Tag Archives: philadelphia

Multimedia piece explores Philly’s medical history

“Now, why Philly?”

That’s how the first stop begins on the interactive map for Marketplace’s “Philadelphia: The Birthplace of Healthcare” but it also could be a question about AHCJ’s 2011 conference.

The answers are remarkably similar.

Philadelphia has played a large role in the development of health care in this country. Some of the notable events, from the Marketplace piece:

  • Benjamin Franklin helped launch the pharmaceutical industry there.
  • Philly resident Philip Physick, inventor of dozens of surgical instruments, also invented an economic instrument that enabled surgeons to get paid.
  • An idealistic eye doctor there at the turn of the century helped launch what’s now a multi-billion dollar screening industry.

Marketplace’s project, which includes an interactive map timeline that leads you to audio and video pieces, provides an interesting tale of health care in that city. Hear about the surgical amphitheatre where people paid to watch surgery and how the first HMO came about. Find out how an eye doctor became responsible for the screening trend.

Most surprising is the use of puppets, a canoe and music to tell the stories.

Gays excluded from clinical trials

Thanks to an awards announcement from the National Lesbian & Gay Journalists Association, we just noticed Jen Colletta’s story in the Philadelphia Gay News about the exclusion of gays from clinical trials. Colletta won an Excellence in News Writing Award. The exclusion of gays in clinical trials is an issue that hasn’t received much mainstream attention, apart from a letter from Colletta’s sources in NEJM, a write-up by Ed Silverman and a story in The Philadelphia Inquirer.

According to Colletta, the data behind the story grew out of a chance discovery by researchers at the Fox Chase Cancer Center in Philadelphia.

“We review all the different trials that are proposed here, and they don’t necessarily open here, but a lot of them are multi-center trials so we do look at them. And I saw that we had been looking at a number of clinical trials that explicitly excluded gay people, and they didn’t necessarily open at Fox Chase, but I started to become more attuned to this and realized that this is a bigger, national issue,” (Brian Egleston, assistant research professor of biostatistics at the center) said.

The researchers analyzed trials listed in the ClinicalTrials.gov database, maintained by the National Institutes of Health and the Food and Drug Administration.

In particular, Colletta reported, homosexuals are excluded from studies about couples, especially those dealing with erectile dysfunction, which are often related to treatments for prostate cancer. It’s entirely normal for a drug trial to have exclusion criteria, but an oversight in NIH regulations mean that the exclusion of homosexuals, unlike exclusion along racial lines, can be implemented arbitrarily.

In the mid-1990s, Congress mandated that NIH establish a set of guidelines that would prevent it from excluding minorities, such as women and African Americans, from federally funded clinical trials unless there was a significant reason. There are currently no such rules regulating the inclusion of LGBT individuals.

The distribution of exclusionary studies is particularly interesting. To put it in perspective, here’s a quick visualization of the data put forth in the NEJM letter:


Philly VA botched 92 of 116 cancer treatments

Walt Bogdanich of The New York Times uncovered an astounding series of regulatory and oversight errors that allowed a “rogue” cancer unit operate with impunity at the Veterans Affairs Medical Center in Philadelphia.

Bogdanich reports that its doctors, primarily Dr. Gary Kao, had botched 92 of 116 cancer treatments in more than six years. The unit treated prostate cancer with radioactive implants, a process known as brachytherapy. Doctors in the unit avoided regulation in part by revising surgical plans to cover for mistakes.

The first clear signs of trouble cropped up in early 2003, the unit was suspended in 2008. Here’s a brief catalog of missed opportunities to reign in Johns Hopkins-trained Kao and associates:

  • The unit did not have any peer review process in place.
  • The V.A.’s radiation safety program didn’t intervene.
  • Neither did the Joint Commission, the group that accredited the hospital.
  • Doctors in the radiation implant program weren’t properly supervised.
  • Or “trained in what constitutes a substandard implant and the need to report it.”
  • Errors went unreported for months, or even years, while patients had no idea they were even made.

The whole house of cards only came tumbling down when a mistaken purchase of lower-radiation implants triggered an investigation of previous cases. Investigators didn’t find any lower-radiation implants, but they did find errors. Lots of them.

No patients are believed to have died from this mistake-riddled treatment; the unit was suspended in mid-2008 and similar programs (whose problems don’t seem to have been as severe) were shuttered in Jackson, Miss., and Cincinnati. Seven of the affected patients were flown to a more experienced V.A. unit for additional treatment.


In a related story, The Philadelphia Inquirer reports that the problems came to light “not because the NRC finished its inquiry” but rather when a Nuclear Regulatory Commission advisory committee asked the agency for an update because “committee members had been hearing disturbing things about the Philadelphia VA’s program.”