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Anatomy of a Tragedy (texasobserver.org)
43 points by devbug 1563 days ago | hide | past | web | favorite | 28 comments

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.

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.

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

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.

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

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.

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.

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.

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

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.

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

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.

You are right, that is a rather weak claim in an otherwise very well written article. I especially don't see how higher pain-and-suffering damages would have helped stopping this criminal sooner.

maybe, maybe, by adding a marginal deterrent for him to become a doctor. Maybe by increasing his malpractice insurance costs (but there would have been no data for him, so it wouldn't have helped, and it would increase malpractice costs for competent brilliant newbie docs)

The pain and suffering damage limit appears to be just one factor of several that worked together in Texas to make it easier for him to get away with his incompetent surgeries.

The other factors make it much harder to prove a malpractice case in Texas than in other states, and then the low limit on the damages (which, as the article notes will leave very little for the patient after costs) makes it not worthwhile to pursue the case.

If he could have been successfully sued then after his first two or three botched surgeries his insurance rates would probably be through the roof, and the lawsuits would be public making it easier for the public to learn that they should never go to this guy for treatment.

The real question is: why was he able to get a medical license in the first place? Why was he able to get good enough grades to get through medical school? Why was a man this incompetent so impossible to spot much earlier?

Our institutions are in shambles, at every level.

The article implies that the Medical Board believed he may have been impaired because of the use of drugs or alcohol. So he could have appeared reasonably competent before he developed those problems.

Yeah, the same board that let him keep practicing. I'll need evidence to believe that the "Doctor" wasn't incompetent the whole way through. Is it possible that something went wrong with his brain? Might he have a tumor or something that's yet to be discovered? Sure. But that's speculation. What's real is the incompetence that's running amok in our institutions. That's the nearest explanation rooted in actual evidence, so I'll go with that one.

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

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":



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...?

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.

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.

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.

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.

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?

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.

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

Anatomy of a paralell trial to me.

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