
Anatomy of a Tragedy - devbug
http://www.texasobserver.org/anatomy-tragedy/
======
loudin
I really wish people talked to others working in the medical industry before
jumping to conclusions about medical practices and norms.

Surgeons are increasingly portrayed by the media as greedy and worthy of
increased oversight. The reality of the situation is that surgeons are just
like you and me - in fact probably better than you in me in a lot of ways.

The vast majority assume a crushing amount of debt and go through 10+ years of
schooling for an intensely demanding job that places them in life-or-death
situations on a daily basis. And that's before dealing with the lawsuits,
shrinking income due to insurance cheaping out on procedures, and the general
distrust from the public.

The bottom line is that situations like these are rare. And instituting a
system geared towards knee-jerk reactions is going to dramatically affect the
ability of good doctors who make genuine mistakes. It's going to scare away
intelligent people from the field who want to do good, but would be
legitimately afraid of losing their livelihood in a lawsuit or protracted
legal process. And it's going to affect the public, who will be likely left
with a lower-quality medical system.

~~~
corresation
_The bottom line is that situations like these are rare._

The article is quite specifically about a rare, incredibly egregious example,
and indeed many of the protagonists of the story are countless other medical
professionals who wanted this dealt with. I'm not sure what your opposition is
about, as you seem to be refuting a position that no one actually holds.

It _is_ absolutely outrageous that this was not dealt with earlier, and that
is what the story is about. Texas is hardly alone -- here in Ontario it is
well known that the same thing happens: grossly incompetent practitioners are
protected by a system that other practitioners do not defend and do not want.

------
lutusp
Not to make light of a terrible story, but:

"Somewhere in the world is the world's worst doctor. And what's truly
terrifying is that someone has an appointment with him tomorrow morning." \--
George Carlin

~~~
mikeash
In an ideal world, even the worst doctor in the world would still be pretty
good.

Of course, here in reality, it seems that about 90% of the population of any
profession is basically incompetent, and doctors are no exception.

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dnautics
the claim is that 'weakened medical regulation' made it difficult to remove
this guy. But don't get things wrong - he WAS removed, after three years. Do
we have any evidence to show that 'more robust medical regulation' would have
removed him sooner? For example, the Anil Potti case (4 years of practice
before removal)
[https://en.wikipedia.org/wiki/Anil_Potti](https://en.wikipedia.org/wiki/Anil_Potti)

~~~
tzs
Potti was a researcher. His misconduct was faking research. Faking research is
something you do in private, with no witnesses other than those helping you
fake the research.

When fake research gets published, it is generally not immediately evident
something is wrong. Eventually someone might notice that the purported
experimental data is too ideal to be from a real experiment, or other
researchers will fail to replicate the results.

The Texas doctor, on the other hand, was a practicing neurosurgeon. Other
surgeons were actually witnessing his surgeries and directly observing his
incompetence. He was leaving behind a trail of dead and crippled patients at
an alarming rate.

I don't see how the two are even remotely comparable.

~~~
dnautics
Anil potti's research was _clinical_ research. There were patients who went
through the WRONG chemotherapy based on his "computer treatment prediction
algorithm". In other words, there were patients who were effectively
chemically tortured to death under the color of medical authority, based on
faked data.

~~~
tzs
Potti's claim was that he could predict which chemotherapy drugs would be most
effective on a particular patient. The test patients were still getting good
anti-cancer drugs. He wasn't giving them random drugs that had nothing to do
with fighting cancer.

The most likely effect of the fake data on the test patients would be that
their treatment was merely as effective as that of patients in the control
group. It is very unlikely his methods produced worse outcomes--if they did,
he would not have needed to fake anything! He could have published his methods
as a way to identify drugs that would be ineffective for a particular patient,
which would be about as big a breakthrough as what he was claiming.

~~~
dnautics
do you know anything about chemotherapy? Taking these drugs is not just
popping a pill and waking home like nothing happened.

~~~
tzs
In the trials, the control group and the trial group were being treated with
the same sets of drugs. In the control group in one of the trials, for
instance, patients were assigned to one of two sets of drugs randomly. In the
test group, they were assigned to one of those same two sets of drugs using
Potti's research.

Note that people in the test group received one of the treatments they could
have received had they been in the control group. Since Potti's research was
fake, there was effectively no difference between the test group and the
control group.

~~~
dnautics
no they wouldn't have. You don't go into cancer drug trials by taking just
anyone who waltzes into the oncology ward.

~~~
tzs
I'm not sure what you are trying to say here. Yes, they don't just take random
people. The breast cancer study, for example, wanted 18+ year old females,
with a T1c to T3 invasive breast cancer, at any N stage, with no distant
metastases, with a tumor size >1.5 cm in at least one dimension. They had to
be a surgical candidate, with no chemotherapy, radiotherapy, or
biologic/targeted therapy for that tumor or any other malignancy in the past 5
years. They had to have an ECOG status of 0-1, and adequate scores on several
measures of organ function, and no significant heart problems or blood
pressure problems.

The patients were randomly assigned to the control group or to the test group.
Those in the control group were either treated with
Doxorubicin/Cyclophosphamide or Docetaxel/Cyclophosphamide, randomly assigned.

Those in the test group were either treated with Doxorubicin/Cyclophosphamide
or Docetaxel/Cyclophosphamide, assigned by the genomic data Potti claimed
would predict which would work better for that patient.

------
makomk
Aren't these Texas laws basically the same as the "reforms" to healthcare that
Republicans wanted to roll out nationwidw?

------
bambax
A search for "Christopher Duntsch videos" results in those gems from Best Docs
Network " _which features some of the best doctors in the entire Dallas Fort
Worth area that help change people 's lives_":

[http://www.youtube.com/watch?v=C542mx2aRJ4#t=1m00s](http://www.youtube.com/watch?v=C542mx2aRJ4#t=1m00s)

[http://www.youtube.com/watch?v=DLN6rOPpE5E#t=20m49s](http://www.youtube.com/watch?v=DLN6rOPpE5E#t=20m49s)

In the second video, one of Dr Duntsch's patient calls him "the best doctor
[I've] ever had" and the procedure she went through "a miracle".

But, curiously, a search for "duntsch" on bestdocsnetwork.com yields no result
whatsoever.

What's happening here? Who pays for what in these kinds of shows...?

------
chiph
There will always be bad doctors. What's needed is transparency, but laws such
as HIPAA protect them (as well as patient privacy), and many doctors now have
you sign a NDA before treatment, to prevent disparaging remarks being posted
online.

~~~
saalweachter
Is practicing medicine a right or a privilege?

While the "free market solution" of letting patients discover and inform each
other which doctors are "bad" and which are "good" certainly requires the free
market principle of open information about goods, services, and prices, it
also also masks a second assumption, that practicing medicine is a right and
that we injure doctors unforgivably by revoking their right to practice it.

Practicing medicine is a privilege. We trust these men and women with
extraordinary rights, to slice into bodies, dose us with precise amounts of
radiation, and prescribe us medicines which in the right dose can kill or
cure. If there is evidence that this trust has been betrayed and a doctor is
killing us instead of curing us, that privilege should be revoked immediately
until we can ascertain the facts of the matter.

~~~
enoch_r
Libertarians agree with you: practicing medicine isn't my right unless I can
find someone willing to pay me to do it. Customers determine whether I get the
privilege to sell any good or service. The question is who _else_ should have
the ability to make such a decision.

~~~
RougeFemme
Even if only customers should have the right to make that decision, customers
should, in a free market, have access to information that would help them make
an informed decision. I think the question in that scenario should be, what
information should the customer have access to, who should vet that
information and how long should the vetting process take? No, you don't want
physicians falsely accused and you don't want information misunderstood, but
this doctor should not have been so protected by the system.

I'm not in favor of higher malpractice maximums, but some mechanism needs to
be in place to "encourage" hospitals and doctors to blow the whistle more
loudly and forcefully.

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mhb
What about the whole rest of society's mechanisms for handling offenses?
Couldn't the Texas attorney general have prosecuted him? Did any of the people
who knew what was going on appeal to anyone besides the medical board?

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MrBra
Crazy crazy story... Thanks for posting/writing this and for putting accent on
such a dramatic case and such a sick malfunctioning system which, of course.
is the result of category self protectionism. And I say this while feeling
great respect and admiration for medicine and for what it takes to become a
doctor.

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mnaqvi
Why can't the public access this information freely? [http://www.npdb-
hipdb.hrsa.gov/footer/publicInformation.jsp](http://www.npdb-
hipdb.hrsa.gov/footer/publicInformation.jsp)

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pvaldes
Anatomy of a paralell trial to me.

