On "Bettelheiming"

 

I began working with children with autism back in 1995, and most of the history of autism before the mid 2000s has been erased (enabling new narratives to be presented and accepted) so I want to add some of it back here. Bettelheim was a complete fraud and charlatan. He fabricated any credentials and expertise he claimed to have, and wrote his book "The Empty Fortress" based entirely on conjecture. Despite this, his book and theory (the notorious "refrigerator mother" theory) were unquestioningly accepted by mainstream medicine and for decades all treatment of autism was based entirely on his "work"- no research or independent inquiry was done at all. What this meant was that children with autism and their mothers were sent to psychiatrists who interpreted everything the child did as a sign of alienation by the mother (for example, a child who had a stim of knocking on things was said to be "knocking on his mother's emotions, asking to be let in"). No attempt was made to try to understand the person with autism or help them or teach them or ease their distress. The mothers were told that they had caused their child's autism (remember that at this time, autism meant the form that we now call "profound" or "level 3" autism only) and were shunned. Often they were made to wait outside because they were told they were so heinous for what they had done that they weren't worthy or deserving of human treatment. There were times when a child died in an accident (remember, we're talking about level 3 autism in a world with zero accommodations or awareness) and the mothers were told that the child had intentionally unalived themselves to get away from them. There were mass self-unalivings of mothers at this time because society trusted and believed what the doctors said without question (until Bernie Rimland came along, who has also largely been erased, and who finally did some research and created the beginnings of the concept of autism we have now of it being a neurodevelopmental disorder), and the weight of that blame and self-blame was more than many could cope with.

When people say that the history of autism treatment is filled with "snake oil salesmen" this began with western medicine. The word "quackery" referring to doctors was first coined to describe AMA doctors when they were new on the scene. They never acknowledged or apologized for the harm they did by embracing Bettelheim with such anti-scientific fervor. "Bettelheiming" is much more than not being believed- it's being scapegoated, bullied into silence, blame-shifted and victim-blamed and it was often deadly. If you listen to what families of people with Level 3 autism have been saying this past month, things haven't gotten much better, only now it's parts of the autism community itself who have been co-opted into this bullying. This is why history matters. This is what can happen when it gets erased. This is the tip of the iceberg of just the history of autism, let alone all the other history that has been erased in America.

The Predatory Financial Structure of the American Medical System

“Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care
"America’s largest insurers hire EviCore to make decisions on whether to pay for care for more than 100 million people.  “The Dial”: EviCore uses an algorithm that allows it to adjust the chances that company doctors will screen prior authorization requests, increasing the possibility of denials.
Lucrative Deals: Some EviCore contracts are based on how deeply the company can reduce spending on medical procedures. It tells insurers that it can provide a 3-to-1 return on investment.

"Over the years, medical groups have repeatedly complained that EviCore’s guidelines were outdated and rigid, resulting in inappropriate denials or delays in care."

"Known as risk contracts, EviCore takes on the responsibility for paying claims. As an example, say an insurer spends $10 million a year on MRIs. If EviCore keeps costs below that figure, it pockets the difference. In some cases, it splits the savings with the insurance company.  “Where you really made your money was on a risk model,” a former EviCore executive said. “Their margins were exponentially higher.  Insurers do not make explicit demands for more denials, a former EviCore sales executive said, Instead, they asked about “controlling the spend” — the amount of money paid out on certain procedures, he said. Nor would EviCore always use the word “denials” — they employed circumlocutions like “inappropriate determinations.”

"A 2023 academic study examined the criteria EviCore used to approve payment for imaging of the lower spine in cases of extreme pain. It found the guidelines deficient. Two of five medical experts who reviewed the guidelines even recommended not using them.  ( A critical appraisal of Evicore’s guidelines for advanced diagnostic imaging of the spine for lower extremity pain with neurological features ) "Nine months after starting at EviCore, Miller quit, disappointed by the attitudes of some of her colleagues. “Most of the physicians who work at these places just don’t care,” she said. “Any empathy they had is gone.”

Another way that EviCore reduces costs for insurers is that doctors make fewer reque4sts for procedures.  EviCore says this is because doctors make fewer inappropriate requests, doctors say they give up because fighting to get procedures for their patients is too time-consuming.  Cigna, who owns EviCore, claims that this effect (called the "sentinel effect") occurs because doctors are kept more up-to-date on current procedures.  "Connecticut’s Insurance Department recently reviewed EviCore and Carelon. It found no problems with Carelon. EviCore was fined $16,000 this year for more than 77 violations found in a review of 196 files."

"In 2022, Carelon settled a lawsuit for $13 million that alleged the company, then called AIM, had used a variety of techniques to avoid approving coverage requests. Among them: The company set its fax machines to receive only 5 to 10 pages. When doctors faxed prior authorization requests longer than the limit, company representatives would deny them for failing to have enough documentation. Carelon denied the allegations in court and admitted no fault."

"Lawsuits against employer-funded health plans, like the one Cupp had with United, must be tried in federal court, where case law favors insurance companies. For instance, insurers found at fault do not pay punitive damages, only the cost of treatment."

AMA survey finds prior authorization hurts patients and doctors
"Health systems should also expect higher drug costs. Hospital drug expenses are 12% higher than in 2020. Hospitals also need to get accustomed to patients shifting more toward outpatient facilities, Swanson said." from https://www.chiefhealthcareexecutive.com/view/hospitals-faring-better-than-last-year-but-a-difficult-path-lies-ahead 

Eat What You Kill
This report is about an oncologist named Dr. Thomas C. Weiner who practiced in Helena, MT and essentially built a kingdom there for himself at St Peter hospital.  He was eventually terminated for all kinds of fraud and harm to patients, including extremely excessive prescribing of opiate medications and the seemingly intentional killing of at least 10 patients but probably many, many more- all under the pretense of "providing comfort".  This man comes across as a psychopathic narcissist, essentially a cult leader who used all manner of coercive control and lying to maintain his powerful and extremely lucrative position in the community.  

This phrase refers to a reimbursal scheme at some hospitals in which providers are paid for the value of  the services they provide.  "Adding to a six-figure base salary, his pay was calculated by the number of relative value units, or RVUs, he billed on behalf of the hospital. The system compensates doctors using weighted values for certain types of visits or treatment. It works like this: A doctor might be paid $100 per RVU. A routine physical might be equal to 1 RVU, or $100; a more complicated and time-consuming procedure like radiation therapy might equal 8 RVUs, or $800. In other words, the more patient visits and treatments a doctor bills to insurance, the more that doctor and the hospital earn. Weiner described this system, which is common in American medicine, as “eat what you kill.”

“Comfort” was a word Weiner used often in our conversations. If a patient dies as a result of his treatment, he told me, it’s not unethical if his intent was to provide comfort. In medicine, this is called the principle of double effect. First developed by the Catholic saint and theologian Thomas Aquinas, it’s a set of criteria by which a person can morally justify ending someone’s life. It stipulates that a harmful consequence of a medical treatment, such as death, is permissible if it’s a secondary effect of beneficial treatment, such as alleviating pain with drugs. “It’s for their comfort,” Weiner told me. “It’s not that I euthanize them.”

Can the new CVS CEO handle the Aetna challenge?
This is an article about the replacement of one CVS Health CEO with another because stock value and profitability are the top priorities in how the health care company is run.  The stock price had fallen, due in part to their insurance arm Aetna "Health insurance companies typically aim to pay out about 80% of the premiums they collect for customer medical services. CVS said on Friday that the percentage of premiums spent on medical services had risen to 95%."

CVS Health slashes infusion services offerings, blaming industry headwinds
"More than 3.2 million Americans receive some type of infusion therapy each year, according to Bourne’s research. The figure is expected to grow over the upcoming years, as the population over 65 years old is projected to double in the next three decades, chronic disease continues to rise and the Food and Drug Administration green-lights new injection-based drugs."

"Nationwide nursing labor shortages have hit the infusion industry hard because infusion therapy can require a 1-to-1 nurse-to-patient ratio and must be performed by nurses with specialized training, according to Bourne Partners.

Training requirements can push compensation for infusion nurses up 10% to 20% higher than nonspecialized nurses, the consultancy said, straining provider budgets.

In 2022, CVS Health closed 36 of its 71 Coram clinics and laid off 2,000 employees including dietitians, nurses and pharmacists. A KFF News report attributed the closure to high overhead costs associated with providing infusion services, labor costs, reimbursement delays and supply shortages."

Parents Want Justice for Birth Injuries. Hospitals Want to Strip Them of the Right to Make That Decision.
A Florida program called NICA was set up to compensate families whose children experienced severe brain damage during delivery, with the condition that the parents can't sue for malpractice.  The program has been badly run, failing to provide the promised care, and parents who try to use the conditions that exist to avoid the program and sue for damages are now being thwarted with the appointment of guardians to make the choice to enroll in NICA on behalf of their children.  

Despite Persistent Warnings, Texas Rushed to Remove Millions From Medicaid. That Move Cost Eligible Residents Care.
"For three years during the coronavirus pandemic, the federal government gave Texas and other states billions of dollars in exchange for their promise not to exacerbate the public health crisis by kicking people off Medicaid.

When that agreement ended last year, Texas moved swiftly, kicking off more people faster than any other state.

Officials acknowledged some errors after they stripped Medicaid coverage from more than 2 million people, most of them children. Some people who believe they were wrongly removed are desperately trying to get back on the state and federally funded health care program, adding to a backlog of more than 200,000 applicants. A ProPublica and Texas Tribune review of dozens of public and private records, including memos, emails and legislative hearings, clearly shows that those and other mistakes were preventable and foreshadowed in persistent warnings from the federal government, whistleblowers and advocates."

We Reported on a Nonprofit Hospital System That Sues Poor Patients. It Just Freed Thousands From Debt.
Methodist Le Bonheur Healthcare filed more than 8,300 debt lawsuits from 2014 through 2018 against patients who owed money.  The hospital had a much less substantial financial assistance program than other hospitals in the area, owned it's own collection agency, and sued many people who owed money, even garnishing wages when it won.  Non-profit hospitals, such as Methodist, receive tax exemptions in exchange for providing community benefit- providing medical services to low-income patients and others who struggle to afford care.  After an expose by ProPublica and a local news source, the hospital forgave the debt of more than 6500 patients.

The Nonprofit Hospital That Makes Millions, Owns a Collection Agency and Relentlessly Sues the Poor
"Nonprofit hospitals pay virtually no local, state or federal income tax. In return, they provide community benefits, including charity care to low-income patients. In Memphis, Methodist Le Bonheur Healthcare has brought 8,300 lawsuits for unpaid medical bills in just five years." 

Low-Wage Workers Are Being Sued for Unpaid Medical Bills by a Nonprofit Christian Hospital That Employs Them
The same hospital mentioned above, Methodist Le Bonheur Healthcare, also sued it's own low-income employees for care they received.

The Growth of Private Equity in US Health Care: Impact and Outlook

Newsom sides with health care industry in rejecting rules for prescription drug middlemen, hedge funds

After private equity takes over hospitals, they are less able to care for patients, top medical researchers say

How "Anti-Abortion" Laws are Pro-Death, not Pro-Life

Reproductive care is health care in more ways than many people have thought through.  The fact that anyone can consider the anti-abortion laws that exist and that are being planned as I write this to be "pro-life" is a sign that life has already become so devalued that it's loss isn't even seen or recognized when it comes to pregnancy and birth.  The lives of women, both in terms of quantity and quality, are invisible, as are the lives of their families and other children and the children they may have had in the future.  If the goal were to reduce the number of pregnancies that are ended intentionally or that end in accidental ways, the solutions would start in other parts of society- we would take meaningful steps to reduce rape and to support pregnant women so they could afford to have and raise a baby unexpectedly.  We would be horrified at the extremely high infant mortality rate for black babies and other babies of color and take immediate steps to provide optimal care for those babies to bring the death rate down.  We would ensure that pregnant women receive appropriate prenatal care and that infants received the care they needed in the early years.  There are many, many things that we would do- but not only do we not do those things, we are allowing our health care system to degenerate such that more and more babies and pregnant women are losing their lives.  Anti-abortion laws, as they stand, are in no way "pro life".  

If You’re Pregnant, Here’s What To Know About the Medical Procedures That Could Save Your Life
Information about medical care for miscarriage, including D and C or D and E.  Both of those procedures can be used for abortion as well so in states with abortion bans, they may not be offered when appropriate and needed.  This video gives basic information about how to educate and protect yourself if you are or become pregnant.

How Do Abortion Pills Work? Answers to Frequently Asked Questions.
Abortion medication, sometimes referred to as the "abortion pill", is two pills taken together- mifepristone and misoprostol.  "Mifepristone blocks a hormone called progesterone that is needed for a pregnancy to continue. The FDA-approved regimen is to take 200 milligrams of mifepristone on the first day. Patients are directed to take misoprostol within 24 to 48 hours of the mifepristone. The misoprostol works to expel fetal tissue from the uterus."

The Impact of Legal Abortion on Maternal Mortality
"Legal abortion has recently been suggested as an essential healthcare service. In this study, we consider whether abortion legalization over 1969-1973 improved women’s health, measured by maternal mortality. Our event-study results indicate that legal abortion substantially lowered non-white maternal mortality by 30-40%, with 113 non-white maternal deaths averted nationally in the first year abortion became legal. We also find that early state-level legalizations were crucial, and more influential than the Roe v. Wade decision itself. "

Dozens of pregnant women, some bleeding or in labor, are turned away from ERs despite federal law
"More than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022, an Associated Press analysis of federal hospital investigations found.

Two women — one in Florida and one in Texas — were left to miscarry in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after an emergency room sent her home. At least four other women with ectopic pregnancies had trouble getting treatment, including one in California who needed a blood transfusion after she sat for nine hours in an emergency waiting room."

Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable.
"Tasked with examining pregnancy-related deaths to improve maternal health, the experts, including 10 doctors, deemed hers “preventable” and said the hospital’s delay in performing the critical procedure had a “large” impact on her fatal outcome."

A Woman Died After Being Told It Would Be a “Crime” to Intervene in Her Miscarriage at a Texas Hospital
"Barnica is one of at least two Texas women who ProPublica found lost their lives after doctors delayed treating miscarriages, which fall into a gray area under the state’s strict abortion laws that prohibit doctors from ending the heartbeat of a fetus.

Neither had wanted an abortion, but that didn’t matter. Though proponents insist that the laws protect both the life of the fetus and the person carrying it, in practice, doctors have hesitated to provide care under threat of prosecution, prison time and professional ruin.

ProPublica is telling these women’s stories this week, starting with Barnica’s. Her death was “preventable,” according to more than a dozen medical experts who reviewed a summary of her hospital and autopsy records at ProPublica’s request; they called her case “horrific,” “astounding” and “egregious.”

A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas Emergency Rooms
An 18-year-old woman died from sepsis after visiting emergency rooms 3 times, when she developed symptoms of sickness and miscarriage.  The hospitals diagnosed her with strep throat, and later a UTI as well and sent her home, despite clear signs indicating a life-threatening infection.  Once she returned for the third time her emergency care was delayed out of concern over the fetal heartbeat.  It's not possible to say for sure if her death could have been avoided, but a lot more could have been done to try.  In Texas, officials have made a point to tell doctors that their abortion ban takes precedence over a federal law that requires emergency rooms to treat women and stabilize them when they have life-threatening complications of pregnancy. 

A Third Woman Died Under Texas’ Abortion Ban. Doctors Are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments.
"The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.

It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage."

"But because D&Cs are also used to end pregnancies, the procedure has become tangled up in state legislation that restricts abortions. In Texas, any doctor who violates the strict law risks up to 99 years in prison. Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.  (E)ven in cases like Porsha’s where there isn’t a fetal heartbeat or the circumstances should fall under an exception in the law. Some doctors are transferring those patients to other hospitals, which delays their care, or they’re defaulting to treatments that aren’t the medical standard.  Texas outlaws abortion from the moment of fertilization; a record showing there is no cardiac activity isn’t enough to give physicians cover to intervene, experts said."

"Staff are familiar with misoprostol because it’s used for labor, and it only requires a doctor and a nurse to administer it. To do a procedure, on the other hand, a doctor would need to find an operating room, an anesthesiologist and a nursing team. “You have to convince everyone that it is legal and won’t put them at risk,” said Goulding. “Many people may be afraid and misinformed and refuse to participate — even if it’s for a miscarriage.  (F)or example, legislators added an update to the ban for patients diagnosed with previable premature rupture of membranes, in which a patient’s water breaks before a fetus can survive. Doctors can still face prosecution for providing abortions in those cases, but they are offered the chance to justify themselves with what’s called an “affirmative defense,” not unlike a murder suspect arguing self defense. This modest change has not stopped some doctors from transferring those patients instead of treating them."

Afraid to Seek Care Amid Georgia’s Abortion Ban, She Stayed at Home and Died
Candi Miller had several chronic health conditions that made pregnancy dangerous and potentially life-threatening for her, but she became pregnant unintentionally soon after Georgia passed a ban on abortion.  She ordered abortion pills through the mail, feeling that she needed to handle an abortion on her own, and didn't go to the hospital when she experienced complications following taking the pills out of fear.  She died, leaving behind three children who now have no mother.  Her death was preventable.  

"ProPublica’s new reporting makes clear, for the first time, that in the wake of bans, women are losing their lives in ways that experts have deemed preventable.  It also underscores the reality that abortion bans have not actually led to a decrease in abortions. But for people like Miller, they have increased the degree of difficulty and risk."  Women with chronic conditions that make pregnancy more dangerous are not helped by the narrow exceptions written into law, and often need to travel out-of-state to get the supportive care they need even to continue the pregnancy.  There is so much confusion around the new laws that women are often not showing up for care until they are already experiencing serious complications.  This system has made pregnancy more dangerous for many women.

Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable.
Amber Nicole Thurman died of treatable complications of abortion medication in Georgia after the state's abortion ban went into effect.  She had a rare complication in which her body didn't fully expel the fetal tissue, which would normally be treated by a common, safe intervention called a D and C.  This procedure was essentially outlawed in Georgia, so she ended up dying of sepsis, an deadly infection that resulted from the lack of treatment that she received.  Her death is "the first time an abortion-related death, officially deemed “preventable,” is coming to public light."
Referenced in the article- The Impact of Legal Abortion on Maternal Mortality
"Our event-study results indicate that legal abortion substantially lowered non-white maternal mortality by 30-40%, with 113 non-white maternal deaths averted nationally in the first year abortion became legal. We also find that early state-level legalizations were crucial, and more influential than the Roe v. Wade decision itself. "

Texas women denied abortions for ectopic pregnancies file federal complaints against hospitals
 "The hospital's intervention was too late, her attorneys say. Her ectopic pregnancy ruptured days later, leaving her bleeding heavily and in blinding pain. She was transferred from a facility in Burnet County to Ascension Seton, where she was told she was "bleeding out," according to the complaint.  To save her life, doctors removed her right fallopian tube, leaving her with lower chances of having a successful pregnancy in the future."

“These women are proof that exceptions do not make abortion bans less dangerous, even when they are exceedingly clear," Beth Brinkmann, senior director of U.S. litigation at the Center for Reproductive Rights, said in Monday's news release. “It’s impossible to have the best interest of your patient in mind when you’re staring down a life sentence. Texas officials have put doctors in an impossible situation.  Numerous Texas OB-GYNs and medical associations have said that the severe repercussions, combined with the state's abortion ban's complicated wording, leave doctors hesitant to administer treatment."

"Texas Alliance for Life in monthly news releases has highlighted that one to 10 "medical-necessity" abortions have been recorded in Texas each month since the U.S. Supreme Court struck down the federal right to an abortion established in Roe v. Wade. More than 50,000 took place each year between 2008 and 2020."

Doctors Warned Her Pregnancy Could Kill Her. Then Tennessee Outlawed Abortion.
Mayron Michelle Hollis became pregnant unexpectedly soon after giving birth to a daughter, but despite the pregnancy posing a very serious risk to her health and life, Tennessee passed an abortion ban before she could end the pregnancy.  Her doctor tried to put together a team to perform the necessary procedure but was unable to gather the needed participants because they were afraid of the legal consequences, so she was left to navigate a terrifying situation with little help- further traumatizing her, jeopardizing her health, her family, her sanity, and her life, and with additional barriers put up by the state to make her already extremely difficult situation orders of magnitude worse.  Amazingly she and her baby survived- despite the medical system, not because of it.  This article is very well done and worth reading.

Her miscarriage left her bleeding profusely. An Ohio ER sent her home to wait
Christina Zielke had a confirmed miscarriage but was left to wait for the tissue to pass on it's own, which didn't happen for weeks.  When it did, she lost a large amount of blood but was not treated and instead sent home due to Ohio's trigger law- meaning that abortion became illegal the same day that Roe v Wadew was overturned.  Many anti-abortion advocates do not understand that miscarriage, a common event in pregnancy, is treated with the same procedures that are also used in abortion.  This means that when abortion is outlawed, miscarriage becomes much harder to get treatment for and becomes a dangerous event when it doesn't need to be, placing the health and lives of large numbers of women in danger- even women who had no intention of having an abortion, even women whose pregnancies are not viable or are ectopic (which must always be terminated).  These laws are having a large amount of unintended consequences that their authors don't take accountability for, at least partially because they lack a basic understanding of the biology and medicine around pregnancy.

North Texas woman says her baby fell on a Dallas freestanding ER floor after she gave birth
In a state with anti-abortion (so-called "pro life") laws, it is horrifyingly ironic that this baby nearly lost her life due to such utter disregard for human life.  The US has a profoundly disturbing history of such incompetent treatment and such complete lack of basic care for black women and their babies that the infant and maternal death rate is many times higher than it is for white mothers and babies.  This just highlights the hollowness of the so-called "pro-life" movement who are nowhere to be seen when it comes to these excess deaths.  In addition, this level of care is the "new normal" in America as we allow private equity and profit-based health care to destroy the health care system and leave only the most minimal skeletal remains, all in the name of short-term value extraction.

The CDC Hasn’t Asked States to Track Deaths Linked to Abortion Bans
"(T)the Biden administration has missed a critical opportunity to illuminate how abortion bans are interfering with maternal health care, leading to deaths and irreversible injuries: The CDC has not pushed state committees that review maternal deaths to examine the role these new laws have played."

If You’re Pregnant, Here’s What You Should Know About the Medical Procedures That Could Save Your Life
"Women experiencing pregnancy loss in states with abortion bans told us they wished they had known what to expect and how to advocate for themselves. We created this guide for anyone who finds themselves in the same position."

Are Abortion Bans Across America Causing Deaths? The States That Passed Them Are Doing Little to Find Out.
"The same political leaders who enacted abortion bans oversee the state committees that review maternal deaths. These committees haven’t tracked the laws’ impacts, and most haven’t finished examining cases from the year the bans went into effect. "

We Don't Do That Here (New York Times)

Five Woman Sue Texas Over the State's Abortion Ban (New York Times)

Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with
complications in 2 Texas hospitals after legislation on abortion
"n 2 Texas hospitals, state-mandated expectant management of obstetrical complications in the periviable period was associated with significant maternal morbidity (Figure). Consistent with reports
evaluating outcomes in women requesting expectant management, most of the pregnant patients at <22 weeks presenting with medical indications for delivery experienced serious morbidity, and fetal outcomes were poor. Expectant management resulted in 57% of patients having a serious maternal morbidity compared with 33% who elected immediate pregnancy interruption under similar clinical circumstances reported in states without such legislation."

Food Supply Dangers (Bird Flu)

Big Ag, Not Wild Birds, Is What Really Spreads Avian Flu

Bird flu (H5N1) was first identified in chickens on a farm in Scotland in 1959.  In 1996 an outbreak occurred on a goose farm in China and spread to humans, killing half of the humans who contracted it.  In 2005 bird flu was spread from domestic birds to wild birds who spread it via migration, bringing it to the Americas in 2021.  The problem of bird flu is usually presented as one in which a virus infecting wild birds is being brought into domestic bird farms, where it spreads like crazy, harming the birds and threatening the health of humans who have contact with farmed birds.  This version of the story seems to be backwards.  The evidence shows bird flu as primarily a problem arising from our farming practices that sometimes spills over into wild birds, who are capable of spreading it.

"We’re getting the story of bird flu backward. The way that we farm animals in the U.S. and the world is amplifying costly and potentially deadly pathogens. Stopping this outbreak and preventing future outbreaks means reckoning with a troubling paradox: Food is essential for our health, but the conditions under which we create our food is making us and the animals around us sick."

Industrial animal farming involves overcrowding animals in cramped and unnatural conditions that jeopardize their health, a situation worsened by poor cleanliness (animals are often sitting in their own waste) and the fact that the animals are often genetically similar which makes them susceptible to the same pathogens.  These factors together create an environment like a petri dish in which the influenza virus can easily mutate and spread, and that spread isn't limited to just other birds- it can also spread to pigs and cows, allowing it to mutate further.  What is particularly dangerous about bird flu spreading to pigs is that their immune systems are similar to those of humans in such a way that when the virus mutates among pig populations it becomes more likely to be dangerous to humans.  There is reason to believe this may also be true of cows, but in cows there is the added risk that sick cows tend to be asymptomatic, so the infections are missed. This is basically a problem with the fundamental way that food animals are produced in the US and many other countries. 

 

The Global Impact of Pharmaceutical Profiteering and Corruption

The Meriam-Webster dictionary defines profiteering as "the act or activity of making an unreasonable profit on the sale of essential goods especially during times of emergency".  Profiteering by pharmaceutical companies has been an increasing problem worldwide for decades.  The fact that medical care is so often needed during times of crisis and emergency makes profiteering easy and commonplace.  This is also facilitated by changing power dynamics globally, providing more opportunities for pharmaceutical companies to exploit.    

Johnson and Johnson are trying to extend their patent for anti-tuberculosis medications that are needed to save millions of lives, but instead of letting the patent expire so that the drug can be made affordably enough to be available to the rest of the world, they are trying to falsely extend the patent to bolster their own profits.  Learn more about it here.

French company bungled clinical trial that led to a death and illness, report says "Why one man died and four others fell ill during a drug safety study in France last month is still very unclear. But a preliminary inspection report lashes out at Biotrial, the company that conducted the study, for how it responded after the first volunteer in the clinical trial was hospitalized. Three major errors by Biotrial put other volunteers at risk, says the report, published yesterday by France's General Inspectorate of Social Affairs (IGAS). Responding to the report, Touraine said that from now on any hospitalization during a clinical trial should be regarded as "new fact" that needs to be brought to the attention of health authorities immediately. Such events should "lead to an immediate suspension of the trial until the safety of volunteers is guaranteed," she said. "Volunteers must be clearly informed about the suspension of the study and its reasons."

Bill Gates Almost Single-Handedly Derailed the Plan That Could Have Led to a 'People's Vaccine'
"But the inspiring plan devised by the scientists—which promised to create a vaccine essentially belonging to the world's people, not to corporate shareholders—was crushed fairly decisively when Bill Gates ventured into the fray."

 "Among other things, the vaccine tragedy highlights the danger posed by the extreme concentration of wealth and power that Bill Gates represents. It turns out that his mega-philanthropy comes with a hitch: it enables Gates to develop extraordinary influence over crucial matters, such as whether or not the world's poor will have a chance to survive the pandemic."

 

How Bill Gates Impeded Global Access to Covid Vaccines: Through his hallowed foundation, the world’s de facto public health czar has been a stalwart defender of monopoly medicine.

The Corrupting Influence of Money in Medicine

The influence of money has wormed its way into all aspects of the American medical system- research, practice, access, the guidelines and advice patients are given about their health, and even how diagnostic criteria are determined.  This money represents the domination of a few pharmaceutical companies that have twisted and tweaked the entire system to serve their profit motive.  The effects of what is called regulatory and institutional capture by economists has had a devastating effect on the health of Americans.  It has also led to an unprecedented amount of wealth consolidation at record speed.

In Minnesota, the Mayo Clinic Sometimes Called the Shots With Gov. Tim Walz
Tim Walz has a very close relationship with The Mayo Clinic, to the point that he has allowed them to re-write legislation that was passed by the Minnesota legislature.  The Mayo Clinic has costs that are 88% higher than average in Minnesota adjusted for medical complexity of patients.  Mayo has consistently fought and eliminated efforts to reduce the cost of health care, often emphasizing internal strategies instead such as AI programs to handle staffing.  They were instrumental in killing any "public option" or single payer healthcare including regarding the ACA under Obama. 

Industry's Influence in Medicine: Duped, Doped and Dying in America
Gwen Olsen, a former pharmaceutical drug rep, tells about her experiences seeing pharma companies from the inside.  She says that the system is predatory and was intentionally set up to control us by doping us up and dumbing us down for profit.  

It finally happened: Goldman Sachs asks 'Is curing patients a sustainable business model?

Mother’s death sparks concern about hospital investment
Private equity firms have bought hospitals and extract all the wealth they can from them, leaving them unable to properly care for patients, which can be deadly.

The healthcare system is a giant SCAM (that you pay for)

The average yearly cost of health insurance in the US is $7 K.  The US spends more on healthcare than any other country, but the quality of care is the lowest among all wealthy nations.  Patients are over0charged by billions of dollars every year.  "A handful of companies have turned healthcare into a trillion dollar scam".  Profits are valued over human lives.  In Canada, one vial of insulin costs $30 but here in America the same vial costs $300, and the price for one specific AIDS drug in the US is $2 K while it costs only $8 in Australia.  From the New York Times-"Among those who reported problems paying their bills despite having insurance, 63% said they used up all or most of their savings; 42% took on an extra job or more work hours; 14% moved or took in roommates; and 11% turned to charity."  A study found that 66.5% of all bankruptcies were tied to medical issues, which is about 500 K families going into bankruptcy each year. The US is the only developed country that doesn't have universal health care.  Many poorer countries, including Pakistan, Iran, and Rwanda, provide free medical care to their people.  

 

Insurance companies have tried to say that they offer a valuable service because they negotiate prices down so much, but it turns out that they start with a very inflated price, so they aren't really saving you money.  Hospitals and other providers won't negotiate their prices down so much with individuals because they say they don't have representation.  Another way of saying this is that hospitals penalize people without insurance by adding a charge of several hundred percent on your medical bill.  You could say that hospitals and insurance companies collude in a mafia-like scheme, where hospitals enforce penalties if you don't pay insurance companies for protection.  The rate of c-sections in America is more than double the world average and this is largely due to c-sections being much more lucrative.  There are even hospitals that charge you if you want to hold your baby after birth as "skin to skin contact".  

Blackstone is one of the largest investing firms on earth, and owns the biggest medical staffing company in America, called TeamHealth.  It came out in a deposition that TeamHealth's prices were "higher than those of 95% of other providers and 8 or 9 times more than what medicare would pay", and that "the actual costs of medical services are not a factor in setting TeamHealth's prices".  So if you've ever wondered where all the money you pay for medical care goes, it goes to investors.  Almost every publicly traded hospital, medical, and pharma company is at least partially owned by either BlackRock or Vanguard.  These two companies have almost total control over the American health care system and use their influence to bring in huge returns while more and more Americans can't afford healthcare at all.

Pharmaceutical companies pay the most to lobby congress by far, which is twice as much as the next highest spender.  Life expectancy is dropping faster in America than anywhere else, and the maternal mortality rate is increasing.  Medical errors are the third leading cause of death in the country, 10% of all deaths each year.

The prices hospitals don't want you to see (NYT)   

How Profiteering and Corruption Harm Patients
A Place to Die’: For-Profit Health Care Crisis EXPOSED

Latest huge Big Pharma fraud settlement + shocking history of injury and death cover-ups

Drug Shortages Forcing Hard Decisions on Rationing Treatments
"In recent years, shortages of all sorts of drugs — anesthetics, painkillers,antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drug makers abandoning low-profit products. But while such shortages have periodically drawn attention, the 
rationing that results from them has been largely hidden from patients and the public."

Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds
"Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs.  The study estimates that medical bankruptcies affect about 2 million Americans annually -- counting debtors and their dependents, including about 700,000 children.  Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy."

The High Cost of Drugs and Treatment and Paying Doctors to Prescribe Drugs
Transparency in medicine Dr Wen 

Leana Wen: What your doctor won’t disclose
TED talk by a doctor about issues of trust in the doctor-patient relationship, doctors resisting transparency about themselves and how they practice (including disclosing payments and perks from pharmaceutical companies). 

Docs on Pharma Payroll Have Blemished Records, Limited Credentials
"The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia — billion-dollar blockbusters until dangerous side effects emerged."
"A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.  More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites.  Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies."

Lawsuits Say Pharma Illegally Paid Doctors to Push Their Drugs
"Pharma companies are being accused in lawsuits of paying doctors to push off-label uses of their drugs or financially rewarding doctors for prescribing their brand-name medications.  In the past three years alone, pharmaceutical companies have anteed up nearly $7 billion for settlements in cases such as one filed by Angela Maher, a former drug sales rep for Ortho-McNeil Pharmaceutical."

Despite improved transparency, conflicts of interest remain issue in medicine
“These conflicts undermine the reliability and credibility of the guidelines,” Nissen told Cardiology Today. “I don’t think that disclosure is the antidote here. The antidote is for physicians who are involved in public policy discussions not to accept money for promoting drugs.”

60 Minutes Episode Pharma execs used strip clubs, broke FDA laws to boost opioid sales

Forty-three percent of pediatricians receive industry payments "A significant proportion of pediatricians received payments from industry sources, such as pharmaceutical and device manufacturers, with the greatest amount of payments associated with attention-deficit/hyperactivity disorder treatments and vaccines, according to recent research in Pediatrics." 

Insulin should be cheap. Here’s why it's not

High Insulin Prices Drive Diabetics to Take Extreme Measures

Diabetics Are Hacking Their Own Insulin Pumps

Lawmakers grill Mylan CEO over EpiPen price hikes
"Jason Chaffetz (R-Utah), chairman of the House Committee on Oversight and Government Reform, held up an EpiPen to punctuate his point that epinephrine — “the juice” inside Mylan’s device — costs about $1 a dose. The list price of a two-pack of the pens is $608, up about 500 percent in a decade."

"You virtually have a monopoly, and you've used it to your advantage - but unfortunately, it's at the expense of people who need it," said Rep. Gerald E. Connolly (D-Va.). "I'm wondering what your sense of social responsibility is to those people."

FDA approves first generic version of EpiPen  The article discusses how the new generic version will help ease the chronic shortage of EpiPens that worsens near the end of the summer as kids need new prescriptions for school and other activities.  It also talks about how Mylan, the brand name version, actively fought the approval of the new generic
version out of self interest. 

Heather Bresch, the CEO of Mylan, testifies in front of congress about price gauging the epi pen 

Damning NEW Email Puts Joe Manchin’s Daughter At Center Of EpiPen Price-Fixing Scheme

Drug executives to testify before Congress about their role in U.S. opioid crisis "Current and former executives with the pharmaceutical distributors that are accused of flooding communities with powerful prescription painkillers have been summoned to testify before Congress about their role in the U.S. opioid epidemic."

"Since 2000, the epidemic has killed 200,000 people — more than three times the number of U.S. military deaths in the Vietnam War."

A Giant Pain in the Wallet
How an effort by the FDA to evaluate drugs that have been on the market since before testing was required has allowed pharmaceutical companies to price-gauge patients.

Pharmaceutical advertisements in leading medical journals: experts' assessments.
"In the opinion of the reviewers, many advertisements contained deficiencies in areas in which the FDA has established explicit standards of quality. New strategies are needed to ensure that advertisements comply with standards intended to promote proper use of the products and to protect the consumer."

Accuracy of pharmaceutical advertisements in medical journals.
"Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomized clinical trials published in reputable medical journals and seem to be evidence-based."

What if all US health care costs were transparent? | Jeanne Pinder
How drug companies make you buy more medicine than you need
This video talks about how pharmaceutical drugs are packaged and sold in ways that deliberately lead to waste, which creates costs that are then borne by the consumer.  For some drugs such as chemotherapy drugs these costs can be very high.  This issue is not something that the FDA regulates. This article by ProPublica goes into more detail about this topic.

Frequency and Magnitude of Co-payments Exceeding Prescription Drug Costs
"A co-payment suggests sharing the total cost between patients and payers. However, drug co-payments sometimes exceed costs, with the insurer or pharmacy benefit manager (PBM) keeping the difference. Furthermore, some pharmacists are contractually prevented from alerting patients when their co-payment exceeds the drug’s cash price. Although some have argued that the practice is uncommon, a 2016 survey of independent pharmacists indicates otherwise."

The case of the $629 Band-Aid — and what it reveals about American health care
We have all experienced the bizarrely high prices charged for many medical services and devices, and I think we can all relate to the parent who wrote this article about the absurdity of medical pricing. 

Pharma Influence over Practice and Patient Care
Leana Wen: What your doctor won’t disclose
TED talk by a doctor about issues of trust in the doctor-patient relationship, doctors resisting transparency about themselves and how they practice (including disclosing payments and perks from pharmaceutical companies).

Conflicts of interest pervade US treatment guidelines, reports say
"Financial conflicts of interest are widespread among the authors of US clinical practice guidelines, according to two research letters and an editor’s note that were published in JAMA Internal Medicine.  Such conflicts are “an intractable problem in the United States,” write Robert Steinbrook, editor at large of JAMA Internal Medicine, and Colette DeJong of the University of San Francisco."

US Physician Societies are completely Corrupted

Dollars for Docs- How Industry Dollars Reached Your Doctors

We Found Over 700 Doctors Who Were Paid More Than a Million Dollars by Drug and Medical Device Companies
"Each year from 2014 to 2018, drug and medical device companies spent between $2.1 billion and $2.2 billion paying doctors for speaking and consulting, as well as on meals, travel and gifts for them."

Docs on Pharma Payroll Have Blemished Records, Limited Credentials

Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds
"A ProPublica analysis has found for the first time that doctors who receive payments from the medical industry do indeed tend to prescribe drugs differently than their colleagues who don’t. And the more money they receive, on average, the more brand-name medications they prescribe."
"doctors who received industry payments were two to three times as likely to prescribe brand-name drugs at exceptionally high rates as others in their specialty."
"nearly nine in 10 cardiologists who wrote at least 1,000 prescriptions for Medicare patients received payments from a drug or device company in 2014, while seven in 10 internists and family practitioners did."

Matching Industry Payments to Medicare Prescribing Patterns: An Analysis
(this is mentioned in the above article)

Private equity ownership is killing people at nursing homes
"The researchers studied patients who stayed at a skilled nursing facility after an acute episode at a hospital, looking at deaths that fell within the 90-day period after they left the nursing home. They found that going to a private equity-owned nursing home increased mortality for patients by 10 percent against the overall average.  Or to put it another way: “This estimate implies about 20,150 Medicare lives lost due to [private equity] ownership of nursing homes during our sample period” of 12 years, the authors — Atul Gupta, Sabrina Howell, Constantine Yannelis, and Abhinav Gupta — wrote. That’s more than 1,000 deaths every year, on average."
This is the working paper behind this article:
DOES PRIVATE EQUITY INVESTMENT IN HEALTHCARE BENEFIT PATIENTS?  EVIDENCE FROM NURSING HOMES

Payments, Conflict of Interest, and Trustworthy Otolaryngology Clinical Practice Guidelines
"Clinical practice guidelines (CPGs) are the cornerstone of the evidence-based practice of otolaryngology–head and neck surgery. The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) CPGs are widely distributed, as judged by frequency of downloads, webpage views, and CPG-related sessions at national meetings. Clinical practice guidelines are developed to reduce variation in care and to improve quality. They create debate and even controversy, with concerns expressed about restraints on clinician decision making as well as the medicolegal implications of recommendations. Clinical practice guidelines must be trustworthy, and the Institute of Medicine (IOM) and the Guideline International Network have provided standards for CPGs.1 A major threat to the creation of trustworthy guidelines is conflict of interest (COI) among the organizations and the committee members who create CPGs.

Influence Over Regulation and Policy
Why HEALTHCARE works the way it does: Look at these SHOCKING lobbying numbers

Third member of prestigious FDA panel resigns over approval of Biogen’s Alzheimer’s drug
"A third member of a key Food and Drug Administration advisory panel has resigned over the agency’s controversial decision to approve Biogen’s new Alzheimer’s drug, Aduhelm, CNBC has learned."

 "Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said the agency’s decision on Biogen “was probably the worst drug approval decision in recent U.S. history,” according to his resignation letter obtained by CNBC."

Secret Clinical Trial Data to Go Public: Drug companies have begun to share their clinical trial data. The long-overdue shift heralds a new era in medicine (from Scientific American)
"How well does a prescription drug work? It can be hard for even doctors to know. Pharmaceutical companies frequently withhold the results of negative or inconclusive trials. Without a full accounting, a physician who wants to counsel a patient about whether a drug works better than a sugar pill is frequently at a loss. Drug companies share only airbrushed versions of data on safety and usefulness.

As a consequence, regulators can approve drugs that have hidden health hazards. Clinical trials of GlaxoSmithKline's diabetes drug Avandia (rosiglitazone) and Merck's anti-inflammatory Vioxx (rofecoxib) revealed an elevated cardiac risk from the drugs, but relevant findings were held back from regulators or never published.* Far more drugs have gone to market with critical safety data kept secret. These scandals have tarnished the reputation of the pharmaceutical industry."

Bill Gates Almost Single-Handedly Derailed the Plan That Could Have Led to a 'People's Vaccine'
"But the inspiring plan devised by the scientists—which promised to create a vaccine essentially belonging to the world's people, not to corporate shareholders—was crushed fairly decisively when Bill Gates ventured into the fray."

 "Among other things, the vaccine tragedy highlights the danger posed by the extreme concentration of wealth and power that Bill Gates represents. It turns out that his mega-philanthropy comes with a hitch: it enables Gates to develop extraordinary influence over crucial matters, such as whether or not the world's poor will have a chance to survive the pandemic." 

 

How Bill Gates Impeded Global Access to Covid Vaccines: Through his hallowed foundation, the world’s de facto public health czar has been a stalwart defender of monopoly medicine.

Money in Medical Research
The Corruption of Evidence Based Medicine — Killing for Profit
"This has huge implications. Evidence based medicine is completely worthless if the evidence base is false or corrupted. It’s like building a wooden house knowing the wood is termite infested. What caused this sorry state of affairs? Well, Dr. Relman another former editor in chief of the NEJM said this in 2002  “The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful”

The people in charge of the system — the editors of the most important medical journals in the world, gradually learn over a few decades that their life’s work is being slowly and steadily corrupted. Physicians and universities have allowed themselves to be bribed."

This Is The Sickening Amount Pharmaceutical Companies Pay Top Journal Editors

"The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research," said the late Arnold Relman, a former editor-in-chief of the New England Journal of Medicine (NEJM) in 2002. He passed away in 2014.

"The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it's disgraceful."

Undisclosed payments in research

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

"Industry payments to journal editors are common and often large, particularly for certain sub-specialties. Journals should consider the potential impact of such payments on public trust in published research."

Oncology trial authors don’t fully disclose financial conflicts of interests, analysis finds "A substantial proportion of US oncologists involved in clinical trials used to gain marketing authorization for cancer drugs do not fully disclose financial conflicts of interest when the trial is published, research in JAMA Oncology shows.  The analysis, published as a research letter,1 found that a of third of oncologist authors failed to completely disclose payments from the drug company sponsor of the trial when the trial was published."

Leading US cancer researcher failed to disclose industry ties in dozens of articles
"One of America’s most prominent breast cancer doctors failed to disclose pharmaceutical industry ties worth millions of dollars in authoring dozens of articles in major journals, according to a report by the New York Times and ProPublica.  José Baselga, physician-in-chief at Memorial Sloan Kettering Cancer Center in New York City, neglected to mention multiple directorships and consultancy fees when completing conflict of interest disclosure forms for leading publications including the New England Journal of Medicine and the Lancet, the report found.  Baselga also left out his industry payments when writing for Cancer Discovery, the journal of the American Association for Cancer Research (AACR), even though he was the joint editor-in-chief and president of the association."

Corruption and Profiteering in Medical Insurance and Medicare
Medicare Privatization Scheme Faced Legal Questions About Profiteering
"Diane Archer, founder of Just Care and a health policy expert, described a similar scenario in an email to The Intercept. “The way they make money is by spending as little as possible on patient care, while ensuring as best they can that they have all diagnoses possible for their enrollees in order to maximize government payments. The more diagnoses, the higher the government payments. Government payments are set upfront and unrelated to the cost or number of services people receive.

“And, yes, the incentive is to deny as much care as possible,” she continued, “it’s also to delay as much care as possible and to create administrative and financial barriers that make it hard for enrollees to get care"

 

Why I Left the Network
Extremely well done article about how insurance companies are avoiding coverage of mental health services, despite the ACA's requirement that they cover mental health services the same as they cover physical health services.  They create what are called "ghost networks", meaning that they will list providers who they know are deceased, retired, or not in their network in order to give the appearance that they have adequate coverage for services when in fact they don't.  They also keep reducing the amount that they reimburse providers, make it harder and harder for providers to get reimbursed, and challenge the legitimacy of provider's qualifications and treatments, all in an attempt to get providers to drop out of their network.  When they do drop out, their names are kept in the listings, and the companies find ways to make consumers work hard and take a long time to establish that care isn't available.

Health Insurance Whistleblower: Medicare Advantage Is "Heist" by Private Firms to Defraud the Public

The Reason Health Care Is So Expensive: Insurance Companies
"But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries."

"Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence."

CNN Exclusive: California launches investigation following stunning admission by Aetna medical director "California's insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients' records when deciding whether to approve or deny care."

Inside America’s ‘GoFundMe’ Health Crisis

Koch-backed study finds ‘Medicare for All’ would save U.S. trillions

Stability, Not Crisis: Medical Malpractice Claim Outcomes in Texas, 1988–2002

"Using a comprehensive database of closed claims maintained by the Texas Department of Insurance since 1988, this study provides evidence on a range of issues involving medical malpractice litigation, including claim frequency, payout frequency, payment amounts, defense costs, and jury verdicts. The data present a picture of stability in most respects and moderate change in others. We do not find evidence in claim outcomes of the medical malpractice insurance crisis that produced headlines over the last several years and led to legal reform in Texas and other states. Controlling for population growth, the number of large paid claims (over $25,000 in real 1988 dollars) was roughly constant from 1990–2002. The number of smaller paid claims declined. Controlling for inflation, payout per large paid claim increased over 1988–2002 by an estimated 0.1 percent (insignificant) to 0.5 percent (marginally significant) per year, depending on the data set we use. Jury awards increased by an estimated 2.5 percent (insignificant) to 3.6 percent (marginally significant) per year, depending on the data set, but actual payouts in tried cases showed little or no time trend. Real defense costs per large paid claim rose by 4.2–4.5 percent per year. Real total cost per large paid claim, including defense costs, rose by 0.8–1.2 percent per year."

 

Rampant Ethics Violations Undermine Credibility in Scientific and Clinical Research

Peer-reviewed published research is supposed to be the foundation for western medicine and evidence-based practice.  However, for quite some time now, one major scandal after another has shaken that foundation to the core- enough for the former editor of the BMJ to declare that published research cannot be trusted, and some other asshole to say that some types of research studies should be presumed to be false unless proven otherwise.  Needless to say, this calls into question much of clinical practice because it cannot be trusted that the evidence underlying that practice is sound.

for making informed choices in regards to medical care.  The process by which studies are carried out, interpreted, published and ultimately assimilated into clinical practice is assumed by many to be a relatively straight-forward scientific endeavor that can be trusted.  However, many people within the system have raised concerns about how this process actually functions.  These concerns range from problems in designing the studies themselves, problems with funding sources influencing the outcomes of studies, journals selectively publishing studies that support the pharmaceutical companies whose advertisements fund their journals, and outright corruption and falsification of research. 

PubPeer is a website where researchers can post about their concerns about published research, a sort of informal peer review. 

An Alarming Number of Clinical Trials Are Greenlit Based on Shockingly Poor Data
"Such pre-clinical data tends to include the results of animal trials that demonstrate the potential efficacy and risks of a potential medical treatment.  Among the 109 investigator brochures there were 708 efficacy studies that used animal models.  Surprisingly, nearly 9 out of 10 studies had no reference to a published report, making it hard to know whether the study would even pass peer review.  What was particularly alarming was the relative absence of details on methodology – 95 percent of the studies contained no mention of processes used to avoid the pitfalls of bias."

This is the research that is being discussed here
Preclinical efficacy studies in investigator brochures: Do they enable risk–benefit assessment?

Study questions animal data underlying many clinical trials
"So-called investigator brochures—the documents that researchers produce to convince regulatory agencies and ethical review boards that a proposed trial is worth the risk—are often lacking crucial information about the efficacy of the proposed therapy in animal models. As a result, it’s often impossible to tell how good the evidence is.

“This is incredibly alarming,” says Shai Silberberg, director of research quality at the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland, who was not involved in the study. The work "shows that decision-makers for ethics related to clinical trials don't get the information they really need to evaluate those preclinical trials.”

Most animal research studies may not avoid key biases

"Researchers who conduct animal studies often don't use simple safeguards against biases that have become standard in human clinical trials—or at least they don't report doing so in their scientific papers, making it impossible for readers to ascertain the quality of the work, an analysis of more than 2500 journal articles shows. Such biases, conscious or unconscious, can make candidate medical treatments look better than they actually are, the authors of the analysis warn, and lead to eye-catching results that can't be replicated in larger or more rigorous animal studies—or in human trials."

Need for Racial and Ethnic Diversity in Asthma Precision Medicine 
This editorial basically says that while asthma is the most racially disparate disease in children, studies into treatments do not reflect this and so place children of ethnic minorities in more danger.
"Asthma is the most common chronic respiratory disease in children and the most racially and ethnically disparate of all health conditions. In the United States, the lifetime prevalence of childhood asthma is highest among Puerto Ricans (23.6%), intermediate among Blacks (18.1%), and lowest among Whites (9.5%) and Mexican Americans (9.6%). Severe and poorly controlled asthma disproportionately affects Black children, and asthma mortality is four times as high among Puerto Ricans and Blacks as among Whites. And perhaps most worrisome, U.S. children with the highest asthma prevalence and death rate have the poorest drug response."

Enhanced funding of pharmacoepidemiology through patenting the disclosure of adverse event information.

Pharmacoepidemiol Drug Saf. 2006 Jun;15(6):390-3
"Known drug adverse events have been estimated to be between the 4th and 6th leading cause of death in the US (1). There are currently insufficient funds to perform the quantity and quality of studies necessary to ensure all drug adverse events are discovered in a timely fashion."

Why Scientific Studies Are So Often Wrong: The Streetlight Effect
This article that appeared in Discover Magazine explores many of the problems that arise in designing clinical trials, even when the researchers have the best of intentions. There can be problems recruiting enough appropriate participants, there are often limited ways that researchers can measure the variables and outcomes that they are looking at, many questions- such as the long-term safety of a medication- would require more time to investigate properly than research allows, so proxy indicators are used that can turn out to be very wrong. Sometimes the results of studies are generalized too broadly. Examples of some of these problems include;

"The streetlight effect is just one way that research measurements go wrong, and measurement mess-ups are just one of several ways that studies go wrong. Bad measurements are not even the biggest source of wrongness in scientific studies. That honor would have to go to “publication bias”—journals’ tendency to eagerly publish the small percentage of studies that produce exciting, surprising, breakthrough results. Of course, the most likely explanation for why one team of researchers comes up with surprising results while several other teams get less-publishable, boring results is that the one team screwed up somewhere. The pernicious effect of this phenomenon on the trustworthiness of study results has been documented at length in scientific journals themselves in several fields."

"Studies in the 1990s appeared to prove that hormone replacement therapy reduced the risk of heart disease by 50 percent. Then in 2002 a large study seemed to prove that the therapy increased the risk of heart disease by 29 percent. It turns out that a woman’s age affects her response to hormone replacement therapy, and the discrepancy arose because the first study looked at somewhat younger women than did the second. The data in both studies were credible; they just did not apply to all women."

"Yet another problem is that much of what scientists think they know about human health comes from animal studies. Unfortunately, three-quarters of the drugs that prove safe and effective in animals end up failing in early human trials, sometimes spectacularly. In 2006 the experimental leukemia drug TGN1412 was given to six volunteer human patients. All six of them quickly fell seriously ill with multiple organ trauma, even though the stuff had worked well on rabbits and monkeys at doses up to 500 times as large."

The Deadly Corruption of Clinical Trials

This is a very long but very worthwhile read written by a professor of medical ethics.  It discusses a particular case in which a man died as part of a clinical trial for atypical anti psychotic drugs, but it also goes into great detail about the system of clinical trials and drug research.

"The cleverest manipulation has been with the clinical trials themselves. For years, critics have charged that pharmaceutical companies massage trials to make their own drugs look better than they really are. One common tactic is to suppress unfavorable data. A notorious example came in the 1990s, when a Wyeth safety officer overwrote the company's computer files, erasing evidence indicating that its diet drug, fen-phen, caused valvular heart disease. A less risky strategy is simply not to publish potentially damaging trials. In 2004, the Canadian Medical Association Journal described a leaked document indicating that GlaxoSmithKline had deliberately hidden two studies from regulators showing that its antidepressant, Paxil (paroxetine), could increase the risk of suicide in children. "

"A 2006 study in The American Journal of Psychiatry, which looked at 32 head-to-head trials of atypicals, found that 90 percent of them came out positively for whichever company had designed and financed the trial. This startling result was not a matter of selective publication. The companies had simply designed the studies in a way that virtually ensured their own drugs would come out ahead—for instance, by dosing the competing drugs too low to be effective, or so high that they would produce damaging side effects. Much of this manipulation came from biased statistical analyses and rigged trial designs of such complexity that outside reviewers were unable to spot them. As Dr. Richard Smith, the former editor of the British Medical Journal, has pointed out, "The companies seem to get the results they want not by fiddling the results, which would be far too crude and possibly detectable by peer review, but rather by asking the 'right' questions."

Deadly Medicine

"Prescription drugs kill some 200,000 Americans every year. Will that number go up, now that most clinical trials are conducted overseas—on sick Russians, homeless Poles, and slum-dwelling Chinese—in places where regulation is virtually nonexistent, the F.D.A. doesn’t reach, and “mistakes” can end up in pauper’s graves? The authors investigate the globalization of the pharmaceutical industry, and the U.S. Government’s failure to rein in a lethal profit machine."

Shocking Report from Medical Insiders
"A shocking admission by the editor of the world’s most respected medical journal, The Lancet, has been virtually ignored by the mainstream media. Dr. Richard Horton, Editor-in-chief of the Lancet recently published a statement declaring that a shocking amount of published research is unreliable at best, if not completely false, as in, fraudulent.

Horton declared, “Much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”

To state the point in other words, Horton states bluntly that major pharmaceutical companies falsify or manipulate tests on the health, safety and effectiveness of their various drugs by taking samples too small to be statistically meaningful or hiring test labs or scientists where the lab or scientist has blatant conflicts of interest such as pleasing the drug company to get further grants. At least half of all such tests are worthless or worse he claims. As the drugs have a major effect on the health of millions of consumers, the manipulation amounts to criminal dereliction and malfeasance.

The drug industry-sponsored studies Horton refers to develop commercial drugs or vaccines to supposedly help people, used to train medical staff, to educate medical students and more."

NEJM editor: “No longer possible to believe much of clinical research published”
"Harvard Medical School’s Dr. Marcia Angell is the author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It. But more to the point, she’s also the former Editor-in-Chief at the New England Journal of Medicine, arguably one of the most respected medical journals on earth. But after reading her article in the New York Review of Books called Drug Companies & Doctors: A Story of Corruption, one wonders if any medical journal on earth is worth anybody’s respect anymore.

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

 

Gamers Versus Scientists - Superior Accountability 

 

AI reveals huge amounts of fraud in medical research | DW News 

 

Blots on a field?  A neuroscience image sleuth finds signs of fabrication in scores of Alzheimer’s articles, threatening a reigning theory of the disease
A medical researcher investigates the research that underlies "the dominant yet controversial amyloid hypothesis of Alzheimer’s, which holds that Aβ clumps, known as plaques, in brain tissue are a primary cause of the devastating illness" and finds what he calls "red flags" that look like image and data tampering.  Matthew Schrag, the medical researcher in question, shared his findings that "implies millions of federal dollars may have been misspent on the research—and much more on related efforts. Some Alzheimer’s experts now suspect Lesné’s studies have misdirected Alzheimer’s research for 16 years."

Schrag's investigation of the research "cast doubt on hundreds of images, including more than 70 in Lesné’s papers. Some look like “shockingly blatant” examples of image tampering, says Donna Wilcock, an Alzheimer’s expert at the University of Kentucky.  The authors “appeared to have composed figures by piecing together parts of photos from different experiments,” says Elisabeth Bik, a molecular biologist and well-known forensic image consultant. “The obtained experimental results might not have been the desired results, and that data might have been changed to … better fit a hypothesis.”
 

NIH launches initiative to double check biomedical studies
The NIH is offering lead researchers the opportunity to have their biomedical experiments rrepeated to ensure that they are replicatable and valid, but few researchers are accepting the offer.

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

"Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research."

Lies, Damned Lies, and Medical Science
"Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science."

Corrupting Science – Hayes, Syngenta and Atrazine
This article presents information that the chemical company Syngenta has been using unethical, illegal, and aggressive methods (including intimidation and threats) to try to discredit a scientist who has raised important questions about the herbicide Atrazine made by this company.  Below is the article mentioned in this one with more information about the situation.

A VALUABLE REPUTATION After Tyrone Hayes said that a chemical was harmful, its maker pursued him.

Why Almost Everything You Hear About Medicine Is Wrong

Newsweek 1/23/11
"But what if wrong answers aren’t the exception but the rule? More and more scholars who scrutinize health research are now making that claim. It isn’t just an individual study here and there that’s flawed, they charge. Instead, the very framework of medical investigation may be off-kilter, leading time and again to findings that are at best unproved and at worst dangerously wrong. The result is a system that leads patients and physicians astray—spurring often costly regimens that won’t help and may even harm you.

It’s a disturbing view, with huge implications for doctors, policymakers, and health-conscious consumers. And one of its foremost advocates, Dr. John P.A. Ioannidis, has just ascended to a new, prominent platform after years of crusading against the baseless health and medical claims. As the new chief of Stanford University’s Prevention Research Center, Ioannidis is cementing his role as one of medicine’s top mythbusters. “People are being hurt and even dying” because of false medical claims, he says: not quackery, but errors in medical research."

Study: Elite scientists can hold back science
"All of this is another example of how progress in science is confounded by human behavior. We see this in so many ways. Scientists lie about results. Or they discount insights derived from failures. Science is so obsessed with the rewards of solving complicated problems that it forgets about the simple ones. The field overwhelmingly is biased toward males (experiments have shown "John" gets more accolades than "Jennifer" with the identical résumé).

It's worth remembering: Science may be a noble discipline based on cold logic and rational observation; but humans are animals fueled by emotion and bias. As the NBER researchers conclude: "[T]he idiosyncratic stances of individual scientists can do much to alter, or at least delay, the course of scientific advance."

Drug research routinely suppressed, study authors find
By John Fauber of the Journal Sentinel
"Drug research, even from clinical trials sponsored by the federal government, routinely is suppressed, harming patients and increasing health care costs, according to new data highlighting an ethical controversy that continues to plague the field of medicine."

Medical Studies Involving Children Often Go Unpublished
NPR August 4, 2016
"The report, reviewing clinical trials started in 2008-10, finds that 19 percent of the studies that recruited children didn't run to completion. That was often because researchers weren't able to recruit as many volunteers as they needed to run the experiments. And of the 455 trials that were completed, the results from 30 percent weren't published.

The harm is we end up with scientific literature that only shows all the things that do work," she said. "It may falsely appear that certain interventions do work. So our literature may become biased and may not be representative of the true efficacy or safety of an intervention.

Ross considers this an ethical lapse. "When you do a clinical study and you're asking patients to participate and subject themselves to a risk, in order to inform science and generate knowledge, you have an ethical obligation to disseminate those results to the wider scientific community," he said."

Publication of NIH funded trials registered in ClinicalTrials.gov: cross sectional analysis.
BMJ. 2012 Jan 3;344:d7292.
"Despite recent improvement in timely publication, fewer than half of trials funded by NIH are published in a peer reviewed biomedical journal indexed by Medline within 30 months of trial completion. Moreover, after a median of 51 months after trial completion, a third of trials remained unpublished."

Research Misconduct Identified by the US Food and Drug Administration
Out of Sight, Out of Mind, Out of the Peer-Reviewed Literature
JAMA Intern Med. Published online February 09, 2015
"Every year, the US Food and Drug Administration (FDA) inspects several hundred clinical sites performing biomedical research on human participants and occasionally finds evidence of substantial departures from good clinical practice and research misconduct. However, the FDA has no systematic method of communicating these findings to the scientific community, leaving open the possibility that research misconduct detected by a government agency goes unremarked in the peer-reviewed literature.

Fifty-seven published clinical trials were identified for which an FDA inspection of a trial site had found significant evidence of 1 or more of the following problems: falsification or submission of false information, 22 trials (39%); problems with adverse events reporting, 14 trials (25%); protocol violations, 42 trials (74%); inadequate or inaccurate recordkeeping, 35 trials (61%); failure to protect the safety of patients and/or issues with oversight or informed consent, 30 trials (53%); and violations not otherwise categorized, 20 trials (35%). Only 3 of the 78 publications (4%) that resulted from trials in which the FDA found significant violations mentioned the objectionable conditions or practices found during the inspection. No corrections, retractions, expressions of concern, or other comments acknowledging the key issues identified by the inspection were subsequently published.

When the FDA finds significant departures from good clinical practice, those findings are seldom reflected in the peer-reviewed literature, even when there is evidence of data fabrication or other forms of research misconduct."

This Reuters article has more discussion about this study.

Harvard Scientists warn about Epidemic of Side Effects due to Corruption
"A recent study about institutional corruption of pharmaceuticals and the myth of safe and effective drugs, warns that over the past 35 years, patients have suffered from a largely hidden epidemic of side effects from drugs that usually have few, offsetting benefits.

The study, published in the Journal of Law, Medicine and Ethics,* conducted by Light, Lexchin and Darrow, warns that the pharmaceutical industry has corrupted the practice of medicine through its influence over what drugs are developed, how they are tested, and how medical knowledge is created."

Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies
PLoS Med 2(5): e138. 
“Journals have devolved into information laundering operations for the pharmaceutical industry”, wrote Richard Horton, editor of the Lancet, in March 2004. In the same year, Marcia Angell, former editor of the New England Journal of Medicine, lambasted the industry for becoming “primarily a marketing machine” and co-opting “every institution that might stand in its way”. Medical journals were conspicuously absent from her list of co-opted institutions, but she and Horton are not the only editors who have become increasingly queasy about the power and influence of the industry. Jerry Kassirer, another former editor of the New England Journal of Medicine, argues that the industry has deflected the moral compasses of many physicians, and the editors of PLoS Medicine have declared that they will not become “part of the cycle of dependency…between journals and the pharmaceutical industry."

A Medical Madoff: Anesthesiologist Faked Data in 21 Studies
Article appeared in Scientific American in March 10, 2009
"Over the past 12 years, anesthesiologist Scott Reuben revolutionized the way physicians provide pain relief to patients undergoing orthopedic surgery for everything from torn ligaments to worn-out hips. Now, the profession is in shambles after an investigation revealed that at least 21 of Reuben's papers were pure fiction, and that the pain drugs he touted in them may have slowed postoperative healing.

"We are talking about millions of patients worldwide, where postoperative pain management has been affected by the research findings of Dr. Reuben," says Steven Shafer, editor in chief of the journal Anesthesia & Analgesia, which published 10 of Reuben's fraudulent papers."

FDA official: “clinical trial system is broken”
BMJ 2013;347:f6980"The clinical trial system is broken and it’s getting worse, according to longstanding Food and Drug Administration investigator, Thomas Marciniak."

“Drug companies have turned into marketing machines. They’ve kind of lost sight of the fact that they’re actually doing something which involves your health,” Marciniak says. “You’ve got to take away the key components of the trials from drug companies.”

What's in Placebos: Who Knows? Analysis of Randomized, Controlled Trials
Ann Intern Med. 2010;153(8):532-535.
"Placebos were seldom described in randomized, controlled trials of pills or capsules. Because the nature of the placebo can influence trial outcomes, placebo formulation should be disclosed in reports of placebo-controlled trials."

Major publisher retracts 64 scientific papers in fake peer review outbreak
"Made-up identities assigned to fake e-mail addresses. Real identities stolen for fraudulent reviews. Study authors who write glowing reviews of their own research, then pass them off as an independent report. These are the tactics of peer review manipulators, an apparently growing problem in the world of academic publishing.

Peer review is supposed to be the pride of the rigorous academic publishing process. Journals get every paper reviewed and approved by experts in the field, ensuring that problematic research doesn’t make it to print.

But increasingly journals are finding out that those supposedly authoritative checks are being rigged.

In the latest episode of the fake peer review phenomenon, one of the world’s largest academic publishers, Springer, has retracted 64 articles from 10 of its journals after discovering that their reviews were linked to fake e-mail addresses. The announcement comes nine months after 43 studies were retracted by BioMed Central (one of Springer's imprints) for the same reason.

The blog Retraction Watch, which monitors and reports on retractions for fraud, plagiarism and other dubious practices in the academic publishing industry, says this latest announcement brings the tally of papers withdrawn for faked reviews up to 230 in the past three years. Those papers make up only a fraction of the hundreds of thousands of studies published each year, but they have the publishing world concerned."

The Peer Review Scam
Nature 515, 480–482(27 November 2014)
"In the past 2 years, journals have been forced to retract more than 110 papers in at least 6 instances of peer-review rigging. What all these cases had in common was that researchers exploited vulnerabilities in the publishers' computerized systems to dupe editors into accepting manuscripts, often by doing their own reviews. The cases involved publishing behemoths Elsevier, Springer, Taylor & Francis, SAGE and Wiley, as well as Informa"

Inappropriate manipulation of peer review
"In November last year, BioMed Central uncovered evidence of repeated and inappropriate attempts to manipulate the peer review process of several journals (see our original statement and update).

The apparent intention was to deceive Editors and positively influence the outcome of peer review by suggesting fabricated reviewers. Given the scale of the deception, we alerted COPE (the Committee on Publication Ethics) and a number of other publishers. COPE issued a statement providing further advice for publishers. PLOS also recently issued a statement here.

Although we originally found only a handful of affected published articles, a subsequent extensive and systematic search of all of our journals identified 43 articles that were published on the basis of reviews from fabricated reviewers."

Former Harvard professor Marc Hauser fabricated, manipulated data, US says
"Marc Hauser, a prolific scientist and popular psychology professor who last summer resigned from Harvard University, had fabricated data, manipulated results in multiple experiments, and described how studies were conducted in factually incorrect ways, according to the findings of a federal research oversight agency posted online Wednesday."

 

Harvard Fake Data Scandal - HUGE NEW DEVELOPMENT
More evidence against Harvard professor Francesca Gino regarding the falsification of data in her studies.

Prescription for a Healthy Journal
PLoS Med 1(1): e22.

"We have decided not to be part of the cycle of dependency that has formed between journals and the pharmaceutical industry, an industry that focuses overwhelmingly on the most profitable drugs, thus sidelining many of the world's health problems. Medical journals have allowed their interests to become aligned with those of the pharmaceutical industry by printing advertisements for drugs, publishing trials designed by drug companies' marketing departments, and making profits on reprints used as marketing tools. PLoS Medicine will not accept advertisements for pharmaceutical products or medical devices. Our open-access license allows free distribution of articles, so PLoS cannot benefit from exclusive reprint sales. And we consider as the lowest priority for publication papers that are simply aimed at increasing a drug's market share without obvious benefit to patients."

Pharmaceutical industry sponsorship and research outcome and quality: systematic review
BMJ 2003;326:1167
"Systematic bias favours products which are made by the company funding the research. Explanations include the selection of an inappropriate comparator to the product being investigated and publication bias."

Outcome reporting among drug trials registered in ClinicalTrials.gov.

"In this sample of registered drug trials, those funded by industry were less likely to be published within 2 years of study completion and were more likely to report positive outcomes than were trials funded by other sources."

A study of manufacturer-supported trials of nonsteroidal anti-inflammatory drugs in the treatment of arthritis
Arch Intern Med. 1994 Jan 24;154(2):157-63."The manufacturer-associated NSAID is almost always reported as being equal or superior in efficacy and toxicity to the comparison drug. These claims of superiority, especially in regard to side effect profiles, are often not supported by trial data. These data raise concerns about selective publication or biased interpretation of results in manufacturer-associated trials."

Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials.
CMAJ. 2004 Feb 17;170(4):477-80."Industry-funded trials are more likely to be associated with statistically significant pro-industry findings, both in medical trials and surgical interventions."

HARLOT plc: an amalgamation of the world's two oldest professions
BMJ. 2003 Dec 20; 327(7429): 1442–1445.
This is a tongue-in-cheek discussion of how the process of clinical trials and publication can be misused and manipulated to promote certain outcomes.

"Through a series of blind, wholly owned subsidiaries, we can guarantee positive results for the manufacturers of dodgy drugs and devices who are seeking to increase their market shares, for health professional guilds who want to increase the demand for their unnecessary diagnostic and therapeutic services, and for local and national health departments who are seeking to implement irrational and self serving health policies."

Why Most Published Research Findings Are False
"There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research."

Essay of the Day: David Graeber on the degradation of research
This is an essay on the changing climate of research in the US and some other countries that began in the second half of the twentieth century, and how is has limited and undermined the development of radically new discoveries. While the author is speaking on research in general, including the social sciences and hard sciences such as physics, his observations apply just as much (if not more) to medical research. He makes the case that the way the system is set up, the incentives and demands that researchers face, makes it nearly impossible for new ways of doing things to be developed that are a radical departure from the current norms. This is not because funding has decreased, it has increased significantly, but has more to do with the encroachment of corporate styles of management and organization into the ways that research is conducted and funded.