An astonished Brit visits our sunny Florida pill mills.

It’s an American catastrophe that has been dubbed pharmageddon, though it rarely pierces the public consciousness. Occasionally a celebrity overdose will attract attention – Anna Nicole Smith, Heath Ledger, Michael Jackson – but they are specks in a growing mountain of human mortality.

This list reminds me that I have meant to list some university students – or recent university graduates – who have in the last few months died of pain-killer overdoses.

Austin Box, University of Oklahoma.

Robert Mueller, Wake Forest.

Wilson Forrester, University of Arizona.

Hope Reichbach, New York University.

Michael Israel, University of Buffalo.

A “pill mill killer” ….

…. with a degree from the University of Chicago.

Details of his activities.

“In 2013, … [Gordon] Freedman prescribed [a] patient about 85,427 oxycodone pills — an average of 234 pills per day.”

Why is it that our most assiduous doctors, our physicians most devoted to the well-being of their patients, are the first to go to prison when an oxy-panic breaks out? Why is it that clinicians on the cutting edge, people willing if need be to try fentanyl, people even willing to kill a patient or two, mavericks in violation of the Anti-Kickback Statute and guilty of honest services wire fraud, are constantly being hounded by the Justice Department and federal prosecutors and judges and juries?

It makes UD angry on behalf of former McKesson CEO John Hammergren, simply a more … ample Gordon Freedman, a man whose company “in 2006 and 2007 … shipped more than 5.66 million opioid pills to a single pharmacy in a tiny town in rural West Virginia.” Quietly retired on his eight hundred million dollars in compensation for a few brief years of stupendous national drug distribution, Hammergren now has to worry that, like Gordon Freedman, he will be punished for his health-care zeal.

Now that the filthy business of paying doctors to promote new pills has gotten so filthy that even…

… GlaxoSmithKline has stopped doing it, UD notes this lament for the end of the practice.

But, of course, [people will say,] these experts are being PAID. How can they be trusted?

Well, can we really expect experts to do this on a pro bono basis? I doubt that any of us would agree to take time to do this sort of work for free.

How in the world can you expect to find one doctor or researcher in the United States willing to review – FOR FREE! – the data on a new drug that might benefit millions?

**********************

More on GSK’s decision:

Neil Barnes, head of respiratory medicines for GSK, says the days of drug companies paying for doctors to attend conferences to listen to doctors paid to speak are coming to end. “It is going to be like smoking on aeroplanes. People will look back and say ‘did we really used to do that?’”

But of course the scandal is what pharma continues to do.

Adriane Fugh-Berman, associate professor of pharmacology at Georgetown University in Washington and an activist for more transparency in drug marketing, says that while GSK’s reforms remove the conflict of interest for individual doctors they do not remove the wider problem of industry influence over medics. “I would be much more impressed if they were getting out of medical education altogether,” she says.

“[The University of Colorado] is $20 million in debt, last on the football field, and its athletic facilities are the league’s worst.”

Or, as the headline in today’s Denver Post has it:

CU’s Tale of Riches to Rags

Another headline might have been

University of Colorado Football: Rape AND Pillage

‘Millennium and its founder say they gave $2 million to the University of Washington in 2010 to study pain … and $250,000 to a Duke University professor in April to host “a business summit on ethical practices in the medication monitoring industry.”‘

It’s awkward. How entangled do universities want to get with businesses like Millennium?

A federal grand jury in Boston is investigating Millennium Laboratories of San Diego, a fast-growing private company selling urine drug testing services to pain clinics across the United States.

The company not only is under investigation by the Justice Department for allegations of health care fraud but also for intimidating former employees, one who was portrayed in a slideshow at a company meeting as a corpse in a body bag…. [It is also accused of] getting doctors to order unnecessary urine tests [– the testing, amid an epidemic of pain pill use, reveals whether patients are abusing the drugs –] and charging excessive fees to Medicare and private insurers.

I mean, nothing wrong with industry money, but you do want to keep an eye on the particular representatives from industry offering it.

Millennium sales tactics [it is alleged] included a chart showing doctors how much they could boost their own income by increasing the number of urine drug tests they ordered. For instance, a $15 payment to test for one drug could balloon to about $800,000 a year if 20 people a day were tested and each urine sample was tested for 11 drugs, the chart said.

It is a beautiful synergy, when you think about it. Keep prescribing the pain pills — the medical profession almost has the entire American population on them — and then, concerned at the shocking escalation in their abuse, make your patients pay for urine tests. It’s funny to think about how America’s hundreds of thousands of pill mills will be giving the test to make sure their customers are taking their Oxy and Roxy. If you’re in the urine testing biz, like Millennium, you get them coming and going, as it were.

So, you know, a very becoming business altogether, and if you’re Duke or Washington you might want to keep an eye on the Justice Department proceedings and ask if you want to continue whitewashing the reputation of these outfits.

Going Postal

A judge has granted an alleged pill mill operator’s request to travel to the University of Richmond’s law library to fine tune his claim that federal courts have no jurisdiction over him because in 1874 the United States joined the Universal Postal Union.

On May 22, he filed a document with the court titled “Response to the Indictment” that says in part: “I do not accept this jurisdiction According to the treaties in which the United States Corporation signed when joining the Universal Postal Union this court is violating International Law. You are hereby compelled to cease and desist on any further action.”

He wrote that he [is an], “American National privately residing in a private domicile outside of Federal District in a non-military private estate located outside of a federal District not subject to the jurisdiction of the ‘United States.’ ”

There’s plenty of intriguing precedent for this sort of thing; and, speaking as an English professor, UD is impressed that the man has clearly read his Thomas Pynchon.

Drug Opera

The producers of the soap opera General Hospital have worked out a deal with a pharma company to give one of the show’s characters a rare disease only the company’s drug can treat.

UD admires this marketing as much as she did the toy blocks with the name of a powerful antipsychotic on them.

Another favorite sales tool that began to be distributed in the waiting rooms of [pediatricians] were Legos imprinted with a Risperdal logo.

It’s our country’s most amazing, most expanding, frontier: Already a huge number of ads that interrupt soap operas are for anti-depressants, etc. etc. Now the shows themselves push controlled substances.

****************

UD sees a new tv comedy set in a hapless but adorable oxycodone clinic. Lil’s Pill Mill is run by a brassy wisecracking distributor with a heart of gold and her tattooed boyfriend Scooter who powers into the West Virginia hollers on his Harley to make deliveries. The simple but desperate mountain folk are colorful and hilarious. Each week brings a new challenge as the LPM staff seeks to evade detection by government agents, or as Lil suspects Scooter’s got “special friends” who turn tricks for him in exchange for the oxy.

The Second Coming of the Lord

If you read UD, you saw Trustee Al “So-Called Victims” Lord coming way back. We covered his campaign for trustee here, paying special attention to his campaign statement (“Wife of 48 years, Suzanne, received her Penn State PHT (Putting Hubby Through) in 1967.”) and his platform:

Graham Spanier and Joe Paterno created the healthy alliance of academics and athletics. Penn State wins national championships in several sports and graduates America’s best prepared students. Our Trustees and Louis Freeh see a different Penn State.

I seek a seat on the PSU Board of Trustees because I can no longer watch the willful, cowardly destruction of our Penn State. “Freeh’s facts” are incomplete, selective, and largely unconvincing. Freeh’s report destroyed our past; left unchallenged it will diminish the future.

I don’t want you to think that our Lord is the only Lord. University BOTs across the nation worship these Big Men and their big talk and big guns and big fights and big business brains. UD spends a good bit of time following trustees who try to smuggle guns into the United States Senate, run pill mills, run the whole university including the sports program, use seven hundred dollars of the school’s money to buy liquor in order to get through one board meeting (I’m talking about one single trustee here), trap and kill “multiple federally protected migratory hawks,” assault the university’s football coach while in court giving a deposition, etc etc etc. Read my Trustees Trashing the Place category for details on these and so many other cases.

Admittedly much of the trustee thing is about appointing rich miscreants and then there’s the waiting game: Will Steve Cohen give us a little of his ten billion dollar personal fortune before the SEC catches up with him…? Or do we risk our reputation on his doing jail time? Bernie Madoff and Ezra Merkin seem to be pumping major bucks into the school, but there are rumblings…

And while our Lord does have a rather shabby financial past you have to go WAY past shabby to lose a seat on a BOT that wants your money.

Anyway. It would all be rather embarrassing if Penn State were capable of feeling embarrassment.

*************

UD thanks Wendy.

Attention, University Development Offices!

Keep your eye on DEA/FBI raids of pill mills. One clinic operator currently on trial for everything from “violations of the RICO organized crime statute to illegal drug distribution to kickbacks to wire and mail fraud to money laundering” decided it was too dangerous to pocket the money he got for talking up his corporate drug supplier’s big drug – because a doc now in jail in Michigan for the same shit this guy’s on trial for pocketed his pharma money and look what happened to him.

So here’s what this guy decided to do, in order not to attract attention from the government.

[One] batch of emails [discussed in the trial] concerned [Xiulu] Ruan’s handling of the fees he collected for speaking for Insys. … Ruan … changed his procedure for handling the money after the Michigan case flared up… Rather than receiving the money, he’d begun routing the fees to various educational institutions, directly or through a charitable foundation, with recipients including the Medical College of Wisconsin and the University of South Alabama.

Good man! Good man! And there’s every reason why your university can also be the beneficiary of alleged drug dealers trying to hide their money from government investigators. Just set up a lunch with the most prominent pusher in your town and suggest your campus as a routing location.

“The university declined to comment.”

Hm yes six years a trustee at Ohio University and now he’s going to prison for five years for hm let’s see running a humongous pill mill, laundering money, and evading multiple millions in taxes.

OU has nothing to say about the fact that this man has for years and years been setting and overseeing policy for thousands of students, faculty, and alumni at Ohio University? How much will your tuition go up? Let’s see what Dr Lake decides! Alcohol and drug policy? You know who to ask!

No, no, we’ve unpersoned him – exactly the way Yeshiva University unpersoned Bernard… uh…

Bernard who?

“McGuire stepped down in 1992 and H. Barton Grossman, M.D., followed McGuire, serving as section head until the arrival of Dr. Joseph Oesterling in 1994.”

The University of Michigan’s urology department shares its leadership history, marking without comment the curiously short reign (he left in ’97) of Joseph Oesterling. But here’s a comment, from a local journalist recalling her most important story:

In the early 1990s, I got a tip from an insider at the University of Michigan that Dr. Joseph Oesterling, chief urologist, had scammed the university on expenses and pocketed money from prostate cancer foundations he created. He used the money to build himself a mighty fine mansion. Through FOIA, I and reporter Maryanne George, who was a cub reporter I edited while we both were at the Michigan State News, got reams of information about his expense records showing he double- and triple-billed the university for expenses drug and medical device companies gave him. He resigned in disgrace but only served a brief stint of community service.

We ran a big story including a photo of the house that my newspaper got by hiring a helicopter (with our lawyer’s OK) and shooting it from above. (The house was on a private road with a chain fence that said no trespassing). Turns out the picture we ran was of the back of the house, but that entrance looked so posh it was taken as the front entrance. I used the photo in speeches and the back entrance comment always got good laughs.

The story opened my eyes to the poor oversight of medical professionals by most states.

Poor oversight? You mean just because Oesterling was – until a few days ago – still practicing medicine?

I mean, yes, twenty years after the Michigan thing, plus a 2005 misconduct charge, plus an arrest at the end of December for running a chain of pill mills, Oesterling’s license has finally been suspended… Not taken away, mind you… Wouldn’t want to act hastily…

But – wait for it – he’s still prescribing!

***********************

… Oesterling’s clinics, including one in Caro, prescribed a total of “some 330,000 dosage units of Norco, a (Schedule II) controlled substance, within a 16-month period.

***********************

If you’re anxious about your fix, you’ll be relieved to know he’s out on bond, and with all his money he’ll almost certainly be able to beat these latest charges.

The Annals of Denialism I

This blog faithfully covers the tendency of universities who hire and retain people who turn out to be big-time crooks to deny, deny, deny.

Most of these stories are about doctors who go to jail for running pill mills or ripping off Medicare.

Jose Katz spent two decades as a respected Columbia University faculty member; his name appears on dozens of scientific papers coming out of Columbia labs. After he retired (probably before too, but who’s counting), Katz set about telling everyone who came to his office that they had angina and needed expensive invasive things done to them. In this way, he accumulated tens of millions of dollars, and now he’s going to jail.

Note that in this report a Columbia spokesperson insists says they haven’t seen Jose around campus for ten years; note too that his lawyer repeatedly calls Katz a professor. He’s a professor … he’s a professor…

UD isn’t, of course, saying that Columbia should somehow have sensed it had a crook in its midst. She is saying that having happily affiliated for years with a convict currently plastering his faculty status all over town, Columbia can do better than issue a flat denial of any connection. Something like this would be good:

Columbia University is dismayed that a person once in good standing on its faculty has been convicted of serious fraud. The university has strict employee vetting procedures in place, and as far as we know Dr. Katz broke no laws while at Columbia. But this case is a reminder that all schools need to remain vigilant.

Corridor for corridor…

… your university hospital is the most treacherous part of campus. There’s lots of money at stake, so corruption is highly likely. Conflict of interest among your professors may be rampant. There’s always someone on the staff stealing oxycontin to sell it. Some of your anesthesiologists are addicts.

Cowboys on the surgery team try this and that without bothering with the institutional review board. Since you don’t really pay attention to the doctors you allow to affiliate, some of them will turn out to run pill mills or, like UCLA’s Arnold Klein, will embarrass you in other ways.

You try to make the hospital a big profit center, but that almost never works. Meanwhile, as in this story from the University Medical Center Göttingen, some of your surgeons are managing to make it work quite nicely on a personal basis.

A surgeon identified as Dr. Aiman O. is suspected of fraudulently manipulating dozens of his patients’ test results, making them appear sicker than they were to get them liver transplants more quickly — and possibly putting them ahead of people who more desperately needed them. The case first emerged in late July at the University Medical Center Göttingen, in the northern German state of Lower Saxony, from where the senior physician has been suspended since November for allegedly tampering with some 23 transplant cases. A gastroenterologist suspected of involvement has also been suspended.

There’s huge money in this. Truly rich, truly desperate people will pay amazing sums for an organ, and all you have to do is shove aside other sick people who’ve been following the rules and waiting.

Is Joseph Castronuovo an assistant professor of medicine at NYU?

It’s hard to say. This directory page is the best I can do, and it might not be the same guy. But a news article about him says he’s an “assistant professor at the New York University School of Medicine.”

As you probably know, medical schools are notorious for handing out the title “professor” to pretty about anyone who hangs around the hospital wearing a white coat. This courtesy isn’t a very good idea, especially at a time when doctors are being arrested for running pill mills all over the country (especially in Florida). Castronuovo faces ten years in prison for writing oxy prescriptions like a bat out of hell.

Next Page »

Latest UD posts at IHE

Archives

Categories