Elan Corp., plc
Semi OT, But Not Really

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By kingrrex
January 19, 2006

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My oldest friend (from college - 35 years and going strong) called me last night in tears. She had fallen a few months ago while walking the dog, did a split and landed on her...butt. She had instant pain and remains sore today. She visited an orthopedist recently and came away raving about his Harvard diploma and friendly demeanor. I knew the name and remembered him as basically so-so, despite his education.

This day, my friend had returned for her follow-up appointment and was told by Dr. Wonderful that she had a "fractured spine" and that he was referring her to a surgeon for a surgical consultation. He assured her that she was very lucky, because he was able to get her an appointment with Dr. Fabulous, whom he characterized as "the best."

Well, she freaked-out...called me sobbing, fearful of that phrase "fractured spine." Having had 25 years in radiology, I advised her that there's nothing emergent in her condition; I knew that he was referring to a pars defect, which is a common fracture of a small bony structure at the point where one vertebral body articulates with the next one - simply put, a sliding joint which allows us to bend. When the pars fractures, one vertebrae can slide forward slightly, and nerve root compression can result. Many people have pars fractures, and it's a leading cause of low back and leg pain. These fractures may go undiagnosed for years.

Anyway, before she could ask, I offered to go with her to the surgeon...that way, I could give her a little perspective on what the guy was saying, as surgeons tend to be a bit cocky and intimidating...they often talk over the heads of their patients, who in turn are too intimidated to ask, "what the heck do you mean by that?" After we agreed on a time to meet, I decided to do a little research on this Dr. Fabulous, who I'd never heard of in 25 years in the field locally.

He began practicing about 5 years ago. Soon after, he surrendered his license in (I won't name the state, but it's a big one) while under un-named charges by the State. A couple of years after that, he was disciplined here in Florida for two separate incidents, one a wrong-site surgery and another where he damaged a nerve. In both cases, he was found to have "failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances."

And the penalty? Pay a fine; pay some administrative costs; promise not to do it again; attend a class on Risk Management (to be completed within one year); attend a one-hour class on wrong-site surgery (to be completed within six months); and perform 25 hours of community service (to be completed within one year).

So, what's this got to do with Tysabri? Well, consider that this surgeon was never asked to stop performing surgery. Also consider that the public knows basically nothing of his prior transgressions, although technically the information is available to anyone ambitious enough to search it out on the Internet - most senior citizens probably wouldn't know where to begin, I think. Also consider that, as intimidating as surgeons and the whole process can be, many patients would be afraid to question the doctor's competence even after learning of these incidents!

Yet, the opportunity to be treated with Tysabri is denied to thousands of MS patients?

Now, in his defense, I'm sure he has performed a lot of successful procedures. I also suspect that he's had a lot of sub-optimal outcomes which were not attributed to his technique...FWIW, he told my friend that he'd love to do her surgery. I advised her to completely reject the idea of having surgery, as so many of them fail and only lead to a second surgery, and often a third.

Seems like a double-standard at work...


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