Should we stop calling it prostate “cancer”?

“We do ourselves a disservice when diagnoses as wildly different as a grade 4 glioblastoma multiforme (a brain tumour that is virtually 100% fatal) and prostatic intraepithelial neoplasia (a prostate condition more likely to make you pee frequently than to kill you) are both described as cancer.”

So claims a thoughtful Globe and Mail reflection called Can the Word ‘Cancer’ Be More Harmful Than the Disease? by health columnist André Picard. It’s all about the power of words – and particularly the C-word. Continue reading

“Distracted Doctoring” – updating your Facebook status in the O.R.

Do you know what your O.R. team is up to while you’re lying there out cold during surgery? The New York Times has taken a revealing peek at the impact of electronic devices like smartphones on modern medical care – and it’s not a pretty picture.

The troubling issue is that your doctors, nurses and techs can be focused on the screen and not the patient, even during moments of critical care.  This includes the neurosurgeon making personal calls during an operation, a nurse checking airfares in the O.R., and a frightening poll showing that half of technicians running bypass machines during open heart surgery had admitted texting while working on a cardiac procedure Continue reading

Things your doctor may not know

Before surviving a heart attack, I was what you might consider a model patient. I was always  cooperative, deferential  and polite with few if any health issues to worry my doctors. Physicians have the letters M.D. after their names, and know all about medicine. I had no reason to ever doubt them.

But all that pretty much changed forever after I was misdiagnosed with indigestion in the middle of a heart attack – despite presenting with textbook symptoms like chest pain, nausea, sweating and pain radiating down my left arm.   Continue reading

Why isn’t California disciplining its dangerous doctors?

Until he was banned in California from operating in 1967, Dr. Walter Freeman performed over 3,500 "ice pick lobotomies" through his patients' eye sockets.

You’d like to think that the doctor trusted to make treatment decisions for you or your family members would be in big trouble if he/she were found guilty of practice violations like “delivering substandard care, wrongly diagnosing surgical patients, improperly leaving surgical equipment in a patient, alcohol/substance abuse, or physical illness/impairment”.  But such is not the case, according to the non-profit watchdogs over at Public Citizen, who claim that the state of California has become delinquent in disciplining 710 physicians with documented records like this.

In fact, 102 of these California doctors have been designated by peer reviewers as an “immediate threat to health or safety” of patients – yet are still allowed to practice medicine in the state.  One question: are their patients aware of this?

Here’s the report:  Continue reading

Remedial training for neurosurgeons: “Don’t bill for procedures you didn’t do!”

Earlier this year, the Chicago Tribune reported on a surgeon who implanted devices in patients without telling them he had invented them himself, that he made a profit every time one was used, and that the devices had not yet received FDA approval.

A U.S. Senate committee launched an investigation into reports that doctors with financial ties to the medical device company Medtronic were aware of potentially serious complications with a spine surgery product made by the company, yet failed to reveal those problems in published journal articles.

And in an extraordinary move, a group of U.S. spine specialists are publicly repudiating the research of other experts that has backed the widespread use of a Medtronic bone growth product called Infuse. In a joint editorial along with a series of reports published in the The Spine Journal on June 28, 2011, the five specialists called this research “misleading and biased”, adding:

“It harms patients to have biased and corrupted research published. It harms patients to have unaccountable special interests permeate medical research.”

As the New York Times described the journal’s action:

“It is extremely rare for researchers to publicly chastise colleagues, and editors of leading medical journals said they could not recall an instance in which a publication had dedicated an entire issue for such a singular purpose.”

At the heart of the issue are potential side effects related to Infuse’s use that emerged during patient studies conducted about a decade ago by outside researchers with significant financial ties to Medtronic. The studies favoured Infuse’s performance over a bone graft, the material traditionally used in spinal fusion procedure. The Times added that it’s too early to predict how the Spine Journal articles will affect the financial fortunes of Medtronic, which earned an estimated $900 million from Infuse in its most recent fiscal year.

Several researchers who were involved in the Medtronic-sponsored studies defended their reports, telling The New York Times that their studies were “scientifically sound and free of company influence, either directly or indirectly”.

One of them, Dr. Thomas A. Zdeblick of the University of Wisconsin, told The Times that he did not have a “direct financial interest in the success of Infuse or Medtronic.” Over the years, however, Dr. Zdeblick received over $20 million in royalty payments from Medtronic in connection with patents on their devices, including one that is used with Infuse.

Five other neurosurgeons at Norton Hospital in Louisville, Kentucky, are also among the largest recipients nationwide of payments from Medtronic. Drs. Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno allegedly received more than $7 million from Medtronic in just one nine-month period.

Do the math here: five docs, nine months, $7 million in kickbacks.

Two members of the Senate Finance Committee contacted Medtronic on June 21, 2011 demanding financial records and communications between the company and doctors who have received millions in royalties and other payments from Medtronic over the last decade.

Tellingly, Medtronic was also warned by Senate Finance Committee investigators “not to destroy or make inaccessible any of the documents, data or other related information”.

Controversial doctors are as old as medicine itself, according to ProPublica investigators.  These doctors’ identities are often known to their peers and even to the government, which compiles a confidential database of physician sanctions.

But patients rarely know.

Restrictions imposed by the U.S. Department of Health and Human Services prohibit naming these sanctioned doctors unless they agree to discuss their Medicare work.  The Wall Street Journal explained:

“The data also reveal that a foreign-born surgeon currently operating in Texas has an unusual number of patient deaths associated with an elective procedure. The surgeon was excluded from both the Medicare and Medicaid programs for nine years in the 1990s after the Office of Inspector General of the Department of Health concluded that he had performed unnecessary and inappropriate procedures on seven patients while practicing in New Jersey.

“In two of these cases, the surgeon inappropriately operated on patients who were nearly dead, and he contributed to a third patient’s death by misdiagnosing his condition, according to a letter the Inspector General sent him when he was ousted from Medicare. He was temporarily barred from practicing in New Jersey.

“The surgeon relocated to southern Texas in 2005. He currently operates at five hospitals there.”

* North American Spine Society, June 28, 2011: The Spine Journal Calls for an End to “Years of Living Dangerously” in Promotion of Bone Growth Factors

See also:

Surgeons Make Millions on Medtronic Payroll

Is Your Surgeon Able to Understand Simple Questions?

Doctors On The Take: How To Read the Fine Print in Medical Research

“Integrity in Science”: Who’s Paying the Piper?

Harvard’s Ethical Ultimatum to Doc: “Give Up Big Pharma Moonlighting Jobs, or Lose Harvard Teaching Post

Does The Medical Profession Need To Wean Itself From its “Pervasive Dependence” on Big Pharma Money?


“You can lead a cardiologist to water but, apparently, you cannot make him drink”

When it comes to interventional cardiology – that’s using balloon angioplasty* and metal stents to open up blocked coronary arteries – it seems that medical evidence is still taking a back seat to doctors’ deeply ingrained practice patterns. Case in point, a warning from the health journalism watchdogs at Health Beat:

“Even though many well-designed clinical studies conclude that drug therapy alone can reduce the risk of heart attack and death in people with stable coronary artery disease just as well as more expensive invasive procedures, many cardiologists continue to use interventions like propping open blocked arteries with costly stents instead of first trying medication.”

Or, as the Los Angeles Times put it in a piece called Cardiologists Rush to Angioplasty Despite Evidence for Value of Drugs:

“You can lead a cardiologist to water but, apparently, you cannot make him drink.”  Continue reading