Gabor Maté: How Capitalism Makes Us Sick

An interview on health and politics

Doctor Gabor Maté is the award-winning author of the books When the Body Says No, Hold On To Your Kids, and In the Realm of Hungry Ghosts. He was recently invited to speak at a conference of the Saskatoon Tribal Council, which includes seven Saskatchewan First Nations. I took the opportunity to interview Dr. Maté about his writing and the intersection between health and politics.

Can you tell me about your new project?

I’m intending to write a book tentatively called Toxic Culture: How Capitalism Makes us Sick. That’s the working title. My contention is that the very nature of the system in which people live their lives is a significant source of illness. Now there are obvious factors like environmental pollution, toxins, and then of course there are the social determinants of health that you write about in A Healthy Society: the impact of poverty, the impact of inequality, the impact of history and continued racism. There’s an article in the Saskatoon Star Phoenixtoday about sentencing practices in the courts of Saskatchewan. People who are identified as Aboriginal are likely to get double the sentences of people who are not identified as Aboriginal. That’s going to have a health impact.

But I’m going to go beyond even that and say that even the people who are not on the wrong end of economic inequality or systemic racism are still made ill just by how we live our lives. The stress that we live under, the competition, the aggressiveness, the uncertainty, the loss of control that we experience in our lives. The gender inequalities, these are not just social phenomena, they have an actual impact on community health. The isolation people are experiencing.

When you think of the individuals who wind up with a double prison term, obviously that has a great impact on their own health. What’s the impact on their family’s health and the community around them?

Families are further deprived of contact and further broken. Children are further deprived of their parents. There’ve been studies in the U.S. on drug sentencing laws and what the impacts are on the children of the people who are jailed. And of course in the U.S., too, the people who are so called coloured or minority are more likely to be jailed for a longer time. There’s nothing equal about the criminal justice system that way, nor about the impact on families.

On the individual level, you can take monkeys and isolate them and then you measure their dopamine receptors and find they are reduced significantly. In other words there’s less receptor for the motivation and incentive chemicals in their brains. Then you put them back into society, those dopamine receptors can come back, unless they’re bullied and underlings in which case they don’t come back. So, the way we treat people has a physiological impact. When you stick them in jails when you treat them with isolation, when you ostracize them, you are hurting them. And furthermore, who is it that’s jailed? Dr. Bessel van der Kork, a trauma expert at Boston University, has said that 99 per cent of the people in the criminal justice system are traumatized children.

I recall hearing of a study showing that more than 95 per cent of inmates have a mental illness.

Yes, absolutely, and the basis of mental illness is trauma. And so, what you’ve got is already traumatized people being further traumatized by the jail system. We don’t have quite the horror stories that you do in the United States with the private prisons, but it’s pretty horrible in Canada.

When you think of the period of their life where people are imprisoned, that’s the period of their life where they’re kept traumatized and kept from growing. I also think of HIV in Africa where you have the death of people in their working and child-rearing years and the effect that has on communities. When you take all the young men from a community what does that do to their economic chances, for their chances to have a generation of kids that aren’t traumatized as well?

Exactly. And nearly 30 per cent of the people in jail in Canada are Aboriginal, even though they only make up 4 per cent of the population.

In Saskatchewan it’s closer to 80 per cent.

What percentage of the population of Saskatchewan is Aboriginal?

Fifteen to 20 per cent.

And they make up nearly 80 per cent of the jail population. So, why are they in jail? Because they were traumatized in the first place, individually and as a people. So they turn to drugs, for example, as a way of soothing their pain. So what do we do? We punish them. We not only punish them, we further traumatize them. Then, under the current rules, we’re going to keep them in jail longer. If we’re going to spend more money on enforcement, and jailing people, there’s less money for programs and rehab in jail. Hence we’ve got this so-called correctional system that doesn’t correct anything.

So, clearly that’s a really great example of downstream thinking; we’ve got a problem, we’re going to lock it up or respond to it in a way that’s after the fact. What would be a way to move further upstream in regard to the crime that does exist?

Well, a lot of crimes are committed because we’ve made something criminal that’s very arbitrary. There’s no criminality in possessing liquor, but there’s criminality in possessing heroin. Why? Heroin is far more benign than liquor is when it comes to health impacts over the long term. It’s not a crime to possess nicotine, or cigarettes, but it is a crime to possess cocaine. Why? I’m not recommending cocaine or heroin to anyone, I’m just saying, if you’re going to talk about health effects, neither can compare with cigarettes.

A lot of our prison population may wind up in prison for a crime in the first place, but they later return due to parole violation or failure to pay a fine, so you have administrative, process crimes, that you or I could pay our way out of with a fine or a lawyer, and they just have to do the time.

And the crimes are committed because certain drugs are illegal, and they have to pay big bucks for it, and to get the big bucks they have to commit the crime to get the money. So, first of all, we create a lot of crime, just by arbitrary decisions about what constitutes criminal behavior.

What’s the quote? “The law in its wisdom prohibits both rich and poor alike from sleeping under bridges.”

That’s right. Anatole France said that.

It prohibits the rich and poor alike from injecting cocaine.

The rich don’t have to, they can buy powdered cocaine.

Right, and nobody notices because they can do it in the safety of their own home.

Exactly. Now in the U.S., the possession of crack cocaine was punished ten times as heavily as the possession of powdered cocaine. Who used crack cocaine? Poor blacks. Who used powdered cocaine? Rich whites. The effects are the same, it doesn’t matter, the one is not worse than the other.

Then, if you look at who becomes alcoholic, who commits crimes of violence, these are people that were traumatized. And they were traumatized quite systemically and deliberately by official government policy. It wasn’t an aberration, it went on for over a hundred years, and in many ways it’s still going on.

So an upstream approach would be to put a lot of the resources and energy that now goes into law enforcement and incarceration into programs that would help young families not repeat the trauma of generations. Educational departments and health departments would have to spend a lot more money. But we would save that money downstream in economic activity, in less crime, greatly reduced health care costs, etc.. Of course, nobody thinks long term. Departments only think in terms of budgets over the fiscal year. So no bureaucrat is going to get a benefit from thinking 15 years down the road.

When I talk about Upstream, that’s the most common objection: Canadians have a four-year political cycle at most. When you look at First Nations communities they have a two-year political cycle for Indian Act chiefs and councils, which makes it even harder for them to have any longitudinal success. That’s true, but there are examples in the past of long-term thinking despite short political terms.

Medicare here in Saskatchewan is a great example. Political terms were no different, but they were thinking 50 years out. So there are problems in the electoral system, but there are also problems in the demand. What could happen for us as a society to actually create the demand for long-term thinking from our political leaders. How do we change their way of thinking by what we reward?

That’s a very idealistic question, because it assumes that political leaders are not just in theory, or not just by intention, but in actual practice there to serve the needs of the people. That’s a fair assumption, but is it true? If you actually look at the policies of political leaders over the generations, whose interests do they actually serve? Are they serving the interests of the people, or are they serving the interests of a small group of people who hold the levers of the economy. I could make a reasonable case that underneath the veneer of political democracy lies a political dictatorship: very few people in charge running the system for their own benefit. So, if that’s the case, there’s no use in hoping for leaders to be any different, because if they’re any different they won’t get elected, because the media that’s controlled by the same elite will never let them have any kind of a voice.

And even if they do get elected they’ll be hamstrung at every opportunity.

If by accident someone’s elected with a slightly different point of view they’ll be totally hamstrung, and whatever they do will be quickly reversed. So even Medicare, which is this Canadian icon, has undergone significant dismantling over the last fifteen, twenty years. And it’s not going to die by a single blow, it’s going to die by a thousand cuts, and the pressure to privatize is increasing. So when you say, how are we going to get the public to put the pressure on politicians, well the other thing is, of course, the public works with the information that’s given to them by the system. And as much as there’s the Internet and people can do any kind of research they want, most people are not motivated to do that. Most people are depoliticized, most people are resigned to leave significant decisions to their politicians.

Although in principle we have freedom of choice, without awareness and consciousness it’s not meaningful to speak about freedom of choice.

And the Internet, whether it’s the amount of information or the way it’s accessible, it may actually be causing people to remain more on the surface than actually digging into ideas.

Which means there are very few conscious people in this country. Ask the average person about any complex issue. It’s fine to have a democracy, but if you have a democracy with a fundamentally unaware population, then the people who are very aware of their interests and have the capacity to control the flow of information that reaches most people, are in an unassailable position. So then, who are these people that are going to challenge the politicians? They’re people who don’t have the information that they can challenge anybody with. And yet what is remarkable is that despite all that propagandistic control, on some significant issues people actually manage to come to some conclusions. For example, at least there seems to be a strong general understanding of climate change. But that hasn’t translated into any kind of political electoral movement. When the next election happens, we’re still going to elect people who have been supporting policies that contribute to climate change. If you poll people, yeah, climate change is an issue, but if you look at how it affects political behavior, it doesn’t affect it very much.

Part two of Ryan Meili’s interview with Gabor Maté is HERE.

Ryan Meili is a Saskatoon family physician, author, medical educator, and founding director of Upstream: Institute for A Healthy Society.

From the Food Babe to Dr. Oz, these four are the media’s biggest fear-mongers and snake-oil peddlers.

4 of the Biggest Quacks Plaguing America with False Claims About Science

Photo Credit: indiamos/Flickr

It may be easy to draw a caricature of a “quack” as a cross between the ShamWow pitchman and an alchemist, but they’re really not so easy to spot. Modern-day quacks often cherry-pick science and use what suits them as semantic backdrop to fool unsuspecting consumers. Quacks may dazzle people with fanciful research studies or scare them with intimidating warnings before trying to peddle products that make unreasonable promises. And those who use these alternative, unproven products may forego treatments that would be more likely to help them.

In short, quackery is dangerous. It promotes fear, devalues legitimate science and can destroy lives. Here are the four biggest quacks giving dubious health advice in the media and some samples of their detrimental advice.

1. Dr. (of Osteopathy) Joseph Mercola. Mercola is not a strict medical doctor, but an osteopath who practiced in suburban Chicago (according to Chicago magazine, he gave up his practice in 2006 to focus on Internet marketing). Mercola has also written several books on health that have become bestsellers.

Mercola operates one of the Internet’s largest and most trafficked health and consumer information sites. With an estimated 15.5 million unique monthly visitors, dwarfs even and The site vigorously promotes and sells dietary supplements, many of which bear Dr. Mercola’s name.

A typical article on Mercola’s site touts the wonders of yet another miracle cure or supplement. Some recent articles include “13 Amazing Health Benefits of Himalayan Crystal Salt” and “Your Flu Shot Contains a Dangerous Neurotoxin.” His site has also touted Vitamin D as “The Silver Bullet for Cancer.”

Many of Mercola’s musings clash — sometimes bitterly — with conventional medical wisdom. Mercola advises against immunization, water fluoridation, mammography, and the routine administration of vitamin K shots for newborns.

The medical community says Mercola is dangerous, and that he steers patients away from proven medical treatments in favor of unproven therapies and supplements.

“The information he’s putting out to the public is extremely misleading and potentially very dangerous,” says Dr. Stephen Barrett, who runs the medical watchdog site “He exaggerates the risks and potential dangers of legitimate science-based medical care, and he promotes a lot of unsubstantiated ideas and sells [certain] products with claims that are misleading.”

Mercola has been the subject of a number of Food and Drug Administration warning letters about his activities, including marketing products as providing “exceptional countermeasures” against cancer, heart disease, diabetes, and a host of other illnesses. He also has marketed coconut oil to treat heart disease, Crohn’s disease, and Irritable Bowel Syndrome. also sold an infrared camera to be used as a cancer screening tool.

Some of Dr. Mercola’s wildest claims include:

  • HIV may not be the cause of AIDS. Mercola believes that the manifestations of AIDS (including opportunistic infections and death) could result from “psychological stress” brought on by the belief that HIV is harmful. has also featured positive presentations of the claims of AIDS truthers who deny the existence of AIDS or the role HIV has in the disease.

  • Mercola has said that microwave ovens emit dangerous radiation and that microwaving food alters its chemistry.

  • Commercial sunscreens increase the likelihood of skin cancer, instead of protecting from it. Of course, he sells his own natural sunscreens on his website.

2. The “Health Ranger,” Mike Adams. Adams runs a website called Natural News that is dedicated to supporting alternative medicine techniques and various conspiracy theories about chemtrails, the link between vaccinations and autism, and the dangers of fluoridated drinking water. Dr. Mercola is a frequent guest blogger on his site.

Natural News, which gets an estimated 7 million unique visitors a month, primarily promotes alternative medicine, raw foods, and holistic nutrition. Adams claims he began the site after curing himself of Type II diabetes by using natural remedies.

Adams seems to revel in going against the grain. He likes to tell readers on his website that if they just exercise, eat the right foods and take the right supplements (he markets supplements on his site) infectious disease cannot harm them. Like Mercola, he is an AIDS denialist, and claims flu vaccines are totally ineffective.

Dr. David Gorski of the Science-Based Medicine website calls Natural News “a one-stop shop, a repository if you will, of virtually every quackery known to humankind, all slathered with a heaping, helping of unrelenting hostility to science-based medicine and science in general.”

Adams also considers himself a scientific researcher, but some of his claims are dubious. He has even bought himself a mass spectrometer which he uses to test various products for toxicity. He recently used this device to show that a flu vaccine containing thiomersal registered 51 parts per million of mercury. But that’s not the news in his findings: Adams went on to insist that his critics must be brain-damaged (or perhaps brainwashed) by mercury:

The only people who argue with this are those who are already mercury poisoned and thus incapable of rational thought. Mercury damages brain function, you see, which is exactly what causes some people to be tricked into thinking vaccines are safe and effective.

Science-Based Medicine blogger Dr. Steven Novella describes Adams’ site as “a crank alt-med site that promotes every sort of medical nonsense imaginable. If it is unscientific, antiscientific, conspiracy-mongering, or downright silly, Mike Adams appears to be all for it —whatever sells the ‘natural’ products he hawks on his site.”

What makes Adams unique is that he likes to mix far-right vitriol and conspiracy theories with his alternative medicine advice. He has come out as a climate-change denialist, 9/11 Truther, and a Birther.

Here’s some more quackery from Adams and Natural News:

3. The “Food Babe,” Vani Hari. She doesn’t have a degree in nutrition, chemistry or medicine, and her work background is as a management consultant. Yet without any serious credentials, Hari—the “Food Babe”—bills herself as a voice of consumer protection on the Internet. In just a few years, she’s assembled an army of followers who have joined her on her quest to get hard-to-pronounce ingredients banned from foods.

Hari’s acolytes see her as a muckraking reporter, saving us from nefarious chemicals, GMOs and unappetizing ingredients like beaver anus, yoga mat and fish bladder. The public and the media love her; a “food safety” campaign by the Food Babe can get thousands of signatures, countless media mentions and guest appearances on television shows such as Dr. Oz and The Doctors.

But Hari is really more of a fear-mongerer and conspiracy theorist than a safe-food advocate. Her campaigns are born of misinformation and anxiety. Recently, she published a petition on her website demanding that the top beer companies come clean about the ingredients in their beer. Citing a long list of creepy, chemical-sounding ingredients that are allowed in beer, she implied that the industry was flying under the radar and obscuring the additives it puts in its products.​ It turned out that the beer companies were actually using very few of the ingredients on her list, and some were only used in the production process and were not part of the finished product. When we looked further into it, we found that many of the nefarious ingredients and techniques she described were either misrepresented or entirely misunderstood by her.​

However, at Hari’s request, the top two breweries in the U.S. acquiesced and listed their ingredients on their websites, and none of the ingredients would come as a real shock to beer drinkers. Still, Hari continued to insist that GMO corn and other bad ingredients were integral ingredients in beer.

In response to critics who say Hari is not qualified to make hard judgments on food ingredients, Hari says, “I don’t think you need to have those degrees to be intellectually honest, to be able to research, to be able to present ideas.”

Dr. David Gorski, a cancer surgeon who writes for the website Science-Based Medicine takes offense to Hari’s food campaigns:

“Her strategy is very transparent, but unfortunately it’s also very effective,” wrote Gorski. “Name a bunch of chemicals and count on the chemical illiteracy of your audience to result in fear at hearing their very names.”​

Gorski says since companies live and die by public perception, it’s far easier to “give a blackmailer like Hari what she wants than to try to resist or to counter her propaganda by educating the public.”​

Some of Vani Hari’s more specious ideas about food are:

  • Microwaves kill food and remove its nutrients. Also, microwaves change the chemical properties of water. She persists with this theory although it has been persistently debunked by science.

  • Water, when exposed to the words “Hitler” and “Satan” changes its physical properties.

  • Flu shots contain “a bunch of toxic chemicals and additives that lead to several types of Cancers and Alzheimer [sic] disease over time.” Actually, flu shots are made up mostly of proteins and preservatives that give no indication of being harmful, despite plenty of medical research.

Hari has not provided any scientific evidence to back her claims as of yet.

4. Dr. Mehmet Oz. What do Vani Hari, Dr. Joseph Mercola and Mike Adams have in common? They’re all guest experts appearing on the Dr. Oz Show.

Dr. Oz is a media darling and cardiothoracic surgeon who first appeared on the Oprah Winfrey Show in 2004. In 2009, Oprah produced Oz’s namesake show focusing on medical issues and personal health.

But before we label Oz a quack, it’s only fair that we also should note he’s a professor at the Department of Surgery at Columbia University, directs the Cardiovascular Institute and Complementary Medicine Program at New York-Presbyterian Hospital, has authored more than 400 medical research papers and holds several patents.

But unless you’ve been living under a rock for the last month, you probably know Dr. Oz has been exposed as a daytime-television snake oil peddler, while being shamed during testimony before a U.S. Senate subcommittee last month.

Sen. Claire McCaskill, the chairwoman of the Senate subcommittee on Consumer Protection, took Oz to task over false claims he’s made for over-the-counter weight loss cures. For example, Oz proclaims that worthless supplements such as green coffee beans have “miracle” properties.

The Missouri senator made it clear that she thinks Oz abuses his great influence. Products he endorses on his show are almost guaranteed to fly off the shelves.

“People want to believe they can take an itty-bitty pill to push fat out of their body,” McCaskill chided the celebrity doctor. “I know you know how much power you have.”

Oz acknowledged to the subcommittee that while there’s no such thing as a “miracle” supplement, and many he touts wouldn’t pass scientific muster, he insisted he was comfortable recommending them to his fans.

“My job is to be a cheerleader for the audience,” Oz says. ”And when they don’t think they have hope, when they don’t think they can make it happen, I want to look and I do look everywhere, including alternative healing traditions, for any evidence that might be supportive to them.”

As McCaskill then pointed out, Oz was giving people false hope. Isn’t that what quacks do?

Oz often uses his show as a soapbox for the likes of Hari, Mercola and Adams. And when they’re guests on his show, they’re handled with kid gloves. Oz even describes Adams as an “activist researcher,” a “whistleblower” and a “food safety activist.” Viewers then open their wallets to Adams, who is there to promote his website. A similar scenario plays out when Mercola, a frequent guest, joins Oz. Hari, for her part, does not market miracle products on her site. She does, however, seem to make money from affiliate advertising.

Oz’s great sin is that he uses his show to promote all types of modern shamanism. Critics find it mystifying that he, a medical doctor, would host and promote people on his show who are anathema to science. It’s Oz’s instant access to millions and his medical degrees and peer-reviewed research papers that have given him credibility, but critics say he loses all of it when he promotes guests who explicitly reject the tenets of reason. So, can Oz still be considered a serious scientist?

Unlike the other three quacks mentioned in this article, Oz is more a ringmaster than a snake-oil salesman. However, he’s not without his list of dubious stances:

  • In November 2012, Dr. Oz invited Julie Hamilton, a representative of the National Association for Research and Therapy of Homosexuality, who claimed that she could heal homosexuality with gay reparative therapy. Although the show did include guests who condemned reparative therapy, Dr. Oz never weighed in on the subject, and the audience was led to believe that there were valid arguments on both sides of this issue.

  • His proclamation on Oprah that resveratrol is an effective anti-aging supplement sparked a resveratrol marketing craze. Numerous fly-by-night online peddlers used his name and likeness (along with the likenesses of age-defying actresses Jennifer Aniston and Marisa Tomei) to peddle the so-called miracle supplement. But it’s anyone’s guess what was in those pills.

  • Oz has invited a medium on his show who told selected audience members that she was communicating with their lost loved ones.

  • Oz once invited a faith healer, Issam Nemeh, to “heal” sick audience members on his show. On his website, Oz bragged about the “Oz Effect”: “Dr. Nemeh has received an overwhelming response from the viewers of the Dr. Oz show. Medical office appointments with Dr. Nemeh are already filled for the next four months.”

Cliff Weathers is a senior editor at AlterNet, covering environmental and consumer issues. He is a former deputy editor at Consumer Reports. His work has also appeared in Salon, Car and Driver, Playboy, and Detroit Monthly among other publications. Follow him on Twitter @cliffweathers and on Facebook.



‘Godfather of ecstasy’ Sasha Shulgin who introduced MDMA dies at 88

Published time: June 03, 2014 09:44
Edited time: June 03, 2014 11:1

Alexander Shulgin (Reuters / Brian Snyder)

Alexander Shulgin (Reuters / Brian Snyder)

American medical chemist and pharmacologist of Russian descent Alexander ‘Sasha’ Shulgin, best known for introducing the MDMA (ecstasy) drug to psychology, passed away Monday “peacefully surrounded by friends and family.” He was 88.

Shulgin was an icon of the psychedelic movement in the US, synthesizing previously unknown psychoactive substances and testing them on himself, making detailed reports of his experience later transformed in a number of books, including PiHKAL (Phenethylamines I Have Known And Loved) and TiHKAL (Tryptamines I Have Known And Loved).

Through his experiments, Shulgin reportedly synthesized over 200 new psychoactive substances and rated them according to his personal Shulgin Rating Scale.

Alexander Shulgin (Reuters / Brian Snyder)

Alexander Shulgin (Reuters / Brian Snyder)

Shulgin studied organic chemistry at Harvard University. After joining US Navy in 1943, he got interested in psychopharmacology and after the end of WWII completed a post-doctoral course at the University of California, San Francisco, in the late 1950s.

After working as a chemist at Bio-Rad Laboratories, he worked for Dow Chemical as senior research chemist. In 1965 he chose to pursue his own research in psychiatry and pharmacology, organizing a laboratory at his house in Berkeley, California.

A major shift in his research took place in 1976, when Shulgin got acquainted with the MDMA substance first synthesized in 1912 at laboratories of Merck, the German chemical and pharmaceutical company.

In collaboration with Californian psychologist Leo Zeff, Shulgin introduced the substance to hundreds of US psychologists as an aide to talk therapy.

In 1979, Shulgin met his wife-to-be Anna, who became his closest research co-worker and co-author of his books over the years to come.

Alexander Shulgin (R), pharmacologist and chemist known for his creation of new psychoactive chemicals, and his wife Ann (Reuters / Brian Snyder)

Alexander Shulgin (R), pharmacologist and chemist known for his creation of new psychoactive chemicals, and his wife Ann (Reuters / Brian Snyder)

In November 2010 Shulgin suffered a stroke and spent some time in hospital in San Francisco. Because the treatment costs were high and Medicare covered only about 80 percent of them, Shulgin’s admirers organized a fundraising campaign, gathering donations that helped him have proper medical treatment over the next few years.

A few months before he suffered a stroke, Shulgin gave a popular interview to VICE Media’s Hamilton Morris, which was published in May 2010 under a title ‘The Last Interview With Alexander Shulgin’.

In March 2010, director Etienne Sauret released a “Dirty Pictures” documentary on Shulgin’s life and scientific research, describing him as a “rogue chemist who discovered the effects of MDMA (aka Ecstasy) and over 200 other mind-altering drugs.”


Dear Friends, Sasha died today, at exactly 5 o’clock in the afternoon. He was surrounded by family and caretakers and Buddhist meditation music, and his going was graceful, with almost no struggle at all.

Thanks to all of you, and Blessings,

Ann Shulgin

Photo: Dear Friends,</p>
<p>Sasha died today, at exactly 5 o'clock in the afternoon.  He was surrounded by family and caretakers and Buddhist meditation music, and his going was graceful, with almost no struggle at all.</p>
<p>Thanks to all of you, and Blessings,</p>
<p>Ann Shulgin


Why Doctors Stay Mum About Mistakes Their Colleagues Make



A doctor draws medicine into a syringe. Telling a patient about another doctor’s medical error can mean losing business or suffering retribution. Now, some physicians are looking for ways to break the code of silence. (File, Brendan Smialowski/AFP/GettyImages)


Patients don’t always know when their doctor has made a medical error. But other doctors do.

A few years ago I called a Las Vegas surgeon because I had hospital data showing which of his peers had high rates of surgical injuries – things like removing a healthy kidney, accidentally puncturing a young girl’s aorta during an appendectomy and mistakenly removing part of a woman’s pancreas.



I wanted to see if he could help me investigate what happened. But the surgeon surprised me.


Before I could get a question out, he started rattling off the names of surgeons he considered the worst in town. He and his partners often had to correct their mistakes — “cleanup” surgeries, he said. He didn’t need a database to tell him which surgeons made the most mistakes.


By some estimates, medical errors are one of the leading causes of death in the United States. Physicians often see the mistakes made by their peers, which puts them in a sticky ethical situation: Should they tell the patient about a mistake made by a different doctor? Too often they do not.


A new report in The New England Journal of Medicine, “Talking With Patients About Other Clinicians’ Errors,” suggests it’s a common problem.


The report’s lead author, Dr. Thomas Gallagher, an internist and professor at the University of Washington School of Medicine, said he conducted a survey of doctors in which more than half said that, in the prior year, they identified at least one error by a colleague. (The survey, unrelated to the NEMJ report, did not ask what the doctors did about it, Gallagher said.)


There’s wide agreement in the medical community that doctors have an ethical duty to disclose their own errors to patients, Gallagher said. But there’s been less discussion about what physicians should do when they discover that someone else’s mistake.


For the NEJM report, Gallagher led a team of 15 experts who discussed the problem. They identified many reasons why doctors may want to stay silent about errors by their peers.


One is that doctors depend on each other for business. So a physician who breaks the code of silence may become known as a tattler and lose referrals, a financial penalty. Or maybe they aren’t sure exactly what happened to the patient and don’t want to take the time to try and unravel it. In some cases, issues related to cultural differences, gender, race and seniority come into play.


The report notes that doctors also may be wary of becoming entangled in a medical malpractice case, or of causing a colleague to face legal consequences.


Dr. Brant Mittler, a cardiologist who now works as a medical malpractice attorney in Texas, told me that he frequently saw errors made by other physicians during almost four decades in medicine.


Mittler remembers a scan read by a radiologist that said a patient had an “ejection fraction” — the amount of blood pumped by the heart with each beat — of zero. But that would only be possible if the patient was dead, he said. He noted the error to the radiologist, who thanked him.


Many times Mittler stayed quiet, he said. He saw many errors reading electrocardiograms at a 500-bed hospital in San Antonio. He said he didn’t know the details of each case, so he couldn’t tell if the errors affected the outcome for the patient. But he did not go to the other doctors to point out the errors — there would have been hostility if he had, he said.


“There’s not a culture where people care about feedback,” Mittler said. “You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you.”


Gallagher said physicians experience the normal range of human emotions when they find a colleague’s error. They wonder if they can keep it to themselves or whether they’re compelled to tell someone. Or they consider what they would want to happen if they had made the error.


That results in too much leniency toward mistakes, he said.


The bottom line: Too often doctors aren’t learning from errors, Gallagher said. Nor are patients getting the information they need to receive proper treatment or compensation when the outcome is harmful, he said.


Even after patients do learn about an error, the lack of communication by doctors often continues.


Almost 400 people who have completed the ProPublica Patient Harm Questionnaire, and more than 1,800 are members of ProPublica’s Patient Harm Facebook Community. Many reported that they experienced the silent treatment from doctors after experiencing harm during medical care.


The NEJM report stresses that patients come first and recommends that doctors should explore, not ignore, a colleague’s error. They should start by collecting the facts, starting with a one-on-one conversation with the physician who made the error so they can decide how to inform the patient.


Hospitals and other health-care institutions must lead by supporting such conversations, the NEJM group reported.


Dr. David Mayer is vice president of quality and safety at Medstar Health, which runs 10 hospitals in Maryland and Washington, D.C. Mayer said reporting of medical errors is a top priority at the organization so everyone can learn from mistakes.


When doctors identify an error, made by themselves or a colleague, they’re required to tell their supervisor, whether the error resulted in harm to the patient or not, he said.


Each month there are about 1,400 reported safety events, Mayer said. Most are “near misses,” though some involve actual harm to a patient (Medstar declined to disclose how many).


The safety events are analyzed for trends that need to be corrected or that need immediate attention to protect patients, Mayer said. Cases in which a patient was harmed are investigated so that the cause can be disclosed to the patient and family, an apology can be made, and compensation can be offered, he said.


Mayer and Larry Smith, Medstar’s vice president of risk management, said their organization is unusual for its proactive approach to reporting medical errors. Smith said most institutions seem to only report them when it’s obvious the harm will be discovered by some other means.


“Far fewer are doing this kind of work when the information would never surface,” Smith said.


Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, which provides guidance for how state boards regulate doctors, said that physicians and health-care organizations need to be more assertive about reporting errors.


Failing to divulge another doctor’s mistake undermines the doctor-patient relationship, Chaudhry said. “It makes patients wonder if they can trust their own physicians,” he said, “and the profession of medicine.”


DISCUSS: Join us for a discussion on why doctors stay silent on Monday, November 11th at 4 PM ET, on Google+. Reporter Marshall Allen will lead the discussion. Dr. Thomas Gallagher, the study’s lead author, and Brant Mittler, a cardiologist and medical malpractice attorney.


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