The Doc Is Incurious

10/9/13 4AM
Yesterday I had my appointment with my John Hopkins Derm Doc. In my last visit, I had rejected her plan to start taking the drug Methotrexate and instead told her I planned to go to a wholly "natural"plan (in large part designed by my Nova Scotia Naturopath Doc). I had not told her the details of my plan or its source (the Naturopath Doc) to avoid possible non-productive discussion, telling her, instead, the broad outlines: mind/body stuff, more exercise, better diet etc. saying we could monitor and revert to her plan if mine didn't work. She accepted my proceeding this way, but made clear she did not endorse what I was doing.



I am eager to see her and show her the progress that has occurred since I saw her 14 days before. The last thing she had said to me was "I hope it works out well for you". This deeply moved me since I had rejected her plan.

We greeted each other warmly when she walked into the examining room and asked me how I was. I replied fine. She looked over my body and declared she saw little change from the last visit. Needless to say, I was taken aback. I told her that I thought I was a lot better and in fact had seen my long time Derm Doc just a few days ago who had declared he saw "dramatic improvement!". And then after taking new pictures with his iPad and comparing them to those taken 4 weeks earlier he reinforced his observation saying "the pictures don't lie". This was all the more meaningful because at our last meeting I told him I had gone to Johns Hopkins to which he responded "Good a Second Opinion". So the improvement he saw, in his mind, must have been the result of Johns Hopkins efforts not something he had a vested interest in seeing. It was only then that I filled him on the natural non-Johns Hopkins plan I had been pursuing.

The Johns Hopkins Derm Doc was unimpressed and told me she wanted me to proceed to take the Methotrexate drug. I told her I was concerned about the side effects and believed that I should continue with the plan, I had adopted, which was achieving such good results. She said she didn't see the improvement. I suggested she call my other Doc, talk to him and look at the proof, the pictures taken before and after. She was not interested in doing that. She asked me if I wanted her to take pictures, I said no that not being the point.

At my last visit,at her request, I had taken blood tests to prepare me for taking Methotrexate. To see if my system could tolerate it, if I changed my mind, and decided to go on the drug. Having passed all tests necessary and not seeing improvement so obvious to me and independently confirmed by my other Doc she again proposed that I go on this drug.

I told her my concerns about Methotrexate pointing out that it is a drug with a "black box warning", a designation given to those drugs with the most serious possible side effects including, for this one at least, fatality.

I urged her to look at the facts - talk to the other Doc or better yet look at his pictures. I had planned to be very diplomatic about the information given to me by both her and my new Johns Hopkins primary care Doc about Methotrexate. I wanted to seek an understanding as to why they hadn't told me of its dangerous side effects and the risks I would be taking with it. Rather than warning me, to the contrary, my Johns Hopkins primary care Doc had considerably put my mind at ease by telling me the drug had a long safe history in treating arthritis among other things. It was the Blog post reporting that discussion that set off the alarm bells for my Nurse Practitioner friend who alerted me to the very real and serious dangers of this drug.

Since nothing seem to get through to the Derm Doc, to get her attention, I then said that I believed she and the primary care Doc had seriously misled me about the drug's dangers. I told her it was impossible for me to believe they didn't know about these risks given that a simple one word Google search immediately brought up a full description pointing, as I said this, to the printout I had brought with me. She denied having misled me and told me she prescribes Methotrexate all the time to her patients for psoriasis among other conditions.

I told her I was puzzled why she wasn't more interested in verifying whether or not I was achieving the results I and the other Derm Doc saw as well as the the treatment plan I was following that was getting them. This led to our discussing the "juicing diet" that was given to me by my Nova Scotia Naturopath Doc. And I told her that the Naturopaths believe that skin diseases, such as I have, are caused by problems in the gut and the cure is to clean out the gut with a juicing diet. Her response was that if the Naturopath Docs had solutions to medical problems, they should publish their findings and subject them to peer review as do the Conventional Docs. I let this comment go although, as I previously reported, my Naturopath Doc had just attended a conference of her peers the subject being the cause (the gut) and treatment of skin disease such as I have. I also didn't mention the considerable flaws in the "peer review" process noted here in a previous post as well as the drug review process so heavily influenced by Big Pharma.

The Doc expressed her frustration with the discussion asking me what I wanted her to do. I said "I want you to be curious" expressing my frustration at her lack of interest in looking at the evidence offered to her. Thank God I had seen my other Doc just before visiting her or her absolute unshakeable position to propose proceeding down the risky path she had previously set might have made me doubt the significant improvement I was seeing with my very own eyes. She maintained she was a curious person and was dedicated to helping people with her profession.

Having reached a stalemate we agreed that I was going to proceed with my Naturopath Doc and that I was going to phase out of the Prednisone drug (the only drug I am taking). She wrote down a schedule for phasing out (6 tabs down to 4 tabs and now 2 tabs and eventually none) and told me that the last day before quitting entirely, I am to come in at 8AM and have a blood test to see if it is OK to stop completely. She also noted in the written record that I was very disappointed in the care given at Johns Hopkins. I asked her was I correct in stating that she believed the cause for this rare disease is unknown as is its cure. She said that was correct. Given that the Naturopaths believe they know both the cause and cure for my disease, I found her lack of interest in the theory and evidence of its possible correctness right here in plain sight baffling.

I'll let you draw your own conclusions.  I am still processing mine and will be discussing them as this adventure continues.  For now, let me say I was indeed disappointed.  This episode mirrored what I had run into with the Conventional Docs in dealing with my Prostate Cancer situation 8 years ago.  This time, I had hoped I would find the Docs more enlightened, more interested in what's best for the patient and more aware and open to the Alternatives.  This could, of course, be an atypical example of Conventional treatment at Johns Hopkins. But the fact that both Docs mislead me argues against that conclusion.

In the days ahead as I see my progress, hopefully, continue I also want to dig into the implications of this visit and the relative opportunities inherent in a better recognition of the benefits of Alternative vs Conventional Medicine.

Thanks for reading!