Q&A with Dr. Stephen Hollis: Can't protect patients from their own stupidity

Dr. Stephen Hollis does not have a book, television show or diet that he is promoting. Yet his views on medicine, physician oversight and our nation's drug laws have sparked quite a bit of interest. The first two parts of my interview with Hollis, an Alabama ophthalmologist who was penalized by a federal court for selling drugs on the internet, drew more views than my initial post about him.

That was a Doctors Behaving Badly post in March 2010. Why all the interest? As Forbes health writer David Whelan said to me, via Twitter, "Seems like a likeable, eccentric guy," which is how I initially described him. That's part of it, for sure. I also think people are curious about what really goes on behind the scenes in medicine. Internet pharmacies are a bit of a black box. "Botox mom" continues to bounce around, even as the mom in question claimed that she had made up the whole story about injecting her daughter with Botox. Part of the fascination is the idea that people can get their hands on dangerous drugs with little effort.

The first part of my interview with Hollis ran Wednesday. The second part ran Friday.

Q: You were indicted by federal prosecutors in Georgia in 2006 for prescribing drugs to patients without examining them. What led up to that?

A: An investigator from the Georgia medical board came all the way into Alabama with FDA officials and federal prosecutors. I think the Georgia board initiated this whole thing because someone on the board or someone connected to the board had been trying to slow me down so my competitors could catch up. So they initiated this thing and came to visit me in Alabama, along with an FDA representative and a federal prosecutor.

I gave them a 4-foot stack of all the paperwork I had ever seen and then I resigned from the internet company. In other words I cooperated fully with the federal prosecutor. I did not hear from the federal prosecutor for five years. And then I was indicted. They did not say one word to me in five years. Also, I think it's strange that there were 12 doctors working for that company and only five were indicted. That seems like unequal application of the law.

Q: Why do you think it's strange?

A: Because they nailed me on drugs that are not dangerous in the least. One of them was phentermine, and the major complication is that it raises the blood pressure as much as a cup of coffee. It's not addictive. The other was Viagra, which is one of the safest drugs out there.

How can I be a drug dealer if I am only prescribing those two drugs? I would not prescribe narcotics, because they are addictive. I would not prescribe antibiotics, because used too frequently they will not work when they are needed. But all of a sudden I'm indicted by the U.S. government. I think the Georgia medical board was primarily interested in protecting the doctors who want to get $100 out of every patient for prescribing Viagra. At the time that they indicted me, I was told that the company was the largest internet drug company in America.

What seems to me happened is that doctors abroad can still do this but U.S. doctors can't. That seems to be another government program to export our good jobs abroad. I resent that. We should have the same opportunities here that they have in places like India. But American doctors are controlled by the medical boards, and the boards aren't about protecting the patients. They are about protecting the doctors. They are protecting the doctor's right to have you visit him in the office so he can get that $100

Q: Did you make $100 for every prescription?

A: They paid me a flat rate of $80,000 a year. It took me two hours a day, seven days a week. So I made $80,000 for working a 14-hour week for a year. I thought that was a pretty good deal. The patient was not charged a doctor fee, and also saved a two-hour wait in a doctor's office. I was paid by the profits the company earned by selling the Viagra.

Q: In just one year, you wrote 43,930 prescriptions for drugs. That's about 170 scrips every work day. How is that even physically possible, especially if you are only working two hours per day?

A: I just had to look at the pattern of the responses given by the patients. The right pattern of "yeses" and "no's" would be shaped like an "L." If I saw an "L," then I would click yes. There are four questions for Viagra. Are you a man? If they say no, we don't prescribe it. Do you have erectile dysfunction? Yes, ok. Have you ever had a heart attack? Yes. See your doctor. Are you taking nitroglycerine? No. Approved.

Every five seconds, I approved one. That's efficient. It isn't medicine, but we don't even need doctors for Viagra. The whole world should be able to get a prescription for Viagra if they want one. Wouldn't it be nice if some medical conditions could be taken care of inexpensively? Our health care system is ridiculously expensive and really not that good.

Q: But what about looking at things from a patient safety standpoint? With any drug, you can have contraindications. And without a physical exam and any sort of one-on-one with the patient, you might not know whether this person has heart problems or is taking nitroglycerine. Isn't it the doctor's responsibility to spend time with the patient to insure that they are a good candidate for the drug?

A: You can't protect patients from their own stupidity. That's not possible. Those are theoretical things you are talking about that are not real. But that's also what the medical board and the government really harps on. They said, "You didn't see these patients. They might not have had erectile dysfunction. I said, "How many times does a doctor in the office make a man prove to him in the office that he has erectile dysfunction. Pull down your pants and prove it to me. I wanted to say, "Give me a f***ing break!"

Q: But the drugs that you were prescribing included more than 26,000 Schedule III and Schedule IV substances. Were these drugs that you typically think of when you hear Schedule III and Schedule IV, which would be things like Valium, Rohypnol and Ambien?

A: No. I am telling you. This was Viagra and phentermine and one other diet pill that is Schedule III. I found nothing in the medical literature listing addiction as a result of this Schedule III medication. But this is all about the stupidity of the drug war. We were spending $100,000 a year on drugs during the Nixon years, but now we are spending $300 billion. The drug war is lots worse than when we lost Viet Nam. And why are all these drugs illegal?

The reason why these drugs are illegal is so that companies can sell Xanax. Let's put people in prison so that drug companies can keep selling Xanax. We have more people in jail in America than any other nation per capita. It's a human rights violation to have all these people in prison.

Q: Do you really think that these drugs on the street – cocaine, heroin, methamphetamine – aren't dangerous?

A: The drugs you mentioned are dangerous, but the drug war is a failure, except for the prison, police and attorney industry. I think marijuana is harmless. It doesn't cause car wrecks. It doesn't cause cancer. Why do we have jails full of people caught smoking pot? And, like in all these federal cases, I was charged with conspiracy, but I didn't conspire with anybody. This is what they did to the governor of Illinois, Blago, and this is what they did with Barry Bonds. It's always a conspiracy.

Q: That's because conspiracy is one of the few federal charges that they can prosecute, right?

A: It's a completely made up charge. Blago said if I make someone a senator, I want a contribution to my campaign fund. He didn't do it, he just talked about it. I can say I'm going to kill you every day, but if I don't kill you, you can't put me in jail. The government is putting in us in jail for words. Pretty soon they're going to lock us up for our hopes and dreams, too.

Q: Actually, if you told me every day that you were going to kill me, I'm pretty sure that I could persuade a prosecutor to go after you. You can't just make threats every day and get away with it. But, you made a deal with federal prosecutors in 2008 and were put on one year of home confinement. What did you do during that time?

A: I just did my regular work. I was allowed 15 minutes to get from home to work. And I had an ankle monitor. My attorney said I should take this plea bargain and said I would serve up to two years in jail. I said, "You have not told me of a law that I have broken." He said, "How much cocaine did you possess with intent to distribute?" That was the law I was tried under. I said, "You need to hear what I'm about to say. If I lose, and they stand me in front of a firing squad and shoot me, I will not back down. If you don't want to represent me under those circumstances, give me my $220,000 back."

The first day of the trial, the prosecutors said to us, "We are going to change it to a misdemeanor, and you will have one year home confinement without electronic monitoring." One of the doctors wanted to take it. Another doctor didn't want to take it. I was in the middle and afraid to do something to hurt the others, and so I took the deal. Two months later, I went before the judge and he said, "You are sentenced to one year home confinement with electronic monitoring and two years probation and 150 hours community service."

Q: Where did you do your community service?

A: For three days a week, I worked in a state park handing out life jackets to people who were going out on boats. And the whole time I am thinking, "My life has been based on being an eye surgeon and always trying to learn more and improve. Why does my idiot government want to lock me down and want to keep me from learning so I can't protect my patients?"

Q: You said before that you thought that the case against you was politically motivated. What evidence do you have of that?

A: In Columbus, there were 30 eye surgeons, and I did most of the eye surgeries. I brought in $12 million to $14 million a year. Somebody went to the board and made a complaint to the board. Did you just watch the movie Atlas Shrugged? This is exactly what they do to the guy in Atlas Shrugged. This guy invented a type of steel that was better than anybody else's steel, but then Congress made a rule that anytime this guy's steel was selling better than the other companies' steel, he had to reduce his production so they could compete. Then he built this train and the politicians told him that the railroad was dangerous.

The owner of his company was this gorgeous lady, and she said "I'm going to drive the train myself, and I'm going to drive it 200 miles per hour." They said, "You can't do that." But then she revved that train up and went across a bridge at 250 miles per hour. It's a great movie. It's based on a book by Ayn Rand, who is the originator of the libertarian party. I'm a libertarian, and think I should be allowed to prescribe Viagra and phentermine on the internet. These things I'm talking about are the libertarian principles that I got from reading her books.

Related Posts:

Q&A with Dr. Stephen Hollis, Part 1: Ban online Botox, but make other drugs more accessible

Q&A with Dr. Stephen Hollis, Part 2: Government tries to "terrorize" doctors into submission

Doctors Behaving Badly: Eye doctor prescribed drugs to patients, sight unseen