-Caveat Lector-
Top surgeons may have falsified more data
Controversy continues over gynecological procedures
By Linda Carroll and Alfred Lubrano
SPECIAL TO MSNBC Nov. 3 - Prominent Stanford University surgeons
already accused of authoring a fraudulent journal article may
have falsified yet another study.
A STANFORD PATIENT who underwent ovarian cancer surgery
by Dr. Camran Nezhat in 1994 said she was "shocked" to learn
recently that a medical journal article written by Nezhat, deputy
chief of gynecology at Stanford Medical Center, and his two
brothers, Ceana and Farr, had, in her opinion, misreported her
case. The Nezhats reported that her surgery was successful and it
was not, said the patient, Harriet Korakas, an ob-gyn from Santa
Cruz, Calif.
The paper itself is particularly important because it
supports the use of laparoscopy - a technique in which tiny
cameras and instruments are placed through small incisions in a
woman's abdomen - in the treatment of ovarian cancer. This is a
hotly debated topic among cancer specialists, many of whom argue
that a large incision must be made so that doctors can find all
cancerous tissue.
In an article in a 1996 issue of Surgical Laparoscopy &
Endoscopy, the authors wrote that Camran Nezhat had "completely
staged" Korakas' cancer. This would mean that Nezhat had removed
lymph nodes from several sites in the body, in particular the
side of the pelvis near the tumor.
Korakas, who had been diagnosed with ovarian cancer before
the Nezhat surgery, said in an interview that Camran Nezhat
removed few nodes and none from the area adjacent to the tumor.
It is standard for cancer specialists staging ovarian cancer to
remove 15 to 20 lymph nodes to determine whether the cancer has
spread beyond the ovaries, experts told MSNBC.
Timeline of events
. June 15: Court documents show that Camran and Farr Nezhat may
have lied in a journal article describing a controversial new
surgery for endometriosis touted for worldwide use. Full story.
. June 28: An examination of long-supressed Georgia medical
board records shows that the Nezhats failed to acknowledge
complications and inaccurately report data in the
endometriosis-surgery journal article. Full story.
. Aug. 28: Farr Nezhat acknowledges presenting incorrect data in
the endometriosis-surgery journal article. Full story.
. Nov. 3: The Nezhats are accused of falsifying yet another
journal article, this one on ovarian cancer. Full story.
Most important are the nodes near the tumor. "You've got to get
some nodes from the pelvis on the side where the tumor was," said
Dr. Stephen C. Rubin, professor and chief of the division of
gynecologic oncology at the University of Pennsylvania. "Getting
nodes from the other side of the pelvis doesn't compensate."
Reached for comment, Nezhat attorney David Walbert said
that Korakas received quality care and that the journal article
was accurate.
"I am familiar with the circumstances of the complaint and
know that it is entirely without merit," Walbert said. "The
patient got proper treatment. This information has been reviewed
by real experts and they were not troubled by the quality of care
or anything written about it."
Walbert declined to name the experts or to provide details
of their findings.
One of Korakas' current physicians, Dr. Nick Spirtos,
former deputy chief of gynecology at the Stanford Medical Center
and a gynecologic cancer specialist, confirmed Korakas'
accusations, saying he subsequently operated on Korakas and
discovered that Nezhat had missed numerous lymph nodes, including
six near the site of the tumor.
Dr. Morris Wortman reviewed Korakas' pathology reports
from both the Nezhat surgery and the later Spirtos surgery at the
behest of MSNBC.
"When you put both pathology reports together I would say
there is very little room for second-guessing," said Wortman, a
clinical associate professor of gynecology and obstetrics at the
University of Rochester and director of the Center for Menstrual
Disorders and Reproductive Choice, both in Rochester, N.Y. "She
was inadequately staged in the first surgery and it's unfortunate
because a real disservice was done to her."
Beyond that, Wortman said, the inaccurate reporting of
Korakas' surgery paints a misleading picture of laparoscopic
surgery.
"To sell laparoscopic surgery as potentially useful in
cancer-staging procedures and then to not accomplish the staging
also does a disservice to the medical community," he said.
Wortman went on to criticize what he termed a
"fraudulent" journal article. "This is further misrepresentation
of scientific findings by the Nezhats," Wortman said. "It speaks
to a pattern of behavior by the Nezhats that very much needs to
be investigated."
Spirtos had notified Stanford colleagues of his findings
in 1994 in an internal memo obtained by MSNBC. He accused the
Nezhats of providing substandard care.
Since that time, Spirtos has become an unpaid expert in an
unrelated Atlanta lawsuit against the Nezhats in which the
brothers are accused of presenting fraudulent data on a surgery
for endometriosis, a painful disorder in which uterine tissue
grows outside the womb.
Korakas, herself a Stanford-trained gynecologist who had
been referred to the Nezhats by colleagues, said she first read
the ovarian cancer article last summer. "I saw it and hit the
ceiling," she said. "I would characterize the paper as a fraud. I
wouldn't even call it an error. It's inaccurate and
scientifically unacceptable."
LEADERS IN THEIR FIELD
The accusation is significant because the Nezhats are
considered highly influential in the field of gynecologic
research. By their own account, the Nezhats have taught or
demonstrated surgery to nearly one in seven American
gynecologists. Additionally, they have authored several textbooks
and more than 130 research papers.
In June, after an examination of long-suppressed patient
records, MSNBC reported that Camran and Farr Nezhat failed to
acknowledge complications and inaccurately reported other
pertinent patient data in a journal article about an
endometriosis surgery the brothers invented.
Two months later, Farr Nezhat acknowledged that data in
the endometriosis article were wrong.
On Aug. 25, Korakas notified Stanford University of the
"shocking and unacceptable" details of her case and the alleged
journal fraud. "I told them this is dreadful, and sent [Dr.]
Eugene Bauer the article and all my medical records," Korakas
said. Bauer is vice president of Stanford University Medical
Center.
Korakas said she sent the same information to Dr. Richard
Popp, senior associate dean for academic affairs and a professor
of medicine at the Stanford School of Medicine, who has been
heading an internal university investigation of the Nezhats.
"I really thought they would be very upset about this,"
Korakas said. "I thought there would be great concern that a
publication under Stanford's auspices contained inaccurate data.
I wanted an apology, a retraction of the article and a correction
in the journal that published the article. But nothing happened."
STANFORD INVESTIGATION
Stanford officials said they are still investigating the
situation.
"Her complaint has been taken seriously," said Dr. Peter
B. Gregory, a senior associate dean for clinical affairs in the
Stanford School of Medicine and chief medical officer at the
Stanford Hospital and Clinics in Palo Alto, Calif. "The
investigation is almost complete. It needs one final review and
once that is done [Korakas] will receive an answer to her
complaint."
Several years ago Stanford did look into whether Korakas
received adequate care, Gregory said. "We drew the conclusion
that the standard of care was met," he said.
Disappointed with slowness of Stanford's response, Korakas
agreed to speak with MSNBC. "My point was, if they [Stanford]
didn't do anything, I would," she said. "I didn't want another
woman to go through what I went through."
Korakas also sent her medical records to the journal and
is awaiting a response. A journal spokesperson said the
information is currently under review.
"As soon as [the editor of the journal] has had an
opportunity to review this comprehensive information and also the
information related to the other journal article ... she will be
making a decision," said Connie Hofmann, a spokesperson for
Lippincott Williams & Wilkins, the publisher of the journal. "But
given the complexity of this information and the importance of
making the right decision they are still reviewing this."
For her part, Korakas said she is dismayed that doctors of
the Nezhats' caliber would present inaccurate data. "People on
the cutting edge of medicine have more of a responsibility to
keep accurate data," Korakas said. "Their work is read by other
doctors, and can affect the standard of care." MSNBC.com
columnist Linda Carroll has been following the Nezhat story for
four years. Alfred Lubrano is a reporter for the Philadelphia
Inquirer.
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Kadosh, Kadosh, Kadosh, YHVH, TZEVAOT
FROM THE DESK OF:
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~~~~~~~~~~~~~~~
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