Feb 18 2016

Practicing Medicine Without a License

fake-diploma1

After four years of rigorous study in medical school, which includes grueling class work and then clinical rotations in which you may work 80 hours a week, followed by killer exams to demonstrate you have mastered a vast body of knowledge, you are not yet competent to practice medicine. Those four years only prepare you for your real training as an intern and then resident, another three or more years.

Even then, newly minted attendings who are supposed to be able to practice independently may appreciate having access to more experienced colleagues.

Further, as you accrue invaluable experience over time your fund of knowledge can actual degrade, because the science of medicine is quickly advancing under your feet. It is a struggle to keep up, which is partly why so many physicians specialize.

This is why one of the most important lessons we teach medical students and doctors in training is to have a very good sense of your own limitations. You need to have some sense of how deep any particular specialty is, so that you can gauge your own relative ignorance. The bottom line is – don’t practice out of your depth.

The public recognizes all of this, at least to some extent, which is why licenses are granted to those who spend years in training and can prove they have mastered their discipline. This is a common and reasonable social contract.

Part of my many problems with so-called alternative medicine (or SCAM for short) is that practitioners often take the short cut. They want to practice medicine without medical training. This includes a broad spectrum.

On the one hand you have professions like naturopaths and chiropractors, who do undergo years of education, but the validity of that education is questionable. They essentially regulate themselves, and there is no burden to demonstrate that what they are teaching is scientifically valid. Further, both professions are constantly trying to expand their privileges beyond what their training prepares them for. Many of them want to be primary care doctors, but that is not what they are trained for.

At the other end of the spectrum are those who have essentially no training. What they have is a philosophy, or just a narrative. They have a story to sell, and they are free to make it up as they go along. That is alternative medicine in general – they’re really just making it up, which is a lot easier than careful scientific validation.

One of the disturbing trends in recent decades has been the increased tolerance for essentially practicing medicine without a license. States are just less willing to prosecute this. Also, the definition of “practicing medicine” is a bit flexible, allowing an increasing number of practices to occur without qualifying as “practicing medicine.”

A recent Florida case shows the extremes to which this trend has gone, and how far you have to go to get law enforcement interested in actually enforcing the law and protecting the public.

Florida resident 18-year-old Malachi A. Love-Robinson was recently arrested for practicing medicine without a license. He has no medical training. He has a certificate that he obtained through the mail from the American Association of Drugless Practitioners, after “reviewing copies of degrees and diplomas sent by mail.” No training or testing was required. He also claims to have a PhD from an undisclosed Christian university in an undisclosed discipline.

Love-Robinson was targeted by a sting operation after a public tip:

He said that the undercover agent who posed as a patient came in complaining of an itchy throat. Mr. Love-Robinson took her weight, checked her breathing and checked her temperature, then recommended she visit a local pharmacy for allergy medication.

“There were no scripts given,” he said, “no medical advice given.”

Taking a history, doing an exam, diagnosing allergy, and recommending allergy medication (even if over-the-counter) is practicing medicine.

He also said in his defense:

“I’m not trying to hurt people,” he said. “I’m just a young black guy who opened up a practice who is trying to do some good in the community. If that is a negative thing, we have a lot more work to do in the community than to single out me.”

and

“I value my practice skills which include great communication skills as well as timely and prompt care,” his biography on Healthgrades said. “I am a strong believer that patients in general are the strongest medical tools there is.”

So he’s a people person. That’s a substitute for 7 or more years of medical education. These excuses are representative of alternative medicine generally. They are just trying to help people. They have skills. Why are we bothering them?

Mr. Rosenthal, who issued the dubious certificate, is quoted as saying:

“We tell them that all they can do is consult and educate.”

And there is vagueness of what constitutes “practicing medicine” that alternative practitioners are successfully exploiting. “Consulting” is actually something that physicians do. You have a problem, you consult a physician. Part of that consultation is getting information from you (history and exam). Most of what we do is then educate the patient about their problem and what to do about it.

Real doctors can also order diagnostic tests, prescribe medication, and perform or refer for procedures. Alternative practitioners, however, can prescribe homeopathy, and perform acupuncture, cupping, manipulation, oxygen therapy – a long and growing list of dubious treatments and procedures. They now even have their quack labs to perform dubious diagnostic tests to confirm their bogus diagnoses.

All of this is somehow not “practicing medicine.”

It is practicing medicine. It’s practicing fake medicine based on pseudoscience and philosophy, without the burden of having to validate practice with actual scientific evidence, and without the burden of having to prove valid expertise. They get to just make it up as they go along, and optimize their practice for marketing and profit.

Reading the accounts it seems to me that the reason Love-Robinson was busted was because he was 18. That was apparently part of the original tip – an 18 year old was passing themselves off as a 25 year old. It is highly likely that when Love-Robinson gets a little older, he will be able to ply his alternative trade unmolested by pesky laws designed to protect the public by ensuring anyone passing themselves off as a medical practitioner has actual knowledge, skill, competence, and professionalism.

24 responses so far

24 Responses to “Practicing Medicine Without a License”

  1. Steve Crosson 18 Feb 2016 at 10:20 am

    I hate to keep beating the same dead horse about “trusting the (actual) experts”, but this is yet another example of why it is important. As the world becomes more complicated and jobs become more specialized as a result, it is increasingly impossible for “average” people to separate fact from fiction.

    We must have reliable, impartial judges to help make sense of the world and allow us to make the best possible decisions. I’m sick of people complaining about “unnecessary” bureaucracy and regulation when the benefit FAR outweighs the cost.

  2. Willyon 18 Feb 2016 at 10:22 am

    I love the certificate, signed by Dewey Cheatem Ann Howe

  3. carbonUniton 18 Feb 2016 at 10:54 am

    And we must have a way to find said reliable, impartial judges.

  4. Steve Crosson 18 Feb 2016 at 11:25 am

    CU,

    It may not have been clear, but I was talking about government agencies like FDA, CDC, etc.

    Of course, it should go without saying that we also need oversight with checks and balances to ensure that the guidelines and regulations are accurate, effective, efficient and minimally burdensome.

  5. Steve Crosson 18 Feb 2016 at 11:29 am

    It should also go without saying that any approach must be comprehensive and fully funded — two serious shortcomings of the current environment.

  6. Clemanceon 18 Feb 2016 at 11:35 am

    Steve Cross,

    I wouldn’t say it’s “impossible for average people to separate fact from fiction.” Yes, there are too many who fall prey to these scams but the vast majority of us are average and if taught, do have the ability to recognize an obvious scam. I don’t believe the answer lies exclusively in bureaucracy and regulation either. The habitual use of critical thinking and education are the most reliable defenses against scams of any kind. If and when all people are educated in the nature of reality, these scams will disappear by default. We should focus our attention on education and dispelling mythologies like religion for example, so the masses do not adapt the inability to parse out fact from fiction.

  7. RCon 18 Feb 2016 at 11:59 am

    Clemence:
    “Yes, there are too many who fall prey to these scams but the vast majority of us are average and if taught, do have the ability to recognize an obvious scam”

    Do you have any evidence of this?

    Homeopathy is an obvious scam, and every drugstore I go into is expanding their homeopathy sections (or has recently). Organic is an obvious scam (in that the regulations are not written with safety in regard, but a specific ideology), and yet the organic industry is growing in leaps and bounds on the perception that they’re safer.

    The problem is that that vast majority actively resist teaching – they start with their ideology and collect or discard facts based on whether or not they confirm or deny said ideology.

  8. Steve Crosson 18 Feb 2016 at 12:04 pm

    Clemance,

    I agree completely that we must increase education in critical thinking. However, the world is too complex (and getting more so) for average people to be able to recognize all scams without some assistance. Too many con artists are too good at what they do. Science is too broad and advancing too rapidly for non-specialists to be be able to reliably determine plausibility. For example, if someone knows anything at all about the weirdness of quantum mechanics, does Deepak Chopra’s BS sound that much more bizarre?

    We also need to dramatically improve funding for testing agencies like the FDA because it is impossible for the average consumer to know what they are buying otherwise. Just last night, I saw a news story about the FDA catching a company selling Parmesan Cheese without any Parmesan.

  9. tmac57on 18 Feb 2016 at 12:52 pm

    Clemance- I agree with Steve Cross that our modern world is much too complex for any individual to truly sort out all facts from fiction. There are just way too many concerns that vie for out attention, and the best that we can do is, as you suggested, acquire and maintain critical thinking skills to help us navigate through those immediate concerns that affect us directly.
    But that leaves mountains of information that we have to deal with that we will never have time to investigate properly, and that’s where trusted individuals and agencies come into play. But even there, how can an average person, who probably has a busy life filled with work, family and social obligations, not to mention free time to enjoy entertainment, exercise, travel and such. find the time to vet every regulatory institution and information outlet to know what the actual reality of every issue is?
    We do the best that we can as good skeptics, and we certainly cannot claim to know the facts of everything that concerns us, so just how well do you think that the average Joe and Jill out there are faring when most of them aren’t even employing skeptical tools?
    Gut judgments rule the day, fueled by all of the cognitive failings of the human brain, and fed by both the intentional and unintentional misinformation that pervades our lives, and when faced with the complexity and nuances of life that seem so overwhelming, people grasp for the simple answers just to try to keep up, and also to try to settle on ideas so that they can reduce cognitive dissonance and go on to other mental tasks that demand their attention.
    Many of our social ills are caused by our inability to see the world as it actually is, because it probably is impossible in principle to do so. We just have to do the best that we can and accept that there is probably no way around this problem except to go back to primitive times where life was basic but also short and probably harsh.

  10. Clemanceon 18 Feb 2016 at 2:52 pm

    RC,

    I think my evidence would be categorized as anecdotal and therefore not evidence at all. My comment was based on my own experience and observations. I am an average person who is college educated but with art degrees. I’ve searched all my life for understanding of the world and it took a very long time for me to understand the benefits of science and gain the ability to use critical thinking to the degree that I do. I no longer believe or follow new age crap or look to religion or Deepak Chopra. I understand and appreciate the theory of evolution and seek out scientific knowledge whenever I can. If I can do this, I think the remainder of the population can do it too. The vast majority of humans have the capacity for understanding the true nature of reality and enjoy the freedom that comes with that understanding. I have nothing against government regulations to protect people from scams and dishonesty but at the same time I think that we do have the capacity to understand whether or not a claim is factually based. Is this idealistic or incorrect?

    Yes, drugstores are expanding their homeopathy departments and the organic industry is making a killing. You’re right, things are worse than I think sometimes. But still, if I (an average person) can understand and make use of science and critical thinking, can’t other people too, given the opportunity? If I’d have been educated about skepticism and applying logic a long time ago, it would have improved the quality of the life I’ve lived. That’s why I so strongly believe in the educational component.

  11. Clemanceon 18 Feb 2016 at 3:04 pm

    Steve Cross,

    Well, we agree with each other then. I’m sure the FDA and other such agencies do need to be funded more. At the same time knowing nothing about quantum mechanics other than it is very, very small stuff, my BS detector does sound the alarm when I hear “Deepak Chopra” after having read many of his books in the days when I was far less informed. It is such freedom to have the SGU and so many other reliable sources to choose from now. In general, as bad off as we are, our culture is evolving more toward the use of science and and away from the BS, no?

  12. tmac57on 18 Feb 2016 at 4:07 pm

    Clemance- ” In general, as bad off as we are, our culture is evolving more toward the use of science and and away from the BS, no?”

    I think this is still an open question, and is also a fluid situation that is prone to ebbs and flows. For example, the teaching of creationism in the guise of ID and ‘teach the controversy’ has had some notable losses, but also some recent wins (if you could call it that).
    Acceptance of AGW seems to be growing in the U.S. as more obvious signs of it are getting the less informed people’s attention now, but since they generally know little about the science of AGW, their opinions are still easily manipulated back toward denialism by dishonest but plausible sounding arguments, especially if it comes from a source that is politically compatible with theirs.
    Religious influence in U.S. politics also seems much stronger and more overt in today’s politics than it was decades ago, and has been leveraged by the GOP to great success, despite polls showing a decline in religious identification here overall. People that I have known as secular for many decades are now somehow beginning to act as if they have gone through some religious conversion (talking about god and asking for prayers for people) apparently because they are of conservative political leanings, and that’s what their fellow travelers are doing. I don’t think they believe it really, it’s just the face that they wear for their tribe.
    Medical pseudo-science is having a heyday that rivals the days of the snakeoil salesmen, in large part because of the internet and social media that is increasingly being Balkanized. There are plenty of anti-science and credulous folks out there, and we should not get too comfortable in our own echo chamber.

  13. Clemanceon 18 Feb 2016 at 6:21 pm

    tmac57,

    I don’t disagree with you on this or your earlier post. I didn’t know that it’s “still an open question” as to whether or not culture is evolving toward science, secularism and a realistic understanding of nature by the masses. I do understand that the world is complex and that advancements are prone to ebb and flow.

    I get angered by seeing how religion has infiltrated our political system and how many don’t accept theories like AGW. What’s even closer to home for me is when I see people asking for prayers and basing important decisions on talks with God. I try to encourage people to think rationally but I get a lot of hate when I do. People are very dependent on their belief system and denial runs very deep even for some I am very close to.

    I hope I’ve said something of use to you and the others. Rest assured that as I am still in a learning phase, your words are very useful to me.

  14. BillyJoe7on 18 Feb 2016 at 10:32 pm

    “if someone knows anything at all about the weirdness of quantum mechanics, does Deepak Chopra’s BS sound that much more bizarre?”

    Oh I think so, but I think there is a better word to describe him.
    Listen to this exchange betwen Chopra and an actual physicist:

    https://m.youtube.com/watch?v=Z17sIJyQ3oY

  15. Steve Crosson 19 Feb 2016 at 10:21 am

    BJ7,

    Thanks for the link … that was pretty funny.

    Deepak is an obvious whacko to many of us, but not everyone has the same level of experience in detecting BS — especially when that BS is so tempting to believe.

    Unfortunately, Common Sense … Isn’t Very Common

  16. RCon 19 Feb 2016 at 2:36 pm

    Clemance:

    ” But still, if I (an average person) can understand and make use of science and critical thinking, can’t other people too, given the opportunity? ”

    I think the issue here is that you think your path here is average – it’s not. The average person (atleast here in the US) doesn’t stop and question things. The average person has an Organic meme pop up on their facebook feed and shares it, rather than digging in and asking “Is this actually true?”

    People generally decide whether information is useful by determining if it fits their pre-existing ideologies – they discard things if they don’t. They don’t gather facts and then move to an explanation, they start with an explanation and gather facts that support it.

    I’m really hoping that the current religious outpouring in the US is largely a result of the younger half of the country being significantly less religious, and the older half basically digging in and being vocal, and things will fix themselves as those people die off (which is similar to what happening with LGBT stuff – the people most opposed are dying off and younger voters have grown up in a much more tolerant society).

    Still though – the current frontrunner for the republican presidential nomination has made the following comments in the last year – and people are voting for him:

    “There is no place for gays or atheists in my America. None. Our constitution makes that clear”

    “Any president who does not being his day on his knees is not fit to be commander-in-chief of this nation”

  17. mumadaddon 19 Feb 2016 at 2:49 pm

    RC,

    I had no idea Trump had said that about gays and atheists. Jeeeezus.

  18. mumadaddon 19 Feb 2016 at 2:50 pm

    Can you link to it?

  19. Fair Persuasionon 19 Feb 2016 at 6:12 pm

    This young man states his surgical treatments are standard practice, however, the techniques are most likely dating back to the 1880s-1920s. He advertises skills as a practicing physician, M.D. and surgeon. He has none of the licenses required. Is he a delusional felon? Forensic clinical services would be best advised for this person.

  20. mumadaddon 19 Feb 2016 at 7:16 pm

    Actually, Trump’s above comments (if he made them) suggest a deeply conflicted mind.

  21. BillyJoe7on 19 Feb 2016 at 11:23 pm

    Actually, it was not Donald Trump. It was Ted Cruz. But then it wasn’t Ted Cruz either.

    http://www.politifact.com/texas/statements/2015/apr/08/facebook-posts/meme-facebook-says-ted-cruz-declared-no-place-gays/

    A quick thirty second Google search RC.

  22. RCon 21 Feb 2016 at 4:40 pm

    I didn’t say it was Donald Trump. I was talking about Cruz. Trump doesn’t seem to have any problem with atheists – although he has said that he doesn’t want to court their votes… which doesn’t mean a whole lot.

    You’re right about one of the quotes – I missed that. He absolutely said the other one though:

    http://www.huffingtonpost.com/entry/ted-cruz-atheists_us_5640b613e4b0411d30719f52

  23. 1RickDon 01 Mar 2016 at 11:07 am

    Well, welcome to america. Here’s a guy thrown to the wolves of an economy that – given his personality and skill set – gives him no good option to do it the right way, but does pretty much let him take his swings the wrong way. And all y’all do is whine about it. Until the genius skeptics crawl out from under their rocks and start companies that give people like this better options, you’re stuck.

    But by all means sit in your jobs, charge $100k for an MRI so the CEOs can swim in obscene pools of cash, ignore the psychology of the average idiot, and push them to the quacks where the profit margins are equally insane.

    Yeah, the truth will eventually win out, but at this rate it’s gonna be centuries.

  24. BillyJoe7on 01 Mar 2016 at 4:02 pm

    Hi Rick….as Tony Jones says “we will take that as a comment” and move on.

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