What the heck? This is completely bizarre. Gallstones don't develop overnight from eating one weird food, and I'm not aware of any other reason gallbladder removal surgery would be performed..
If you present to the ER with pain in the upper right abdomen, with blood test results showing raised liver enzymes, meeting some or most of the "fair/fat/female/fertile/forty" risk factor mnemonic criteria, and have imaging that doesn't completely rule out gallstones, then the overwhelming probability is that you're suffering from gallstones, and that's the diagnosis you'll be given.
Since the gold standard treatment for symptomatic gallstones is gallbladder removal, that's likely what will happen. Under normal circumstances, far more aggregate patient harm would be caused by trying to make the diagnosis more certain than is caused to the few patients who undergo surgery but don't actually have gallbladder disease.
Unfortunately, these aren't normal circumstances: it appears that the liver damage produced by this lentil product produces similar pain and blood test results to gallstones, the risk factors for gallstones are very common in the US population, and it's actually quite hard to completely rule out gallstones by imaging. So more patients than expected are currently being harmed with unnecessary surgery.
It's important that this be publicized, so that doctors making these diagnoses know that asking "did you eat anything from Daily Harvest" is now a diagnostically relevant question when considering upper abdomen pain, and the answer may change those prior probabilities drastically.
That said, I do think the underlying point I'm trying to make is still accurate. Most of the audience here are software engineers. Unlike debugging software, where we can often eliminate possibilities with 100% accuracy through objective tests and come to a conclusion with complete confidence, or at least run experiments with no consequences, humans are messy, poorly observable, and heterogeneous. A relevant history helps speed things up when trying to fix software, but it can be vital when fixing humans.
Given the rate of asymptomatic gallstones visible to imaging in the population, if these lentils are causing acute liver injury, I think it's reasonable to expect that some people have had unnecessary surgery as a result. If you knew your patient had eaten these lentils, would you still send to surgery with positive imaging, or wait a few days and see if things improved?
If the signalling controlling eg the sphincter is messed up, the bile won’t escape to the intestines, and if the bile stops flowing you’ll get liver and pancreatic inflammation.
It might be that some toxin in the food could cause such an effect?
I’m not sure how easy it would be to tell if this was the case in an acute setting though. It isn’t exactly common, and is usually chronic and intermittent. Gall bladder removal would seem to be the wrong treatment in this case, but it might be hard to establish? My amateur medical knowledge is insufficient to know, just hypothesising other potential mechanisms.
Yeah, the fact that this even made it to the legal system says everything.
Gallstones are normally a gooey crystal. It's cholesterol that has "crystallized" slowly over time. It's one of the reasons why they don't have very good drugs to treat gallstones--any drug would have to "ungrow" that crystal which would take just as long.
A lawsuit was filed. That’s it. Just about anyone can file a law suit alleging just about anything. Now Daily Harvest will have the opportunity to get it tossed. That’s how the system works. That’s how the system is supposed to work.
There are several questions here, and the legal system is the right place to unpick them. From the top of my head:
- did DH's lentils cause liver injury?
- is that injury permanent or temporary?
- were gallstones misdiagnosed because of the injury inflicted by DH's lentils?
- was unnecessary surgery performed due to misdiagnosis?
- did the doctors misdiagnosing gallstones/performing unnecessary surgery meet the standard of care?
- did the unnecessary surgery cause permanent/temporary harm?
- was the direct harm (temporary liver injury) caused by DH's lentils reasonably foreseeable?
- was the indirect harm (surgery, surgical complications, lifelong side effects) caused by DH's lentils reasonably foreseeable?