Category Archives: medicolegal

Lance Armstrong – Cheat, Liar & Cancer Survivor

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Confession on TV..the body language speaks volumes

A serial cheat and liar he may be after his confession on the Oprah Winfrey show, but there’s no denying he’s a cancer survivor. In this blog entry, I would like to elaborate on what he suffered from – cancer of the testes with spread to the brain and lungs – and the chances of survival in patients with this condition.

In  October 1996, after delaying seeing a doctor and after his testes had swollen up to three times the normal size( he was also coughing up blood), he finally sought a medical consultation which confirmed that he had advanced stage three testicular cancer, of the subtype embryonal carcinoma. Worse, the cancer had already spread to the lungs and brain. Immediate surgery was done to remove the diseased testicle as well as the satellite tumors in the brain. Subsequently,  chemotherapy, an essential part of the two-step treatment, was planned.

Here, instead of the standard chemotherapeutic regimen (the BEP regime), he opted for one (the VIP regime) which did not contain the drug bleomycin, which has toxic effects on the lungs and would probably have meant that his cycling career would have been finished. The course of chemotherapy finished in December 1996, and in February 1997, he was declared cancer-free, which he apparently remains to this day.

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An interesting fact to note is that, prior to the surgery, he had already won two Tour de France titles. Following the cancer treatment, he was recruited by US Postals, resumed training, and was able to win the Tour de France every year from 1999 till 2005, when he officially retired.

Quite an amazing feat, even if it was tainted by the use of performance-enhancing substances. I would be hesitant to call them drugs, as the alleged substances involved (EPO, testosterone , human growth hormone, corticosteriods and blood transfusions) are all part of normal body constituents.

So, is what Armstrong the cancer survivor experiencing  something out of the ordinary? Unknown to many, testicular cancer has one of the testeshighest cure rates of all cancers –  in excess of 90 percent overall; almost 100 percent if it has not spread elsewhere. Even if the cancer had spread widely, as in Armstrong’s case, the cure rate is over 80% following chemotherapy. Indeed, it is the most common form of cancer in males aged 20-39 years.

 

Pediatrician Guilty of Child Abuse

What happens when an internationally renowned child specialist working in one of the world’s best children’s hospitals is found guilty of sexually abusing young boys? The news barely made it  into most of the world’s mass media 2 weeks ago..read on.

Phillipp Bonhoeffer..found guilty of sexual child abuse

Prof Philipp Bonhoeffer, former head of cardiology at the Great Ormond Street Hospital for Children, London until 2010, was found guilty by a panel of the Medical Practitioners Tribunal Service on 21st September 2012 of sexually molesting young boys in France and Kenya. Read the full details here.

In a subseqent meeting of the Panel a few days later, it ruled that Prof Bonhoeffer’s fitness to practise was impaired by reason of misconduct and decided to erase him from the  General Medical Council register, thereby barring him from practising as a doctor in the UK.

The punishment appears appropriate but some isuues need to be highlighted:

-Why did it take so long for the Panel to formalise the charges when the first reported abuse was as early as 1995?

-Was there any element of cover-up by peers or the hospital in an attempt to save face?

-Being struck off the GMC Register in the UK merely means being barred from working in that country. He is still able to practise in Belgium (where he hails from) as well as the Continent.

This case highlights once again that professionals,  being placed in a privileged position as a member of the medical profession, are entrusted with certain reponsibilities for which they are beholden to uphold. When this trust is abused, mechanisms must be in place to protect this trust. The question is, are these mechanisms adequate?

The Best and Worst Doctors of 2011,part 2

Took me some time to compile this list, so here goes:

The Best Doctors

1.Drs Beutler, Hoffman and Steinman

These three were the winners of the 2011 Nobel Prize in Medicine and the impact of their research will be felt for many years to come.

In essence, they discovered receptor proteins in the body that can spot bacteria and other microorganisms and then activate the body’s innate immunity to defend itself. These dendritic cells activate the T cells which then produce antibodies which attack the invading germs.

Their studies determine  how clinicians prevent and treat infection, inflammatory diseases, and cancer in the future. Strangely enough, one of them, Dr Steinman (right,above pic) himself died of cancer of the pancreas before he won the award. This disease was one of the potential beneficiaries of his research.

2. Dr Valentin Fuster

This Spanish cardiologist, who is the Head of Mount Sinai Heart Centre in New York, is the only person to be awarded the top research awards from all the four main cardiovascular organisations.

He is best known for his profound contribution towards the understanding and prevention of atherothrombosis and was the first to have highlighted the role of platelets in acute coronary syndromes. In other words, how heart attacks happen-see below.

Dr Mark Kris

Lung cancer specialist at one of the top cancer centres in the world, Memorial Sloan-Kettering in Houston,Texas, he was recognised for his  dedication and compassion in his professional work and volunteer efforts by being awarded the inaugural ASCO Humanitarian Award .

He has built homes for families in Hyde Park, New York,  gone to Costa Rica to build a basketball court and a church and made several trips to assist with earthquake relief in Haiti; and helped with relief efforts in Biloxi, Mississippi  after it was hit byHurricane Katrina.

Of course, to the unsung heroes out there,those who have toiled without bells and whistles, well done for being a credit to your profession!

 

The Best and Worst Doctors of 2011,part 1

Couldn’t help recalling that last year, quite a number of physicians made the headlines..so here’s my list of the Dr Jekylls and Dr Hydes of 2011.

The Worst Doctors

1. Conrad Murray,MD

Physician to the King of Pop.. in November he was sentenced to 4 years in jail for his conviction on a charge of involuntary manslaughter in the pop star’s death. There wasn’t much substance in his defence once he admitted to using propafol injected intravenously into Michael Jackson’s veins so as to enable him to sleep at home. What was worse was that this drug is normally used in a hospital setting with the patient hooked on close monitors; using it otherwise (at home) constitutes negligence and inappropriate use.

2. Gerald J Klein, MD

Gerald who? Well, he was one of 14 Florida doctors indicted in August 2011 for illegally distributing opioid analgesics such as oxycodone and sedatives like Xanax. Drug addicts and dealers would queue in their clinics to sell or receive drugs illegally under the pretext of valid medical reasons. Opioid analgesics were dispensed and prescribed on an assembly line basis,  paid for with cash and credit cards. Clinic employees hauled their money to the bank in large garbage bags. This way, each doctor netted USD 1 million yearly. “Drug dealers in white coats”, said the FBI.Read more here.

Dr Gerald Klein..described as a drug dealer in a white coat

3. John R McLean,MD and others

The Maryland cardiologist was convicted on 6 charges of healthcare fraud relating to insurance claims that he had filed for doing unnecessary coronary angiograms and angioplasties (invasive test and treatment of blocked heart arteries), as well as for ordering unnecessary tests and making false entries in patient medical records. In November, Dr. McLean was sentenced to 8 years in jail.

The buck does not stop here in Maryland – already two other cases are being heard (see here and here) of similar cases where cardiologists have done unnecessary procedures on otherwise well patients, in return for unethical financial rewards.

In the next blog entry, I will name the best doctors of 2011.

Michael Jackson Trial: The Verdict Could Only Go One Way

Efficient Justice - a police guard fastens the handcuffs soon after the verdict is read

The verdict’s in..and the stifled shriek heard in the courtroom when the jury foreman announced it appeared more of a confirmation of the expected, rather than a well-earned heavily-fought court battle.

Indeed, the alibis created by the Dr Conrad Murray‘s defence lawyers that MJ had drunk the propofol (which was eventually dropped) and  that he had self-administered the injection with the intention that the singer could be partially blamed for his death smacked very much of desperation than anything else.

It seemed clear to the jury that propofol, a drug that needs to be administered intravenously, was beyond MJ’s state of mind and ability, especially since  he had already popped in a myriad of sleeping pills earlier. Therefore, the drug had to be administered by the attending doctor. Therein lay the catch – propofol, as an anaesthetic, is only administered with continuous monitoring in a hospital setting, with emergency resuscitation equipment on standby and various devices monitoring the patient’s bodily functions.

The jury was sensationally shown this image of Jackson's dead body by the prosecution early on in Murray's trial (Reuters)

Under California’s tough involuntary manslaughter statute, it is not enough for the defence  to demonstrate that MJ had contributed to his death as a result of his drug addiction; Dr Murray should have forseen, as his attending doctor, that MJ was a drug addict, and hence should have forewarned the victim.

Given this tough standard, there was not much chance of Dr Murray escaping the inevitable conclusion..

Licence to Practise…And Be Sued

Here’s some sobering news for doctors and those who aspire to be one. If you are a neurosurgeon or a heart surgeon, you’re going to face a malpractice claim at least once by the time you reach 65. Coming from the New England Journal of Medicine study published recently, even if you’re a doctor in a low-risk speciality eg  GP or skin specialist, the chances of being taken to court by age 65 is still high, at 75%.

Brain and Heart Surgeons Top the List of Those Being Sued (courtesy NEJM)

I’m not surprised at all..what with more well-informed patients, an egalitarian society, litigation-conscious families and the ever-present doubt on the quality of medical education..one can only expect malpractice claims to rise.

Medical students in particular should take note of this trend. Medical schools need to also address this issue in their curriculum. As it is well-known that, even after an untoward event, whether the patient decides to sue is largely dependent on effective doctor-patient communication – medical schools would do well to introduce communication skill as an integral part of a medical course.

Good patient-doctor communication can make the difference in whether a malpractice claim surfaces

A good doctor is more than just being adept at diagnosing and treating diseases – they have to be skilled at managing information and communicating with their patients.

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