Is Trust in Our Physicians Misplaced?

TrustA Shocking Mis-diagnosis

A diagnosis of cancer is devastating. What’s equally devastating is going through months of difficult treatment believing that you have a deadly disease, only to find out later that your physician erred in diagnosis. Yet that’s exactly what happened to fifty-four-year-old mother of four Herlinda Garcia.[i]

After discovering a lump in her breast, Garcia went to see Dr. Ahmad Qadri, a board-certified medical oncologist/hematologist who had been in practice for more than twenty years. Upon his recommendation, Garcia had a lumpectomy whereby the tumor was excised and examined.

As the weeks following her surgery passed with little news from her physician, Garcia’s anxiety began to build. Then came the call: Dr. Qadri informed Garcia that she was suffering from Stage IV breast cancer.[ii] Cure would not be an option, and her only hope of prolonged survival would be through a debilitating regimen of chemotherapy.

In her mind, Garcia had no choice but to trust Qadri’s diagnosis and treatment recommendation. She would spend the next seven months getting her affairs in order while enduring eight rounds of chemotherapy.[iii] Just as the harsh chemo agents took a toll on her physical body, the prospect of a dramatically shortened life damaged her psyche. By the time treatment ended, Garcia was sufficiently anxious and depressed that she sought medical help for these symptoms.

As part of her medical evaluation for anxiety, a physician at Citizen’s Medical Center in Victoria, Texas, evaluated the progression of her cancer. There was only one problem—he couldn’t find it.[iv] Suspicious that something was terribly amiss, the physician sent Garcia to the world-renowned MD Anderson Cancer Center in Houston “where she was tested, her original records reviewed, and it was revealed that she never had cancer and never needed chemotherapy.”[v]

A flood of emotions swept over Garcia. She was tremendously relieved to have the death sentence lifted yet simultaneously angry at the tumultuous journey she had been made to endure by a physician’s incompetence. Dr. Qadri had misread the pathology report on Garcia’s tumor.[vi] It was benign . . . not cancerous.

Had Garcia’s case been presented in a tumor board, which is standard procedure in many cancer centers, the findings, prognosis, and treatment plan would have been critiqued by an interdisciplinary group of physicians. It’s hard to imagine that the error would not have been detected almost instantly. But Garcia was not so lucky. No one was looking over the shoulder of Dr. Qadri. Nor did Garcia think to question him or seek a second opinion . . . She put her full faith and trust behind her doctor and prayed that somehow she would make it through the ordeal.

Dr. Ahmad Qadri died in March 2013. Herlinda Garcia was awarded $367,500 for the anguish she had endured . . . an award to be paid by the estate of Dr. Qadri.[vii]

Medical errors are commonplace. Sometimes they are an almost inevitable consequence of the complexities of medicine intersecting with the fallibility of human beings. Other times, however, they are due to incompetence, impairment, or other preventable factors that put patients in harm’s way. 

I’ve watched as a surgeon, who was too drunk to operate, left a bar and headed straight to the OR in response to a call. I’ve watched the calamitous impact of a fire breaking out in an OR suite and injuring the patient. And I’ve been privy to the egregious errors reviewed in medical executive committees where the discussions would remain safely ensconced in a veil of secrecy.

Replacing Blind Trust with Respectful Discernment

The trust we place in our physicians is part of the very foundation of American medicine. Unlike other professions, in medicine trust does not have to be earned by its practitioners. Rather, it is bestowed on every doctor upon earning their MD.

Implicit trust in our doctors is like a curtsy or bow in the presence of royalty. Based on what we know today, this blind trust is not only unwarranted, it is dangerous. What is called for in its place is respectful discernment on the part of the patient and the expectation of collaboration when determining what care is required. Unfortunately, that’s easier said than done.

Why do physicians enjoy a uniquely privileged role in our society—a role in which their life-and-death decisions are beyond public scrutiny? For three primary reasons—beginning with a need that is inherent in humankind: our need to believe in the power of a privileged caste to shield us from life’s suffering while keeping death at bay. In primitive societies, it was the role of the shaman. In contemporary societies, that power has been bestowed on physicians.

Second, American medicine has solidified its cultural foothold by taking an already horrifically complex field and further ladening it with a unique brand of jargon—demanding a skilled translator. Medical jargon serves to reinforce our belief in the discipline’s scientific rigor while simultaneously rendering its clinical observations and treatment recommendations impenetrable to mere mortals. A sweaty patient is diaphoretic. A patient with no appetite is anorectic. And a dead patient, similar to a parking meter, has expired. The implied argument is that surely individuals scholarly enough to discern meaning in these arcane terms are due respect.

Finally, much of the power enjoyed by our doctors is a testament to the extraordinary efforts of the American Medical Association. Over more than a century, the AMA has worked relentlessly to convince us of the impeccability of its scientific practitioners while trampling any competing schools of thought or methods of healing. Homeopathy, osteopathy, chiropractic, Chinese medicine, and other forms of “alternative healing” have struggled to establish legitimacy under the reign of the AMA.

If we put aside the issues of catering to our human frailty, masking the simple in the arcane, and lobbying to ensure the power of their profession, the question still remains, Are physicians due our respect?

For the vast majority of doctors, the unequivocal answer is yes. It is respect that is hard earned through years of personal sacrifice during medical training and practice. You can often identify these physicians by their humility. For some, humility is born from staring death and disease in the face while realizing the limitations of their art to intervene. For others, it is rooted in compassion and respect for their patients.

For the minority, however, the answer is no, for they have broken their sacred covenant to “bear a fiduciary trust in regard to their patients’ health-care needs . . . physicians agree to place their patients’ health before any other outcome or goal and swear an oath to act as their patients’ health-care advocates.”[viii] In medicine, a few bad apples can indeed spoil the lot. As we shall see, medicine has done an abysmal job of culling out the bad.

If you would like to continue reading, you will find the conclusion of Chapter 5 in The Myths of Modern Medicine: The Alarming Truth About American Health Care – available at


[i] Pam Stephan, “Herlinda Garcia Survived Stage 4 Breast Cancer Misdiagnosis,”, July 24, 2013,

[ii] “Cancer-Free Woman Undergoes 7 Months of Chemotherapy after Misdiagnosis,”, July 18, 2013,

[iii] Ibid.

[iv] Justin Caba, “Texas Mom’s Cancer Misdiagnosis: 54-Year-Old Herlinda Garcia Suffered 7 Months of Chemo, Damages Included Depression and Anxiety,” Medical Daily, July 17, 2013,

[v] Stephan, “Herlinda Garcia Survived Stage 4.”

[vi] Ibid.

[vii] “Cancer-Free Woman Undergoes 7 Months.”

[viii]Brent C. James and Elizabeth H. Hammond, “The Challenge of Variation in Medical Practice,” Archive of Pathology and Laboratory Medicine124, no. 7 (July 20001001

What I Learned From the Death of My Parents


Jack & Shirley Leifer in Havana, Cuba -- 1946.

Jack & Shirley Leifer in Havana, Cuba — 1946.

Every family has its rituals, and one of ours was Sunday night dinner. It was a time to share news, to talk about our hopes or dreams, to simply relish time spent together. Sunday, May 20, 2001, was no exception. I went home after dinner, counting my blessings—so grateful to have my parents, despite their advancing ages.

On Monday, a call from my mother changed my world. My father had slept-in, which despite being 86, was not his habit. When she went to rouse him, there was no response. He seemed to be breathing okay, but was completely unresponsive. That’s when I got the frantic call.

So began our final odyssey with my father…a trip that would take us into the deepest realms of the health care system.

Eight minutes after calling 911, EMS paramedics were on site preparing my father to be transported to a nearby Emergency Room. Upon arrival at the hospital, the frenetic pace of the first responders was replaced by long hours of waiting as my father slowly moved from the ER to the ICU. There, a team of specialists went to work seeking to identify the underlying cause of his condition.

My father remained in a coma throughout that week, during which time our family maintained a vigil at the ICU. The waiting room, our temporary home, was bathed in the green sterile glow of fluorescent lights. It was a spaced shared with other families in crisis. Its eerie quiet was punctuated only by breathless sobs as bad news was delivered to loved ones. Whenever possible, we escaped to be at my father’s bedside, though watching the life slowly ebb from this once strong man was so painful.

Toward the end of the week, the doctors informed us that an underlying blood disease had transformed into a fulminating type of leukemia, from which my father would not recover. We were told that the merciful thing to do would be to let him go. When I asked for more information upon which to make such a difficult decision, a female oncologist turned away from me and directed her response to my brother, a physician. She seemed annoyed that I would not blindly accept what had been recommended, and cloaked her response in impenetrable medical jargon.

I again asked a series of questions—including whether my father was aware of his surroundings. A different physician addressed me directly and provided assurance that my father had no awareness and promised that he would quietly pass when we removed life support. After a family conference, we agreed to take him off the respirator.

As my father’s lungs labored for breath, he raised his arms up over his head and let them drop. I shot a sharp look at the ICU physician, who said that it was nothing more than a muscular reaction. My father repeated this motion several times before giving up. It was no simple twitch…it was more of a plea not to give up. His instructions to us had always been “Do everything in your power to keep me alive.” He was a fighter with an indomitable spirit. I will always feel that we let him down.

I hugged him for a last time, told him how much I loved him and would miss him, and said goodbye. I promised my nearly atheistic father that he was in for a beautiful surprise at what lay ahead of him.

After we had said our collective goodbyes in the bustling ICU, my brother and I took my mother’s arms and walked her out. Her inseparable partner for 61 years was gone.

My brother and I feared that it would not be long before we lost our mother. Life without her soul-mate would simply be too much to endure. But thankfully, she proved us wrong and lived another six years.

My mother’s death could not have been more different and opened my eyes to what Dr. Ira Byock refers to as “dying well.”

As my mother approached her 88th birthday, it was clear that she was growing weary of life without my father, as well as contending with an increasingly list of infirmities. Due to a series of falls, my brother and I had arranged for caregivers to be in her home 24 hours a day. This, too, she tired of, but accepted as a condition of maintaining some level of independent living.

Despite the careful eyes of her caregivers, she nonetheless fell again; this time breaking her knee. She was briefly hospitalized, during which time she was evaluated by an orthopedic surgeon. After viewing her x-rays, he recommended an immediate operation to pin the broken bone.

I asked if he was aware of my mother’s staggeringly high blood pressure and poorly controlled diabetes. He said yes. I asked if these conditions would substantially increase the risk of surgery. He grudgingly said yes. Finally, I asked what would happen if we did nothing other than bed rest. He indicated it would probably take an additional two to three weeks for her bones to heal.

It was stunning to me that the surgeon was willing to trade off a couple of meager weeks of bed-rest for a significant risk of surgical complications or death. My mother and I agreed that it was time to leave the hospital and go home. I informed the orthopedic surgeon that there would be no operation.

I’m not sure exactly when it happened during my mother’s convalescence, but, at some point, she decided it was time to let go. The fight was over, and she was ready to join my father. So she simply stopped eating.

I sat on the edge of her bed and asked if she knew what she was doing. She told me that she had been graced with a glorious life, and it was time to say goodbye. Her knee was mending. That was not the issue. My mother had watched as more and more elements of her life lay beyond her control. Through a simple, passive action, she could regain control and direct the remaining course of her days on earth.

It would take many weeks for my mother to pass. We brought in hospice, which helped us maintain her comfort and manage any pain or anxiety. Though painful to anticipate her loss, we nonetheless managed to savor every moment with my mother.

In the last few weeks, she became very confused and fatigued. Lucid moments seemed to be forever gone. I knew that death was near as I arrived early one morning to check on her. I was prepared to see the progressive and inevitable decline that had marked each of the past few days. But instead, I found my mother sitting in bed fully awake. She said, “John, honey, come here, I want to talk with you.”

Something incredibly powerful and unexplainable was happening. My mother was completely lucid and focused. It was as though her age and infirmity had been momentarily erased. She spoke with exacting clarity—wanting to ensure that I took in every measure of love and wisdom being doled out.

She said, “Remember how much your father and I treasured you. Always carry our love with you. And know that we will be looking down upon you…we will always be with you.”

I told her I loved her and reassured her that she wasn’t going anywhere quite yet…it wasn’t her time. But my mother knew differently. She told me she had to rest. That was the last time I spoke with my mother. She would pass away the next evening with my wife and me at her side. I would hold her hand as her body took its final breath. There was a peace in life’s finality.

I had once asked Elisabeth Kübler-Ross, “What happens at the moment we die?” She responded, “It’s like a cocoon. When a butterfly is ready, the cocoon opens up and out comes a butterfly.”

That’s how I choose to remember my mother’s passing—like a cocoon opening to let a beautiful butterfly soar.

I witnessed two parents die under very different circumstances: one confined to an ICU and tethered to a ventilator; the other lying peacefully on a bed at home surrounded by loved ones. The experiences could not have been more different, and the lessons learned will stay with me forever.

Death Is Not the Enemy

Whether it is driven by cultural narcissism or some unique feature of our genetic make-up, most Americans are undeniably unaccepting of the inevitability of death. George Lundberg put it succinctly: “Let’s face it, no one wants to die but everyone must. Despite this overwhelming reality, we continue to chase the illusion of life everlasting.”[i]

This lack of understanding and avoidance of the reality of death come at a price. Without discussion, our fears, hopes, and final wishes go unattended. As Otis Brawley, MD, observed: “We cannot accept that death will come, and thus we cannot make a plan, talk reasonably about it, work our way to understanding, to the basic part of our humanity.”[ii]

Yet, as Lundberg and others have pointed out, death is not the enemy: “The real enemies of medicine are premature death, disease, disability, pain, human suffering.” [iii] Kübler-Ross would add “peace and dignity” to the list of enemies: “We would think that our great emancipation, our knowledge of science and of man, has given us better ways and means to prepare ourselves and our families for this inevitable happening. Instead the days are gone when a man was allowed to die in peace and dignity in his own house.”[iv]

The Road Less Traveled

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.[v]

Nowhere do Frost’s words ring more true than when facing end-of-life decisions. One path, if pursued to the end, leads to a medicalized death. Along the way, every tool, technology, and trade-craft is used by physicians to preserve life. It often begins in the ER and ends in the ICU, as it did with my father.



After You Hear It’s Cancer: A Guide to Surviving the Difficult Journey Ahead. It is available at:

The Myths of Modern Medicine: The Alarming Truth About American Health Care.   It is available at:

[i] Lundberg, Severed Trust, 221.

[ii] Brawley, How We Do Harm, 122.

[iii] Lundberg, Severed Trust, 231.

[iv]ElisabethKübler-Ross, On Death and Dying (New York: Macmillan Publishing, 1969), 7.

[v] Robert Frost, “The Road Not Taken,”

The End of Blind Faith and the Beginning of Transformational Change in Health Care Painful Truth:

The American health care system is terminally ill. It is astonishingly expensive, remarkably variable in quality, and incapable of stemming the rising tide of chronic illness in our population.

Yet, the majority of Americans believe it is the best system in the world and cling to the belief that, far from ailing, it delivers care superior to those of countries across the globe.

The system has obliged us by providing an elaborate set of myths about American health care that significantly shape our beliefs  These myths keep us blissfully ignorant about the true quality, safety, and value of the care we receive. This ignorance has a price: it leads us to draw erroneous conclusions about our conditions, fail to properly evaluate potential treatment options, and rarely question our providers’ competency.

This book is based on the premise that consumer empowerment begins with an understanding of the true state of the health care system. Such knowledge not only increases the consumer’s ability to receive appropriate care, but also to take effective action to change the system. Armed with the correct information, consumers can make smart decisions for their health and the health of their families, as well as coalesce into social action groups.

The 10 Myths

The book identifies ten myths that must be debunked to achieve a true appreciation for the condition of our system. It also provides, where appropriate, specific steps that every consumer can take to optimize the quality, value, and effectiveness of the care they and their family receive. The Epilogue provides a preliminary roadmap to social action—changes that should be called for by consumers, and how, by coming together in organized structures, such changes are possible.

Throughout the book, the reader is reminded of his or her stewardship responsibility for their own health. Perhaps the most important lesson to be gleaned is the degree to which we can avoid encounters with the health care system by judiciously making smart decisions about our health.

If we are to heal the American health care system, we must understand how our false beliefs impair our ability to get efficient, effective, and safe care. Only then can we exercise stewardship responsibility for our own health. If patients understand how these myths influence their care, they might make better choices about their care, get more value from the system, and enjoy improved health and well-being. And, if we all use the system differently, the process of reshaping the system would begin to happen more naturally. We, as patients, can drive the reform of the system.

ACA is a Red Herring

The Affordable Care Act has made health care reform one of the most hotly contested topics in America, but it does not address the core problems in our system. Meaningful health care reform isn’t likely to happen as a result of legislative edicts from Washington. There is simply too much avarice and greed vying for its bounty. Reform will only happen when you as a patient, fully empowered with information, begin to assert your rights.


ARE YOU READY TO READ MORE?  Please order your copy of The Myths of Modern Medicine today:



iStock_000014969854SmallThere is a fascinating article in a recently published, special edition of Forbes detailing efforts by Novartis to become the leading force in cancer therapeutics. The article begins with a powerful and poignant story in which a breakthrough therapy brings a new lease on life to a young girl (as well as numerous other individuals who were involved in an early-stage trial).

Applauding Medical Breakthroughs:

No one, with a shred of compassion, would find anything but joy in the revelation that great strides are being made in treating previously devastating cancers; and there need to be incentives in place for corporations to pursue such work – since our economy is not driven by altruism. But there are troubling aspects to this story as well…as evidenced by comments made to Forbes by Novartis CEO, Joseph Jimenez.  

Separating Science from Sales:

As Forbes notes, cancer drugs currently account for just under 20 percent of Novartis’ total sales – bringing in $11.2 billion annually. Now, according to Mr. Jimenez, “He’s ‘doubling down’ on the cancer business” – an expression I would normally reserve for a bet at the blackjack table.

Where’s the proof? “In April he did a deal that essentially traded Novartis’ unprofitable vaccine and consumer businesses and up to $9 billion in cash to GlaxoSmithKline in return for Glaxo’s cancer drugs, which currently generate $1.6 billion sales but which Jimenez says include three pills he can turn into $1 billion sellers.”  

From Consumer Goods to Cancer Cures:

From a profit-making perspective, Mr. Jimenez strategy to become the leading force in the emerging field of personalized medicine seems astute. He is, after all, a “Marketer by trade who, until he came to Novartis in 2007, managed brands like Clorox and Peter Pan Peanut Butter before running the North America business for Heinz, the ketchupmaker.”

But we are not talking about whitening our clothes, satisfying a sweet tooth, or putting a topping on a burger. We’re talking about life and death stakes for millions of cancer patients in the future.

As Mr. Jimenez executes his market strategy and potentially gains increasing clout in controlling what may prove to be true cures for cancer, what will prevent Novartis from leveraging its power over the lives of cancer patients by raising the prices of newly developed products to the very edge of what the market can bear…and is there a precedent for concern?

Reasons for Concern:

Novartis already produces a “miracle drug” known as Gleevec. It has made a life and death difference for some patients. Forbes notes, “Patients stay on it for years, and it is so valuable that Novartis has quadrupled its annual price from $24,000 per year in 20001 to more than $90,000 today.” The article goes on to state: “What the marketers thought was a $400 million drug, Jimenez notes, is now a $4.6 billion one…”

What will Novartis do in the future…what is morally right or what the market will bear? Mr. Jimenez, I’m truly grateful for the research you are funding, but wonder who will be whispering in your ear, “Are we doing the right thing for both our shareholders and our patients?

A Case Study in Greed

pride; greed; envy; sloth; gluttony; lust; envy

“Health is Priceless:”

A recent article in the New York Times stated that pharmaceutical companies are employing a new rationale to justify the seemingly irrationally, exorbitant prices being charged for pharmaceuticals: “Health is priceless.” While true, many people afflicted with dire conditions live under profound financial constraints…and thus cannot afford “priceless” drugs.

It’s All About Returns:

The article then goes on to quote Steve, Francesco, a pharmaceutical consultant, as stating: “To understand drug pricing you have to shed your sense of value as a consumer and as a noble human being. You have to put on the lens of the health care industry, where what you’re doing is looking for opportunities to maximize return.”

Gilead: A Poster Child for Profiteering:

Mr. Francesco is dead on the money: The level of returns are obvious…raising the price of some pharmaceutical stocks to stratospheric levels. Gilead Science is a poster-child for profiting from arguably exorbitant drug pricing. According to the most recent edition of Barron’s (4/28/14), “On Tuesday, the biotechnology giant reported a profit of $2.2 billion, tripling its profit of a year ago. That’s thanks to the runaway success of its hepatitis C drug Sovaldi, which had sales of $2.3 billion during the first quarter, making it one of the most successful drug launches ever.” 

Up and up it goes, where it stops nobody knows. If you own the stock, perhaps you should hold-on, for Barron’s states that “Analysts expect Gilead to earn $10.1 billion in 2014, up from $3.1 billion last year…” And Gilead is not the outlier – they are rapidly becoming the norm in a pharmaceutical industry unfettered by any type of logic, ethic, or regulation relative to pricing.

Sarepta Poised to Profit:

Sarepta Therapeutics is yet another example. The FDA has put their drug, Eteplirsen, for treating Duchenne muscular dystrophy on the fast track for review and approval. According to another article in Barron’s (4/24/14), “Baird analyst Brian Skorney, who lifted his price target to $53 from $35, wrote that the situation is “commercially ideal” because “the patient population is readily identified, the unmet medical need is high, the treatment is likely to be lifelong, and the market will be insensitive to price. Eteplirsen could cost up to $500,000 a year per patient.”

Life is precious…the market is insensitive to price…and pharmaceutical companies are capitalizing on these facts at level never before seen in history! 

A Sad Commentary on our Values:

While I thank god for the medical breakthroughs we are experiencing today, I feel great reproach for the executives within pharma who are profiteering in such a shameless manner. Is the only way to win in this game is by owning their stocks? I hope not.