PHYSICIANS BEWARE

When a physician has his or her license to practice medicine taken away, it
is usually a personal tragedy, sometimes the result of alcohol or drug
addiction, sometimes incompetence, greed or worse. But it is also, usually,
a social good, a determination by the disciplinary body that this doctor is
a danger to the community and should no longer be free to practice.

Unfortunately, the case of Dr. Robert Sinaiko, a San Francisco internist
and allergist, is not quite so simple. Sinaiko, 53, is an impressively
credentialed physician whose practice consists of treating difficult cases
involving complicated environmental and other allergies with experimental
therapies. He works on the frontiers of medicine, where there are no easy
or well-trod paths to clinical success.

Sinaiko's license was revoked last month by an Oakland administrative law
judge after a 25-day hearing. The decision was approved by the Medical
Board of California. He also was fined $99,000 for the cost of the
proceeding. No patient complained about Sinaiko's treatment. No patient
testified against him. No patient was shown to have been harmed.

Judge Ruth Astle ruled that Sinaiko was practicing "fringe" medicine
because he was prescribing experimental drugs in four specific cases,
including drugs for "off-label" uses -- that is, for things other than what
the label calls for. This, she said, constituted" an extreme departure from
the prevailing standard of practice among the community of licensed
California practitioners," even though many physicians assert that they do
this all the time. In the case that triggered the initial investigation by
the attorney general's office, Sinaiko was caught in the cross-fire of a
divorce and child custody dispute in which the parents differed over the
treatment he prescribed for their hyperactive child.

He has appealed the decision to the Medical Board, which has grated as stay
until Sept. 14, when it will decide the appeal. If this decision is allowed
to stand, Sinaiko's attorney, Richard Turner, wrote in his petition, "All
doctors who say to a patient,'I'm not sure what's wrong with you. Let's try
this,' now risk losing their license. All progress in medicine through
clinical observation of patients in day-to-day medicine will become too
hazardous."

The license revocation has outraged many in the medical community, who have
come to Sinaiko's defense, including the California Medical Association,
highly reputable medical school physicians and even San Diego attorney
Robert Fellmeth of the Center for Public Interest Law, which has often
challenged the Medical Board for going too easy on disciplining bad
physicians, The grounds cited for revocation, they say, threaten and chill
every doctor who practices medicine in California.

One of Sinaiko's defenders is Dr. Phillip Lee, a former chancellor of the
UC San Francisco medical school. One of the most respected physicians in
the nation. Lee until last year served four years as U.S. assistant
secretary for health in the Department of Health and Human Services.

Lee was one of some 10 expert witnesses who testified for Sinaiko. All of
their testimony was dismissed by Astle with one sentence in a 27-page
decision. These experts, who testified on such things as chronic fatigue
syndrome, attention deficit hyperactivity disorder, multiple chemical
sensitivity and other areas at the crux of his practice, "were of
questionable credibility in that their testimony was not based on generally
accepted scientific and medical principles," she concluded.

"Absolutely no analysis was given to these experts individual, and no
explanation was offered as to where or how their testimony failed to be
based on 'generally accepted scientific principles,'" CMA President Robert
Reid wrote in a blistering letter to the Medical Board this week.

"There were no patient injuries, no patient complaints, and much of the
medicine alleged to be inappropriate by the Medical Board.," Reid wrote,
"apparently has ay least a significant, if not a majority, following among
the medical profession.

"The Medical Broad's decision does not inspire confidence," Reid continued.
"The decision fails to show how the Medical Board proved by clear and
convincing evidence that Dr. Sinaiko was guilty of the charges alleged."
Indeed, Reid said, the board's action "raises a question as to exactly why
the Medical Board went after Dr. Sinaiko with such vengeance, a vengeance
reflected amply in its ($99,000) cost recovery bill. If the Medical Board
just wants to 'get the doctor' it any cost, this decision shows how its
(sic) done."

Unrepentant because he believes he has done nothing wrong, Sinaiko faces
bankruptcy, professional ruin and years of expensive legal appeals. "This
is an abuse of the Medical Board's authority," said Lee. "The judge went
to extremes to dismiss our testimony as though it had no legitimacy. We
have alcoholic doctors and drug-addicted doctors. We put them in rehab and
suspend their license for a month. Here we take his licence away. The
remedy far exceeds the alleged infraction."

So why did the Medical Board pursue Sinaiko so vindictively?

John Jabobs is political editor for McClatchy Newspapers. His e-mail
address is jjacobs@sac-bee.com OR jjacobs@sacbee.com

Checked-by: Joel W. Johnson