Articles Posted in Conflicts of Interest

death-certificate-state-by-state-default-750_50California regulators have reversed themselves and decided to require hospitals to report outbreaks of “superbug” cases, rare infections that also can prove deadly. At the same time, officials in the Golden State haven’t moved to increase the information disclosed on death certificates−data that advocates suggest would give the public clearer outlines of just how severe a problem hospital-acquired infections have become.

Kudos to the Los Angeles Times, which delved in a recent front-page investigation into the dearth of information disclosed on death certificates, especially about hospital-acquired infections. The paper detailed how a Los Angeles area patient had contracted, while hospitalized, a rare carbapenem-resistant enterobacteriaceae or CRE infection. This superbug resists treatment with an array of antibiotics, eventually killing half those it afflicts. Its outbreaks are a huge concern for public health authorities.

But, The Los Angeles Times said, hospitals had cried “poor me” to the state, saying it required extensive resources to monitor and report CRE outbreaks. The death certificate for the patient with the CRE infection, the newspaper said, listed a perforated ulcer as her cause of death. Her family was outraged because they had urged Torrance Memorial Medical Center to report a CRE outbreak to the state.

SupremeCourtSealSouth Dakota’s highest court has been asked to reject hospitals’ attempts to keep secret why a doctor, who also is a convicted burglar with a checkered medical past that could have easily been uncovered, passed a peer review that permitted him to perform brutal, excruciating, and unnecessary spinal surgeries on dozens of patients.

A lower court rejected the sweeping claims by the hospitals that the reviews can never be disclosed. The judge said that indications of crimes or fraud, as raised by evidence-based malpractice lawsuits, are sufficient reason to breach confidentiality protections shielding vital insights into how hospitals judge physician performance and permit doctors to practice in their institutions.

More than 30 patients have sued surgeon Allen Sossan. He is a convicted felon, who had changed his name, and who apparently has fled to Iran. Patients assert he caused them great pain and maimed them with unnecessary, complex back procedures. Further, patients have sued more than a dozen doctors who reviewed his credentials and granted him privileges at Avera Sacred Heart and Lewis & Clark Specialty Hospital, both in Yankton, S.D.

drugpriceBig Pharma’s dubious hype of its sometimes risky products marched on last week, with the industry racking up a half-billion in regulator penalties and settlements but no seeming end to its questionable strategies and tactics:

$465 million penalty, settlement for EpiPen maker

Raw_cane_sugar_lightWe’ve seen this playbook before, and it’s never pretty how wealthy industries can distort scientific research and harm the public health for decades. Think tobacco and cancer, oil and climate change, football and brain injury. Now: sugar.

Big Sugar secretly paid influential experts, steered and reviewed their inquiry, and, as a result, American health policy at a critical point in the 1960s–and since–has emphasized the role of fats and downplayed sugar’s harms in the rising incidence of heart disease, researchers have found.

This influence-peddling involved then-prominent (now dead) Harvard nutrition experts and the highly respected New England Journal of Medicine (NEJM). The prevailing ethics then differed. Authors were not required by medical journals to disclose conflicts of interest, as they are supposed to now.

Barry_Goldwater_photo1962muskieThey’re crazy, right? Or maybe they have a “personality disorder.” Our current political season is raising the issue about how wise it is for commentators and the rest of us to put labels on politicians we don’t like  in terms of their mental health.

Susan Molchan, a psychiatrist in the Washington, D.C.-area, provides a thought-provoking commentary on this topic at, the excellent watchdog site for hype and misinformation about health-related matters. She argues that, barring a careful, expert, and actual diagnosis of a patient, it can be destructive to the public dialogue and stigmatizing to those with true mental health afflictions, for the media, in particular, to speculate about public figures’ mental disorder.

Many of these pieces, of course, focus on a polarizing current candidate−and she provides examples of his coverage with commentators’ theorizing. Others could be added, such as: this column in which its author analogizes her own negative health experiences on to the candidate; or this piece−which drew attention because its author also happens to be a psychiatrist.

Operating_theatreIf the time in a doctor’s office or the hospital isn’t  frightening enough already for most patients, some recent publications by MDs in prominent, peer-reviewed medical journals may ramp up that anxiety to new heights: Just who is skulking around, with institutional blessing, when you’re getting your medical care? And what role are these official-looking people playing?

A tip of the hat to Morning Rounds, the daily newsletter from the health news site Stat, for pointing out a newly published study on PLOS One that details how sales people for surgical device makers conduct themselves when they are routinely allowed into operating rooms. They are gowned, often wear badges like hospital staff, and they consult with the surgical team, as doctors allow. They bring laser pens that they use to point out instruments and anatomical features. They never touch patients or handle any part of the surgery.

But, the study notes that the sales reps:

headsupfootballAs a former president used to say with finger pointed and head cocked: Well, there they go again. That same angry but resigned tone should be applied to the National Football League, and its dissembling use of data. The NFL keeps damaging its own reputation as it seeks to persuade the public that it recognizes the major, lasting health damage that head injuries inflict, and that the league is doing something about it−especially when it comes to kids who idolize the game and its athletes.

The New York Times has caught yet another instance of league officials’ duplicity, and summed it up well in its Page One headline: N.F.L.-Backed Youth Program Says It Reduced Concussions. The Data Disagrees.

To dwell on the details is only to get enraged by league officials’ attempts to play fast and loose with data, research, and supposed evidence−and to the detriment of kids. The Times drills down on Head’s Up, the NFL’s flagship initiative to educate kids, parents, coaches, and schools on protecting football players from the risks of head trauma, especially concussions. As the paper reports:

Doctors who sexually abuse their patients too often get away with it because of weak oversight, sympathetic regulators, and their capacity to move around to elude punishment, a new investigation has found.

The Atlanta Journal Constitution says it spent months, scrutinized more than 100,000 medical board disciplinary orders from across the nation, and found too many disturbing instances where perverse physicians harmed patients but escaped punishment or received only a slap on the wrist.

Stacks_of_moneyBig Pharma is not just  whistling Dixie, as Southern, for-profit hospitals lead the nation in rolling out the welcome mat so doctors can take meals, consulting, and promotional payments from drug and medical device companies, an investigation shows.

Pro Publica, the Pulitzer Prize-winning investigative site, has put up its latest findings from its multi-year tracking of which doctors at which hospitals across the country report, as they are legally required to, to federal authorities that they have taken the blandishments of Big Pharma or medical device-makers.

Docs scooped in the most green from these providers in the Garden State: Pro Publica found almost 8 in 10 MDs in New Jersey−where many in Big Pharma have their headquarters−took such pay in 2014. Almost 8 in 10 physicians in Louisiana, Mississippi, Florida, South Carolina and Alabama took the money.

$20 billA primary care physician in the United States receives an average, total, annual compensation of roughly $195,000, and likely will take in more than $6.5 million over a lifetime of practice. Ask most Americans and that’s a respectable, and deserved, income.

Which makes it all the more eyebrow-raising that a leading journal,  JAMA Internal Medicine, published a study that finds that Big Pharma can sway doctors’ drug prescribing practices for about the cost of a large pizza and a few sodas, roughly $20.

Just to be clear, this scrutiny involved more than 275,000 MDs, and more than 65,000 payments over four medications. The research doesn’t purport to demonstrate cause-and-effect but shows a troubling correlation.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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