Vignette #11 — Martha

photo by Daan Spijer

The room is oppressive — dark wood panelling, three suited men sitting at a table on a raised platform, flickering fluorescent lighting.

Martha, a GP, is sitting at a table facing the three men. She has a friend with her, another female doctor. The three men constitute a medical investigation committee — they are medical specialists and one is also a medical professor, acting as chairman.

“Dr Agropoulos, can you explain to us why, on the 4th March 2015, you gave your patient, a fourteen-year-old boy, a very high-dose intramuscular injection of vitamin D?”

Martha looks through her notes. “The boy had a very low blood vitamin D level.”

“How did you ascertain that, Dr Agropoulos?”

“I sent a blood sample to a pathology lab. And it reported a level of 45. The optimal level is over 90.”

“Isn’t it standard practice to supplement with tablets or an oral liquid?”

“Yes, that is standard practice. But it is only useful for maintaining levels. It doesn’t bring the levels up when someone is very deficient.” Martha finds a document and waves it at the committee. “There was an Australian medical trial that concluded a high-dose injection is warranted where a patient has low levels.”

“Yes, yes. That is one trial. High-dose injections are not registered in this country or endorsed by your peers, Dr Agropoulos.”

“They are registered in Europe, and these injections are commonly used by bariatric surgeons.”

“They are not your peers , Dr Agropoulos.”

“But they are your peers, gentlemen.”

“That is as it may be. Let’s move onto the next patient.” The chairman examines a file. “A fifty-year-old woman with shortness of breath. You administered chelation therapy.”

“Yes, I did, eventually. She had been to a major hospital and they diagnosed myocarditis, but they could suggest no treatment and sent her home. Her condition gradually deteriorated. I heard from a colleague that chelation had been used for that condition with some success and that it was worth trying.”

“We understand, Dr Agropoulos, that chelation is used for lead poisoning. Your records show a pathology report with high lead levels. However …” The chairman picks up a sheet of paper. “The Health Department took soil samples and paint samples from around the patient’s house. They found no lead in her environment. How do you explain that?”

“I don’t see that it’s up to me to explain it. The patient had a high lead level in her blood and chelation is a registered treatment for that.”

“It is only registered for acute lead poisoning in children, Dr Agropoulos. Not in adults”

“As a doctor, under the terms of the Helsinki Agreement and the guidelines of the Australian Medical Research Authority, I am allowed to use so-called unconventional treatment for a patient if nothing else has worked or is known to work, and if it is safe, it is clinically indicated and I explain everything about it to the patient.”

“Dr Agropoulos,” the chairman almost growls at her, “as I have said, you had no knowledge of the source of the lead poisoning. That should have been investigated further.”

“And, Professor Jones, in the first instance I am interested in what is poisoning my patient. The source may never be identified and she could die while we are looking for it.”

Martha’s friend passes her a note. Martha reads it and then flips through her file. “In any case, gentlemen, my patient’s shortness of breath has completely resolved and at her last visit to the cardiologist it was confirmed that the myocarditis is no longer detectable.”

“Dr Agropoulos, this committee is not interested in whether your patients improve or not, although we acknowledge that in both these cases your patients have fared well. We can only examine if you are using approved treatments, and it appears you are not. The practice of modern medicine is about using tested and approved treatment protocols that have been shown to be safe and effective.”

“I don’t mean any disrespect, Professor, but that is patently not true. Prescribed anti-inflammatory drugs cause over two thousand deaths in Australia every year, while there is an ‘unapproved’ treatment for arthritis that is as effective and has no side effects and certainly doesn’t kill patients. It’s also the case that there are approved prescription antidepressants that cause deaths through heart attack in otherwise healthy individuals.”

“That is irrelevant, Dr Agropoulos. Those have all been approved by the relevant authorities. What you have been using in your practice has not been approved. We will now adjourn and consider whether to place conditions on your medical registration.”

The three men leave the room.

Martha has tears in her eyes as she turns to her friend. “It’s getting so ludicrous, I’m considering leaving medicine and getting a job as a street sweeper.”