“Crank?” was my first reaction when I saw the review copy of the new book “Scrubbed Out: Reviving the Doctor’s Role in Patient Care.” It was a slim, self-published volume with a cartoon cover and an M.D. after the author’s name. Usually, that means rosy, false promises of health panaceas.
But Dr. Salah Salman, the author, is not a crank at all. On the contrary, he’s a distinguished doctor, retired now at 75 after an impressive career in the Lebanese cabinet and in high positions at the prestigious Massachusetts Eye and Ear Infirmary. It’s just that he’s so pained and appalled by what he’s seen in the American health care system that he has decided to speak out, exposing the unnecessary surgeries, the hyped research, the passive doctors and a few who are out-and-out venal.
His book amounts to a medical cri de coeur — “This is not how it should be!” — and more than anything, it reminds me of a phenomenon called “samizdat” in the old Soviet Union: Manuscripts written by dissidents because conscience would not allow them to remain silent, even though they knew the Communist regime would never allow them to be officially published. Things would have been different if they’d had e-books and print-on-demand back then.
Dr. Salman’s critique of American medicine is wide-ranging, from the millions who lack health insurance to the dangerous failure of doctors to police each other. But one of his central tenets is that medicine should not be seen as a business, and that money corrupts its practice. The following lightly edited excerpt, posted with his permission, focuses on an area of his expertise as an ear, nose and throat specialist: Chronic sinusitis, and a form of surgery to treat it that has exploded despite questionable benefits.
Excerpt from “Scrubbed Out” by Salah D. Salman, M.D.
The sad story of chronic sinusitis and functional endoscopic sinus surgery is worth describing in some detail. When fully told, it illustrates many of the problems that have plagued health care and that this book discusses.
As an ENT surgeon, I have witnessed its unhindered growth and development for years; a new theory about the cause of sinusitis and a new surgical technique to cure it were widely adopted fast, without convincing proofs of their value. Evidence against them was suppressed when it surfaced. The medical and hospital leaderships failed to intervene when they should have to monitor quality of care and to control cost.
The see-no-evil attitude of medical doctors helped the wide spread of a questionable theory and a questionable surgical technique. The absence of user-friendly venues provided no opportunity for caring and dissenting doctors to speak out against a lucrative doubtful practice. The power of marketing and promotion contributed significantly to the problem. The current malpractice system, which scares doctors, continues to fail as a quality controller in health care.
The saga of chronic sinusitis and FES began during the last three decades of the twentieth century. Continue reading