August 26, 2013
Forbidden Topics In Health Care–Part Three
By Michael D. Shaw
A couple of weeks ago, in Part Two of this series, we explored the mind-boggling amount of waste within health care expenditures. That figure was estimated—in 2009—to be $765 billion. Of this, nearly 10 percent ($75 billion) is said to be fraud. However, since other categories of waste are also identified, including excessive administrative costs and unnecessary services, exactly what constitutes “fraud” is clearly subjective.
Since the two other categories mentioned contribute an astonishing $400 billion to the total, you don’t have to be a cynic to suspect that fraud is understated—probably vastly understated. Which brings us to the far too sacrosanct matter of federally-funded medical research. Bottom line, the public should be mad as Hell.
In round numbers, the Feds spend around $31 billion annually on medical research, with more than $5 billion targeted toward cancer. As it is, we’re still in the midst of Richard Nixon’s “War on Cancer,” which was officially declared on December 23, 1971, and was likened at the time to JFK’s May, 1961 “Man on the Moon” speech. Unfortunately, on July 20, 1969 this metaphor was shown to be a cruel travesty, when Apollo 11 brought our astronauts to the Moon, and the best progress against cancer was still (and remains to this day) “Stop smoking.”
As radiologist Margaret Cuomo noted in her book A World Without Cancer:
More than 40 years after the war on cancer was declared, we have spent billions fighting the good fight. The National Cancer Institute (NCI) has spent some $90 billion on research and treatment during that time. It’s true there have been small declines in some common cancers since the early 1990s, including male lung cancer and colon and rectal cancer in both men and women. And the fall in the cancer death rate—by approximately 1 percent a year since 1990—has been slightly more impressive. Still, that’s hardly cause for celebration. Cancer’s role in one out of every four deaths in this country remains a haunting statistic.
Dr. Cuomo urges more of the budget go toward prevention, and laments the overemphasis on understanding mechanistic details of the disease. Ironically, she says, even though prevention gets less than 10 percent of the funding, the National Cancer Institute itself recently stated that “Much of the progress against cancer in recent decades has stemmed from successes in the areas of prevention and control.”
Author Clinton Leaf bemoans the risk averse culture that is big-time oncology. He complains that it “has grown progressively less hospitable to new voices and ideas over the past four decades.” The same projects keep getting renewed, and the same few institutions obtain the bulk of the money. Leaf reminds us that the inventor of chemotherapy, iconic pathologist Sidney Farber, was anything but risk averse. His methods would be frowned upon these days. Farber disobeyed superiors, conducted his own trial-and-error studies, and foisted unproven drugs on sick, vulnerable children.
Farber was remembered for being far more interested in curing cancer than in understanding the disease. As he put it, “[T]he history of Medicine is replete with examples of cures obtained years, decades, and even centuries before the mechanism of action was understood for these cures.”
As to fraud, a recent issue of The Cancer Letter gave extensive coverage to a whistle-blower case in which Northwestern University (admitting no wrongdoing) agreed to pay the Feds $2.93 million. At the core of the case were claims that NCI grant money was misdirected to cover personal expenses. Northwestern was quick to point the finger at researcher Charles L. Bennett, but much of the information being released does not add up.
For one thing, Bennett himself was reporting financial irregularities on the grants. For another, it was scarcely publicized that a former research administrator at the university’s medical school—Feyifunmi Sangoleye—pled guilty to felony charges stemming from administration of Bennett’s NCI grants. A scheme was created whereby $86,000 was diverted to her personal accounts to finance a wedding and European honeymoon. And you thought this stuff was audited.
But wait, there’s more. The whistle-blower (or “relator” as the courts call it) stands to receive $498,100 from the payback. The relator is one Melissa Theis, who had a brief tenure with Northwestern from 2007-2008. Inasmuch as principal investigators such as Bennett don’t actually cut the checks, it is argued by Brown University physician and blogger Roy Poses that she “may have had more direct responsibility for making the payments in question than did Dr. Bennett.” Poses also implies that Theis’ involvement—and her windfall as a whistle-blower—may have encouraged Northwestern to settle the case.
Some have suggested that Bennett was singled out because as one who studies negative effects of oncological agents, he could have made some powerful enemies, such as Big Pharma. Indeed, this entire matter is dwarfed by a host of gigantic settlements made by the pharmaceutical industry with the Feds—and almost never is a name even mentioned, let alone dragged through the mud as Bennett’s was in this case.
Your tax dollars at work.