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Testing Program Fails Soldiers, Leaving Brain Injuries Undetected

Posted by defensebaseactcomp on November 28, 2011

A version [1] of this story was co-produced with NPR and aired on All Things Considered [2]. (Check here for local listings [3].)

by T Christian Miller and Joaquin Sapien at ProPublica and Daniel Zwerdling at NPR

About 40 uniformed soldiers take the ANAM test inside this squat rectangular building on the Fort Lewis-McChord military base near Tacoma, Wash., in early September, weeks before they deploy to Afghanistan. (Joaquin Sapien/ProPublica)

In 2007, with roadside bombs exploding across Iraq, Congress moved to improve care for soldiers who had suffered one of the war’s signature wounds, traumatic brain injury

Lawmakers passed a measure requiring the military to test soldiers’ brain function before they deployed and again when they returned. The test was supposed to ensure that soldiers received proper treatment.

Instead, an investigation by ProPublica and NPR has found, the testing program has failed to deliver on its promise, offering soldiers the appearance of help, but not the reality.

Racing to satisfy Congress’ mandate, the military chose a test that wasn’t actually proven to detect TBI: the Automated Neuropsychological Assessment Metric, or ANAM.

Four years later, more than a million troops have taken the test at a cost of more than $42 million to taxpayers, yet the military still has no reliable way to catch brain injuries. When such injuries are left undetected, it can delay healing and put soldiers at risk for further mental damage.

Based on corporate and government records, confidential documents, scores of interviews and emails obtained under the Freedom of Information Act, our investigation found:

  • The people who invented ANAM and stood to make money from it were involved in the military’s decision to use it, prompting questions about the impartiality of the selection process. No other tests received serious consideration. A report [4] by the Army’s top neuropsychologist circulated last year to key members of Congress labeled the selection process “nepotistic.”
  • The Pentagon’s civilian leadership has ignored years of warnings, public and private, that there was insufficient scientific evidence the ANAM can screen for or diagnose traumatic brain injury. The military’s highest-ranking medical official said the test was “fraught with problems.” Another high-ranking officer said it could yield misleading results.
  • Compounding flaws in the ANAM’s design, the military has not administered the test as recommended and has rarely used its results. The Army has so little confidence in the test that its top medical officer issued an explicit order [5] that soldiers whose scores indicated cognitive problems should not be sent for further medical evaluation.
  • Top Pentagon officials have misrepresented the cost of the test, indicating that because the Army invented the ANAM, the military could use it for free. In fact, because the military licensed its invention to outside contractors, it has paid millions of dollars to use its own technology.
  • The military has not conducted a long-promised head-to-head study to make sure the ANAM is the best available test, delaying it for years. Instead, a series of committees have given lukewarm approval to continue using the ANAM, largely to avoid losing the data gathered so far.

Several current and former military medical officials criticized the Defense Department’s embrace of a scientifically unproven tool to use on hundreds of thousands of soldiers with TBIs

Please read this article in it’s entirety at ProPublica

Posted in Afghanistan, Civilian Contractors, Dropping the DBA Ball, Injured Contractors, Iraq, PTSD and TBI, T Christian Miller | Tagged: , , , , , , , | 1 Comment »

Gov’t Watchdog Criticizes Pentagon Center for PTSD, Brain Injuries

Posted by defensebaseactcomp on July 11, 2011

By T Christian Miller and Joaquim Sapien at ProPublica  July 11, 2011

If you want more explanation about the military’s troubles in treating troops with traumatic brain injuries and post-traumatic stress, read no further than two recent but largely unnoticed reports from the Government Accountability Office.

It turns out the Pentagon’s solution to the problems is an organization plagued by weak leadership, uncertain priorities and a money trail so tangled that even the GAO’s investigators couldn’t sort it out. The GAO findings on the Pentagon’s Defense Centers of Excellence (DCOE) echo our own series [1] on the military’s difficulty in handling the so-called invisible wounds of war.

“We have an organization that exists, but we have considerable concern about what it is that it’s actually accomplishing,” said Denise Fantone, a GAO director who supervised research on one of the reports. She added: “I can’t say with any certainty that I know what DCOE does, and I think that’s a concern.”

First, some background. After the 2007 scandal over poor care delivered to soldiers at the Walter Reed Army Medical Center, Congress ordered the Pentagon to do a better job treating soldiers suffering from post-traumatic stress disorder and traumatic brain injury. The Pentagon’s answer was to create DCOE [2]. The new organization was supposed to be a clearinghouse to foster cutting-edge research in treatments.

DCOE was rushed into existence in late 2007. Since then, it has churned through three leaders, including one let go after alleged sexual harassment of subordinates [3]. It takes more than five months to hire each employee because of the federal government’s glacial process. As a result, private contractors make up much of the center’s staff.

“DCOE’s development has been challenged by a mission that lacks clarity and by time-consuming hiring processes,” according to the first report in the GAO series [4], focusing on “management weakness” at DCOE.

Just as concerning, the GAO says that it can’t quite figure out how much money DCOE has received or where it has all gone. DCOE has never submitted a budget document that fully conformed to typical federal standards, according to a GAO report released last month [5]. In one year, the center simply turned in a spreadsheet without detailed explanations

Please read the entire article at ProPublica

Posted in Department of Defense, Political Watch, PTSD and TBI, T Christian Miller | Tagged: , , , , , , , , | Leave a Comment »

ProPublica Honored With Two George Polk Awards

Posted by defensebaseactcomp on February 22, 2011

by Minhee Cho at ProPublica

ProPublica is pleased to announce that it has won two George Polk Awards this year, in collaboration with our partners NPR and Frontline, for the series “Brain Wars” and “Law & Disorder.”

A collaborative project by ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling and Susanne Reber, “Brain Wars ” found that the U.S. military was failing to diagnose and treat traumatic brain injuries suffered by soldiers. It has been selected for the George Polk Award for Radio Reporting.

ProPublica’s A.C. Thompson along with our partners Raney Aronson and Tom Jennings at Frontline and Laura Maggi and Brendan McCarthy at The Times-Picayune won the George Polk Award for Television Reporting for “Law & Disorder ,” which took an in-depth look at the controversial and often brutal actions taken by the New Orleans Police Department in the aftermath of Hurricane Katrina.

The George Polk Awards are conferred every year to honor special achievement in journalism, particularly investigative and enterprise reporting. ProPublica’s Abrahm Lustgarten was among the winners last year for his reporting on the dangers of drilling for natural gas.

Congratulations to all of the winners Please see the original here

Posted in PTSD and TBI, T Christian Miller | Tagged: , , , , , | Leave a Comment »

Scientific Review Kicks Off to Weigh Treatment for Brain-Injured Soldiers

Posted by defensebaseactcomp on February 7, 2011

Perhaps one day diagnoses and treatment options will be made available to Injured Contractors.

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR Feb. 7, 2011

The Institutes of Medicine kicked off its yearlong study of cognitive rehabilitation therapy on Monday, a process that will help the Pentagon decide whether its health plan will cover the treatment for troops who have suffered brain injuries in Iraq and Afghanistan.

We’ve previously reported [1] that Tricare, which covers troops and many veterans, relied on a controversial study to deny coverage for the treatment, which helps rewire soldiers’ brains to perform basic tasks such as memorizing lists and following orders. Tricare said the study showed there wasn’t enough evidence to support paying for the treatment, which can cost more than $50,000 per soldier. The Pentagon says nearly 200,000 troops have suffered traumatic brain injuries since the wars began, though our own reporting [2] shows the numbers are probably a lot higher.

The IOM panel of experts will review scientific literature and ultimately render a decision on whether it supports the efficacy of cognitive rehabilitation therapy. If the experts reach this conclusion, they will hardly be the first to do so. In April 2009, a consensus panel assembled by the Pentagon said the therapy works, especially for soldiers suffering more severe forms of brain injury. Other groups, such as the Brain Injury Association of America, have weighed in to support it. Even some major private insurance companies pay for it.

The head of the IOM panel, Georgetown University neurologist Ira Shoulson, pointedly quizzed Tricare on this issue at Monday’s session, asking what the current review would produce that previous reviews had not.

Capt. Robert DeMartino, Tricare’s director of behavioral health, said he hoped the panel would be able to pinpoint what types of cognitive rehabilitation works best, and what kind of civilian doctors and clinicians were best qualified to provide it. He noted that stories published last year by ProPublica and NPR have cast a “shadow” over the issue, prompting congressional committees and lawmakers to pressure Tricare to provide cognitive rehabilitation therapy.

“For us, we know that we’re in a field like a gray zone,” said DeMartino, who addressed the panel by speakerphone. “We want to make sure the [treatments] that work are the ones we are going to use.”

The IOM review will continue through the end of the year, and the panel expects to convene other public sessions to help them arrive at a determination.

Posted in Department of Defense, PTSD and TBI, T Christian Miller | Tagged: , , , , , , , | Leave a Comment »

OT: ProPublica Furious Growth and Cost Cuts Led To BP Accidents Past and Present

Posted by defensebaseactcomp on October 26, 2010

This is OT but there are so many similarities regarding Cover Ups and Safety and Compensation issues here not too mention that ProPublica deserves another nod

A ProPublica and PBS FRONTLINE investigation. “The Spill [1],” a PBS FRONTLINE documentary drawn from this reporting, airs tonight. Check local listings. [2]

Jeanne Pascal turned on her TV April 21 to see a towering spindle of black smoke slithering into the sky from an oil platform on the oceanic expanse of the Gulf of Mexico. For hours she sat, transfixed on an overstuffed couch in her Seattle home, her feelings shifting from shock to anger.

Pascal, a career Environmental Protection Agency attorney only seven weeks into her retirement, knew as much as anyone in the federal government about BP, the company that owned the well. She understood in an instant what it would take others months to grasp: In BP’s 15-year quest to compete with the world’s biggest oil companies, its managers had become deaf to risk and systematically gambled with safety at hundreds of facilities and with thousands of employees’ lives.

“God, they just don’t learn,” she remembers thinking.

Just weeks before the explosion, President Obama had announced a historic expansion of deep-water drilling in the Gulf, where BP held the majority of the drilling leases. The administration considered the environmental record of drilling companies in the Gulf to be excellent. It didn’t ask questions about BP, and it didn’t consider that the company’s long record of safety violations and environmental accidents might be important, according to Carol Browner, the White House environmental adviser.

They could have asked Jeanne Pascal.  Please read the entire story at ProPublica

Posted in Cancer, Civilian Contractors, Department of Labor, Follow the Money, Toxic Exposures | Tagged: , , , , | Leave a Comment »

Dollars for Docs- What Drug Companies are Paying Your Doctor

Posted by defensebaseactcomp on October 19, 2010

Docs on Pharma Payroll Have Blemished Records, Limited Credentials

Hundreds of doctors paid by pharmaceutical companies to promote their drugs have been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists, ProPublica has found. We compiled data from seven companies, covering $257.8 million in payouts since 2009 for speaking, consulting and other duties.

The Ohio medical board concluded [1] that pain physician William D. Leak had performed “unnecessary” nerve tests on 20 patients and subjected some to “an excessive number of invasive procedures,” including injections of agents that destroy nerve tissue.

Yet the finding, posted on the board’s public website, didn’t prevent Eli Lilly and Co. from using him as a promotional speaker and adviser. The company has paid him $85,450 since 2009.

In 2001, the U.S. Food and Drug Administration ordered [2] Pennsylvania doctor James I. McMillen to stop “false or misleading” promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.

Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.

And in Georgia, a state appeals court in 2004 upheld [3] a hospital’s decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He’d also been accused of exposing women’s breasts during medical procedures. When confronted by a hospital official, Taylor said, “Maybe I am a pervert, I honestly don’t know,” according to the appellate court ruling.

Last year, Taylor was Cephalon’s third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.

Leak, McMillen and Taylor are part of the pharmaceutical industry’s white-coat sales force, doctors paid to promote brand-name drugs to their peers — and if they’re convincing enough, get more physicians to prescribe them.

Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.

But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.

This story is the first of several planned by ProPublica examining the high-stakes pursuit of the nation’s physicians and their prescription pads. The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia — billion-dollar blockbusters until dangerous side effects emerged.

“Without question the public should care,” said Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has written about the industry’s influence on physicians. “You would never want your kid learning from a bad teacher. Why would you want your doctor learning from a bad doctor, someone who hasn’t displayed good judgment in the past?”

To vet the industry’s handpicked speakers, ProPublica created a comprehensive database [4] that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.

Although these companies have posted payments on their websites — some as a result of legal settlements — they make it difficult to spot trends or even learn who has earned the most. ProPublica combined the data and identified the highest-paid doctors, then checked their credentials and disciplinary records.

That is something not all companies do.

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.

In interviews and written statements, five of the seven companies acknowledged that they don’t routinely check state board websites for discipline against doctors. Instead, they rely on self-reporting and checks of federal databases. Only Johnson & Johnson and Cephalon said they review the state sites.

ProPublica found 88 Lilly speakers who have been sanctioned and four more who had received FDA warnings. Reporters asked Lilly about several of those, including Leak and McMillen. A spokesman said the company was unaware of the cases and is now investigating them.

“They are representatives of the company,” said Dr. Jack Harris, vice president of Lilly’s U.S. medical division. “It would be very concerning that one of our speakers was someone who had these other things going on.”

Leak, the pain doctor, and his attorney did not respond to multiple messages. The Ohio medical board voted to revoke Leak’s license in 2008. It remains active as he appeals in court, arguing that the evidence against him was old, the witnesses unreliable and the sentence too harsh.

In an interview, McMillen denied nearly all of the allegations in the FDA letter and blamed his troubles on a rival firm whose drug he had criticized in his presentations.

“I’m more cautious now than I ever was,” said McMillen, who said he also does research. “That’s why I think a lot of the companies use me. I’m not taking any risks.”

Taylor said that the allegations against him were “old news” from the 1990s and that regulators had not sanctioned him. “It had nothing to do with my skills as a physician,” said Taylor, noting that he speaks every other week around the country and sometimes abroad. “Even my biggest detractors in that situation lauded my skills as a physician. That’s what’s most important.”

Disclosures are just the start

Payments to doctors for promotional work are not illegal and can be beneficial. Strong relationships between pharmaceutical companies and physicians are critical to developing new and better treatments.

There is much debate, however, about whether paying doctors to market drugs can inappropriately influence what they prescribe. Studies have shown that even small gifts and payments affect physician attitudes. Such issues have become flashpoints in recent years both in courtrooms and in Congress.

All told, 384 of the approximately 17,700 individuals in ProPublica’s database earned more than $100,000 for their promotional and consulting work on behalf of one or more of the seven companies in 2009 and 2010. Nearly all were physicians, but a handful of pharmacists, nurse practitioners and dietitians also made the list. Forty-three physicians made more than $200,000 — including two who topped $300,000.

Physicians also received money from some of the 70-plus drug companies that have not disclosed their payments. Some of those interviewed could not recall all the companies that paid them, and certainly not how much they made. By 2013, the health care reform law requires [5] all drug companies to report this information to the federal government, which will post it on the Web.

The busiest — and best compensated — doctors gave dozens of speeches a year, according to the data and interviews. The work can mean a significant salary boost — enough for the kids’ college tuition, a nicer home, a better vacation.

Among the top-paid speakers, some had impressive resumes, clearly demonstrating their expertise as researchers or specialists. But others did not –contrary to the standards the companies say they follow.

Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies.

Experts say the fact that some companies are disclosing their payments is merely a start. The disclosures do not fully explain what the doctors do for the money — and what the companies get in return.

In a raft of federal whistleblower lawsuits [6], former employees and the government contend that the firms have used fees as rewards for high-prescribing physicians. The companies have each paid hundreds of millions or more to settle the suits.

The disclosures also leave unanswered what impact these payments have on patients or the health care system as a whole. Are dinner talks prompting doctors to prescribe risky drugs when there are safer alternatives? Or are effective generics overlooked in favor of pricey brand-name drugs?

“The pressure is enormous. The investment in these drugs is massive,” said Dr. David A. Kessler, who formerly served as both FDA commissioner and dean of the University of California, San Francisco School of Medicine. “Are any of us surprised they’re trying to maximize their markets in almost any way they can?”

From drug reps to doc reps

For years, drug companies bombarded doctors with pens, rulers, sticky notes, even stuffed animals emblazoned with the names of the latest remedies for acid reflux, hypertension or erectile dysfunction. They wooed physicians with fancy dinners, resort vacations and personalized stethoscopes.

Concerns that this pharma-funded bounty amounted to bribery led the industry to ban most gifts voluntarily [7]. Some hospitals and physicians also banned the gift-givers: the legions of drug sales reps who once freely roamed their halls.

So the industry has relied more heavily on the people trusted most by doctors — their peers. Today, tens of thousands of U.S. physicians are paid to spread the word about pharma’s favored pills and to advise the companies about research and marketing.

Recruited and trained by the drug companies, the physicians — accompanied by drug reps — give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.

These presentations fill an educational gap, especially for geographically isolated primary care doctors charged with treating everything from lung conditions to migraines. For these doctors, poring over a stack of journal articles on the latest treatments may be unrealistic. A pharma-sponsored dinner may be their only exposure to new drugs that are safer and more effective.

Oklahoma pulmonologist James Seebass, for example, earned $218,800 from Glaxo in 2009 and 2010 for lecturing about respiratory diseases “in the boonies,” he said. On a recent trip, he said, he drove to “a little bar 40 miles from Odessa,” Texas, where physicians and nurse practitioners had come 50 to 60 miles to hear him.

Seebass, the former chair of internal medicine at Oklahoma State University College of Osteopathic Medicine, said such talks are “a calling,” and he is booking them for 2011.

The fees paid to speakers are fair compensation for their time away from their practices, and for travel and preparation as well as lecturing, the companies say.

Dr. Samuel Dagogo-Jack has a resume that would burnish any company’s sales force: He is chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center. Dagogo-Jack conducts research funded by the National Institutes of Health, has edited medical journals and continues to see patients.

While most people are going home to dinner with their families, he said, he is leaving to hop on a plane to bring news of fresh diabetes treatments to non-specialist physicians “in the trenches” who see the vast majority of cases.

Since 2009, Dagogo-Jack has been paid at least $257,000 by Glaxo, Lilly and Merck.

“If you actually prorate that by the hours put in, it is barely more than minimum wage,” he said. (A person earning the federal minimum wage of $7.25 would have to work 24 hours a day, seven days a week for more than four years to earn Dagogo-Jack’s fees.)

For the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.

Glaxo’s drug to treat enlarged prostates, Avodart — locked in a battle with a more popular competitor — is the topic of more lectures than any of the firm’s other drugs, a company spokeswoman said. Glaxo’s promotional push has helped quadruple Avodart’s revenue to $559 million in five years and double its market share, according to IMS.

Favored speakers like St. Louis pain doctor Anthony Guarino earn $1,500 to $2,000 for a local dinner talk to a group of physicians.

Guarino, who made $243,457 from Cephalon, Lilly and Johnson & Johnson since 2009, considers himself a valued communicator. A big part of his job, he said, is educating the generalists, family practitioners and internists about diseases like fibromyalgia, which causes chronic, widespread pain — and to let them know that Lilly has a drug to treat it.

“Somebody like myself may be able to give a better understanding of how to recognize it,” Guarino said. Then, he offers them a solution: “And by the way, there is a product that has an on-label indication for treating it.’’

Guarino said he is worth the fees pharma pays him on top of his salary as director of a pain clinic affiliated with Washington University. Guarino likened his standing in the pharma industry to that of St. Louis Cardinals first baseman Albert Pujols, named baseball player of the decade last year by Sports Illustrated. Both earn what the market will bear, he said: “I know I get paid really well.”

Is anyone checking out there?

Simple searches of government websites turned up disciplinary actions against many pharma speakers in ProPublica’s database.

The Medical Board of California filed a public accusation against psychiatrist Karin Hastik in 2008 and placed her [8] on five years’ probation in May for gross negligence in her care of a patient. A monitor must observe her practice.

Kentucky’s medical board placed Dr. Van Breeding on probation [9] from 2005 to 2008. In a stipulation filed with the board, Breeding admits unethical and unprofessional conduct. Reviewing 23 patient records, a consultant found Breeding often that gave addictive pain killers without clear justification. He also voluntarily relinquished his Florida license.

New York’s medical board put Dr. Tulio Ortega on two years’ probation [10] in 2008 after he pleaded no contest to falsifying records to show he had treated four patients when he had not. Louisiana’s medical board, acting on the New York discipline, also put him on probation [11] this year.

Yet during 2009 and 2010, Hastik made $168,658 from Lilly, Glaxo and AstraZeneca. Ortega was paid $110,928 from Lilly and AstraZeneca. Breeding took in $37,497 from four of the firms. Hastik declined to comment, and Breeding and Ortega did not respond to messages.

Their disciplinary records raise questions about the companies’ vigilance.

“Did they not do background checks on these people? Why did they pick them?” said Lisa Bero, a pharmacy professor at University of California, San Francisco who has extensively studied conflicts of interest in medicine and research.

Disciplinary actions, Bero said, reflect on a physician’s credibility and willingness to cross ethical boundaries.

“If they did things in their background that are questionable, what about the information they’re giving me now?” she said.

ProPublica found sanctions ranging from relatively minor misdeeds such as failing to complete medical education courses to the negligent treatment of multiple patients. Some happened long ago; some are ongoing. The sanctioned doctors were paid anywhere from $100 to more than $140,000.

Several doctors were disciplined for misconduct involving drugs made by the companies that paid them to speak. In 2009, Michigan regulators accused one rheumatologist of forging a colleague’s name to get prescriptions for Viagra and Cialis. Last year, the doctor was paid $17,721 as a speaker for Pfizer, Viagra’s maker.

A California doctor who was paid $950 this year to speak for AstraZeneca was placed on five years’ probation by regulators in 2009 after having a breakdown, threatening suicide and spending time in a psychiatric hospital after police used a Taser on him. He said he’d been self-treating with samples of AstraZeneca’s anti-psychotic drug Seroquel, medical board records show.

Other paid speakers had been disciplined by their employers or warned by the federal government. At least 15 doctors lost staff privileges at various hospitals, including one New Jersey doctor who had been suspended twice for patient care lapses and inappropriate behavior. Other doctors received FDA warning letters for research misconduct such as failing to get informed consent from patients.

Pharma companies say they rely primarily on a federal database listing those whose behavior in some way disqualifies them from participating in Medicare. This database, however, is notoriously incomplete.

The industry’s primary trade group says its voluntary code of conduct is silent about what, if any, behavior should disqualify physician speakers.

“We look at it from the affirmative — things that would qualify physicians,” said Diane Bieri, general counsel and executive vice president of the Pharmaceutical Research and Manufacturers of America.

Some physicians with disciplinary records say their past misdeeds do not reflect on their ability to educate their peers.

Family medicine physician Jeffrey Unger was put on probation [12] by California’s medical board in 1999 after he misdiagnosed a woman’s breast cancer for 2½ years. She received treatment too late to save her life. In 2000, the Nevada medical board revoked Unger’s license for not disclosing California’s action.

As a result, Unger said, he decided to slow down and start listening to his patients. Since then, he said, he has written more than 130 peer-reviewed articles and book chapters on diabetes, mental illness and pain management.

“I think I’ve more than accomplished what I’ve needed to make this all right,” he said. During 2009 and the first quarter of 2010, Lilly paid Unger $87,830. He said he also is a paid speaker for Novo Nordisk and Roche, two companies that have not disclosed payments.

The drug firms, Unger said, “apparently looked beyond the record.”

Companies make their own experts

Last summer, as drug giant Glaxo battled efforts to yank its blockbuster diabetes drug Avandia from the market, Nashville cardiologist Hal Roseman worked the front lines.

At an FDA hearing, he borrowed David Letterman’s shtick [13] to deliver a “Top Five” list of reasons to keep the drug on the market despite evidence it caused heart problems. He faced off [14] against a renowned Yale cardiologist and Avandia critic on the PBS NewsHour, arguing that the drug’s risks had been overblown.

“I still feel very convinced in the drug,” Roseman said with relaxed confidence. The FDA severely restricted access to the drug last month citing its risks.

Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues.

Roseman’s public profile comes from his work as one of Glaxo’s highest-paid speakers. In 2009 and 2010, he earned $223,250 from the firm — in addition to payouts from other companies.

Pharma companies often say their physician salesmen are chosen for their expertise. Glaxo, for example, said it selects “highly qualified experts in their field, well-respected by their peers and, in the case of speakers, good presenters.”

ProPublica found that some top speakers are experts mainly because the companies have deemed them such. Several acknowledge that they are regularly called upon because they are willing to speak when, where and how the companies need them to.

“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.

“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”

To check the qualifications of top-paid doctors, reporters searched for medical research, academic appointments and professional society involvement. They also interviewed national leaders in the physicians’ specialties.

In numerous cases, little information turned up.

Las Vegas endocrinologist Firhaad Ismail, for example, is the top earner in the database, making $303,558, yet only his schooling and mostly 20-year-old research articles could be found. An online brochure [15] for a presentation he gave earlier this month listed him as chief of endocrinology at a local hospital, but an official there said he hasn’t held that title since 2008.

And several leading pain experts said they’d never heard of Santa Monica pain doctor Gerald Sacks, who was paid $249,822 since 2009.

Neither physician returned multiple calls and letters.

A recently unsealed whistleblower lawsuit against Novartis [16], the nation’s sixth-largest drug maker by sales, alleges that many speakers were chosen “on their prescription potential rather than their true credentials.”

Speakers were used and paid as long as they kept their prescription levels up, even though “several speakers had difficulty with English,” according to the amended complaint filed this year in federal court in Philadelphia.

Some physicians were paid for speaking to one another, the lawsuit alleged. Several family practice doctors in Peoria, Ill., “had two programs every week at the same restaurant with the same group of physicians as the audience attendees.”

In September, Novartis agreed to pay [17] the government $422.5 million to resolve civil and criminal allegations in this case and others. The company has said it fixed its practices and now complies with government rules.

Roseman, who has been a pharma speaker for about a decade, acknowledged that his expertise comes by way of the training provided by the companies that pay him. But he says that makes him the best prepared to speak about their products, which he prescribes for his own patients. Asked about Roseman’s credentials, a Glaxo spokeswoman said he is an “appropriate” speaker.

Getting paid to speak “doesn’t mean that your views have necessarily been tainted,” he said.

Plus pharma needs talent, Roseman said. Top-tier universities such as Harvard [18] have begun banning their staffs from accepting pharma money for speaking, he said. “It irritates me that the debate over bias comes down to a litmus test of money,” Roseman said. “The amount of knowledge that I have is in some regards to be valued.”

Please see the original story at ProPublica

See also DME Doctors at American Contractors in Iraq and Afghanistan

Posted in Defense Medical Examinations, Department of Labor, Follow the Money | Tagged: , , , , , , , | Leave a Comment »

Leader of Military’s Program to Treat Brain Injuries Steps Down Abruptly

Posted by defensebaseactcomp on June 25, 2010

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR

WASHINGTON, D.C.–The leader of the Pentagon’s premiere program for treatment and research into brain injury and post traumatic stress disorders has unexpectedly stepped down from her post, according to senior medical and congressional officials.

Brig. Gen. Loree Sutton told staff members at the Defense Centers of Excellence [1], or DCOE, on Monday that she was giving up her position as director. Sutton, who launched the center in November 2007, had been expected to retire next year, officials with knowledge of the situation said. The center has not publicly announced her leaving.

Sutton’s departure follows criticism in Congress [3] over the performace of the center and in recent reports [4] by NPR and ProPublica that the military is failing to diagnose and treat soldiers suffering from so-called mild traumatic brain injuries, also called concussions.

It comes just as the Pentagon prepares to open a new, multimillion-dollar showcase treatment facility outside Washington, D.C., for troops with brain injuries [5] and post traumatic stress disorder, often referred to as the signature wounds of the wars in Iraq and Afghanistan.   Read the Entire Story here

Posted in Contractor Casualties and Missing, PTSD and TBI, T Christian Miller | Tagged: , , , , , , , , , , , | 5 Comments »

Pentagon Puts Its Spin on Brain Injuries

Posted by defensebaseactcomp on June 9, 2010

After Our Investigation, Pentagon Puts Its Spin on Brain Injuries

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR

ProPublica and NPR reported today that the military is failing to diagnose soldiers who suffered brain injuries in Iraq and Afghanistan. It didn’t take long to get a response. Soon after learning that the stories were about to air, the Pentagon’s public affairs machine began circulating talking points on traumatic brain injuries—just in case senior medical commanders weren’t up to speed on what the military’s been doing for troops with one of the wars’ signature wounds.

The talking points, which we obtained and were sent to top Army officials, don’t directly address the findings of our investigation [1]. We found that the military’s system has repeatedly overlooked soldiers with so-called mild traumatic brain injuries. These blast injuries, which some doctors call concussions, leave no visible scars but can cause lasting physical and mental harm in some cases. The Pentagon’s official figures [2] say about 115,000 soldiers have suffered a mild traumatic brain injury since the wars began. But we found that military doctors and screening tools routinely miss soldiers who have suffered mild traumatic brain injuries on the battlefield. Experts we interviewed and documents we obtained said the military’s count may understate the true toll by tens of thousands of soldiers.

The talking points are upbeat. One says that the Department of Defense has the “world’s best TBI medical care for our service members [3].” Leading neuropsychologists and rehabilitation therapists have told us that’s not true, however. They say the military doesn’t always provide the kind of intensive cognitive rehabilitation therapy most experts recommend. The talking points also stressed that one military screen, called the ANAM [4], for Automated Neuropsychological Assessment Metrics, will be “utilized when soldiers come home [5] to help measure the effects of any identified mild brain trauma that may have gone unnoticed or untreated.”

But when we talked to the man who ran that program, he told us the ANAM was rarely used that way. Lt. Col. Mike Russell, the Army’s senior neuropsychologist, said that more than 580,000 ANAM tests have been administered to soldiers before they deploy to the battlefield. But doctors have only used them about 1,500 times to diagnose soldiers after they’ve suffered a blow to the head.

The talking points tick off a number of initiatives the military has undertaken to better diagnose and treat the soldiers. But as we note in our stories, the problem is not the lack of initiatives, it’s that nine years into the war, nobody at the Pentagon knows how big the problem is, nor how best to treat it. You can find the complete talking points memos [6] and PowerPoint [7] here.

Phone calls to the medical command’s spokeswoman were not immediately returned.  Original here

Posted in ACE, AIG and CNA, Civilian Contractors, Contractor Casualties and Missing, PTSD and TBI, T Christian Miller | Tagged: , , , , , , | 8 Comments »

T. Christian Miller Wins Special Recognition ICIJ Daniel Pearl Awards

Posted by defensebaseactcomp on April 26, 2010

ICIJ Names Winners of 2010 Daniel Pearl Awards

WASHINGTON, D.C. — A gutsy, collaborative series by four European news outlets about toxic waste dumping in Africa and a surprising exposé by a freelancer on payoffs by U.S. military contractors to the Taliban won the 2010 Daniel Pearl Awards for Outstanding International Investigative Reporting.

In addition to the two winners, the judges awarded a special Certificate of Recognition to T. Christian Miller , Disposable Army, ProPublica; Doug Smith and Francine Orr, Los Angeles Times; and Pratap Chatterjee, freelance (United States), for their impressive series “” on how injured civilian contractors working for the U.S. military have been abandoned by Washington. Read the full story here

Posted in Civilian Contractors, T Christian Miller, Uncategorized | Tagged: , , , , , , , , | 2 Comments »

Overseas Press Club Awards for international journalism

Posted by defensebaseactcomp on April 22, 2010

ProPublica, with reporters T. Christian Miller, Doug Smith and Pratap Chatterjee, won the award for Web coverage of international affairs forDisposable Army: Civilian Contractors in Iraq and Afghanistan.

The Overseas Press Club Awards were founded in 1940 to recognize excellence in foreign coverage in the categories of print, broadcast and photography. Read more at the Washington Examiner:

Posted in Interviews with Injured War Zone Contractors, T Christian Miller | Tagged: , , , , , , , , | Leave a Comment »

Contractor Deaths Accelerating in Afghanistan as They Outnumber Soldiers

Posted by defensebaseactcomp on April 14, 2010

by T. Christian Miller, ProPublica - April 14, 2010

A recent Congressional Research Service analysis [1] obtained by ProPublica looked at the number of civilian contractors killed in Afghanistan in recent months. It’s not pretty.

Of the 289 civilians killed since the war began more than eight years ago, 100 have died in just the last six months. That’s a reflection of both growing violence and the importance of the civilians flooding into the country along with troops in response to President Obama’s decision to boost the American presence in Afghanistan.

The latest U.S. Department of Defense numbers show there are actually more civilian contractors on the ground in Afghanistan than there are soldiers. The Pentagon reported [2] 107,292 U.S.-hired civilian workers in Afghanistan as of February 2010, when there were about 78,000 soldiers. This is apparently the first time that contractors have exceeded soldiers by such a large margin.

Using civilian contractors to haul food, prepare meals and act as bodyguards has kept the Pentagon’s official casualty figures lower than they would have been in past conflicts, where contractors were not as heavily used.

Contractor casualties are, by and large, invisible to the public, disguising the full human cost of the wars in Iraq and Afghanistan. They are not reported in totals given by the government. If they were, the death toll in Afghanistan would have surpassed 1,000 — 848 soldiers, 289 civilian contractors — from 2001 to 2009, a milestone that has gone entirely unmarked.

The number of contractor dead are released only though the Labor Department, which keeps count as part of an insurance program for contractors known as the Defense Base Act. And these numbers, agency officials have admitted and our reporting has shown, undercount fatalities. As David Isenberg [3] pointed out in the Huffington Post recently, a new database designed, in part, to track contractor deaths is still not being used to do so.

Staff researcher Lisa Schwartz contributed to this report. Original here

Posted in Contractor Casualties and Missing, Department of Labor, T Christian Miller | Tagged: , , , , , , , | 1 Comment »

AIG Employees fly in secrecy and evermore on the taxpayer dollar

Posted by defensebaseactcomp on April 13, 2010

Off the Radar: Private Planes Hidden From Public View

You’ll want to read this story in it’s entirety at ProPublica

We’ve only claimed that they are greedy and ruthless, never that they were stupid

Taxpayers subsidize system

The use of corporate jets stoked the anger of the public and even President Obama in the wake of the 2008 financial crisis and government bailout as banks continued to buy planes and fly executives to resorts and vacation homes.

Firms such as AIG decided to sell aircraft and cancel purchases of new ones. AIG spokesman Mark Herr said in an e-mail that AIG blocked its aircraft years before the meltdown.

“It’s been AIG’s historical practice going back years to not disclose its aircraft identifiers to the general public,” Herr said. “In light of the surge in numbers and intensity of the threats directed at the physical safety of our employees, it’s only common sense to continue this practice.”

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Miller Uncovers the ‘Hidden War’

Posted by defensebaseactcomp on April 13, 2010

By Gretchen Parker on April 13, 2010 8:10 AM

USC NEWS University of Southern California

For his work uncovering the “the hidden war” – the casualties and neglect of injured contractors in Iraq and Afghanistan – journalist T. Christian Miller of ProPublica was honored April 9 with the 2010 Selden Ring Award for Investigative Reporting.

The $35,000 annual award, which has been presented for the past 21 years by USC Annenberg School for Communication & Journalism, honors outstanding work in investigative journalism that made an impact. This year’s award was the first to go to a journalist at a non-traditional news organization.

“It’s a particular pleasure for me to give this award to T., because it represents the kind of collaboration I am confident will be an increasingly important part of the future of journalism,” said Geneva Overholser, director of the School of Journalism, as she presented the award to Miller at a luncheon ceremony.

Miller began reporting on the plight of war contractors when he worked for the Los Angeles Times. He continued his work when he moved to ProPublica, a New York-based nonprofit news organization that focuses on investigative stories that serve a public interest. The agency partners with newspapers, network news and online outfits to get the stories published and aired.

Besides the Times, which collaborated with Miller on his stories, ABCNews.com, The Washington Post, Salon.com and TheDailyBeast.com also ran pieces of the series.

Over three years, Miller untangled the bureaucracies of the Department of Defense and the Department of Labor to uncover for the first time how many contractors have died in the wars in Iraq and Afghanistan – 1,757, as of April 9. Another 37,000 have been injured.

“No one tracks these people. There is no accountability for them,” he said of the contractor ranks, which he said have become a “disposable army.”

Beyond the casualties, Miller revealed that contractors were not receiving even minimal benefits owed to them when they are injured in war zones. He also found that many of those suffering are working-class Americans who saw the contract work as a way to dig themselves out of debt and take care of their families.

Thousands of them are from Third World countries hired to do the work of cleaning toilets and mopping floors for the American military.
“What the U.S. has done is hire some of the poorest people in the world to do the dirtiest jobs in the most dangerous countries in the world. These are the people who are being killed,” Miller said.

Because of Miller’s work, congressional hearings were held and legislation is being prepared that will hold the Department of Defense more accountable for its hired workers. And the Labor Department also is taking action to step up penalties against errant insurers.

News gathered by collaborative partnerships is becoming increasingly common as news organizations struggle to make the most of resources. But Miller pointed out that these partnerships have the potential to carry more influence than one high-profile outfit pursuing a story.

“The benefit is that you can’t dismiss this as one crazy reporter at one crazy newspaper who is waging a crusade,” he said. “It’s a reverberation effect of many media and many voices participating in many different directions. And it’s increasingly difficult to ignore that story.”

Winning the Selden Ring Award has helped shine even more light on the issue, Miller said.

“The day after I won the award, I sent e-mails to all the congressional committees involved in this topic and said, ‘This has become a Selden Ring Award winner,’ ” Miller said. “They all wrote back. It’s a way to put it on their radar screens. They know it’s been recognized. They know we’re going to continue to cover it, and it’s not going to go away.

“That kind of dogged investigative journalism is the exact type that the award was created to recognize.”

And although the award also has brought more attention to non-traditional and nonprofit news organizations, Miller cautioned against looking to ProPublica to save the investigative journalism that is seeping out of established newsrooms.

“I hope it raises the profile of collaborative media, but I don’t think nonprofit journalism is ever going to replace for-profit journalism. It gives a boost to what is out there,” he said. “I really hope a message out of this is that there’s no reason not to work with nonprofits. So let’s go down this path and try to double the firepower we used to have by bringing in an outside partner.”

Miller was congratulated at the awards luncheon by legendary investigative reporter Seymour Hersh, who related the stories behind how he broke the My Lai Massacre and its cover-up during the Vietnam War.
He encouraged the audience, which included young reporters from an Investigative Reporters and Editors workshop, to pursue investigative journalism.

“It’s truly a great way to spend time, and I urge all you young people to keep at it,” he said.

The award luncheon also featured a tribute by past award winners to Douglas Ring, benefactor of the prize. Ring died in November 2009.

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ProPublica Wins Pullitzer Prize

Posted by defensebaseactcomp on April 12, 2010

ProPublica reporter Sheri Fink has been honored with a Pulitzer Prize for investigative reporting for an article published last August in the New York Times Magazine. In addition, reporting by Charles Ornstein and Tracy Weber of ProPublica on lax oversight of nursing in California, published in the Los Angeles Times, was a finalist for the Pulitzer Prize for Public Service, the Pulitzer’s highest honor.

Sheri Fink’s shocking 13,000-word chronicle, “The Deadly Choices at Memorial,” revealed how some New Orleans doctors – in the gathering chaos as Katrina’s flood waters rose, generators failed, and their hospital was cut off from the world – decided to give lethal injections to patients whom they feared could not be evacuated.

Sheri’s work is a powerful example of what ProPublica was founded to do: shine light on possible abuses of power or failures to uphold the public interest, so that the public can learn from and remedy them. In this case, her reporting provides crucial information for those charged with designing guidelines for coping with medical disasters. The key questions are who should be saved first and who should decide.

This prestigious award caps a series of honors voted for ProPublica’s work in 2009, its first year of operation with a complete staff.  They include a George Polk Award, the Selden Ring Award for investigative reporting, and two Investigative Reporters and Editors awards for subjects as diverse as environmental risks from natural gas drilling, denial of government-mandated insurance benefits for dead or wounded employees of military contractors abroad, and police shootings in New Orleans.

The honors are gratifying, and we deeply appreciate them, but they are not a goal in themselves. We view them as a sign that our nonprofit, non-partisan model – publishing both on our own Web site and in partnership with major print, video, audio and online news organizations – can make a meaningful contribution to the information needs of the American people in an era of explosive change in newspapers and other media.

Paul Steiger

President & Editor-in-Chief
ProPublica

Posted in AIG and CNA, Contractor Casualties and Missing, T Christian Miller | Tagged: , , , , | Leave a Comment »

Two ProPublica Reporters Win IRE Awards

Posted by defensebaseactcomp on March 30, 2010

ProPublica reporters T. Christian Miller and A.C. Thompson have won best-of-category awards in the 2009 Investigative Reporters and Editors Awards.

Miller won the top award in the Online category for “Disposable Army [2],” along with Doug Smith and Francine Orr of the Los Angeles Times, Anvi Patel of ABC News and Pratap Chatterjee, an independent journalist and author.

Thompson won the top award in the Magazine/Specialty Publication category for “Katrina’s Hidden Race War” and “Body of Evidence,” which were published both by ProPublica and The Nation. “Katrina’s Hidden Race War” also received support from The Investigative Fund [3]. His latest reporting on the issue can be found here [4].

Additionally, Karen Weise, a once and future ProPublica intern who is at the Berkeley Graduate School of Journalism, was a finalist in the Student Work category for her articles on loan modifications [5], and ProPublica reporter Sheri Fink”s story, “The Deadly Choices at Memorial [6],” was a finalist in the Online category.

The IRE judges said [7] (PDF) that “…ProPublica’s reporting with the Los Angeles Times and ABC News in the ‘Disposable Army’ series is remarkable for its depth and complexity…” and that “the reporting led to a congressional hearing and a systemic overhaul by the Labor Department and the Pentagon.”

About Thompson’s reporting on the aftermath of Katrina, the IRE judges commented [7] (PDF) that Thompson “…conducted an examination that shed light on a sensitive subject and detailed a largely unexplored story…”

The top awards in the annual competition, the IRE Medals, were given to The New York Times for its “Toxic Waters” series and to KHOU, Houston for “Under Fire: Discrimination & Corruption in the Texas National Guard.”

Congratulations to all IRE winners and finalists [8].

Update: This post has been updated to show that A.C. Thompson’s reporting for “Katrina’s Hidden Race War” also received support from The Investigative Fund.  Original Story here

Posted in Contractor Casualties and Missing, T Christian Miller | Tagged: , , , , , | Leave a Comment »

 
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