Dr. Bex
speaker
498 appearances
7 recordings
1 series
first heard Nov 2024
last heard Jun 2025
Dr. Bex’s voice in public audio — every appearance, attributed to the second.
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Appearances
that they are actually doing it because they are choosing the procedure and that they aren't, you know, there isn't some other, you know, motive of the physician or of the person signing the consent that they're doing this voluntarily, you know, without any other motive than they understand the procedure and that's what they want.
And I think in pediatrics, this still gets me a little bit in the terms of the child is not consenting, the parent is consenting, which is, yes, that's how we work in this country. That is who signs for things. But just keep in mind that the people receiving consent in some of these cases was not even the patient themselves.
It's along the terms of ketamine, where it's FDA approved in very specific situations, but not in all situations. And what it sounds like, at least from my reading, is that they were using it, what we call off-label, but they were not being informed necessarily that, yes, the FDA does approve it for certain things, but not for this specific consideration is what it sounds like.
And it's become everything they're doing. Like their whole life. This is everything. It's not one of the things they do.
And I think that's what I try to explain to people that's so hard is a niche practice where this is all they do. A doctor who did all of their research on one genetic condition, it's named after them. There's one, like that's everything. To be fair, I say this all the time that I want to keep a bit of a...
I need like a sounding board for cases of Munchausen by proxy abuse because of course I do all my research. It's everything I do. So I love that I have residents and teammates and other people that do other things and they can have their own opinions and ideas. And this idea of a multidisciplinary approach I think is so important because once you get so niche,
It's a little bit hard to see what is it, the forest for the trees or whatever that, you know, you assume if someone's there, there's already certain things that line up and then you're doing your whatever review and then doing your testing. But again, all of that can be clouded by them being there kind of in the first place, if that makes sense.
Like they walk through the door, there must be something bringing them there. And once we get into clinical diagnoses, these ones that there is not a gene test for, they're that even though there is a test like an MRI for, these ones don't meet that normal criteria, it becomes very subjective.
And that's when I get a little bit worried that whether intentional or unintentional, it is easier to see the thing that you work on every single day. It's a bias, like no matter what. And so you have to have that grounding. But if your entire center institute, everyone, this is all they ever see, and this is all they do, And then it leads to the surgery that brings in, to be fair, more money.
And then there's the follow ups. And then that's your research. You know, there's these centers that it's also they're the ones doing the research on this niche medication, niche surgical procedure. So then their results become the research that then furthers more, that then brings more to their clinic. It's this cyclical thing where nobody is outside of this. Yeah.
And of course, as a physician, I want to believe there was a point at which they saw some connection between Ehlers-Danlos and these things, and they felt like they were the ones that were maybe having worse outcomes or maybe weren't getting the care they needed. I worry about parents, patients who are just looking for answers and reasons for why do I hurt so bad every day?
Why are my headaches so bad all the time? and they find this website and it seems like the freaking like light from heaven goes on and you're like, oh my God, this is me. So you go and they offer something and it's not until you're what five, I mean, some of these people had greater than 20 surgeries done. You know, that like how many surgeries are you like, oh, what did I do?
You know, if you really still believe in this. And then there's also the flip of that where there are parents and are patients who are specifically finding these places because they know you don't have to go through the same pipeline or series of events again. to get there. And he says he reviews the medical records.
Maybe that is to make sure you've done X, Y, and Z, but that's not clearly delineated here. And we know specifically from other cases we've reviewed that it's going to the extreme. There's no timeline that makes sense. Like that, how in eight weeks a child has a GJ tube when they were a healthy baby eight weeks ago, like that timeline, there was not enough time to give things time to work.
And so I think it's and it's just the extreme, the extremity of these things is just cannot be cannot be left unsaid.
So again, because of the way some of these things are being diagnosed, the idea is we're steering a little bit off of the standard of care for diagnosis, but then follow that up with steering off the standard of care for the treatment, even if the diagnosis was something that everyone agreed upon. So the diagnosis is made...
In these cases, it seems some of the ones that came up in the lawsuits based on what's called morphometrics. And the idea is basically measurements. And to be fair, there are things like, for instance, endocrinology is the most mathematical specialty we have. It's like if the glucose is this, you increase the insulin to this. It's a very like...
If then very objective, like if a doctor really likes that stuff, endocrine seems to be like a good fit for them. And then there are parts of medicine that aren't so clear cut. So what we want to do as physicians is we want to make it make sense. We want to make it objective. And so we try to find measurements, angles, things that everyone can agree upon that
The thing is, everyone, it's how you measure it too. So it's, are you on the exact middle image of the exact MRI on the exact slice that everybody is looking at? And if you put 20 radiologists, 20 neurosurgeons in the room, would they all get the same measurement?
Because technically, you could just shift to the next picture or the next picture, and it's going to make that angle or measurement look bigger or smaller. So it's still based on how the pictures were taken, the position the patient was in, who is doing the measuring. And again, if that person is not licensed at all, it even becomes more questionable.
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