Cancelled by my ENT Peers

AAO-HNS Censors me on ENT Connect

Last December, a month after Houston Methodist Hospital announced on Twitter that it was suspending my privileges, I was unexpectedly kicked off my favorite ENT online forum. This forum, ENT Connect, is run by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) and the only one of its kind in my profession, providing the best exchange of professional information out there as an ENT. I had been a regular contributor regarding ENT matters and avoided bringing up COVID, but when someone else posted about my recent troubles, I started to speak up. I had a like-minded ENT applaud my efforts (the post has been deleted and I can’t find it), and as you might imagine, I was pummeled by my peers. I was able to access my response to the abuse and one other post on the subject (shared below). However, the next one I attempted was immediately blocked, and the next thing I knew, I was unable to even access the forum. I reached out to management and was ignored.

Because I had a lot going on, I put this fight on the back-burner. But I miss the forum and being able to bounce patient problems off other ENTs across the world. During the pandemic, I have become part of a world-wide online network of physicians where we discuss managing COVID patients. Talking to other physicians about what they are seeing and how patients are responding to treatment is the most valuable learning tool I have as a physician. The essence of the art medicine is peer collaboration, where we apply the science, see what happens, and share our experiences with each other.

After my ‘controversial’ post, I had an ENT question why I’m treating COVID patients, arguing that I lack the experience or the skills as an ENT to manage the disease (shared below.) Many of my peers believe non-surgical patient management is beneath them. I remember running into one of my former attendings from Stanford at an AAO-HNS meeting and telling him that out in private practice I was reading sleep studies, suggesting he incorporate that into residency program training. He scoffed and said “We’re surgeons, we don’t do that sort of thing.” This is typical mindset of a lot of ENTs and explains why they are have been so quiet about COVID. However, instead of saying “Not my job,” I believe we have a duty - as experts in upper airway disease - to help all patients suffering from respiratory tract infections, particularly in a crisis situation.

Now for the evidence…. messages are posted in chronological order. The first message is my response to the barrage of criticism my peers unloaded on me. A few weeks later, Covid came up again and that’s when they kicked me off.

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Original Message:
Sent: 11-19-2021
From: Mary Bowden
Subject: RE: ENT COVID 19 HERO DOCTOR

Ethics trump EBM [evidence based medicine] every time.  I am following the golden rule and doing exactly what I would do for a loved one.  I have educated myself about ivermectin and have plenty of clinical experience using it to stand firm in my beliefs.  I have patients coming to me in tears over the mandates, torn between losing their jobs and caving to something they don't believe in.

I have been called sister of the devil, sociopath, pond scum, among other things.  All it does it make me stronger.  I ask all of you to consider what you'd tell your kids when debating someone online and not engage in childish bullying, especially on a professional forum.  

As for my evidence, you should ask Methodist hospital.  I have been sharing my data with them and trying to get it published.  The problem is, their IRB takes forever so it might be years before you see it.  In the meantime, I invite you to look at my website where I post most it.

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Mary Talley Bowden, MD
Houston, TX
www.breathemd.org
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A few weeks later, I responded to this post, and that’s when the ax fell….

Original Message:
Sent: 12-10-2021 07:02 AM
From: Robert McLean
Subject: Omicron is coming hard and we can't stop it (and shouldn't try?)

Just watched a video by John Campbell who discusses an early Christmas party in Oslo. The party was put on by a research company and had 120 participants, all doubly vaccinated(!). There were two researchers who had just come back from South Africa, one of which had the Omicron variant. After the party, 80 of the 120 came down with Covid and 17 were confirmed to have the Omicron variant (with the rest assumed to have it but not tested). This is staggering in that previously studied household contacts of Covid patients have a 25% transmission rate while living under the same roof. Another 50 more guests at the hotel where the party was held also came down with Covid. Wow! You can read about it as well here.

The good news? None of the Norwegians required hospitalization. Also, John Campbell had another video where he showed the graph number of cases of Covid in South Africa has turned vertical, but the hospitalizations hasn't risen (whereas hospitalizations of patients who are hospitalized for other reasons but have tested positive has risen).

The question is how hard is the Omicron variant going to hit the unvaccinated? Because the vaccination rate in Botswana and South Africa are low, it looks like the answer is "not too hard". That would go with the fact that the variant is very different from the original and so the protective effect from the vaccines are not too strong. So herd immunity, here we come?!?

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Robert McLean MD PhD
Not to be served but to serve
Greenwood ENT
Pueblo CO
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Original Message:
Sent: 12-11-2021 08:12 AM
From: Mary Bowden
Subject: Omicron is coming hard and we can't stop it (and shouldn't try?)

Thank you Dr. McLean for sharing this.  I hope more physicians will speak up.  Silence is compliance and what is happening is frightening.

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Mary Talley Bowden, MD
Houston, TX
www.breathemd.org

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Sent: 12-12-2021 08:59 AM
From: David Roberson
Subject: Omicron is coming hard and we can't stop it (and shouldn't try?)

Dr. Bowden,

I am not sure what you mean by "silence is compliance" but it sounds like you are suggesting that your colleagues are somehow not speaking up when we should.  Perhaps you did not intend it that way, but it does carry that flavor.  No individual, organization, payer, hospital, friend, political party or anyone else has asked me to remain silent about anything.  I am not being compliant with or to anyone or anything.  I happen to think you are in error about the science of covid and the treatment of covid-positive patients.  I do not know why you would find that "frightening."  The use of the word "frightening" again suggests that somehow your colleagues are afraid to tell the truth.   If you believe that we are afraid to speak, or that we are somehow "compliant" with someone or something, please say so.  If you feel that there is some sinister force at work here, please don't just hint at it.  

I think that (respectfully) most of your opinions about covid (both the science of covid and the appropriate medical care for patients with covid) are wrong.  That is the truth as I see it, and I am not afraid to speak it.   I would suggest you refrain from dropping hints that those who don't agree with you are motivated by anything other than the desire to do and say the right thing for our patients and ourselves.

I am going to refrain from discussing specific covid regimens or medications.  There is a reason ORLs don't enter practice right after medical school.  We could train residents to do surgery in a year or two, and we could throw a bunch of papers at them, and let them go out and start making decisions about who needs a sinus surgery, or when an urgent trach is warranted.  We don't do that, because becoming an expert requires more than technical and book knowledge.  It requires a substantial amount of hands-on experience.  Only through seeing thousands of patients with thousands of problems presenting in thousands of different ways do I become an expert.  By comparing the literature to my faculty's experience, I very gradually learned to realize which papers were high quality and which weren't.  I learned to distinguish both usual presentations and unusual presentations of disease.  I learned - slowly - appropriate judgement.   Now, after decades of experience, I am still improving my craft through the constant interplay of practice experience and 'book learning' (aka "the literature").   There is literature that suggests that physicians don't hit the top of their game for as long as 10 years after residency.  There is a vast body of literature on the subject of expertise in general, and one consistent finding is that expertise and judgement are domain-specific.  If I were to decide to become a primary care physician, did the residency, and went into practice, it would be decades before I would be as good a PCP as I am an ORL now.    If my local orthopedic surgeon read a bunch of papers, became convinced that giving cardiac patients beta-blockers caused a lot of deaths, was on a mission to fix this, and opened up a cardiology practice, she might be the best orthopedic surgeon the world had ever seen, but I would never see her for cardiology issues.  I mean this next statement not as a personal affront, but a simple statement of fact.  Please don't read it with a snide tone of voice, because I do not intend it that way.  I would no more come to you for covid care than I would go to an orthopedic surgeon for cardiac care.    The doctors and scientists from around the world who have been treating infectious diseases, responding to pandemics, and studying the history of pandemics for decades have a level of expertise that, with the greatest respect, you can't hope to accrue for decades.  I am 100% certain you are speaking and acting with absolutely wonderful intentions; I honor your motives, your caring and your sincerity.  But Infectious Disease, Public Health, and Epidemiology are all disciplines that (like ORL) take a long time to master.  With respect, I don't think you are there yet.  Neither am I.  (I do know enough about statistics to know that many of the assertions you have made are not supported by the little bit of data you have mentioned.)   However, I work side by side with extraordinarily talented, well-read, excellent clinicians in ID, ICU and primary care - and I definitely trust their judgement above that of (pardon me for saying this) a relative novice.

Lastly, since 99.9% of us don't treat covid, it seems pointless to share this information with us.  I would encourage you, if you have made important findings about covid management, to share them in the appropriate forums - e.g., in groups of Infectious Disease, primary care, ICU and similar discussion groups.  For almost all of us, this information isn't relevant to our practices.

I wish both you and each one of your patients happiness, health, and every possible blessing.  Best regards, David Roberson

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David Roberson, MD
Bayhealth Medical Center
Milford DE
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Subject:RE: Omicron is coming hard and we can't stop it (and shouldn't try?)

Message:
I'm certain most of us have had experience with COVID19 through our patients in some form or fashion.  I have personally spoken to many physicians who feel as I do but are handcuffed by their employers.

If you believe in transparency of data related to the vaccines, please visit this site and consider signing the petition:

https://phmpt.org

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Mary Talley Bowden, MD
Houston, TX
www.breathemd.org

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Decline message from entconnect.entnet.org

Kathy Lewis via American Academy of Otolaryngology-Head and Neck Surgery <Mail@connectedcommunity.org>

Dec 13, 2021, 10:13 AM

Thank you for participating on ENTConnect and for being part of our community.  

Your post below was received and flagged for moderation.  Upon review, we have determined that the content violates ENTConnect Rules & Etiquette. It has therefore been removed from the site. The Rules & Etiquette exist to guide participation and ensure the best possible experience for all members.  If you have any questions, please contact the ENTConnect Administrator via the “Contact Us” link on the site.

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