DEAR DR. ROACH: The physician group I go to recently sent out letters to their patients that they are going to a partial concierge format. Each doctor will accept 150 patients, in addition to his or her regular patient base, for $2,500 each. They sent a list as to why one should consider this, including an annual ”in depth” lengthy exam, a special office hotline to get same-day or next-day appointments, and the cellphone of your doctor, should you need him ASAP. There is no way I could afford to join the selected group of elite patients. I would like your opinion. — S.F.

ANSWER: Concierge practices have the potential for both good and bad, and there are clear ethical issues with the practice. In this case, the important point seems to me to be what happens to the patients who choose not to pay the concierge fee. If they continue to get the same care, which it sounds like you are not complaining about, then this may be an ethical way for the doctors in the practice to allow greater access for a limited number of patients.

However, my experience is that physician time is highly limited, and I worry that increased access for some may lead to decreased access for the rest, making them feel (and be) second-class.

The American College of Physicians has written a position paper noting that:

”Physicians in all types of practices must honor their professional obligation to provide nondiscriminatory care, serve all classes of patients who are in need of medical care, and seek specific opportunities to observe their professional obligation to care for the poor.

”Physicians who are in or are considering a practice that charges a retainer fee should consider the effect that such a fee would have on their patients and local community, particularly on lower-income and other vulnerable patients, and ways to reduce barriers to care for lower-income patients that may result from the retainer fee.”

I agree with the college, and feel that these are important ethical principles that should guide physicians. I think you need to watch carefully what happens to your care and your relationship with your doctor.

DEAR DR. ROACH: I received an email message (that has been around the Internet many times) touting the benefits of drinking a glass of water with lemon juice in it daily. It says lemon juice cures cancer, and it is 10,000 times as potent as chemotherapy. Since it sounds too good to be true, I’m guessing it probably is, but I’d like a professional opinion. Doing an Internet search brings up plenty of articles talking about lemon juice, but none of them seems to be a respected medical source. So, is the article true, or just another cock-and-bull story that gets passed off as truth because someone ”read it online”? — T.W.

ANSWER: I’m afraid you are right, and it is too good to be true. The harm in an email like this is not that lemon juice is harmful (it isn’t), but that when a person with cancer reads it, it is frustrating and depressing to see that a friend or relative really believes that it is so easy to treat cancer, and that the person with cancer is a victim of the purported mass conspiracy keeping this miraculous information from becoming known. It is hurtful to imply superior knowledge. Perhaps the worst outcome is that someone stops potentially curative treatment in order to try this or another not only unproven, but physiologically improbable, remedy.

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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 or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.