The quality most prized by a world-class research institution such as Duke University Medical Center boils down to one word: credibility. It’s hard to earn and oh-so-easy to tarnish.
There are errors in medicine, and then there are blind-eye errors in medicine. The latter led Duke to settle with eight cancer patients or their estates for a sum that likely will never be disclosed, but surely falls into the category of staggering.
If it is true that all science consists of careful observation, it was the eagle eyes of biostatisticians at the M.D. Anderson Cancer Center in Houston who affirmed the grievous flaws in what Duke researchers hailed as a revolutionary means of using genomics to target malignancies.
But long before the M.D. Anderson crew destroyed Duke’s claims, which were shown to be based on fraudulent science, a drama had played out at Duke Medical Center that likely cost the lives of unsuspecting patients.
It’s breathtaking to think that scientific fraud on such a scale occurred at Duke, and even more shocking to learn that it could have been avoided if administrators had listened to the warnings of a brilliant third-year medical student.
No doubt institutional pride and the trembling that comes with the possible revelation of fraud on a seismic scale caused senior researchers and administrators to pressure the med student and budding researcher, Bradford Perez, to finesse his criticism.
In other words, Duke sought to portray Perez’ courageous whistleblowing as a difference of opinion with his superiors instead of what it was: lifting the veil on a concocted protocol fraught with consequences.
The upshot of Perez’s crisis of conscience was the downfall of his mentor, Anil Potti, and another senior researcher, Joseph Nevins. What happened to Duke administrators who had also been told that the science was flawed, and who apparently did nothing, is not clear.
If past is prologue, however, those who knew are so high on the pecking order that I would be surprised they were held to account.
All this occurred on the watch of then Chancellor for Health Affairs Victor J. Dzau, who left Duke last year to head the prestigious Institute of Medicine. Interestingly, what the hard-charging Dzau knew and when he learned it remains a question unanswered, at least publicly.
Once Duke could no longer ignore Potti and Nevins’ fraud, which was revealed by The Cancer Letter, an insider journal for cancer researchers, Potti got the boot (he later surfaced at the University of North Dakota) and Nevins retired. Both men left with shredded reputations.
In the long run, all this follows a familiar scenario: Duke ‘fesses up with a settlement, the headlines fade, life at the medical center goes on. Most people don’t file such scandals in their long-term memory.
Who today remembers the 2003 Jessica Santillan debacle, in which a Duke surgeon mistakenly gave the Mexican teenager a new heart and lungs incompatible with her blood type?
Or, even further back to the 1980s and the Bernard Bressler affair, in which a Duke psychiatrist and the medical center were found liable for his sexual predation? That resulted in what the plaintiffs’ attorney called one of the largest malpractice settlements in North Carolina history.
Like other deep-pockets medical centers, Duke will do anything to avoid malpractice trials. Thus the huge settlements that inflate malpractice insurance costs for physicians and hospitals.
Still, errors of judgment may be forgiven, but errors compounded by ignoring warnings of dark science – they are an order of magnitude greater, never to be forgotten lest they happen again.
Bob Wilson lives in southwest Durham.