Plagiarism, psych wards and physician payments: Antidote's favorite health stories of 2010

It's time again for Antidote to list, in no particular order, my favorite health stories from the year. The first five are below. The next five will be posted later in the week.

"Napa State Hospital's Grisly Inside Story," Katharine Mieszkowski, The Bay Citizen, December 2010

When something awful happens in a small community, reporters often try to pick up the pieces and, as an editor might tell them, "make sense of the tragedy." Mieszkowski took the killing of a psychiatric hospital worker by a patient and went far beyond any typical weekender. She persuaded people inside the hospital to talk with her in depth about the conditions there. In the resulting story, she details the factors that created what appears to have been a highly charged atmosphere with no accountability:

In many ways, the brutality at Napa State Hospital reflects changes that have occurred at mental institutions statewide. Since the early 1990s, thousands of mentally ill patients have been moved from state hospitals to community settings, opening up beds for patients who have been ordered there by criminal courts.The Department of Mental Health reports that 92 percent of patients in state mental hospitals were referred by the criminal justice system; 15 years ago it was just 20 percent. 

Mieszkowski never excuses individual acts of violence. She merely presents readers with the broader scope of how a seemingly out-of-nowhere event can actually be the culmination of many warning signs that were ignored.

"Dollars for Docs," Charles Ornstein, Tracy Weber, Nicholas Kusnetz, Quadia Muhammad, Marian Wang, Dan Nguyen, ProPublica, October–December, 2010

Even if ProPublica had not written a single story, the nonprofit would have provided an invaluable public service by creating a database of payments from pharmaceutical companies to physicians. As the reporting has taken care to show, the payments don't mean doctors are being controlled by Big Pharma. But the lack of transparency about those payments has kept patients in the dark while, in some cases, physicians pushed pills or treatments in which they had a financial stake. The reporters also did the drug companies a favor by pointing out how some of their top paid speakers had nasty skeletons in their closets.

A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses. More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don't post these actions on their web sites.

These stories and the database have contributed greatly to the nationwide discussion on the influence of money in medicine and clearly have led to changes in the way drug companies vet their hired hands and how some states report physician payments.

"Human Toll Reaches Millions as Asbestos Industry Expands Worldwide,"Jim Morris, Fair Warning and The Center for Public Integrity, August 2010

Nobody seems to care about asbestos anymore. After Andrew Schneider's groundbreaking series of stories about Libby, Montana, and asbestos in products like crayons, there seemed to be nothing more to say. Haven't we solved this problem? Jim Morris answers with a definitive, and unsettling, no. Like so much of the dirty industry that creates the products we buy in the US and the rest of the developed world, asbestos has been exported.

Perilous conditions have been documented from Mexico City to Ahmedabad, India. And yet, despite waves of asbestos-related disease in North America, Europe, and Australia, bans or restrictions in 52 countries, piles of incriminating studies, and predictions of up to 10 million asbestos-related cancer deaths worldwide by 2030, the asbestos trade remains alive and well. Asbestos is banned in the European Union. In the United States it is legal but the industry has paid out $70 billion in damages and litigation costs, and asbestos use is limited to automobile and aircraft brakes, gaskets and a few other products.

The industry has found new markets in the developing world, however, where demand for cheap building materials is brisk. More than two million metric tons of asbestos were mined worldwide in 2009 - led by Russia, China, and Brazil - mostly to be turned into asbestos cement for corrugated roofing and water pipes. More than half that amount was exported to developing countries like India and Mexico. 

This is an exhaustively reported and authoritatively written piece that should be a blueprint for reporting on other industries. You probably never have heard of The Chrysotile Institute, but, after reading this story, you will want to look for similar enterprises in your own corner of the world.

"The Deadly Corruption of Clinical Trials," Carl Elliott, Mother Jones, September 2010

It's rare that one person's death results in a sea change for an industry – or a culture. Elliott's story about Dan Markingson may prove to be the beginning of just such a change. Elliott read about Markingson's death in the St. Paul Pioneer Press, where Jeremy Olson and Paul Tosto had done a great job detailing some of the troubling conflicts of interest at play in the clinical trial that appears to have led to Markingson's suicide. Elliott then explored every nuance of the story, from Markingson's personal history, to the particulars of the arrangement between the University of Minnesota and AstraZeneca, to the history of drugs to treat psychiatric disorders. The story pulls no punches.

Before dawn on the morning of May 8, a police officer and a Catholic priest knocked on Mary's door. Mike Howard, a family friend who lives at her house, answered. Later, in a deposition, Howard described what happened next: "Mary jumped out of her bed and went into the kitchen and stood there, and the priest extended his hand out and said, 'Mary, I'm here to tell you that Dan passed away.' And Mary just literally fell down to her knees and started to shriek and cry, and just started begging, 'Please, no, no, don't let this happen.'"

Dan had stabbed himself to death in the bathtub with a box cutter, ripping open his abdomen and nearly decapitating himself. His body was discovered in the early hours of the morning by a halfway-house worker, along with a note on the nightstand that said, "I left this experience smiling!" Later, when the blind on the study was broken, researchers found that Dan was being treated with Seroquel, the drug manufactured by the study sponsor, AstraZeneca.

 The story has led to a surprising response in academia. Eight bioethicists at the University of Minnesota called on the Board of Regents to launch an investigation into Markingson's suicide. The university had this tone-deaf response: General Counsel Mark Rotenberg told Molly Priesmeyer at the Twin Cities Daily Planet, "We have to ensure that research subjects trust us. We can't have funding if we don't have research subjects." Doesn't that speak volumes?

"Sultans of swap: List of plagiarized papers grows to include BMJ," Adam Marcus, Retraction Watch, December 2010

I could have picked any of the posts Marcus and Ivan Oransky have made on their witty and wise Retraction Watch blog. This is blogging at its best: fast but never sloppy, open to debate and intensely focused. Marcus and Oransky are tracking where science has gone wrong and educating readers in the sometimes messy world of scientific journals. I picked this piece because it captures the strong ethic and the humming energy of the Retraction Watch enterprise.

Although some readers evidently have yawned at revelations that Vahdettin Bayazit, of Alparslan University in Turkey (and, we are tempted to assume, at least a few of his co-authors) appears to have plagiarized wantonly in numerous published articles, one follower of Retraction Watch was on to this case even before we were. In an e-mail, the tipster laid out a picture of intellectual dishonesty audacious for both its scope and ham-handedness. The researcher, who wanted to remain anonymous, used Google to detect instances of plagiarism, just as we had, coming up with "more than 10″ papers with passages stolen from the scientific literature and even Wikipedia, including not only lifted text but figures, too. And, just as in our case, the editors our source contacted about the misconduct have essentially ignored it.

Retraction Watch – and its cousin Embargo Watch – are daily must-reads for health writers and anyone who cares about science.

Antidote will post another five terrific health stories next week.