Do Significant Numbers of Physicians Lie or Conceal Information from Patients? — Apparently Yes, Says a Survey from Health Affairs — and an Outrageous Example of Data Manipulation from a Science-Fraud-Committing Cancer Researcher (Anil Potti)

13 February 2012

First the “mild stuff” — the difficulty of agreeing on (and enforcing) the boundaries of professional ethics in regard to truth-telling

A survey of 1,891 physicians in 2009 revealed that quite a few leave probably large amounts of wiggle room in regard to lying to patients:

Overall, approximately one-third of physicians did not completely agree with disclosing serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients.

Just over one-tenth said they had told patients something untrue in the previous year.

Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.

© 2012 Lisa I. Iezzoni, Sowmya R. Rao, Catherine M. DesRoches, Christine Vogeli, and Eric G. Campbell, Survey Shows That At Least Some Physicians Are Not Always Open Or Honest With Patients, Health Affairs 31(2): 383-391 (February 2012) (from the abstract) (paragraph split)

Here, you have a scientifically-oriented health journal saying that medical ethics are not what they should be.

Translating:

20 percent of physicians left room for maneuver in regard to lying,

33 percent apparently believed that concealing serious medical errors might be okay,

and

40 percent said hiding financial conflicts could, presumably, sometimes be fine.

Even with caveats about the way in which the survey questions were worded, this apparently is not a profession with a unanimously high regard for truth. Nor one with a homogeneously shared regard for patient autonomy.

Second, an extreme example of medical corruption — The Economist and 60 Minutes did stories about a Duke University cancer researcher who had falsified data, and lied to patients, in order to profit in the future

Weakened standards of truth in science and medicine have slippery-slope pitfalls. Here is one such.

Among the more visible media, this story was initially tackled in detail by the Economist in September last year. 60 Minutes picked up the ball yesterday.

Citations

Editor, Science and Technology, Misconduct in science: An array of errors — Investigations into a case of alleged scientific misconduct have revealed numerous holes in the oversight of science and scientific publishing, The Economist (10 September 2011)

Kyra Darnton, Scott Pelley, and 60 Minutes, Deception at Duke, CBS News (12 February 2012)

Note — which to read, if only one

The Economist’s version is the more detailed and “system”-aware. I recommend it.

Anil Potti, MD, came to Duke University, lied about one of his credentials, and hooked a respected laboratory chief (Dr. Joseph Nevins) into letting him do cancer research:

[F]ive years ago, when Duke University announced that it had an advanced, experimental treatment that would match chemotherapy to a patient's own genetic makeup, it was hailed as the holy grail of cancer care.

The scientist behind the discovery was Dr. Anil Potti, and soon Dr. Potti became the face of the future of cancer treatment at Duke, offering patients a better chance even with advanced disease.

However, when other scientists set out to verify the results, they found many problems and errors.

What our 60 Minutes investigation reveals is that Duke's so-called breakthrough treatment wasn't just a failure -- it may end up being one of the biggest medical research frauds ever.

Duke unwittingly and carelessly bought into Potti’s research scam

Once in Dr. Nevins’ prestigious lab, Dr. Potti claimed to have discovered how to genetically target chemotherapy to the genetics of individual patients. Terminally ill patients were recruited into Duke’s clinical trial of the method.

If the therapy worked, Potti, Nevins, and Duke would make gobs of money by patenting the process.

However, independent cancer experts — Keith Baggerly and Kevin Coombes at the MD Anderson Cancer Center in Houston, Texas — questioned Potti’s data.

The National Cancer Institute joined them. Something smelled.

Duke suspended the clinical trial and asked an outside group to investigate. According to the Economist, Duke did not give these investigators the details of the National Cancer Institute or the Coombes-Baggerly critiques.

The investigation supported Dr. Potti and the validity of his data. The clinical trial resumed. Patients were not told about outside experts’ criticisms of Duke’s data. Instead, Dr. Potti told at least one patient that there was an 80 percent chance the drug chosen for her would work.

Note — regarding unwarranted statistical predictions in clinical trials

Statistics-based specificity of this kind is unheard of in clinical trials. The whole point to trials is that no one knows how safely or effectively the drugs being tested are going to work.

Potti’s claim was particularly stupid — and outrageously unethical — when the method involved supposedly targeted patient’s specifically individual genetics.

In practice, the more individualized a proposed treatment is, the less research data one has regarding its outcome. Making predictions (under these circumstances) is ethically dishonorable and intellectually asinine.

Dr. Potti’s moral rottenness shows in even this one illustration.

Why didn’t anyone at Duke stop him from making such professionally unethical claims?

Potti then caught in an unrelated lie

An anonymous source prompted Paul Goldberg, editor of The Cancer Letter, into discovering that Anil Potti was not the Rhodes Scholar he claimed to be.

Once Dr. Nevins recognized that his own reputation was at stake, he took a look at the data himself:

Nevins: It became clear that there was no explanation other than there was a manipulation. . . . It simply couldn't be inadvertent. It had to have been based on a desire to make something work.

Duke University thereafter admitted that Potti’s fraudulent technique did not work. And prestigious medical journals retracted Dr. Potti’s published papers.

Note — regarding the dishonor that is usually involved in retracting scientific papers

In medicine (especially) a retracted paper is like signing a confession that one is science criminal or simpleton.

People generally do not retract, unless and until they have been caught red-handed doing professional evil. Meaning that they have been exposed as (a) having fabricated data or (b) being too stupid to see that the information they collected did not at all support their conclusions.

Retraction (within narrowly specific research communities) is like having a red “R” branded onto one’s forehead.

How would a prestigious university and famous laboratory director make such an avoidable mistake?

Greed.

60 Minutes was diplomatic enough to let Duke and Dr. Nevins get away with saying that Anil Potti had fooled them. The inference was that wanting to help patients blinded them to his falsifications.

Thoughtful reflection exposes the psychological denial involved.

In medicine, if you genuinely want to help people, the first thing you do is keep the science honest. That means not falsifying data.

The fact that Dr. Nevins subsequently so easily pinned down the fraud in Dr. Potti’s experimental records indicates that a motivated someone at the University should have found it earlier, especially after outside criticism began coming in.

This is the essential absurdity of Duke’s initial position. Outside experts had called Potti’s bluff, using information that they could get their hands on. But a supposedly independent review panel, presumably granted with authoritative investigative power, missed the lies, distortions, and manipulations.

How did this happen? Duke apparently had confined the investigators’ purview to whatever Potti wanted to turn over to them. After all — the realists among us can surmise — why wreck a potential cash cow by approaching the investigation the way real fact-finders would?

The juxtaposition of the competing inside and outside perspectives in regard to uncovering Potti’s duplicty screams self-interest on the University’s part.

Almost certainly, the prospect for tons of money psychologically closed Duke’s and Dr. Nevins’ eyes to Fraud’s warning signs.

An Institute of Medicine investigation of the Duke situation uncovered a host of errors, including the influence of rampant self-interest:

The university’s lapses and errors included being slow to deal with potential financial conflicts of interest declared by Dr Potti, Dr Nevins and other investigators, including involvement in Expression Analysis Inc and CancerGuide DX, two firms to which the university also had ties.

Moreover, Dr Califf and other senior administrators acknowledged that once questions arose about the work, they gave too much weight to Dr Nevins and his judgment.

That led them, for example, to withhold Dr Baggerly’s criticisms from the external-review committee in 2009.

They also noted that the internal committees responsible for protecting patients and overseeing clinical trials lacked the expertise to review the complex, statistics-heavy methods and data produced by experiments involving gene expression.

© 2011 Editor, Science and Technology, Misconduct in science: An array of errors — Investigations into a case of alleged scientific misconduct have revealed numerous holes in the oversight of science and scientific publishing, The Economist (10 September 2011)

The Institute of Medicine also found that the anti-truth corruption (that often affects prestigious medical journals) contributed to Potti’s success in evading censure.

Note

I have explained how peer-reviewed journals contribute to the corruption of science, here.

Dr. Baggerly could not get medical journals to publish his letters critical of Potti’s work. He wound up publishing in a statistics journal — which, unlike its medical peers, obviously had no prestige or financial interest in preventing Potti’s fraudulent applecart from being tumbled.

Here, it helps to recall that revolutionary advances in medicine generally do not come easily. The proper initial scientific stance in the face of extraordinary claims is skepticism.

This is especially true where patients’ well-beings, even in the last weeks of life, are at stake.

Terminally ill people were depending on Potti’s “treatments” to work at least as favorably for them as drugs being used in other clinical trials. But Duke — in addition to not telling patients about the controversy that already erupted — overlooked telling them that Drs. Coombes and Baggerly suspected that Potti’s data interpretation was so backwardly flawed that they were actually receiving drugs that would make their conditions worse.

Flying the coop with his medical license still intact

According to 60 Minutes, after resigning from Duke, Anil Potti is still practicing medicine and bragging about his contributions to treating cancer.

The morals? — (i) Money corrupts clear thinking, (ii) extraordinary scientific claims require skepticism, and (iii) just because one is a science-fraud-committing rat, doesn’t mean that one's medical license is in jeopardy

Truth is in short supply. Market and political forces almost always work against honesty.

The goal of professional ethics is to counter our tendency to slide down Perdition’s Slippery Hill. Medicine’s code is not working particularly well.

PeteFree.com

Do Significant Numbers of Physicians Lie or Conceal Information from Patients? — Apparently Yes, Says a Survey from Health Affairs — and an Outrageous Example of Data Manipulation from a Science-Fraud-Committing Cancer Researcher (Anil Potti)