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Dr Hook's medicine show

By Terry Joseph
April 28, 2006

As early as the 14th century in Europe but mushrooming into more lucrative business 500 years later in American frontier towns, con-artists quickly amassed fortunes peddling wagonloads of quack remedies for medical problems of varying gravity, any resulting death euphemistically described as misadventure.

Luring crowds through entertainment events, the medicine show, itinerant doctors avoided enduring relationships with victims whose maladies remained unaffected by snake-oil. Patronised by the gold rush that began in 1848, medicine shows brazenly disregarded the regulatory American Medical Association, founded a year earlier, until law-enforcement stepped in.

But based on evidence presented Tuesday by an internationally respected researcher, the medicine show is still alive and well in Central Trinidad where, Prof Courtenay Bartholomew said, a medic (whom we shall call Dr Hook) has administered inappropriate treatment to 14 HIV patients and misdiagnosed and treated at least two others for AIDS when, in fact, they were HIV negative.

Prof Bartholomew gave a chilling description of patients who, for monthly fees (ranging between $2,000 to $4,000), received only inadequate treatment, including unlabelled medication which, Dr Hook reportedly said, was dispensed in that fashion because the drugs have not been approved by the US Food and Drug Administration (FDA).

Quite apart from issues that should snap the Pharmacy Board to attention, Prof Bartholomew further astonished us by saying no blood tests were ever done on the case he detailed, although this is normally considered an essential prerequisite to determination of any such treatment.

It is widely known that cavalier dispensing of antiretroviral drugs can lead to development of resistant strains in the patient, putting society at large to greater risk and deceiving the victim into thinking cure was imminent, even as the condition worsened. In short, Dr Hook's recklessness could lead to death of not just the initial carrier.

A letter from the Medical Research Centre to Dr Hook requesting a report remained unanswered after 18 days, so the matter was brought to the attention of the Medical Association Ethics Committee. Prof Bartholomew said no appropriate action was taken, so Dr Hook remains free to conduct business. A file showed 13 other patients wrongly treated by Dr Hook.

Given the nature of the ailment and perceived need for privacy, some affected persons may still select medicine-show solutions over proven scientific technique so, not for want of preventive and containment options, the doctor has a built-in hook by which his clientele will increase, as would the social difficulties concomitant with augmenting his revenue.

The sheer cruelty of misleading patients afflicted with potentially fatal illnesses is bad enough but much more distressing is the reality that, according to local law, Dr Hook has committed no crime, so it is not a question of the Fraud Squad swooping down and curbing the unseemly practice, even as he appears before the court, with the promise of severe jail time if convicted.

In the circumstances, our hope lies with lawmakers or the Medical Ethics Committee who, to date, seem less than curious about the matter, Prof Bartholomew breaking rank in a manner uncharacteristic of his professional colleagues to alert us to the situation, media debarred by law from publishing Dr Hook's real name without holding hard evidence required to thwart libel litigation and doctor/patient confidentiality preventing the professor from sharing such information.

Civilisation has long shot past this local quandary imposed by the circle of silence, enacting legislation to allow evaluation of medical therapies and deal with those found in breach of clear guidelines.

To quote Dr John Renner, president of the US Consumer Health Information Research Institute: "Many of the expert quacks in arthritis, cancer, and heart disease have now shifted into AIDS as a business option and every quack remedy seems to have been converted into an Aids treatment."

At least, he lives in a country where health administration cares enough to ensure no single league of gentlemen could protect each other in perpetuity and worse, if one of their colleagues is willing to publicly accuse another of malpractice, the complainant is guaranteed a formal investigation by the appropriate authority.

But in the interim between now and when Parliament considers such matters important enough to warrant discussion, the Medical Ethics Committee finds this case interesting, the Pharmacy Board springs to action or 2020 (whichever comes first), the medicine show continues.

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