Thousands, perhaps millions, of persons of my generation should give thanks that Dr. John Sarno came to prominence in an era when doctors were not only allowed to have controversial medical opinions, but they were also celebrated in the media for having them. Sarno, a physician specializing in rehabilitation medicine, was the author of a best-selling book in the early 90s called Healing Back Pain-The Mind-Body Connection in which he warned that most back surgeries were unnecessary. Count me among the legions of back pain sufferers who escaped surgeries and other interventionalist procedures because we heeded Sarno’s advice that back pain almost always was triggered by psychological issues, not structural ones involving the back or spine.
A series of articles in recent days made me further appreciate Sarno’s insights and how fortunate he was to have been practicing medicine before it became the money-grubbing business that it’s become. Back and spine surgeries are among the most profitable procedures, and if Sarno were alive today espousing his controversial views threatening the revenues of U.S. hospitals, the medical establishment, the legacy media, and social media censors would rally together and do to Sarno what they’ve done to Dallas cardiologist Peter McCullough and Houston ENT specialist Mary Talley Bowden.
Put simply, Sarno would be publicly maligned as a nut job spreading medical “misinformation” and causing great harm.
I profiled Sarno in March of last year and followed up with this post three months later warning about spine surgeons. The follow-up was triggered by this Kaiser Health News investigation revealing that medical device makers had funneled billions to spine surgeons who used their products. KHN’s findings were alarming, but not surprising.
In August 2020, I reported for Deadline Detroit about how orthopedic surgeons at Beaumont Royal Oak hospital in suburban Detroit were being pressured to use medical devices manufactured by Stryker Corp. they considered inferior. Beaumont got a rebate, or kickback as I prefer to call it, if Beaumont orthopods used Stryker devices for most of their procedures.
After continually refusing the Stryker devices, Dr. Jeffrey Fischgrund, Beaumont’s associate chief medical officer, mandated that any Beaumont orthopod wanting to use alternative products to Stryker’s needed to get his permission. Fischgrund asked that the requests not be submitted in writing.
Fischgrund’s surgical specialty: He’s a spine surgeon, who at the time had received more than $931,000 from Stryker for consulting and other services. (Beaumont dropped its Stryker requirement after I reported the story.)
I was reminded of Sarno’s warnings yet again finding this April Department of Justice news release disclosing the Providence hospital chain had settled for $22.7 million to “resolve allegations that it fraudulently billed Medicare, Medicaid, and other federal health care programs for medically unnecessary neurosurgery procedures.” According to Venessa R. Waldref, the U.S. Attorney for the Eastern District of Washington, Providence gave a couple of spine surgeons financial incentives to do more complex cases, which were unnecessary and put patients at serious risk.
“Ensuring that surgical procedures are medically appropriate and properly performed is critical to building safe and strong communities here in the Eastern District of Washington,” Waldref said in her release.
“Patients with back pain and spinal injury deserve top-notch care from a provider who puts the patient first and is not improperly influenced by how much he can bill for the procedure. Providence’s failure to ensure that Dr. A and Dr. B were performing safe and medically-appropriate surgery procedures, despite repeated warnings, put patients’ lives and safety at serious risk. I am also gravely concerned that Providence’s decision not to report Dr. A or Dr. B to federal or state medical oversight bodies allowed both surgeons to simply resign from Providence and then continue to endanger patients at other hospitals.”
Let’s credit Waldref and the other government agencies that played a role investigating Providence, but it’s disappointing that she didn’t name the surgeons who performed the unnecessary and costly procedures so the public could be alerted of their wrongdoings.
Although the $22.7 million penalty was the largest healthcare fraud settlement ever in Waldref’s jurisdiction, it doesn’t strike me as much of a deterrence; Providence paid McKinsey $45 million or more to develop a controversial bill collection program targeting poor people that Washington AG Bob Ferguson has alleged committed “thousands of Consumer Protection Act violations.”
The DOJ office in Texas’ Northern District is seemingly much tougher on those involved in healthcare wrongdoing. In March 2021, that jurisdiction secured the convictions and sentencing to a combined more than 74 years in federal prison, plus $82.9 million in restitution, of 14 defendants involved in a hospital bribery scam.
Not surprisingly, three of those sentenced were spine surgeons.
One of the most lucrative areas of healthcare are ambulatory surgery centers, where surgeries not requiring overnight stays are performed. According to a recent report in the trade publication Becker’s ASC Review, cardiology is “ASC’s next big thing.”
Patients who have been advised by their cardiologist to get a stent should be aware that various medical studies have conclusively proven stents in stable patients provide no value, yet the procedure continues to be performed almost unabated. Here’s some wisdom from a Substack column by Dr. William Bestermann Jr., an internist who practiced preventive cardiology for 20 years:
Stents in stable patients are done electively-they are scheduled procedures. A mountain of research proves they have no value, but practice has changed very little. After the landmark COURAGE trial in 2008, elective stents in stable patients declined 24% between 2010 and 2013. Since then, they have increased by 2%. Does that mean that only one fourth of interventional cardiologists can interpret this evidence to provide patient-centered care? No. Let me be blunt. It means the hardest lesson a human being can learn is one that reduces his or her income. Stents in stable patients have not decreased because of perverse financial incentives. Stents and hospitalizations generate a lot more money than OMT (optimal medical treatment) which only requires primary care office visits and proven generic drugs.
One of my clients when I had a PR firm was an otolaryngologist who for years was ranked by New York magazine as one of NYC’s top ENT docs. My client taught me that most sinus surgeries were unnecessary, and that most patients suffering from sinus issues would be better off irrigating their noses with a nasal wash. My client, whose practice was focused on repairing damage caused by other ENTs’ surgeries, developed and patented a nasal wash that offered me, a chronic sinus sufferer, considerable relief. Unfortunately, the miracle product is no longer available.
I thought of my client reading Mary Talley Bowden’s moving Substack article about how she was banned from ENT Connect, an online forum run by the American Academy of Otolaryngology – Head and Neck Surgery. Bowden, who did her ENT residency at Stanford, says she contributed to the forum solely on ENT issues, but when someone brought up her Covid treatment controversy, she felt compelled to defend herself. One of her responses got her banished from the forum.
“Many of my peers believe non-surgical patient management is beneath them,” Bowden said in her Substack piece. “I remember running into one of my former attendings from Stanford at an AAO-HNS meeting and telling him that out in private practice I was reading sleep studies, suggesting he incorporate that into residency program training. He scoffed and said, “We’re surgeons, we don’t do that sort of thing.”
Prior to Covid, Bowden’s ENT practice was focused primarily on holistic and non-invasive treatments considerably less costly than surgery, which she also performs. Bowden reminds me a lot of my former client in that sinus surgery was always an option he tried to avoid.
I’d encourage the leadership of the American Academy of Otolaryngology to undergo a collective nasal washing because banning Bowden really stinks. Bowden is a committed ENT specialist and deserves to be treated with respect.