What Drives Me

Dr. Franco is an accomplished physician with a long career distinguished by renowned research, global teaching, speaking and collaboration, and a thriving medical practice at Massachusetts Eye and Ear, Harvard University. He is a co-founder of Reflux Gourmet.

 

Every person deserves the highest quality of healthcare.

This is my mantra…or was it my father’s? As I look back on my life, it becomes harder to distinguish where my calling began – because it is a calling that I share with my father. Did I carefully weigh the endless options for the many futures I could choose, or was it inevitable from the moment my dad started taking me to clinic with him that I, too, would pursue medicine? Was it ever a choice, or is it written in my DNA?

Whatever the reason, I am grateful for the result. In this special season of giving thanks, what I am most grateful for is the privilege I have of caring for others and the responsibility of their trust that I so cherish. My father showed me in word and deed that there is no more humbling a mantle.

 

The mantle of Medicine, like other scientific disciplines, is dynamic – changing when new information is discovered. After rigorous testing and peer review, those ideas that remain supplant the old ideas and are incorporated into the new and improved Medicine. Thus, determining what is “best,” what is “the highest quality of healthcare,” is a dance where the steps are constantly changing. A dance I have strived my entire career to ensure reflects the highest quality of healthcare for those who place their trust in me.

With this in mind, reflux has posed one of the trickiest problems facing my patients and my practice. I began my residency in Otolaryngology in 1995 and quickly learned that PPIs (proton pump inhibiting drugs) were the prescription of choice for the treatment of gastroesophageal reflux (GERD) and laryngopharyngeal reflux (LPR). By 1999, Prilosec became the first $5 billion prescription medication – and by 2002 it was above $10 billion! Based on the record-breaking sales figures alone, we must have been curing reflux like the plague, right? The scientific literature echoed these sentiments describing the key role PPI acid suppression therapy had in the treatment of reflux.

The funny thing is, PPIs don’t stop reflux at all

PPI drugs turn the tiny molecular acid pumps off in the stomach, making whatever refluxes up into the esophagus just burn less. The medical world continued to largely ignore other treatment modalities and prescribed PPIs like candy, happy in the fact that we were at least making patients feel better – disregarding the fact that the actual underlying problem (reflux itself!) was not being addressed. The dance was starting to feel a bit off the beat.

I could argue that I began my medical career spinning in one the many office chairs I took full childish advantage of while accompanying my father to the emergency room, the clinic, or the surgeon’s lounge. A full residency of experience all gained before I began my formal training, wherein I learned the most important lesson of all: The patient comes first. Then my formal training was thankfully comprised of the most rigorous and bespoke education and clinical experience I could ever have dreamed of (minus the fun of spinning in the office chairs), culminating in my practice at Massachusetts Eye and Ear Infirmary, Harvard Medical School. Here I was at a beacon on the forefront of medical care and research, but were we doing what was best for our patients?

This is the question I was asking myself when an initial report of a possible link between long-term PPI therapy and the risk of hip fractures was published in 2006. People had now been on chronic PPI acid suppression long enough that the anecdotal drip of reported side effects associated with long term PPI use soon became a steady stream detailing complications such as nutrient malabsorption, osteoporosis, dementia, hypomagnesemia, pneumonia, and C. difficile diarrhea, just to name a few.

These alarming issues raised the demand for alternative methods to treat reflux and people began to discover the benefits of alginate therapy for reflux. Alginate is natural as it is harvested from seaweed. Used after meals, before exercising, at bedtime – whenever it’s needed – it works by forming a hearty gel raft that rides on the top of stomach contents, plugging the entrance to the esophagus when the stomach contracts. This elegant mechanism reduces, and in many cases eliminates, the movement of stomach contents into the esophagus – the very definition of reflux. The alginate raft is then safely digested along with the food in the stomach.

 

The problem was not unfamiliarity with alginate, it has safely been a part of our food chain for the past 100 years. The problem was, it was not given credibility during the time of the PPIs – even though alginate rafts in the stomach can stop reflux while the expensive PPIs, H2 blockers and antacids do not. After that rigorous testing and peer review me and my colleagues are so fond of, in the current GI literature, alginate therapy is now promoted as first-line reflux treatment, along with diet and behavior modifications.

I was getting my groove back, the new dance was working. I had another tool in my box, a safer, more effective option for most of my patients…almost. It nagged at me that the only alginate options contained some ingredients I’d rather they not take on. Was this the highest quality of healthcare I could provide for those placing their trust in me? Could I go home at the end of the day and forget about it? Was that putting my patients first? My father’s voice answered, No.

This is why I am grateful to be a co-founder of Reflux Gourmet. I needed to put in the work to research and develop a safe, all-natural alginate for every person who places their trust in me. Because I can’t go home at the end of the day and stop thinking about the people who place their very wellbeing in my hands. Because that is not what I saw my father do, or who he taught me to be. Because not striving for the highest quality of healthcare is not an option. This is my driving force. And I am grateful for it.