Posted tagged ‘fraud’

Toxic mold? No, toxic scam

May 10, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Props to a local reporter here in Atlanta for uncovering quackery – not just quackery, but outright fraud. Randy Travis (not the other Randy Travis) with Fox5 has investigated an unlicensed non-doctor, Michael Pugliese, who operates the National Treatment Centers for Environmental Disease right near my practice in Alpharetta, GA.

Though his victims are told to call him doctor, it’s unclear what (if any) medical training Mr. Pugliese has had. What is clear is that worried people from around the country have gone to his clinics for treatment for all sorts of ailments. After a $3,300 up-front fee, all of them, based on his testing, are told that they’re suffering from the ill-effects of mold. And all of them are sold a variety of supplements and nose-sprays, some of which are made in his laundry room. Adding insult to injury, they’re told to eat canned chicken three times a day. That’s just weird.

Read more details of the investigation here and here.

The whole “toxic mold” thing is another money-draining, predatory quackfest. It’s not clear at all that mold causes any of the neurologic symptoms or other Big Problems it’s being blamed for – but that hasn’t stopped lawyers from suing, and scamsters from setting up fake labs and giving themselves fake credentials.

Mold can be an eyesore, and sometimes makes houses smell musty. Some people are allergic to indoor molds, which can then trigger symptoms like itchy eyes or noses, or worsening asthma symptoms. These symptoms can be prevented and treated by talking with a primary care doc or allergist.

But beware: there are a whole lot of scammers out there looking to take advantage of people. These are people who are hurting, and who have genuine concerns, and they’re looking for answers. It’s sad how many of these alt-health fraudsters are so eager to suck their bank accounts dry, preventing them from getting the real help they need.

 

Protect yourself from Bad Science

February 18, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Science, to use the term correctly, isn’t a body of knowledge or a bunch of facts written up on a whiteboard by a crazy-haired professor. It’s a method, or way of figuring out things. Thinking and reading and learning from experts are all important, sure. But real science relies on experimentation.

First, make an educated guess about how something works. Then design an experiment to test your guess (I’m oversimplifying here. Designing the correct experiment takes genius and inspiration). Collect your data carefully, and see if you were right. Then do it again, and again.

Ideally, your experiments and conclusions are written up and published in what are called “peer-reviewed journals,” where fair-minded and educated people review your work to make sure it’s up to par. Then it’s published, and other scientists can see what you’ve done. Your experiments can be repeated and tweaked, maybe confirmed or refuted. In time, the body of what’s become known as “accepted scientific knowledge” grows. And voilà, we’ve landed a man on the moon, unlocked the secrets of the atom, or turned HIV into a treatable infection.

Lather, rinse, repeat. Science isn’t fast, and there are a lot of details that have to be done right. Some experiments, just from bad luck, will lead to dead ends or false conclusions. But it’s clear from the pace of modern progress that The Scientific Method is the best way to figure out how the natural world works.

Still, it’s far from perfect. And a few troubling trends are contributing to a sense that scientists might not always get it right.

These days, anyone can publish anything, either online or in print. I’ve got a few self-published books out there (ie, I paid to print them), along with books that were professionally edited by a genuine publisher (ie, they paid me. Suckers!) Most readers would have a hard time telling the difference. Likewise, blogs and websites—who knows who’s behind most of what’s linked out there? In the past, the quality of scientific publication was guaranteed by a process called “peer-review”, where a new paper was read by several independent experts.

A December, 2015 editorial in the New England Journal of Medicine reviews a growing problem with peer-review: hacking. The authors of a new paper often suggest their own peer reviewers, who sometimes turn out to be fake people with fake e-mails—the “peer review” is actually being done by the authors themselves. Hundreds of articles have been retracted, now that editors know to look for peer review hacking, but it’s likely that thousands more studies already out there are similarly tainted by poor or fraudulent vetting.

But what about the journals themselves? Another huge problem is the proliferation of for-profit, “predatory” journals. They make their money by publishing anything that’s submitted, with zero-to-no editorial review or peer-review. You pay, you play. Some of these are respected journals that have been bought out by shady profiteers. Some are new journals, just made up, that exist only in cyberspace – they have essentially no operating expenses, and publish only online for a fee. Just because you read that something was “published”, doesn’t mean that it’s anything worth reading or paying attention to. Experiments are either entirely faked or done so poorly that they’re worthless – but they’re still published, and unfortunately still reported in the media.

The best defense against the influence of crappy science is for audiences to maintain their skepticism. Something published in a barely-known or predatory journal (yes, there are established lists of these) shouldn’t be turned into headlines or Facebook clickbait. Though everyone is an expert who’s told to “do their own research”, there’s still a place for genuine science journalists and genuine experts to help guide the rest of us through the confusing maze of new information. Don’t believe everything you read, even if it’s couched in sciency-looking terms and looks like it’s been published in a sciency-looking journal.

Science is slow, and far from perfect. But it’s still the best method we’ve got.

Step right up!

Wasting your healthcare dollars

April 16, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

As I’ve said before, the biggest problem with health care delivery in the USis cost, which seems to have taken a back seat to other issues meant to be addressed by health care reform. We spend about $2.5 trillion dollars a year on health care—that’s over eight thousand dollars a year for every man, woman, and child. What’s that getting you? Accord to the government, about 30% goes to hospitals; 20% goes to doctors & other clinicians, 10% goes for prescriptions, and the other 40% or so goes for “other spending,” mostly administrative costs and haircuts for insurance executives. But it’s probably even worse than that: according to a recent JAMA study, about 20% of total healthcare expenditures are wasted dollars.

20% of 2.5 trillion dollars, by the way, is 500 billion dollars. Each year. The JAMA article (which, ironically, will cost you 30 clams to see in its entirety) breaks down the waste into several categories:

Failure of care coordination ($25 to $45 billion wasted): I see examples of this all the time. Docs and hospitals don’t talk to each other, and patients don’t bring records—so tests get repeated, or (even worse), medicines are added on top of other (unknown) medicines, creating costly havoc. The patients suffer. Why does this happen? Docs (like me!) get paid to see patients, not to read charts and chase down forms. In fact, HIPAA “privacy” laws have made care coordination even more time-consuming and frustrating for everyone.

Failure of care delivery ($102 to $154 billion): I’m not really sure exactly what that means. I imagine they mean waste created by not treating medical conditions early, when they’re less expensive to address.

Overtreatment ($158 to $226 billion): In part, this is defensive medicine—docs do whatever they think they need to do to they don’t get sued. Show up in the ER with a headache? You get a $1600 CAT scan! Those tests not only cost money themselves, but they lead to more tests and procedures and costs that really aren’t making anyone healthier. (Except the medical-malpractice industry. They’re doing real well.) Overtreatment also includes steps taken by lazy doctors who find it quicker—and better for business—to just order the tests and treatments the patients expect, rather than doing what’s medically appropriate.

Unnecessary administrative complexity ($107 and $389 billion): We love filling out forms, and we love hiring staff to wait on hold for administrative pygmies at the insurance agency to approve Grandma’s catheters. Yup, that’s why we went to med school.

Noncompetitive pricing ($84 and $178 billion): “Noncompetitive”, I think, must be a euphemism for “batshit crazy”. Ever see a doctor or hospital’s price sheet? They’re locked up, guarded by poisonous lizards deep in an underground bunker. Prices have to be super-inflated so the insurance companies can negotiate them down to what they’ve already decided they’ll pay (when they get around to it, which is after they’ve paid for the VP’s executive jets and haircuts.) People who don’t have insurance, of course, get hosed.

Fraud and abuse ($82 to $272 billion). With this much money sloshing around, scumbag frausters (including some with MD degrees) crawl out and starting grabbing what they can. For every jerk the government finds and prosecutes, there’s a handful of other cockroaches to take their place. Though there’s certainly insurance fraud in the private market, there is far more abuse designed to extract money from government health programs. Insurance companies do what they can to guard against fraud, which could hurt their profits or drive them out of business. Government agencies just don’t seem as driven to control costs. I guess they figure we can always borrow more money from our grandchildren.

I have no idea if that 20% estimate of wasted dollars is accurate—the researchers claim to have used the lowest, most conservative numbers. It wouldn’t surprise me if the percentage were actually quite a bit higher. I don’t know if these figures even include the huge amount of waste that occurs when people seek health care through emergency rooms inappropriately. Whatever the exact number, it’s certainly true that after waste, fraud, and the huge expense of our enormous, multilayered government and private insurance industries, it’s unlikely that even half of the money spent on health care does anything that plausibly improves anyone’s health. The system itself is obviously bloated and unhealthy, staggering under its own weight. Do we have the guts to fix it?