Our services

ADC Review
is made possible by:




Profile Photo

About Gerard Gianoli, MD, FACS
Gerard J. Gianoli, MD, FACS specializes in Neuro-otology and Skull Base Surgery. He is in private practice at The Ear and Balance Institute, located in Covington, Louisiana but is also a Clinical Associate Professor in the Departments of Otolaryngology and Pediatrics at Tulane University School of Medicine. He pioneered treatments for Superior Semicircular Canal Dehiscence and other vestibular disorders. His private practice has a worldwide reach, with patient referrals coming from all over the United States and from around the world. Gianoli opted out of Medicare in 2001 and has had a 100% third-party-free practice since 2005. He has lectured and written extensively (as well as had numerous media interviews) on third party free medical practices and free market medicine. His editorials have appeared in The Wall Street Journal, Forbes, Investor’s Business Daily, The Hill and other popular periodicals. Gianoli has received numerous awards, including the American Academy of Otolaryngology’s Honor Award, and has been named in America’s Top Doctors and America’s Top Physicians every year since their inception in 2001 and 2003 respectively. Gianoli practices all aspects of neuro-otology but has a special interest in vestibular (balance) disorders. He has researched, lectured and published extensively on the topic of vestibular disorders

Articles by Gerard

Death of the Great Laboratory of Clinical Medical Science

12 July, 2016

Free-market capitalism has brought unimaginable innovations to mankind in the last 200 years, more so than any other economic system in the history of the world: airplanes, telephones, personal computers, ele...


Death of the Great Laboratory of Clinical Medical Science

Published on 12th July

Free-market capitalism has brought unimaginable innovations to mankind in the last 200 years, more so than any other economic system in the history of the world: airplanes, telephones, personal computers, electric lightbulbs. Far less appreciated, even by those who are ardent advocates of free markets, are the innovations brought by private medical practices through the magic of free-market capitalism.

Philippa Thomson, who lives in Scotland, describes her battle with an inner ear condition known as Superior Semicircular Canal Dehiscence (SSCD) in a new book titled A Hole in my Life—Battling Chronic Dizziness. The picture of her struggle to get help within the socialized medical system of the British National Health Service (NHS) is not a pretty one. She is eventually tossed aside by a system that shows her little compassion. However, she doesn’t give up and she finds an experienced specialist in the United States who can help her — me.

Medical innovations
People may ask, “How is it that no one in the UK-NHS was able to help her, but a guy in private practice in Louisiana could?” Such people have been conditioned to believe that government or universities are the sole source of innovation. This is far removed from reality.

Throughout the last 70 years, the U.S. has been the greatest mover and shaker in the world of medicine. Most major medical innovations have either been born or significantly developed here. And, many of the major innovations have come from small private practices—certainly not from the government. Innovative changes do not come from out of our universities — they come from individuals who work at our universities. However, true radical, transformative innovations have often come from private practices.

William F. House ( January, 1968).House's first design for a cochlear implant was surgically implanted in 1961, but the implant was rejected by the patient's body. A longer lasting model was developed and successfully implanted in 1969, and it was introduced commercially in 1972
Photo 1.0. William F. House (January, 1968) invented the cochlear implant. His first design was surgically implanted in 1961, but was rejected by the patient’s body as a result of lack of biocompatibility of the insulating material. A longer lasting model was developed and successfully implanted in 1969. The cochlear implant was commercially introduced  in 1972 by 3M Corporation. The House-3M single-channel implant was the first FDA-approved impact and between 1972 and the mid-1980’s more than 1,000 were implanted..

Neuro-otology
Looking at my field of neuro-otology (inner ear disorders), three major innovations came from private practices. William F. House, DDS, MD, was a medical researcher who invented the cochlear implant, an electronic device considered to be the first to restore hearing to the deaf. He was in private practice and braved skepticism when he was condemned by academics, who claimed it was an assault to shove a “wire” into someone’s ear.[1][2]

John Epley, MD, a solo private practitioner, developed canalith repositioning, or the “Epley maneuver,” which was the single biggest advance in the treatment of vertigo* — ever. He almost lost his medical license due to objections from the academics at the university. Now the Epley maneuver is routine everywhere.

John Joseph Shea Jr. MD, also in private practice, developed stapedectomy surgery, which restores hearing to those who have otosclerosis, a disease that causes the last hearing bone to harden in place. This procedure was initially condemned by academia until eventually accepted and embraced. [3]

You may have noticed a pattern here. Academic institutions are reticent to embrace radical transformative ideas. However, they are great places to refine those ideas, once accepted.

Publish or perish
Academic physicians are paid to do research and write papers. While “publish or perish” is the rule, what gets published is often rubbish. The editors in chief of two of the most prestigious medical journals (the New England Journal of Medicine and Lancet) recently expressed their distrust of the published medical literature, estimating that half of what is published may simply be untrue. What is published has to be accepted by “peer review.” Unfortunately, “peers” usually frown on radical new ideas. Consequently, this restricts the academic to a narrow range of possibilities, or marginal advances rather than great advances. More often, the published papers simply entrench the established viewpoint, rather than challenging it.

Better patient outcomes
In private practice, innovations can only succeed if they result in better patient outcomes and satisfied patients. If not, they are not repeated. There is no pressure to publish. The only incentive is better patient outcomes. The private practitioner’s focus is not constrained by what the peer reviewers will say—only what his patients will say.

Best Practices
Government intervention such as by the NHS in the UK and now Medicare and Affordable Care Act (ACA) also known as ObamaCare in the U.S. constrain physicians’ actions by “best practices” and “cookbook medical decision trees“. These constrained medical decisions have been institutionalized via the electronic medical record (EMR), which has been mandated by the federal government. This not only squelches innovation, but has a chilling effect on physicians’ actions, preventing them from doing anything beyond the regimented government-sanctioned prescriptions.

Imagine if the government had clamped down on doctors and ordered “best practices” in the 1950s? We’d still be stuck with 1950s medicine, without the cochlear implant, stapedectomy, or the Epley maneuver.

Unfortunately, ObamaCare is killing private practice with bureaucracy and nightmarish mandates. In the few years since Obamacare has been enacted, roughly half of doctors in private practice have left for hospital employment. ObamaCare is killing the great laboratory of clinical medical science.


*Canalith repositioning is designed to help relieve Benign Paroxysmal Positional Vertigo or BPPV, a condition in which the patient may experience brief, but intense, episodes of dizziness that occur when they move their head.

Last Editorial Review: July 10, 2016

Featured Image: Young female physician with stethoscope prescribing treatment Courtesy © 2016 Fotolia. Used with permission.

Copyright © 2016 InPress Media Group. All rights reserved. Republication or redistribution of InPress Media Group content, including by framing or similar means, is expressly prohibited without the prior written consent of InPress Media Group. InPress Media Group shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. ADC Review / Journal of Antibody-drug Conjugates is a registered trademarks and trademarks of InPress Media Group around the world.


Print Friendly, PDF & Email
Share

Leave a Reply


Skip to toolbar