Anatomy of a Tragedy
texasobserver.org
texasobserver.org
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 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.
"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
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 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.
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.
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.
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.
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.
Our institutions are in shambles, at every level.
http://www.youtube.com/watch?v=C542mx2aRJ4#t=1m00s
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...?
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.
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.