McDonalds and the Responsability for Corporate Obesity

Dr. Levy,

Thank you for reading my McDonald's story. Due to the hundreds of e-mails I received after the original story ran, I'm behind in responding to all of them. I apologize for the delay and wanted to let you know that I appreciate you sharing your thoughts.

Best

Julie Jargon
Staff writer
The Wall Street Journal
twitter.com/juliejargon
312.750.4105


-----Original Message-----
From: Stuart levy [mailto:bigstu52@gmail.com]
Sent: Tuesday, May 17, 2011 8:34 PM
To: Jargon, Julie
Subject: McDonalds article

Dear Ms Jargon,


I appreciate your article about McDonalds.  But I do believe that the people that find fault with Ronald McDonald promotion of the restaurants forget that there are healthful menu items at these restaurants and that it is the parents responsibility to guide the children to make healthy choices like oatmeal, fruit and vegetable salads, orange juice etc.  
Why not mention the Ronald McDonald House which supports the families of children hospitalized for illness?

Childhood obesity is not the responsibility of corporate america.   Childhood obesity is the result of parental neglect not corporate misconduct.   Time strapped parents  find it easier to plug a child into a nintendo and give into the whine for chicken nuggets than to teach the child to exercise and make wise choices when deciding what to eat.

Family planning, financial counseling, and nutritional counseling trump finger pointing at an American born- now-international corporation of which we Americans can be proud.  Ever travel out of this country, get hungry and look for a good meal at a reasonable price?   You can count on McDonalds to deliver.  I can't imagine the logistics that their management makes to constantly deliver their ever expanding menus all over the world.  I am sick and tired of this corporation being accused of being responsible for the American Obesity Epidemic.   It is easier for America to make scapegoat out of a corporate symbol than to look into the mirror and kick itself in the ass.



Stuart Don Levy MD

Cooking for Friends

I prepared a marvelous meal for Sandy, myself and two other couples. They had gotten tickets for us to attend ball games and tennis matches. The dinner was Ciappino which is a seafood stew which in this case was made up of sea scallops, mussels, calms, shrimp, grouper, and salmon along with onions, mushrooms, zucchini, shallots, garlic, and fennel. The dinner was a success. I love to shop and cook. It relaxes me.

Medical Knowledge, Uncertainty and The Standard of Care

Pre-term, premature rupture of membranes remote from term is a serious complication seen often in any active Obstetric Practice. A women is cruising along in her pregnancy and without warning experiences a gush of fluid from her vagina. She seeks medical care and examination shows a immature or premature fetus who could experience serious or grave complications if delivered so early. Examination of the uterus with ultrasound shows the paucity of amniotic fluid in most cases. The baby is squooshed into the smaller intrauterine space. Potential complications to the mother include infection because the membrane barrier to bacteria is broken, trauma to the uterus resulting from premature attempts to deliver a baby from a uterus not prepared to go into labor, and psychological trauma from the sudden and unexpected jolt that changes the happy uncomplicated pregnancy into a medical nightmare. Potential Complications to the baby include, immature lungs, decreased immunity, poorly developed digestive system, thin skin, a brain and nerve tissue that is precariously balanced over risks of hemorrhage, trauma, too little or too much oxygen.

Often especially close to the due date the mother goes into labor. In cases close to term it seems that mother nature has things worked out and it is best for the physician to follow nature's lead and allow her to deliver. But what if she does not go into labor? What if the baby is very premature, say less than 33 weeks, or immature, less than 28 weeks, or non-viable, less than 24 weeks? Do you induce labor hear? Do you try to stop labor? Do you give the mother antibiotics to prevent infection? Do you give her medication to accelerate the baby's lung maturation? Do you deliver by Cesearean or Vaginally? How can you tell if the baby is thriving in the uterus? Can the umbilical cord be crushed or kinked without its cushion of amniotic fluid? Where should the premature baby be delivered, in the community hospital or at a "center" many miles from home and family?

The reason I am writing about this is to illustrate the variability in expert management of this problem. About 20 years ago a leading medical journal in Obstetrics and Gynecology published a study on the management of PPROM (Pre-term Premature Rupture of Membranes Remote from Term.) The study consisted of a survey of Perinatologists (High Risk Pregnancy Specialists) in how they manage this problem. There was no consensus. This means that if a baby is born to a women with this problem and if that baby dies, or has neurologic problems as a result of being born prematurely it could always be possible to find a specialist who could state that he or she would manage the problem differently. Parents of these unfortunate children are under enormous social and economic stress. Attorneys advertise on TV that they can help parents make claims against medical caregivers and seek economic compensation for damages resulting from medical "mismanagement." A lay jury of so called peers can't help feeling sorry for the families of these unfortunate children. There is enormous downside risk defending these claims. A physician expert witness has little downside risk. All he has to do is testify in court. He can sell his testimony. He does not have to get up at all hours of the night to attend to women in labor with complicated cases. Many physician expert witnesses are former faculty members of medical schools that have been forced to downsize recently. They have impressive resumes that look great in the court room.

I worked very hard in medicine. I saved my money for my family's future. As I accumulated assets I began to feel more and more like I was a target of the plaintiff's bar. There was no way that I could get enough insurance to protect my assets. I saw each medical problem as a potential economic liability. Each patient, no matter how much she enjoyed my care for no matter how long was only one decision away from taking away everything that I had saved form over thirty years.

There was this beautiful young mother of three. She was a member of a large family which I considered to be my friends. I delivered her three children I made sure that I was available to take care of her when she went into labor and I was not on call. Six months after she gave birth to her third child I found out that she had suddenly died while I was out of the country with my wife on vacation. My nurse attended her funeral and found out that this patient's mother was blaming me for her death. It turned out that she had a rare tumor of the heart that the coroner thought could have caused an irregular heart beat. There was no way that I could have known about this. The lesson learned is no matter how good you are and how well you treat your patients they can turn against you in a heart beat. Today's physician has to be tuff enough to cary that burden.

Medical Memories

It has been three and one half years since I stopped practicing medicine. I graduated medical school in 1978 and practiced until the end of 2007. There were so many experiences that I am rapidly losing. It is like I am on a boat traveling away from land and what was so large is getting smaller and smaller with time.

I still maintain my license. I occasionally dispense medications and advice to family and friends. I don't miss practicing medicine. I still run into many of my former patients around town so I still have much of the satisfaction of seeing children I delivered grow up. In a way I get many of the benefits of having practiced in one town for 28 years without the pressure of having to worry about bad outcomes, unhappy patients, greedy insurance companies and increasing costs and regulations.

Medicine and especially Obstetrics and Gynecology changed significantly during my watch. Patients seemed easier to please when I started practice. They were happy to have a caring person to diagnose and treat. I basically followed two principles. First do no harm. Second, treat patients like I would like to be treated. It was simple. After a few years in practice I was quite confident.

Mother nature likes to throw curve balls. Early in my career it seemed that patients and families were more understanding and accepting of unfortunate outcomes that are part of any medical practice. Today with the internet, the proliferation of medical malpractice attorneys and second opinions, a clinician is more like a prize fighter bobbing and weaving to avoid trouble. After the fact there is always someone willing to be a Monday Morning Quarterback.
People have such high expectations especially after hearing news reports of advances in medicine. Medical options are numerous today while yesterday's options were few.