Walter & Lap Band & Dr. Pories, etc

[Guest guest]

Dear Walter:

I'm sorry that my posting of a few Lap Band abstracts has caused you

to become so angry at me and others on this list. In the future, if

you have a problem with something I say or do on this list, please

direct your bile toward me, rather than spewing it at our fellow list

members and, in particular, at the moderators. Don't worry, I won't

reflux. I can't, I've had a DS. < >

I think it's wonderful that you've devoted part of your practice to

helping MO people get the surgeries they need. But you have to

realize that your long membership in the ASBS has made you an

institutional insider of that organization -- something which we are

not.

The recent decision by BC not to pay for any malabsorbtive procedures

any longer has hurt many people on this list and frightened many

others. Hull theorized that this decision might have been

based upon that short " Ask the Expert " piece by Dr. Pories. Given

how respected you say Dr. Pories is among bariatric surgeons, it

would not surprise me to learn that is correct in his

hypothesis.

Under these circumstances, I think it is perfectly natural that at

least some of the affected persons would transfer at least some of

their anger at Blue Cross onto Dr. Pories. I think it is also

perfectly natural that at least some of us would be dismayed at the

thought that Dr. Pories will be the next president of the ASBS.

Dr. Pories' statement has been characterized differently by different

people. Personally, I had to think about it for a while and learn

more about Dr. Pories before I could come up with my own

characterization. After much thought, I think that what Dr. Pories

did can be characterized as " damning with faint praise. "

To see what I mean, one must look at the statement in the context of

who made it, i.e., Dr. Pories. From what I gather, Dr. Pories has

vast experience as a bariatric surgeon. This vast experience as a

bariatric surgeon has, presumably, also given him quite a bit of

experience with and knowledge about insurance companies -- in

particular, how far they will go to deny any expensive procedure.

Furthermore, Dr. Pories is a longtime, highly respected member of the

ASBS.

When asked about the DS, Dr. Pories could have said something along

the lines of, " It's not my preferred procedure, but the available

literature -- by Dr. Hess, Dr. Rabkin, Dr. Baltazar, etc. --

indicates that it is effective and safe -- certainly safer than

remaing morbidly obese, in any event. "

But instead of tempering his remarks in some such manner, Dr. Pories

first dismissed the literature on the DS as lacking proper " rigor " --

actually citing Dr. Hess's ten year followup study as evidence

against the DS. Then, at the end of the piece, after tearing the

surgery down, he offers a few kindly-sounding platitudes about how it

just may prove to be a good surgery ... someday.

As I read the piece over again, I find myself asking several

questions:

-- If he really thinks that smelly stools, and possible diarrhea and

halitosis are serious complications, how can he justify performing

the RNY, an operation that leaves the patient with almost certain

dumping syndrome as well as at risk for bowel-breath, (not to mention

smelly stools and diarrhea if the surgery is distal)?

-- Does he really think that fat people are so stupid and lazy that

we can't be trusted to take a few supplement pills every day?

-- Does he not know that the insurance industry reads the medical

press too, looking for excuses to limit benefit payouts?

-- Has it slipped his mind that the word " investigational " is a

favorite word in the insurance industry; a word they use like a

shield between their subscribers and their bank accounts?

-- Has he forgotten how many times he had to struggle to get a

patient approved for his surgery?

-- Does he have no respect for his fellow surgeons of the ASBS who

happen to disagree with his narrow view of what is and what is not a

proper study?

-- Does he not care how devastating it can be on someone to come

close to life-saving surgery, only to have the rug pulled out from

under them at the last minute by an insurance company armed with

the " I " word -- HIS WORD?

To my mind, the assertion that Dr. Pories is unbiased toward the DS

just doesn't pass the sniff test. ( " Smells like rotten meat, it must

be rotten meat. " )

I realize, Walter, that your perspective is different from mine,

different from most on this list. You know (of?) Dr. Pories as a

revered " elder statesman " of the ASBS. But I wonder if you realize

how different your perspective is?

This brings me to the Lap Band controversy.

When you defended the Lap Band, you said that the long-term

literature showed it to be a very good alternative that has helped a

lot of people, etc. To me, it sounded as though you were speaking as

an ASBS insider, rather than an objective observer. Perhaps I sould

clarify what I mean by " ASBS insider? "

By that phrase, I simply mean that, having been inside the

organization for some time -- particularly in the honored position as

the only non-surgeon among the regular membership -- you have become

acculturated to the organization and it's (written and unwritten)

norms. In most large, formal organizations with which I have had

experience, one such norm is an unwritten prohibition on criticizing

one's fellow members and/or the work they do.

The rather strident manner in which you defended both Dr. Pories and

the Lap Band made me think that this is what was at work behind your

words.

But, as anyone who has been reading my posts for any length of time

knows, I am often wrong about things. Perhaps Dr. Pories is as

neutral as neutral can be and the Lap Band is the best thing since

sliced bread. If so, I reasoned, then I should be able to apply Dr.

Pories' standards of longevity and scholarship to the literature on

the Lap Band, and the procedure would come up smelling like roses.

So I set out to do some research on the Lap Band, and asked you to

give me some citations to the long-term studies showing what a great

procedure it is.

What I found was disappointing. The longest positive study I could

find billed itself in its title as a five-year study but, in reality,

only followed the patients for four years. Most of the studies I

found were in the one to three year range -- too short to be very

meaningful in a Pories-centric universe.

I also found a few studies reporting negative conclusions and/or

providing anecdotal evidence of potentially nasty complications from

the Lap Band. Given that you had already argued the pro-Lap side,

(and being a bit peeved because such anecdotal evidence is often used

by people " dissing " the DS), I thought it only fair that I present

the other side of the picture. So much for my hidden agenda.

During my research on the Lap Band, I must have looked at several

hundred abstracts in a vain attempt to find a long-term, rigorous

study on the subject, but I failed. I can only assume that they

either are not online, or that they are hidden away someplace that I

don't know about.

If you would be so kind as to provide at least a single such

reference, I will be happy to read the article and report back to the

group what I find therein, good, bad, or indifferent. I can't say

that reading such an article, (or tens of such articles), will change

my views on the Lap Band, but I will nonetheless describe to my

fellow list-members the results of the studies to the best of my

ability.

Cheers,

Tom

[Guest guest]

At 4:19 AM +0000 7/2/01, tlarussa@... wrote:

>Dear Walter:

>

>I'm sorry that my posting of a few Lap Band abstracts has caused you

>to become so angry at me and others on this list. I

" Angry? " I did not detect anger in Walter's replies.

>n the future, if

>you have a problem with something I say or do on this list, please

>direct your bile toward me, rather than spewing it at our fellow list

Tom, " bile " and spewing " are hardly neutral words. In fact, my

e-mail client, Eudora pro, turns the word " spewing " into bright red

on my screen just to warn me that it is a highly charged word.

Surely your tone does not not sound conciliatory to me. Pity, too,

because the points you then bring up make so much sense, and they are

so well reasoned.

>members and, in particular, at the moderators. Don't worry, I won't

>reflux. I can't, I've had a DS. < >

>

>I think it's wonderful that you've devoted part of your practice to

>helping MO people get the surgeries they need.

I do , too.

>But you have to

>realize that your long membership in the ASBS has made you an

>institutional insider of that organization -- something which we are

>not.

I'm thrilled that Walter is in the ASBS positions where he can help

us all. Surely, if he wanted to make tons of money as a lawyer, he

could have chosen a more lucrative specialty 9e.g., medical

malpractice).

>...

>This brings me to the Lap Band controversy.

>

>When you defended the Lap Band, you said that the long-term

>literature showed it to be a very good alternative that has helped a

>lot of people, etc. To me, it sounded as though you were speaking as

>an ASBS insider, rather than an objective observer. Perhaps I sould

>clarify what I mean by " ASBS insider? "

>

>By that phrase, I simply mean that, having been inside the

>organization for some time -- particularly in the honored position as

>the only non-surgeon among the regular membership -- you have become

>acculturated to the organization and it's (written and unwritten)

>norms. In most large, formal organizations with which I have had

>experience, one such norm is an unwritten prohibition on criticizing

>one's fellow members and/or the work they do.

>

>The rather strident manner in which you defended both Dr. Pories and

>the Lap Band made me think that this is what was at work behind your

>words.

If this was a tepid form of apology to Walter on your part, it is

certainly well-deserved.

>

>But, as anyone who has been reading my posts for any length of time

>knows, I am often wrong about things.

Hmmm . . . maybe once again, as far as Walter and his motives are concerned?

Tom, you are a brilliant man, and your energies in providing grist

for all of our mills is much appreciated. But, to me, you do much to

undermine your own talents when you come out swinging, especially

when you target the wrong people. it is not needed here. it is

destructive here.

Thanks,

Steve

--

[Guest guest]

Hi Steve:

Walter seemed angry, not to mention a bit derisive, to me. I guess

on this point we'll simply have to agree to disagree.

The bile-spewing comment was supposed to be little bit of DS post-op

humor, (although it apparently didn't come out that way), hence the

attempted punchline " Don't worry, I won't reflux. I can't, I've had

a DS. < > "

Now you know why I don't make my living as a comedian.

As far as directing comments *about* me *to* me, well, I have to

stand by that one. et al do an incredible job providing free

resources for people thinking about having the DS. I'd be willing to

bet that were it not for their heroic efforts, there are plenty of DS

post-ops who, for lack of information, would have chosen one of the

lesser weight loss surgeries. I don't think they should be treated

like grammar school yard monitors -- called in to fix things whenever

one of us has a problem with something another of us says.

> If this was a tepid form of apology to Walter on your part, it is

> certainly well-deserved.

I'm frankly puzzled by this remark, but then I, (and perhaps I

alone), saw the bile-spewing comment as part of an attempt at humor.

> >But, as anyone who has been reading my posts for any length of time

> >knows, I am often wrong about things.

>

> Hmmm . . . maybe once again, as far as Walter

> and his motives are concerned?

I think you have me confused with someone else on this point Steve,

or maybe I just didn't make myself clear. I don't question Walter's

motives, (which, in the absence of any evidence to the contrary, I

assume to be honorable), I merely suggest that his bias vis a vis

various weight loss surgeries is different than that of many people

on this list.

This wasn't intended as an attack on Walter. I was merely trying to

explain why Walter didn't seem to understand some list-members' anger

at and/or distrust of, Dr. Pories.

Cheers,

Tom