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Are dermatologists ‘zapping’ for dollars?



DEAR DR. ROACH: I am 73 years old and lived on a boat in my 40s. Now, whenever I go to the dermatologist (two to three times each year), he “zaps” me about 20 times and burns off “cancer cells” or maybe “potential cancer cells.” Some of them have been cancer and were healed with MOHS procedure. While I am grateful for the care he gives me, I also sometimes feel that he zaps because each zap means more money. Can you please clarify this for me? — G.B.

ANSWER: I often get questions like this, where a patient has a concern that their doctor is performing unnecessary medical care for the purpose of enriching himself or herself. I always have trouble believing it, since I can’t really imagine it, but I recently read about an oncologist pleading guilty to treating with chemotherapy people who didn’t really have cancer, which shakes my faith in my profession (and colleagues).

Still, I truly believe that, in your case and probably more than 99 percent of the time, the doctor is being extra cautious to treat you for the sole purpose of reducing your likelihood of developing an invasive skin cancer later on.


DEAR DR. ROACH: My mother lives in Florida. Her major discomfort is fatigue and no energy. I have asked her doctor to please give her a vitamin B-12 injection, even though her B-12, thyroid function, vitamin D and blood count are all in the normal range. Her doctor does not believe in B-12 injections. Do you think it might help? — J.L.

ANSWER: Vitamin B-12 is necessary for proper function in many tissues, but it is critical for blood cell production and neurologic function. B-12 deficiency causes an unmistakable anemia (called megaloblastic anemia) and can cause neurologic and psychiatric disturbances even in some people with no anemia. The blood test for B-12 is quite reliable. The major cause of B-12 deficiency is an autoimmune disease that prevents the stomach from making intrinsic factor, which is necessary for efficient absorption of B-12. B-12 can be absorbed orally by people with pernicious anemia by taking very high doses, such as 1 mg. This gives as good a replacement as injection.

It was common 50 years ago to give B-12 injections as a “tonic.” However, it offers no advantages for people with normal B-12 levels beyond the placebo response. As I have noted many times, the placebo response can be very powerful, and 1 mg of B-12 orally is very safe.

DEAR DR. ROACH: I have heard that drinking water with your meal is bad for you. Is this true? And if so, why? I have a dry mouth due to cancer treatment and must have water with everything I eat. Is something bad going to happen to me? I am otherwise healthy. — R.G.

ANSWER: It’s not true at all. Water is, generally speaking, the healthiest drink. It is possible to drink too much water, but it’s very hard to do so unless you are taking medications that affect your kidneys or you have excess anti-diuretic hormone, an unusual medical condition. Keep drinking your water.


Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. ©2017 North America Synd.

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