Articles Posted in Conflicts of Interest

allchildrens-300x220When big hospitals aim to get even more giant, they do so at risk of the quality of care they offer to their patients — and they can do much damage to their brand and hard-to-repair reputations. That may be a reality that elite Johns Hopkins may be discovering.

The Tampa Bay Times deserves credit for its detailed take-down of the “internationally renowned,” Baltimore-based medical institution for the deaths and harms suffered by child heart patients at All Children’s hospital in Florida. Johns Hopkins took it over, and, according to the newspaper, within a half dozen years made a debacle of its well-regarded pediatric heart surgery program, which worsened until youngsters were dying at a “stunning rate.”

As the newspaper reported, based on a year’s investigation of the All Children’s program:

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FDA Commissioner Scott Gottlieb

If the federal Food and Drug Administration expected any public goodwill for putting forward long-term proposals to change a fundamental way that medical devices win agency clearance, forget about it.

Instead, FDA Commissioner Scott Gottlieb and lawmakers should be reeling still from a salvo of news organization investigations into unacceptable ways that patients in this country and around the planet suffer pain, injury, and other harms from products that go in or on the body. Under industry pressure and spurred by pro-business lawmakers, the FDA, the investigations show, has exercised a weak, poor, and unacceptable oversight of medical devices, including:

diagnosis-300x200If patients weren’t already unhappy with drive-by medicine, in which clinicians spend on average of 15 minutes with them in an office visit, safety experts warn that too many doctors’  providing of harried care can worsen a medical menace that’s already hard to ignore: misdiagnosis.

Figuring out what ails a patient and taking a correct course of action already is a “complex, collaborative activity that involves clinical reasoning and information gathering,” reports Liz Seegert, a seasoned health journalist and a senior fellow at the Center for Health Policy and Media Engagement at George Washington University.

But, in a briefing posted online for her journalistic colleagues, she goes on to amass some eyebrow-raising information on diagnostic errors, their frequency, harms to patients, and why experts in the field see corrections in this area needed, stat. Among the data points she reports:

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Dr. Otis Brawley, formerly of the American Cancer Society

The rising flood of health care hype, bunk, and conflicts of interst really can harm patients, as has just been emphasized by a $105-million jury verdict, the brave actions of a leading patient advocacy expert, and the commentary of an expert health researcher and New York Times columnist.

In a more perfect world, a patient like Dawn Kali, 45, and a mother of four, wouldn’t give the time of day to the wild claims of Robert Oldham Young. Both live in San Diego, and when she was diagnosed with cancer, she told a court that she found Young persuasive.

hpvshot-300x231Women may need to double-up on their consultations with their specialists about treatment for serious gynecological concerns, as new studies have raised troubling questions about a much-touted minimally invasive surgery for early-stage cervical cancer.

These concerns, in a more perfect world, also would prompt greater questioning and oversight by doctors, hospitals, regulators, and lawmakers of surgical “innovations.”

The procedure now in question removes the uterus, part of the vagina, and other surrounding tissues via small incisions and with special laparoscopic instruments, including robots. Surgeons have advocated for this surgery rather than making a large incision in an “open” procedure, arguing the less invasive approach promotes less discomfort and faster healing for patients.

crowdfunding-300x150Although the sky-high cost of providing medical care to sick or injured friends and loved ones might seem good reason to encourage community altruism to the nth degree, new technologies that have made it easy, fast, and convenient to “crowd source” online donations also may be sending well-intentioned gifts to dubious and dangerous types of treatment.

A new  study by researchers in Atlanta and New York shows that campaigns on GoFundMe and other social media platforms, sought to raise tens of millions of dollars, and brought in millions for sketchy health-related applications. Experts found “1,059 campaigns that raised money for five unproven or possibly risky treatments: homeopathy or naturopathy for cancer, hyperbaric oxygen for brain injury, experimental stem cell therapy for brain or spinal cord injuries, and long-term antibiotics for chronic Lyme disease,” reported Stat, an online health and medicine news site.

CNN reported that online solicitations were targeted to allow patients to seek dubious therapies at “clinics” in Germany and Mexico (homeopathic or naturopathic cancer care), New Orleans (hyperbaric oxygen for brain injury), and Panama, Thailand, India, China, and Mexico (“stem cell” treatment).

brca-cancer-risk-261x300Even as a pair of prominent researchers saw their reputations crumble over controversies connected to their work, a University of Washington team showed anew the importance of rigorous, transparent, independent, and widely shared medical science  to patients, in this case those with cancer.

Let’s start with the seemingly positive take that’s accompanying publication in the journal Nature of research regarding an open database with prospectively valuable information on BRCA1 variants, what some have dubbed the “cancer risk” gene.

Everybody carries both BRCA-1 and BRCA-2 genes, named because BR stands for breast and CA for cancer. All of us have two copies of each gene, one passed down from our mother, the other from our father. The genes make proteins that help repair errors in our DNA that pop up from time to time when our cells divide and duplicate their genetic code.  Mutations in either BRCA gene can disable the repair process and make both women and men carriers of the defect susceptible to certain kinds of cancer.

cduntsch-300x300It carries the plot line of a compelling crime story: A knife-wielding assailant works his way into exclusive institutions across a metropolis. There, time after time, he rips into  victims, inflicting great pain and suffering. He acts under the noses of people who should know better. He gets stopped only when someone in law enforcement steps beyond norms to bring him to justice. There’s even a systemic flaw that makes the drug abusing criminal’s acts more awful.

It’s painful and tragic, however, that the saga of Christopher Duntsch, aka “Dr. Death,” is all too gory, true, and potentially avoidable. It has become even more public via modern technology, an increasingly popular and free podcast by Laura Beil on the Wondery site.

Duntsch, now serving a life sentence in prison, moved from one hospital to another in Dallas, where the cancer-researcher and neurosurgeon morphed himself into a spinal surgeon. He was awful. Colleagues reported him to hospitals and medical licensing officials. They stepped in front of him in operating suites and took instruments out of his hands during surgeries. Duntsch, D magazine says, abused drugs, partied, and talked about having wild sex often before long, complex operations. There have been reports that he may intentionally have tried to maim patients. His surgeries were tied to deaths.

chriscollins-300x201At a time when prescription drug prices keep skyrocketing and Americans pay hundreds of billions of dollars for medications that account for as much as 15 percent of all U.S. health care spending, federal law enforcers provided a rare and jarring sight with the public arrest of a congressman on charges he engaged in insider trading involving an Australian drug maker.

Chris Collins, a Republican who represents a western New York district and was among President Trump’s earliest and most vocal supporters in Congress, insists he committed no wrong. He says he will be exonerated, but he has pulled the plug on his plans to seek reelection in November.

The sordid details of his financial dealings, as laid out in news stories and a damning indictment, however, may keep front and center not only the charges against him but also troubling questions about members of Congress and their private investing, corporate board roles, and especially their tenacity as Big Pharma lapdogs, instead of being watchdogs on behalf of besieged, too often bankrupted American patient-consumers.

VA-300x202So, see, Ike, Marc, and Bruce may be pretty swell guys. They’ve done well in business: Ike in comic books and entertainment, Marc in the law and consulting on white collar crime, and Bruce as a medical  concierge who gets affluent patients in to see big name doctors.

But this odd trio —Ike Perlmutter, Bruce Moskowitz and Marc Sherman — never served in the U.S. military. They’re certainly not veterans. Perlmutter and Sherman have zero experience in health care. And Moskowitz, while a doctor, is a respected primary care practitioner — not someone known for his direct experience in running big, complex operations.

They also, however, happen to be FOT — Friends of (President) Trump. They pay him to belong to his Mar-a-Lago country club. And, apparently at his request and with the assistance of powerful partisans and the acquiescence of sheepish bureaucrats, Perlmutter, Moskowitz, and Sherman have become  “shadow rulers” of the U.S. Department of Veterans Affairs.

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