• Quick note - the problem with Youtube videos not embedding on the forum appears to have been fixed, thanks to ZiprHead. If you do still see problems let me know.

Is my Doctor a Quack?

scribble

Master Poster
Joined
Nov 16, 2001
Messages
2,687
Hello JREFfers!

I went to a doctor yesterday for the first time in ages and ages. I've been feeling some "heart palpitations" (I'm not sure they are really, but the description works pretty well) and I have a lump growing on the back of my noggin, which I expect is probably just a cyst. I smoke, and I drink a TON of caffeine.

So, first off, the hospital who recommended the doctor (using a referral service) called him "Gus" and all the paperwork called him "Gus" but the sign on the office door and his diplomas were all for "Constantine." His last name (changed to protect the possibly innocent) was Mydoctor and the office next door was Mydoctor and Mydoctor law offices. So I was tempted to ask him whether his parents were more proud of him, or his brothers, but I didn't. :)

Anyhow, that's just setting the scene. I met the nurse, waited for Gus to show up, and when he did, we got right to talking. He struck me as a straight shooter... I told him my problems and he asked how much I smoke. I said, "about a pack a day -- I'd really like to try quitting again, I hear there is some new drug that makes it much easier."

He says, "No, you don't want that drug; it's not going to work for you. What you need is laser treatment!"

Well, I'm intrigued. I say, "Laser anti-smoking treatment? Never heard of it... what is the mechanism by which that is supposed to work?" -- I'm having a hard time imagining how to apply a laser to stop you from smoking, unless they burn off my hands or lungs, I suppose.

His response? "I don't know and you ask too many questions!" and then he went on to tell me how laser treatment works for so many people, the drugs only work if you've convinced yourself to quit, if I'm not into it mentally, then I won't stay quit regardless, etc. Then he adds, "The laser treatment works because you pay $400 for it."

Well, I was embarassed FOR him at this point so I said, "You mean it's the placebo effect?" He took a little while before agreeing yes, it is. And still recommended to me that it was the path I take. I don't get that at all.

a) Can a physician recommend a placebo treatment in the first place? If he does, why is it so hard to get double-blind medical testing done? Just give half of them the placebo; it's OK.

b) Is laser smoking treatment absolutely BS? All I can find about it is it's accupuncture. It works on "meridians." It's BS.

c) If I, the patient, know it's just a placebo, doesn't that ruin any possibility of it working?

( d) if he knew how to read people even the littlest bit wouldn't he reaslize I'm not the type of person for whom a ******** treatment is going to work? Does that mean he thinks the laser treatment is the real thing? )

The "I don't know and you ask too many questions" bothered me; especially considering it was the first question I'd asked him. A few other lines stand out from the consultation: he asked me out of the blue if I was one of the smartest guys in my class, I said, "uh... maybe" instead of "yes" and he made a comment about my modesty. But then later he asked me where I went to college and I admitted I didn't, and he said, "oh, you're too good for the rest of us?" I think he was joking but it was hard to tell. And at one point I started addressing him by name, I said, "Gus, right?" He said, "yes" and I said, "is Gus usually short for Constantine? I never knew that!" and he kind of flinched and said, "Well, you learn something new every day!" It was just an odd response; you might have had to be there. NOT that I suspect there is anything actually weird about his name; it's just another point of interest. I know other greeks with weird nicknames, like a Konstantino who goes by "Jimmy."

His advice to me about the things I came in for was equal parts good and disturbing: he said, cut out the caffeine, stop smoking, and you'll be all good. I'm pretty certain he's right about that. He also refused to give me any smoking treatment, drugs or lasers, until I was SURE I wanted to quit. Since I went in saying I wanted to quit, I'm not sure what else he wanted, but OK. He also said "But you're the customer; if you want me to write you a prescription I will." To me, that's another big red flag.

As far as the cyst on my noggin, he touched it once, declared it a swollen lymph node, and declared that is normal for smokers, and to not worry about it. I've been smoking for almost ten years and never had a lump like this, or like anything else for that matter. Did he dismiss it too casually?

Anyhow, I'm going to talk to the people at Blue Cross about whether my health plan will cover another visit to another doctor for the same problems if I think my current doctor might just be a quack. I have almost no knowledge of what to expect from Doctors, though, since I really have lamost never been to one as an adult. What shoudl I expect? Assuming I have the option of picking a better one, how do I actually choose?

Any advice appreciated.

-Chris
 
Last edited:
Sounds like a quack to me. Or maybe just profoundly lazy. Not sure which is worse.

Laser treatment for smoking HAS to be woo, I think. I've tried before to think of some mechanism by which it could work, but I can't think of anything. I'd like to be wrong about that, though. But I'm pretty darn sure it's quackery.

As far as picking a new doc goes...I have no advice. Maybe ask your friends if they have a doctor they like?
 
It was discussed in this thread. Basically, as you surmised, it is an expensive placebo. Unfortunately it's not quite as clear-cut as you might think though, because in order to quite smoking (or other addictions) sometimes that can be what people actually need. Something cheap and easy like gum just doesn't provide an incentive to quit, but knowing you'll have wasted $400 dollars if you don't can provide the extra bit needed to actually manage it.

However, this certainly doesn't excuse a doctor from prescribing what is know to be a placebo. There are endless debates about placebo, but the result is always the same. If a treatment is known not to do anything in itself then it is unethical to prescribe it to a patient, especailly if there are other treatments that are known to have some effect, however small it might be. I don't know if there are actually any laws about this though. Of course, the ethical implications also prevent any methodical testing of placebo as an addiction cure, so although the idea is fairly well accepted it is based more on anecdote and common sense than any good evidence. My advice is that if you have any suspicion that something might be just placebo, or outright fraud, then don't do it.

As for giving up caffeine and smoking at the same time, by all accounts that is just about the worst thing you can do. One thing at a time. If you can't manage to give up either one by itself you have virtually no chance trying to do both at once. One of the reasons that people often give (anecdotally) for failing to quit smoking is that they tried to be generally healthy at the same time, changing diet and so on, but then couldn't cope with it all and fell back into their old habits.

As for the cyst, I'm afraid I know nothing about that. There are some medical types on here who might know something but, as always, the best advice is to see a professional.
 
Incidentally, try cutting back on the caffiene if your heart "palpitations" (that's what I called 'em, too, when I saw my cardiologist) bother you. That's one of the known side effects of large doses of caffiene. I had the same problem, and it helped. But "all good?" Possibly not. See a REAL doctor!
 
Last edited:
Hey Scribble,

Sounds like a quack to me, too. Laser treatment? Admitted placebo?!?!

Ironically, I am seeing a new doctor today and a swollen lymph node on the back of my neck is one of my issues. It's been here for about five years, and I've been told "It's fat, it's nothing, you have a cold" et cetera. I gave up smoking almost a decade ago.

The search for the right doctor can be painful and frustrating. I have been through two this year(I can't even count the number in the last five), and found one that required a three month wait just for the initial appointment (existing patients don't see these kinds of waits, I checked). This doctor is the result of two people recommending her, and we'll just see. (I have conflicting diagnosis of fibromyalgia, hypopituitarism, estrogen dominance--which seems to be total woo--and possible MS. Ummm, I'd like an answer and treatment, please!!!).

I blather on just to let you know you're not alone in seeking good medical care. Doctors are human beings just like everyone else. Ever had an incompetent mechanic, store clerk, repair man? Yep, doctors come in the dolt variety, too. But there are good ones.

Keep searching, and seek out personal referrals. If you feel like your doctor is not doing their job well, find another. I don't know how today will go, but the referral that won me over in this case was that several prior doctors found the causes of a friend's pain and fatigue to be "depression and obesity". Turned out it was LUPUS, and thanks to this doctor, she's being treated.
 
Always get a second opinion.

I know people who were told they had cancer by one doctor, went to a second doctor, and magically, the cancer was all gone.

Of course, turn that around. Some doctors say you don't have cancer...some say you do, and are correct in saying that.

Like I said, ALWAYS get a second opinion.
 
It's time to move on. He is dead to you now...

But seriously, how could you trust what he says after that? I mean, at least he was honest. Which is a plus. But come on!
 
I vote quack. Or incompetent.

As for quitting smoking. Drug treatment (Zyban) absolutely does work (at least for some people). I was a 2 pack a day smoker and was being treated for depression with Wellbutrin. I wasn't planning to stop smoking but I just lost the desire to smoke and so I quit. I told my doctor about that, and he said that it was interesting because studies were being conducted as to the effectiveness of Wellbutrin for smoking cessation treatment. Two years later they came out with Zyban (same stuff as Wellbutrin).

As to the heart problems, it could be acid reflux (at least in part). Cigarette smoking as well as heavy coffee/tea consumption can increase stomach acids. I went to the doctor with chest pains and he checked out other things and also prescribed prilosec - it did the trick. The chest pains were heartburn related.
 
Look at: http://www.ncahf.org/digest06/06-30.html concerning laser and smoking. It is a variant of acupuncture.

For all sorts of quackery, www.quackwatch.org (which led to the link, above) and www.skepdic.com (I think it's .com, it's the Skeptic's Dictionary) are good sources. For me, if I found an MD proponent of any kind of quackery, I would move along; expense-be-damned.

I think you also know the answer as to how to treat treat a doctor who considers your first question as excessive.
 
...

His response? "I don't know and you ask too many questions!"

...

ANY time a doctor who tells you that you're asking too many questions, run -- do not walk -- out of their office. Not only will a good doctor answer any and all questions you have, he or she will likely provide you with pamphlets or other printed information about your condition and any therapies recommended.

Also, any doctor who tells you beforehand that a medication (one that is indicated for use with your disease or condition) "won't work" has some serious 'splaining to do.

You were right to be concerned about this guy. Save your time, money, and sanity by finding a good doctor.
 
Thank you, everyone! I have contacted Blue Cross and they say I am absolutely welcome to go to other doctors until I find one I am happy with. That's great news! I was afraid the answer would be something like, "Well, all our doctors are board-certified, so if you saw one, that's all you should need!" I'm glad it wasn't.

As far as it goes, I'm already drastically reducing my smoking and caffeine intake. I hope to have a new appointment with a new doctor in the near to immediate future, and I'm sure it will be a much better experience.

Thanks again for all the insight... sometimes you know what the Right Thing is but you need someone else to tell you you're not crazy.

-Chris
 
Laser treatment to cure disgusting habits.

"Do you expect me to die!?"

"No, Mister Bond... I expect you to stop smoking!"

Seriously, I'm thinking *that* laser treatment would get you to *start* smoking, like a charred peice of meat.
 
As for quitting smoking. Drug treatment (Zyban) absolutely does work (at least for some people).

So I've heard -- but I think the drug I've heard so much about that a few friends have recommended lately is Chantix:

http://en.wikipedia.org/wiki/Chantix

This medication is the first approved nicotinic receptor partial agonist. In this respect it reduces cravings for and decreases the pleasurable effects of cigarettes and other tobacco products, and through these mechanisms may assist some patients in smoking cessation.

In other words, I guess it takes all the pleasure out of smoking. Sounds good to me. My friends who have used it describe it as going even further; they report getting ill when trying to smoke after having been on chantix for a week.
 
Well, he may have just been ignorant of the method behind laser therapy. After all, doctors are people too. Just like you may not be up on everything under the sun, neither is the doctor.

I imagine that he has heard positive things about laser treatment from his patients, and just has no clue what the hell it really is. Not his area of expertise.

Also one should never underestimate the value of having a doctor with an open pad for drugs. Nothing is more frustrating than explaining to a doctor why I need a particular drug when I've read more about the medication then they have. Ugh. Give me a doc who can sign me a RX and all is good.
 
I would not go to a doctor who was that impressed by placebo effects. It appears he is convinced if you pay a lot for a placebo it works better. But one has to question if it isn't simply rationalizing that your money was well spent rather than actually getting a benefit from the placebo. And of course, the more motivated you are, perhaps you'd pay more. But then any study of expensive placebos would have a self selected study population. How would you create a control group? The study group gets the placebo and the control group gets?????

So quit the quack but educate him on your way out. Here are some studies available on the new drug you mention.

Varenicline: a selective alpha4beta2 nicotinic acetylcholine receptor partial agonist approved for smoking cessation.
Varenicline is the first drug in a new class known as the selective alpha4beta2 nicotinic receptor partial agonists. In several randomized, double-blind, 52-week clinical trials involving healthy chronic smokers, varenicline demonstrated superiority to placebo and bupropion in terms of efficacy measures. Additionally, it improved tobacco withdrawal symptoms and reinforcing effects of smoking in relapsed patients. Patients should start therapy in combination with tobacco cessation counseling 1 week before quit date and continue the regimen for 12 weeks.

An additional 12-week maintenance therapy may be considered for those who achieve abstinence. The most common side effects are nausea (30%), insomnia (18%), headache (15%), abnormal dreams (13%), constipation (8%), and abdominal pain (7%).

Smoking cessation with varenicline, a selective alpha4beta2 nicotinic receptor partial agonist: results from a 7-week, randomized, placebo- and bupropion-controlled trial with 1-year follow-up.
METHODS: A phase 2, multicenter, randomized, double-blind, placebo-controlled study of healthy smokers (18-65 years old). Subjects were randomized to varenicline tartrate, 0.3 mg once daily (n = 128), 1.0 mg once daily (n = 128), or 1.0 mg twice daily (n = 127), for 6 weeks plus placebo for 1 week; to 150-mg sustained-release bupropion hydrochloride twice daily (n = 128) for 7 weeks; or to placebo (n = 127) for 7 weeks. RESULTS: During the treatment phase, the continuous quit rates for any 4 weeks were significantly higher for varenicline tartrate, 1.0 mg twice daily (48.0%; P<.001) and 1.0 mg once daily (37.3%; P<.001), than for placebo (17.1%). The bupropion rate was 33.3% (P = .002 vs placebo). The carbon monoxide-confirmed continuous quit rates from week 4 to week 52 were significantly higher in the varenicline tartrate, 1.0 mg twice daily, group compared with the placebo group (14.4% vs 4.9%; P = .002). The bupropion rate was 6.3% (P = .60 vs placebo).

Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial.
RESULTS: For weeks 9 through 12, the 4-week continuous abstinence rates were 44.0% for varenicline vs 17.7% for placebo (odds ratio [OR], 3.85; 95% confidence interval [CI], 2.70-5.50; P<.001) and vs 29.5% for bupropion SR (OR, 1.93; 95% CI, 1.40-2.68; P<.001). Bupropion SR was also significantly more efficacious than placebo (OR, 2.00; 95% CI, 1.38-2.89; P<.001). For weeks 9 through 52, the continuous abstinence rates were 21.9% for varenicline vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; P<.001) and vs 16.1% for bupropion SR (OR, 1.46; 95% CI, 0.99-2.17; P = .057). Varenicline reduced craving and withdrawal and, for those who smoked while receiving study drug, smoking satisfaction.

Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial.
RESULTS: During the last 4 weeks of treatment (weeks 9-12), 43.9% of participants in the varenicline group were continuously abstinent from smoking compared with 17.6% in the placebo group (odds ratio [OR], 3.85; 95% confidence interval [CI], 2.69-5.50; P<.001) and 29.8% in the bupropion SR group (OR, 1.90; 95% CI, 1.38-2.62; P<.001). For weeks 9 through 24, 29.7% of participants in the varenicline group were continuously abstinent compared with 13.2% in the placebo group (OR, 2.83; 95% CI, 1.91-4.19; P<.001) and 20.2% in the bupropion group (OR, 1.69; 95% CI, 1.19-2.42; P = .003). For weeks 9 through 52, 23% of participants in the varenicline group were continuously abstinent compared with 10.3% in the placebo group (OR, 2.66; 95% CI, 1.72-4.11; P<.001) and 14.6% in the bupropion SR group (OR, 1.77; 95% CI, 1.19-2.63; P = .004). Treatment was discontinued due to adverse events by 10.5% of participants in the varenicline group, 12.6% in the bupropion SR group, and 7.3% in the placebo group. The most common adverse event with varenicline was nausea, which occurred in 101 participants (29.4%).

Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial.
CONCLUSIONS: Smokers who achieved abstinence for at least 7 days at the end of 12 weeks of open-label varenicline treatment and were randomized to receive an additional 12 weeks of varenicline treatment showed significantly greater continuous abstinence in weeks 13 to 24 compared with placebo. This advantage was maintained through the nontreatment follow-up to week 52.

I'd say it's definitely worth a try.

-


Then there is the Cochrane Data Base review of all the woo anti-smoking treatments.
Acupuncture and related interventions for smoking cessation.
CONCLUSIONS: There is no consistent evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but methodological problems mean that no firm conclusions can be drawn. Further research using frequent or continuous stimulation is justified.
They were unable to find many decent studies.
 
Last edited:
Well, he may have just been ignorant of the method behind laser therapy. After all, doctors are people too. Just like you may not be up on everything under the sun, neither is the doctor.

I imagine that he has heard positive things about laser treatment from his patients, and just has no clue what the hell it really is. Not his area of expertise.

It's nice to have a contrary viewpoint after so many people agree with me.

That said, I don' think this excuses his behaviour. He shoudl recommend treatments based on their proven efficacy, not just something he heard from some of his patients. I expect my doctor to knwo the difference between anecdote and experiment. And I expect him to not tell me to skip the proven treatment in favor of the unproven one, unless he's got some brilliant reason he can explain.

Also one should never underestimate the value of having a doctor with an open pad for drugs.

If I just want a drug, I'll order it from outside the country. Despite what they say it's still quite easy to do. Anyone can get drugs; you don't need a doctor for that.
 
I would not go to a doctor who was that impressed by placebo effects.

Hey, wow... that's great information!! Thank you very much for taking the time to find those studies! Despite being a pretty non-confrontational guy, I probably will present these to the Doctor ... maybe in a letter or something.
 
Last edited:

Back
Top Bottom