the researchers used an abnormal embryo that could never have developed into a baby anyway.

"None of us wants to make designer babies," said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at NewYork-Presbyterian/Weill Cornell Medical Center.

The idea of designer babies is that someday, scientists may insert particular genes into embryos to produce babies with desired traits like intelligence or athletic ability. Some people find that notion repugnant, saying it turns children into designed objects, and would create an unequal society where some people are genetically enriched while others would be considered inferior.

The study appears to be the first report of genetically modifying a human embryo. It was presented last fall at a meeting of the American Society for Reproductive Medicine, but didn't draw widespread public attention then. The result was reported over the weekend by The Sunday Times of London, which said British authorities highlighted the work in a recent report.

Rosenwaks and colleagues did the work with an embryo that had extra chromosomes, making it nonviable. Following a standard procedure used in animals, they inserted a gene that acts as a marker that can be easily followed over time. The embryo cells took up the gene, he said.

The goal was to see if a gene introduced into an abnormal embryo could be traced in stem cells that are harvested from the embryo, he said. Such work could help shed light on why abnormal embryos fail to develop, he said.

No stem cells were recovered from the human embryo, said Rosenwaks, noting that abnormal embryos frequently don't develop well enough to produce them.

Marcy Darnovsky, associate executive director of the Center for Genetics and Society, said the Cornell scientists were developing techniques that others might use to make genetically modified people, "and they're doing it without any kind of public debate."

A London-based group called Human Genetics Alert similarly criticized the work.

But Kathy Hudson, director of the Genetics and Public Policy Center in Washington, D.C., said she's not troubled by the work. She said the idea of successfully modifying babies by inserting genes remains a technically daunting challenge.

"We're not even close to having that technology in hand to be able to do it right," she said, and it would be ethically unacceptable to try it when it's unsafe.

A few questions:

1. Does it matter that they used an "abnormal embryo?"

2. While it would certainly be unethical for this group of scientists to use this technology for human modification, aren't others able to do so?

3. If so, should the progress be halted based on the possible malfeasance/malevolence of others?

4. Although the idea of successfully modifying babies is a technically daunting challenge at this time, doesn't that seem to be a planned goal?

5. Is that bad?

6. Couldn't we have a better name than "Designer Babies." Sounds like an LA girls pop band.