Strange, that the meningitis-tainted steroids in Tennessee make me think of the chocolate bar case from Oklahoma. Two young, and it seemed to me, perfectly honest if somewhat histrionic young women who found worms in their Hershey bars — the hard way. Both were unemployed and mothers of several children each, and one was pregnant. They were enjoying their chocolate bars in a dark room by the light of the TV set when one noticed something funny. Comparing experiences, the other one agreed that the bars tasted “off.” Turning on the lights (and — pardon me — spitting out the foul tasting candy) they saw a horrible sight. The almonds were infested with worms. Oh, it was scary, and one in particular told me she started throwing up, and had lost weight. She had developed some sort of a phobia for chocolate bars in general, and had poor sleep, and was 3 months pregnant. They both had the classic signs of Post Traumatic Stress Disorder — they could not stop thinking about and reliving the ordeal, they developed an avoidance of any chocolate or other type of candy bar, and they had a violent “startle” reaction if they encountered a TV commercial or if somebody they saw in public was eating a candy bar. Now the expectant mother did not particularly want to medicate for fear of damaging her unborn child, and that was fine with me. I recall we tried to use a little relaxation, or NLP (neurolinguistic programming), or anything, really, non-medical to calm down this young lady. We succeeded, at least somewhat, but not entirely. She did tell me that the Hershey bar had “been around” for a little, but I was unaware of any expiry date existing for Hershey bars; checked some at the supermarket, and never saw a date.

They took their complaints to a lawyer who accepted this case on contingency, expecting a big company like Hershey to have deep pockets. Also, there was the expectation that this could be a class-action suit, and the millions he and the patients would receive would make his career. But alas — There were no millions. In fact there was much disillusionment for the attorney, the young ladies and even for me. I was somewhat naive, also, and learned about corporate America. Apparently this was not a rare occurrence, but it happened quite a bit. Enough so that the company had decided that everyone it happened to got $1500, which is what they (each, I guess) got. I remember rolling my eyes heavenward and wondering, why $1500? And the answer — as always was — money.

The company claimed that it was impossible to obtain a supply of almonds that were not infested with eggs, and that given enough time (stored in a warehouse, or on a store shelf) the little worms would hatch. Treating almonds chemically would be too expensive (and heaven knows what chemicals they would use, and how those would affect humans). So it was a numbers game. The odds were that the bars would be sold and eaten before the larvae hatched, and nobody would really think about it. Except — now that you know, can you EVER stop thinking about it? Food purity regulations in this country allow for a certain amount of little bugs and rat hairs and things like that in our food. They just have to be under a certain level to pass inspection. Doesn’t that make you feel wonderful? So obviously it must have been cheaper just to pay the $1500 per person. Why pay lawyers and go to court — just settle and move on. It’s another cost of doing business.

Fast forward to compounding pharmacies and injectable steroids. The industry is largely unregulated. Like most industries, there are self-sponsored groups that set standards and urge voluntary assessments of compounding pharmacies. In the past few years we have seen way too many instances where self-regulation fails. Think of the BP oil spill, the Fukushima atomic plant melt-down, the Massey Energy mine explosion that killed at least 25 miners in West Virginia — after the mine had been cited for dangerous violations 50 times. I have not seen a lot of folks in any industry who flock to voluntary assessment. Two really important questions were raised by the Tennessee folks. Were the preparations sterile in the first place? Nobody checked. Were the preparations left on the shelf for too long? No expiry dates, just a vague assumption that things move quickly. These are both situations that precautions could have eliminated. That would surely have been associated with more record keeping, more precautions, maybe throwing some things out after they are around for a certain amount of time. In other words — unacceptable expense.

I have known folks who have declined steroid injections for all sorts of pains. Steroids, like antibiotics, the miracle drugs of the mid 20th century, are horribly overused by physicians, and responsible for knocking down immune systems. The thing I have not heard — the unsaid agenda — is that someone, somewhere, knew about precautions, but may actually have had the thought that either the shortening or sickening of human life is somehow the price of doing business. I might be able to live with the $1500 per tainted Hershey bar. I have never found any deaths from that. I think we have all figured out by now that compounding pharmacies are a lot more dangerous than chocolate factories.

Author's Bio: 

Estelle Toby Goldstein, MD is a board-certified psychiatrist in private practice in San Diego, CA.

Practicing Medicine Since 1981

In her medical career, she has studied in Europe and Canada as well as the USA. She has attended specialty training beyond medical school in the fields of general surgery, neurology and neurosurgery and psychiatry (specializing in psychopharmacology).

Experienced In Many Situations

She has worked in a variety of positions, including:
■Medical school professor
■General and Orthopedic surgeon
■Brain surgeon
■Army Medical Corps psychiatrist
■Prison psychiatrist
■Community Mental Health Center staff
■Consultant to a major transplant hospital
■Drug researcher

“Whatever It Takes!”

She currently has her own indepenent clinic in San Diego where she is concentrating on what she calls Mind/Body medicine — or Integrative Medicine. Her practice is cash-only, doesn’t accept insurance or government payments, and she operates on the concierge, or “private doctor” practice model to give her patients the absolute best quality of care and the highest level of confidentiality.

Dr. Goldstein’s philosophy is “Whatever It Takes!” Her goal is to do everything possible to solve whatever problem she is presented. This includes seeing patients as quickly as possible — not making them wait weeks for an appointment. This includes making appointments days, nights, weekends or holidays. This includes making house-calls. And it includes using the best, most innovative treatments available — most of which are unknown to standard, mainstream doctors.

Her focus is on transitioning patients away from prescription drugs and onto natural substances. She is also a master practitioner of Emotional Freedom Technique, a powerful and dynamic form of energy psychology that usually brings quicker results than traditional psychotherapy.