I spend a lot of time talking about the damage that quackery can do, but this week the New York Times is carrying a story on the flip side: a VA hospital in Philadelphia whose cancer unit continually botched procedures.  Over the course of six years, one particular doctor was found to have screwed up 92 of 116 cancer treatments. 

This is the kindest or that makes people turn to homeopathy and "neutraceuticals," because hey, how much damage can they do?  Dr. Gary D. Kao received his MD from Johns Hopkins, and a PhD from Penn.  Despite his Ivy League education, Dr. Kao caused untold amounts of misery and suffering for his patients.  At the Philadelphia VA hospital, he specialized in a treatment for prostate cancer in which radioactive pellets are inserted into the prostate.  Dr. Kao continually failed to insert the pellets in the correct location, sprinkling them throughout the lower halves of his patients' bodies.

He covered up these mistakes by revising his surgical plans after the fact.  Let's say Dr. Kao planned to insert 60 pellets into the patient's prostate, but 54 of them ended up in the patient's bladder.  After the procedure,  Dr. Kao would rewrite his paper work, saying something along the lines of, "upon surgical examination, I decided the what the patient really needed was 52 pellets in his bladder and only six in his prostate."

Other people at the VA hospital knew there was a problem, but they said nothing. Dr. Kao's mistakes were only revealed during a Nuclear Regulatory Commission investigation of a supply chain problem.

One of the foundations for good science is peer review.  If you submit a scientific paper, a panel of other scientists reviews it for accuracy and possible problems.  And trust me, they are merciless.  Peer review is also a cornerstone of good medicine.  Most hospitals have an entire department of doctors whose job it is to comb through medical files and second guess the work of other doctors.  This peer review process would have caught Dr. Kao's misdeeds immediately.  So it's too bad that the Philadelphia VA hospital doesn't have a peer review process.  No explanation is given for why this is so.

The most terrifying aspect of the story is that Dr. Kao was ruining the lives of his patience for many years, and his mistake was only caught by accident.  How were Dr. Kao's patients to know that he was completely incompetent?  They had no way of knowing this, and you have no way of knowing if you are visiting your own Dr. Kao the next time you check into a hospital for medical procedure.

This lack of transparency in the medical industry both serves as cover for incompetent doctors, and breeds fear and conspiracy theories among the general public.  It only makes things worse for everyone, but I'm not sure how it could be different.  The problem is that health care regulations require a great deal of secrecy, and this is a good thing.  Unfortunately, if we have no choice but to place our faith in the hands of medical professionals when the need arises, and we get frustrated with people who refuse to do this, stories like this make me understand their fears.