Big Medicine - Big Problems?

The TV show we all love to hate, "Big Medicine" which details two surgeons in Texas, father and son, who "practice Weight Loss surgery together" seems to have run into some problems.

First, in the last episode I watched, they heavily - shall we say - misrepresented a weight loss that is, how much weight was lost as a result of a gastric bypass.

I've seem them do this previously but perhaps not as much as an exaggeration as with this patient.

That is, when she came to see Dr Davis, she weighed in at 335. She told Dr D that her high weight had been 360 but she had apparently been losing some weight on her own. Dr D, as is his protocol with patients to be, put her on a liquid diet to lose some more weight. He states that this liquid diet usually takes care of any fatty liver present and makes the gastric bypass surgery less risky.

"What we are doing, " said "Big D" the dad surgeon candidly in one show, "is creating a situation of malnutrition in our patients!"

So on the day of surgery, after being very conpliant to her liquid diet, she had lost another 17 lbs and weighed in at 318.

They showed her a month later for her follow up visit and at that time, she weighed in at 290, a loss of 28 lbs, 4 weeks after her gastric bypass. While that isn't a bad weight loss, apparently those in charge of the show felt that was not the huge number on the scale which tends to sell the surgery better.

No problem - this is TV so they can change it. They flashed on the screen a before and after photo - The after photo was the usual type cover-up because with a 28 lb weight loss, she didn't look that different (especially considering that most of the weight lost after a gastric bypass because of the low amount of caloric intake, is muscle and bone mass - muscle is compact tissue which does not show much when it's lost). That is, more slimming clothing and a more flattering angle in her "after" photo.

But they openly misrepresented the numbers. They listed her beginning weight as 267 and her weight, 1 month after surgery as 290, with a total weight loss of 70 lbs which they claimed happened in 4 weeks after the gastric bypass. Yes, I stopped the DVR and made sure that was the claim.

This was going one step further than the usual - claiming the high weight and then the current weight and hinting the surgery had been totally responsible when in fact, it never was. I sat staring at the stopped video in amazement about how they could openly misrepresent things when folks' lives were at stake.

After every show, they give a promo of what's on the next show and the show after this one looked interesting. It promised to show us a 20 year gastric bypass patient who had regained all her weight. This is not surprising considering one of the few 10 year studies on gastric bypass done in 2006 suggested a 34 percent failure rate - weight wise with gastric bypass in patients who had BMI's over 50 - that describes most patients seeking gastric bypass! That failure rate is true even though the surgeons generously count a maintained loss of 50 percent of the initial loss as "success" (as small as 40 or 50 lbs kept off in many patients) and keep in mind most patients have the surgery to keep off 100 percent of their excess weight because they can keep off a percentage of excess weight by themselves without surgery! (cite: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD Abstract: Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.)

I thought that show was going to be interesting and looked forward to it. Revisions on Gastric bypasses are highly risky and quite ineffective i.e. either the patient loses only another 20 lbs or so or worse yet, the patient loses too much weight and may require take down.

But my wait was in vain. That show never was aired. In its place, a re-run was shown and the following week, "Big Medicine" had been replaced by another show.

"Big Medicine" has been pulled suddenly from the air with no explanation.

I wrote to TLC asking about it and got a polite form letter back explaining that they received so many letters they just can't answer each one but thanks for writing. TLC has left their area on "Big Medicine" up only when you click to "get the schedule" (when the shows are aired) you get a blank screen. No plans to air it in the near future, it suggests.

Several are asking on the TLC forums, places which are moderated and usually receive a quick response but in this case, no one is talking. No one has answered the questions about where the show disappeared to.

Finally in desperation, I called the Surgeon's offices in Houston. They were polite and friendly - and totally evasive. They didn't know why the show was pulled - "Just probably some scheduling changes" the nice young female voice suggested and they could not say when it would come back on the air. "Probably in a couple of weeks," the lady assured me but when I asked her for a date, she didn't have that. "They don't tell us when the shows will air," she said. I asked her whether there had been a problem with the revision patient in the show which never aired and she said "Oh no! Everything is fine!". I asked her about one of the larger patients who had had his gastric bypass a year ago and who was not walking at the 7 month point post op, opined Dr Garth Davis, because his breasts were weighing him down so they scheduled him for a mastectomy which was done in August 2007. To date, he has lost down to 300 some lbs. "is he walking yet?" I asked. She lowered her voice a bit and mumbled, "n-no." Obviously the reason he was bedfast was not his weight which begs the question whether they should have operated on him at all.

"Perhaps they are faced with a lawsuit," suggested my engineer husband whose cleverness I really enjoy. I had not even considered that possibility but now as I think of it, that's a rather good possibility. Gastric bypass surgeons often weather many lawsuits because the gastric bypass has a high failure rate and a high complication rate combined with less than inpressive results especially in the longer term (more than 3 years post op). One study of 10 year gastric bypass patients found that only 7 percent were able to keep off all the weight they lost. This isn't much better than diets and at least you can walk away from a diet. (cite: (Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study) Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew))

I googled "Big Medicine" this morning and found that on one site, people were asking some questions about it and the gastric bypass in general. One letter suggested that some of the plastic surgery patients looked less than great after surgery and that one lady might have had a reason for a lawsuit - her implants had ended up in the wrong place. This writer went on to say that one of the patients, a man, looked like death warmed over after his gastric bypass.

So people are asking questions about it.

It remains a mystery for now.

There are many mysteries connected with this surgery. Dr Paul Ernsberger, PhD and associate professor of nutrition at Case Western medical school, detailed one of those most baffling mysteries on the Donahue show a few years back. He stated:

Well, the gold standard in medicine is the controlled clinical trial. We don't go subjecting 100,000 people to a surgical procedure without doing a controlled clinical trial or dozens of clinical trials, and then looking at the results. Do you know how many clinical trials have been published on weight-loss surgery or gastric bypass? Zero. None of them have compared it to clinical conservative treatment and found it to be superior for life expectancy or for anything else other than, you know, risk factors.
A number of trials have been started, and the final results have never been reported. We have to ask, you know, why haven't we seen the final results? I think it's because it's bad news.

Perhaps what we think is a mystery about the gastric bypass or the sudden and unexplained disappearance of "Big Medicine" (in addition to a couple of the new shows never being aired) is really also, bad news.