I have a friend and medical colleague who is, I daresay, smarter than me but shares my ethics and attitude toward medicine and the practice thereof. To us, medicine is about the patient in front of us and doing our utmost to provide competent, compassionate care on the same level as we would wish for ourselves and our loved ones.

Our major area of disagreement has been the past three years of the Covid pandemic, more specifically how it has been managed. Unlike me, he bought into many of the policies of the bureaucratic medical establishment exemplified by Drs. Fauci, Birx, Redfield, and Collins. In our friendly debates and discussions about how the pandemic has been managed/mismanaged he answers my opinions and references to multiple sources that I happen to consider credible (see below) with a single response, which is whatever the CDC is recommending. This pertains to wearing masks, social distancing, and, especially the role, effectiveness, and potential dangers of the new mRNA vaccines. He is vaccinated; I am not.

There is room for debate on many fronts related to these vaccines. Never an anti-vaxxer, I approached them with a cautious skepticism. I was skeptical of the rapid rollout, the glowing promises made for them, and concerned regarding the absence of long-term data for something so novel and universally recommended. There is little question that vaccination of the elderly and other high risk persons saved lives by mitigating serious disease, especially during the more virulent Delta variant surge of Covid. I caught Delta and as a healthy, adult over 65, I can say it was no picnic, although I was never hospitalized and recovered, I feel, fully.

You can’t make this stuff up. I recently received an email from a website for cosmetic gynecology. Yes. You read that right- cosmetic gynecology. It featured a video by a “urogynecologist” on his technique for performing a “Barbie labiaplasty”. I have performed labiaplasties, but I confess I had never heard of this so, out of professional curiosity, I viewed the video.

The operation involved a complete amputation of the labia minora at the vaginal introitus (opening), along with removal of skin on either side of the clitoris and clitoral hood. The surgeon, who I will not name and, of course, practices in California, extols how nicely the surgery produces the “clamshell” look, which is the goal. His website lists his stellar credentials and features a gallery of before and after crotch shots showing the beautiful results of these surgeries.

The intent of the Barbie labiaplasty is to produce a look to the external female genitalia that matches that on the iconic Barbie doll by Mattel. Barbie, by the way, has never been crafted to be anatomically correct. If she were a real person, her measurements would be 39-18-33. She would be 5 foot 9 inches tall and weigh about 110 lbs. How’s that for realistic? Check under the skirt and you will find…..nothing.

The list of media narratives that have proved to be fraudulent or simply wrong is long and grows ever longer. The Trump-Russian collusion hoax, the Hunter Biden computer “fabrication”, the Ivermectin as horse de-wormer misrepresentation, and the Covid lab leak as the delusion of conspiracy theorists were all embraced and promoted by “experts” and the main stream media, and all were wrong. Easily, provably wrong.

Now we have the story circulating that Governor DeSantis wants to ban books from K-12 schools including some considered classics, such as Of Mice and Men, by John Steinbeck or To Kill a Mockingbird by Harper Lee. This has become widespread in the media. The only problem is, it is false.

One of my close friends has a neighbor who is a Canadian snowbird. The neighbor just returned to spend the winter in Florida. When my friend spoke to him and expressed his opinion of how good a governor Desantis has been for Florida, the Canadian neighbor strongly disagreed and gave as one example the claim derived from the news media of DeSantis banning books in Florida. My friend had not heard this particular story and, true to form, he researched it carefully. Below is his response to his Canadian neighbor:         

When I transferred to the University of Miami as a junior student, my pre-medical education began in earnest. Competition was fierce for medical school admission, and it was critical for pre-medical students to do not just do well, but very well, in the core subjects: physics, calculus, physiology, organic chemistry, and physical chemistry. The last two were spoken of in hushed tones as the most difficult of the undergraduate curriculum. Many an aspiring medical student’s hopes were dashed on the rocks of organic chemistry and “p-chem.”

My organic chemistry professor was Harry P. Schultz. Dr. Schultz was a legend among pre-medical students for his personality and classroom behavior. He was known to ask a question and then run to the back of the auditorium challenging anyone to answer before he exited. He was no nonsense when it came to teaching and grading and I and my classmates spent countless hours in the library reviewing chemical reactions for his exams. I would carry a stack of 3X5 cards when walking about the campus with questions on one side and answers on the other. Despite the difficulty of organic chemistry, Dr. Schultz was one of the most popular teachers on campus and it was a rite of passage to take organic chemistry with him. He passed away at 102 on Pearl Harbor Day 2020.

My $800 prescription Costa del Sol sunglasses are falling apart. I justified the purchase, banking on the reputation of Costas for durability and their lifetime warranty, knowing that if my prescription changed in time, I could just replace the lenses and keep the frames. Now the rubberized portions are breaking down and coming off the plastic stems. I don’t abuse them. I keep them in a case when not wearing them and I don’t wear them all that often in rugged outdoor activities for which they are supposedly designed.

I took them to the optician, where I bought them, and she informed me they no longer carry Costas because the quality and support have gotten so bad. The lifetime warranty has been replaced with a two year limited warranty, so I am SOL. She said the decline began when Costa was bought by the French eyeglass company, Essilor, and accelerated in 2018 when Essilor merged with Luxottica to become the single largest supplier of eyeglass lenses and frames in the world. EssilorLuxottica now owns Oakley, Ray-Ban, Chanel, Coach, Polo Ralph Lauren, Prada, Costas, and dozens more.

What does this have to do with the state of medicine today? It shows what corporatization does to small firms that start out producing a high quality, popular product or service. The firm loses its soul. The same thing has happened to medicine.

My maternal grandfather, a retired physician, once took me on a walk around his neighborhood in Rio de Janeiro, Brazil when I was somewhere around five or six-years-old. “I want you to meet a very distinguished gentleman,” he said. In those days, his neighborhood street was cobblestone with high curbs on either side.  Today, we have big trucks with air-conditioned cabins and large, rotating brushes to sweep off our street. Back then, street sweepers were day laborers, most of whom lived in the ‘favelas’ (slums) for which Rio is known. They were transported each morning to their respective locations throughout the city with their large garbage cans on a hand cart, broom, and shovel to sweep the gutters.

As we approached one of these street sweepers, Vovo (grandpa in Portuguese) greeted the middle-age black man by name and the greeting was returned with a smile, “Bon dia, Dr. Abel (my grandfather’s first name).” Vovo introduced me as his grandson and we shook hands. Vovo inquired about the man’s wife and children and they spoke for perhaps 5 minutes or so before we left and the man resumed work. I later learned that he was one of my grandfather’s patients from years earlier.

You will not hear about this in the mainstream media.

Thanks to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 the push for adoption of electronic health records (EHR) began with a vengeance, long before these programs were truly ready. The government adopted a carrot-and-stick approach, rewarding those who jumped onboard and punishing those who did not.

If you ask any physician what they think about HER, be prepared for a profanity-laden reply. The programs are too complicated, requiring more data input than necessary. The screens are too full of extraneous information. The endless point and click to accomplish a simple task is maddening. They abet abuse such as copy/pasting the same patient information over and over. They allow for upcoding simple encounters, a form of fraud to increase reimbursement. Things get missed. They slow physicians down. Even the manufacturers of these programs acknowledge they decrease physician productivity. We are promised improvements as new programs come out, but this seems to never be realized. The recent switch to EPIC at local hospitals is an example.

Ever have one of those days that just don’t start well and put you in a foul mood from the get go? Last Friday, I had two surgical cases scheduled at the hospital. I love surgery and being in the operating room is my happy place, most of the time. The first case was to start at 09:15. It was a straightforward debridement and skin grafting of an open wound on the leg in a patient with a complex medical history. The surgery itself, however, was relatively easy even if the outcome was not assured. My second case was much more complex, a bilateral breast reconstruction. These are always a challenge because there is so much that has to go right for success. I wasn’t stressed about the first case but the second weighed heavily on my mind. I was looking forward to getting the first case done with dispatch so I could focus my attention and energy on the second.