Chapter One
Butchered by "Healthcare"
Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation for his failures.
--Rene Leriche, Philosophy of Surgery, 1951
In the summer of 2013, when I was 61, I had two women in their 30s die in my surgical center. I sent them to the emergency room, but nothing worked. It was my place, so I was responsible. It was the worst period of my life. I felt guilty and was sleepless, and my wife thought we would have to give up our practice.
I did not learn why it happened until the autopsy reports came back fully six months later. One woman had an embolus of fat blocking her lungs. This occurs unpredictably, and there is no way to prevent it.
The second had a high local anesthetic blood level. We inject this drug into fat to decrease pain, and after liposuction, we sometimes transplant the fat back into breasts and buttocks. This may have raised her levels and caused her death, but there was no way to be sure.
To occupy my mind, I started reading medicine twenty to thirty hours a week. My original training was as a generalist, but for decades I had studied only cosmetic surgery.
I began with the Prozac-class antidepressants, which I had prescribed since their invention. It stunned me to learn that they hardly worked and were often damaging. I read further and found that other psychiatric medications produce irreversible brain and health problems. Doctors have been trained to pass them out like jelly beans.
I learned that many drugs are given for wholly theoretical, even speculative benefits. Many are damaging. I consulted people for cosmetic surgery who were taking ten (10) of these at once. I began to see how medical corporations had done this to us.
I read about back pain. Most of it goes away on its own, but doctors had been thoughtlessly prescribing opioid painkillers and turning many patients into struggling addicts. Back surgeries are the most expensive and some of the least effective procedures in all medical care, bar none. No one admits this even to themselves—not the surgeons, the hospital administrators, nor the surgical centers’ owners. The enormous profits short-circuit everybody’s judgment.
I also realized that over the past three decades, younger and younger people had been getting heart disease, obesity, and diabetes. I wondered if healthcare, particularly medication use, might be the cause. I thought about Peter Van Etten’s line, “In this insanity of healthcare, the patient always loses.” I saw that we were breaking them on a medical torture-wheel.
The amount of wealth thrown into American healthcare is astounding. Since the corporations took over, hospitals, drug companies, and senior doctors on their payola are scrapping for it like giant carp eating bread. We pay them handsomely for anything they can slap a billing code on, and they dictate every move according to profitability. Patient wellbeing is now secondary. Healthcare quality—and our general health—has deteriorated.
I have affluent peers, and many are not shy about it. A gastroenterologist boasted in the doctors’ lunchroom that he puts diamonds on the fingers of his infant daughters. In 2004, a cardiologist wearing a $3000 suit told me he “couldn’t pay his personal expenses” if he made less than $600,000 a year. Nouveau riche posturing like this is usually accompanied by stories about expensive, supposedly lifesaving treatments. I always vaguely smelled a rat, but I was busy and never gave it much thought.
As I continued to study, I realized that newer science proved that many of the therapies these people were selling were worthless. I wondered what profit their fancy cars or high incomes could be for them if they did not put patients first.
After a great deal of personal and professional reflection, I decided to write about the whole medical-industrial calamity. I understand I am a whistleblower, what it means, and what I face. In late 2019, I quit practicing, resigned from my medical license, and left the melee. I can now say what I need to from outside the tent and without conflicts of interest.
My story is not the narrative of Wikipedia, WebMD, or other online sources. These are constantly being rewritten by marketers. Wiki is the most reliable, but like the others, it is under guerrilla attack by corporate ghostwriters. Most physicians disagree with me as well. When I shared my conclusions with them, most became resentful, cited their training, and told me I was dead wrong. The few who know the story are afraid to speak up.
Industry shills and people born yesterday say my tale is dated and claim everything has changed. They are right—it is not a new story. Since information remains concealed until drugs are off-patent, some of my references are ten to twenty years old. But they are only half-right: they are wrong about the change—the situation has become progressively worse.
Even though this history has been an open secret for decades, only an elite few understand the whole dysfunctional puzzle. You have the chance to join them, but the more you learn, the more it will break your heart.
Physicians, to practice effectively and ethically, must understand what they face. Familiarity with these controversies is indispensable, even if you reject some conclusions. Your work will improve after you realize that doing less may produce better results.
Likewise, patients must learn about these issues to have the best chance of benefiting from healthcare. I share practical, little-known ways to deal with doctors and hospitals. You will also learn about health, sickness, and the limits of medicine. The more you know, the more confident you will be accepting—or in some cases, refusing care.
Despite my best efforts, I may be partly wrong. For example, statisticians are more optimistic than I am about the trifling improvements shown in large studies. You may also think you “know” about an area where I am mistaken, and that this destroys my credibility. For some cautious readers, what follows may even sound like a hostile, one-sided polemic.
So proceed with caution. If some disagreement kidnaps you and you quit reading, you will lose your chance to understand the ecosystem. Before feuding with me about a tree in this forest, scan at least the first dozen anecdotes. Money has poisoned our well, and this pattern establishes legitimacy even before you look at references. You need not swallow everything I serve up to believe that we are managing patients poorly.
The first step to deal with the situation, either as a doctor or a patient, is to learn the truth. This is also necessary for reform. By the end, you will understand the mess that has developed after we permitted industrialized medicine to snowball for thirty years.
Robert Yoho, May 2020
Pasadena, CA