Monday, October 17, 2011

Dr. Conrad Murray and Dr. Joachim Boldt have likely never met. One is a disgraced cardiologist who is on trial for the death of a music superstar and the other is a disgraced researcher who may have forged his data and whose many publications have been retracted. Separate worlds, separate circumstances but together become a reminder of some of the problems facing medicine today. Integrity and trust are the building blocks of the doctor-patient relationship and the actions of these two have undermined both.

Dr. Murray may be found innocent of the charges that his injecting propofol killed Michael Jackson, but every physician, intern, medical student and every nurse knows that what he did was wrong, negligent and likely unethical. Propofol is a general anesthetic that is under tight control in most hospitals, requiring specialized skills and equipment to administer and monitor. Dr. Murray did not have the training or the monitoring and rescue equipment when he chose to use the drug in an inappropriate setting.

Dr. Boldt is, that is was, a world respected anesthesiologist and researcher in Germany who published many studies on the use of fluids to resuscitate patients in shock. At last count, 88 of his papers published in major medical journals around the world, have been retracted because it seems that Dr. Boldt made up the data and faked his results and conclusions. Who knows how many patients’ care was affected by those false conclusions. Dr. Marcia Angell, the former editor of the New England Journal of Medicine, wrote in 2009 that “it is simply no longer possible to believe much of the clinical research that is published.”(Angell M. Drug companies and doctors: a story of corruption. New York Book of Reviews 15Jan09).

Patients give permission to doctors and allow them to invade their lives and their bodies. They do so presuming that the doctor has their best interest and intentions. The doctor has a duty to respect the wishes and boundaries set by the patient, but the doctor is not a servant to obey all wishes and commands. Dr. Murray is ethically bankrupt when he suggests that other physicians had already begun the propofol treatment for Mr. Jackson, and if he hadn’t agreed to continue, other physicians would be found. He has a duty to provide appropriate care and also has a duty to walk away from the $150,000 per month salary if he is asked to do something unsafe and dangerous.

Research that is published in a medical journal is supposed to be rigorously reviewed by the members of the editorial boards. While these experts can review the techniques described, the analysis of the results and the conclusions drawn, they do so presuming that the results that are reported actually occurred. There is an element of trust that presumes that scientist won’t make up the results as he goes along. The damage is more than a researcher’s reputation or the reputation of a hospital or university. The real damage occurs when those flawed results affect actual patients. In 2010,the Lancet, a highly reputable journal retracted an article published in 1998 by Dr. Andrew Wakefield that linked the measles, mumps and rubella immunization to the development of autism. The chief editor stated that the researcher’s conduct was dishonest and irresponsible. This study was perhaps the basis of thousands of parents refusing immunizations for their children.

The actions of just a few people can undermine the perception of a whole profession. Doctors are still held in high regard but that status is on shaky ground. News stories routinely report on the bad found in medicine including Medicare fraud, unqualified physicians performing surgery and narcotic prescription mills. It should remind physicians that their credibility begins and ends at the bedside with each individual patient and that their integrity cannot and should not be for sale.

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