The rising flood of health care hype, bunk, and conflicts of interest 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.
He, after all, was the author of a best-seller about his extreme and unsupported theory on how the body’s “balance” of acidity and alkalinity purportedly affected individuals’ health. He told her to not bother with mainstream medical care for her cancer.
Instead, she and others paid him as much as $500 per go to receive what turned out to be ordinary intravenous fluids (a salt water solution) that also included baking soda.
Her cancer did not improve — it worsened, such that her lawyers told the court that Kali has advanced to stage 4 of the disease, meaning her prognosis for living for more than a few years is bleak.
Young is sticking by his hype, which, incidentally, has sent him to jail for several months for practicing medicine without a license. He says he will appeal the jury verdict.
Prosecutors, and the lawyer in Kali’s civil case, both have noted how vulnerable very sick patients can be to medical chicanery. A recent, widely reported study found, for example, that overpowering numbers of patients diagnosed with cancer add so-called alternative therapies (including acupuncture, yoga, and dietary supplements) in hopes of improving their disease outcomes. A small but significant number of patients, Yale researchers found, also reject traditional medical care altogether — and their death rates are significantly higher, as a result.
To the conflation of medical science and dubious providers of wellness care, Otis Brawley, executive vice president and chief medical officer of the American Cancer Society, said, “Enough!” After 11 years as a chief with one of the leading and largest patient advocacy groups, Brawley quit.
His reasons, of course, likely are complex, and they may not be fully disclosed. But he made clear that he would no longer tolerate the aggressive partnerships, marketing, and promotion by the funds-seeking cancer society, such that it had hooked itself to Herbalife International, a major commercial purveyor of herbal supplements, as well as Long John Silver’s, a seafood restaurant, and Tilted Kilt, a sports tavern chain known for touting its skimpily clad, kilt-wearing waitresses.
Brawley has been a blunt, important, and decisive clinical voice, chiding colleagues, for example, about their over-use, over-reliance, and over-promotion of screenings in cancer care, observing once, “People in America may not live longer but we sure do a better job taking pictures (scans) of them dying.” He has showed professional grace in not blasting the cancer society publicly for potential conflicts between its commercial and clinical interests, a matter that not only has been a past but continuing concern.
The independent, nonpartisan Kaiser Health News Service has created a telling database that shows how slightly more than a dozen Big Pharma firms gave more than $100 million to influential, outspoken patient advocacy groups, raising questions as to whose interests such organizations most robustly represent. The cancer society and various of its arms show up in this accounting, accepting Big Pharma cash — and the New York Times article on Brawley indicates the organization has wrestled for some time now with revenue challenges, particularly as benefit walks, its signature fund-raising activity, has become a popular and competitive tool for an array of groups.
But gifts and donations, partnerships, speaker fees, honoraria — you name the money form — have become worrisome and corrosive in modern medicine, argues Aaron E. Carroll in a column in the New York Times. The professor of pediatrics at Indiana University School of Medicine, who blogs on health research and policy at The Incidental Economist, wrote in the evidence-based “Upshot” feature for the newspaper, detailing all the ways that doctors’ medical and intellectual independence gets compromised, whether by attending expense-paid symposia at posh resorts or having financial interests while weighing in on drugs or therapies.
He says doctors resort to “magical thinking” in disregarding the obvious: They’re human and their judgement can be swayed by good old money, in dribs and drabs or in significant sums:
Conflicts of interest are real, and they are still influencing decisions from the level of the patient all the way up to national health policy. We will never be able to eliminate them all. But acknowledging them and talking about them openly is an important first step toward minimizing their impact.
Good words and true. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, effective, and excellent medical care, particularly when they confront great uncertainty and complexity in medical treatment these days and its costs and risks can be staggering.
Cancer care, in particular, hits very sick patients and their families with sky-high costs, so much so that experts describe routinely its “financial toxicity.” Braver experts also question its outcomes for its bankrupting expense, noting that some much-promoted approaches may suggest which medications may best target certain tumors, while others may shrink growths — but these cutting edge therapies don’t necessarily improve or extend patients’ lives.
When you or a loved one is in bad shape, due to injury or illness, you may need to lean on an advocate — a family member, friend, or colleague — to assist. It would be great to think that you both could put unerring trust in your doctors and other caregivers, knowing their learned, experienced judgements are the best they can offer for your care. Caveat emptor, however, and, as we all can, we sadly need to be skeptical about hype, humbug, and conflicts of interest that infect and taint our doctors, hospitals, academic medical centers, clinics, and other caregiving institutions. We have much work to do.
