Longtime Madison Park psychiatrist suspended and sued over sexual misconduct

For reasons unknown to us, Madison Park and its environs seem to have a disproportionately high number of mental health practitioners in residence.  The offices of psychotherapists, psychoanalysts, psychiatrists and other related professionals abound both here and in Madison Valley (Yelp lists 19 psychiatrists, for example, as practicing in Madison Park alone).



Last year, the local mental health community gained a bit of unwanted notoriety when the State announced that it was investigating longtime Madison Park psychiatrist Dr. Richard T. Adamson, who for many years practiced in offices just above the WaMu (later Chase) bank branch on E. Madison St.  The Washington State Department of Health alleged last summer that Adamson had, among other questionable actions, engaged in improper sexual relations with a patient and had disclosed confidential patient information without authorization.



After investigating the charges, the State’s Medical Quality Assurance Commission late last month suspended Adamson’s license to practice, stating that his sexual relationship with the female patient had violated standards of professional conduct.  Additionally, according to the State, Adamson later disclosed information about the woman to a second patient, also a violation.  Adamson has until later this week to respond to the suspension, which will otherwise become permanent, according to published reports.



The State’s case against the 56-year-old Adamson is a pretty serious one.  He is accused of having engaged in an “abusive and potentially harmful” sexual relationship with the patient, who he had been treating for depression.  The woman, a family-practice doctor, was dealing with issues related to sexual abuse by her father.  According to the State’s “Statement of Charges” (as reported by the viagra cialis online pharmacy pharmacy Psychiatric Crime Database), in November 2008 Adamson encouraged his patient to seek psychotherapy treatment from someone else, following which he immediately entered into a sexual relationship with the woman, who later left her husband.  Adamson is alleged to have had sex with his former patient at both his office and her apartment.  Adamson reportedly ended the relationship by stating that he was obsessed with another, younger woman with whom he had been engaging in “phone sex” and “instant messaging sex.”



Earlier this month the former patient with whom Adamson had the affair sued him in King County Superior Court, according to the Seattle PI.  The civil complaint reportedly accuses Adamson of negligence for having caused his former patient “severe psychological and emotional injury.”



Publicity about these allegations has apparently not been helpful to Adamson, who is now the subject of two new complaints of misconduct filed with the Department of Health last month, at least one of them involving an allegedly improper sexual relationship with a patient.  In the “Amended Statement of Charges” filed by the State, Adamson is reported to have revealed to a patient with whom he was having an affair that “he was involved sexually with numerous women, including a 30 year old married woman with whom he was currently emailing and texting, a married woman whom he had been involved with since his wife died, an infectious disease physician, and a family practice physician.”  The recipient of this uninvited disclosure then “ended the relationship” with Adamson, according to the Amended Statement.



Adamson, who has since moved his practice (such as it is) to Lake City, apparently has not spoken publicly about any of the charges. His former space in Madison Park no longer houses a psychiatric office.

Três pessoas são presas e 11 farmácias interditadas em Carpina e Ipojuca

Três pessoas foram presas e 25 farmácias, notificadas, em uma operação da Agência Pernambucana de Vigilância Sanitária (Apevisa), nas cidades de Ipojuca, no litoral sul, e Carpina, na zona da mata norte do estado, que resultou na apreensão de quase 5 mil caixas de medicamentos. Do total de estabelecimentos, 11 foram interditados e 15 tiveram apreensões de remédios controlados, que eram vendidos de forma inadequada, com uso de receituários irregulares, fora da validade, contrabandeados do Paraguai ou mesmo armazenados incorretamente. A polícia ainda investiga o possível envolvimento de uma médica na ação.



As autuações foram realizadas no âmbito criminal e também administrativo. Todos responderão por tráfico de drogas, como são considerados os medicamentos controlados. “Em todas as farmácias vistoriadas nessa semana foram encontradas irregularidades, mas nem todas foram fechadas. Foram 16 autuações e 6 notificações, além dos locais onde havia crime”, explica o gerente geral da Apevisa, Jaime Brito.



Se condenados, os três proprietários dos estabelecimentos onde foram verificados crimes, apenas por este crime, podem cumprir penas que variam de 5 a 15 anos de reclusão. Em Ipojuca, João Amaral de Oliveira, 65, foi flagrado vendendo o remédio para disfunção erétil online pharmacy viagra falsificado e deve ter a pena agravada.



Já em Carpina, Everaldo Barbosa da Costa, 51 anos, ainda deve responder por crime de contra a saúde e economia públicas, mediante relação de consumo. Daxciane Coelho Silveira, 34, proprietária de duas farmácias na mesma cidade, ainda pode responder por contrabando, uma vez que comercializava o ‘Pramil’, remédio de disfunção erétil que teve a venda proibida no Brasil e que é produzido de forma ilegal no Paraguai.



As investigações começaram há dois meses, quando foram identificadas irregularidades na movimentação de produtos de seis estabelecimentos das duas cidades junto ao Sistema Nacional de Gerenciamento de Produtos Controlados. Apenas em uma farmácia de Carpina, 500 caixas de Artane, indicado para mal de Parkinson e normalmente utilizado como potencializador do efeito de drogas, foram encomendadas e repassadas à população sem o devido registro, em um prazo de apenas dois meses. A média nacional é de apenas 10 caixas por farmácia em um mês.



De acordo com a delegada Maria Helena Couto Fazio, do Departamento de Repressão ao Narcotráfico, durante a ação ainda foram encontrados talões de receituários médicos carimbados e assinados, supostamente pela médica Erivalda dos Santos Ramos. O fato também configura crime e a profissional deverá prestar depoimento para verificar se há envolvimento nos crimes ou se as receitas haviam sido falsificadas com seu nome.



Erivalda dos Santos atualmente trabalha no Hemocentro de João Pessoa, na Paraíba, e não tem registro junto ao Conselho Regional de Medicina de Pernambuco (Cremepe) e, no entanto, nos receituários, a origem indicada na prescrição seria do Hospital Belarmino Correia, em Goiana, na Mata Norte do estado. “Já verificamos que o registro é de uma pessoa ‘real’, que não foi falsificado. Resta saber se a autoria da prescrição foi, de fato, da médica em questão”, explica a delegada.



Balanço - Ao todo, foram apreendidas 4.985 caixas de medicamentos, com uma média de 20 comprimidos cada, tanto pela polícia, quanto pela Vigilância Sanitária. Entre os principais produtos estão o Rivotril, Lexotan e Diazepan e outros psicotrópicos, anticonvulsivantes e anorexígenos. A ação fez parte de uma busca pela fiscalização, por parte da Apevisa, de medicamentos controlados a exemplo do Artane e do Desobesi, um inibidor de apetite também utilizado por condutores de caminhões para manter-se acordados em longas viagens (popularmente conhecido como ‘Arrebite’).

A última operação do gênero foi deflagrada em fevereiro deste ano em Serra Talhada, no sertão do estado, até então principal fornecedor de drogas controladas de forma irregular no estado. Somente do remédio Desobesi, de um total de 118 mil caixas comercializadas em Pernambuco, 102 mil foram vendidas por apenas três farmácias da cidade. O segundo polo, Carpina, foi desarticulado nesta terça-feira.



Por Ed Wanderley

Fonte: Redação do DIARIODEPERNAMBUCO.COM.BR

Postdoctoral Research Fellow - Society, Sexuality and Sexual Health, University of New England

Deadline: 25 October 2010

The University of New England (UNE) is investing in the strategic enhancement of research capability in a number of areas through the creation of six fixed-term postdoctoral research lectureships/fellowships. Three such lectureships have already been allocated. Applications are now being sought for the remaining three positions in the areas of Biophysics of Soil Carbon; Resilience of Freshwater Ecosystems; and this position in the area of Society, Sexuality and Sexual cheap cialis.

This position, to be located in the Faculty of The Professions, will be a member of a collaborative research team with the focal objective of enhancing and extending UNE’s research and scholarship role in Society, Sexuality and Sexual cheap cialis.

The successful appointee will work with senior and other academics at UNE, and postgraduate research students in conducting a range of activities including preliminary and background work for grant writing, project development and mining of data that will allow a significantly increased capacity to achieve the project outcomes. Strategically, this position will add new strengths that build upon the research team’s collective work in research and scholarship, as well as their ongoing connection with major sexuality research centres of excellence in Australia and internationally to establish a regional hub for sexuality and sexual health research at UNE.

The successful applicant will take an active role in the design and implementation of this research; will develop and lead their own research activities; and will work within the research program developed by the senior researchers of this project.

Applicants must have: a PhD in the social sciences or health area; demonstrated ability to take initiatives and independently develop research proposals; and a demonstrated ability to communicate research outcomes and research ideas.

This is a two year fixed-term position. Consideration may be given to filling the position on a less than full-time basis.

Informal enquiries may be directed to Professor Victor Minichiello, Pr Vice-Chancellor and Dean, Faculty of The Professions, phone: (02) 6773 3862 or email: vminichi@une.edu.au

Salary

$74,438 to $88,222 per annum (Level B)
plus 17% employer superannuation and optional salary packaging

Closing Date: 25 October 2010

Reference Number: 210/080w

Please ensure that the coversheet is attached to your application. Instructions on how to send your application to the University are available on this coversheet.

Your application should include: the reference number; a curriculum vitae; a statement that addresses the selection criteria; and names, addresses, telephone numbers, facsimile numbers/email addresses of three relevant referees.

Applications must be received by 5pm on the closing date.

This position is only open to applicants who are Australian citizens or who hold a valid working visa at the closing date for applications. The visa must cover the period required for the fixed-term position from the commencement date of employment. The University will not sponsor an appointee for this position including any further appointment to this position.

More information here.

Viagra Causation Goes Limp

Imagine this: The only published article in the medical literature reaching a statistically significant result concerning a drug and an outcome turns out not to have been what it seems. Rather, over a third of the subjects in the relevant category turn out to be misclassified. When properly reclassified, the statistical significance between the drug and the outcome goes away.

If that study had been sponsored by the drug company, and involved the benefit of the drug, imagine how the plaintiffs would have reacted. Would they demand that the drug be removed from the market? Would they seek punitive damages? Sanctions? A criminal investigation?

Of course they would. We see this kind of response just for results unearthed by new studies or supposed e-discovery violations -- let alone the publication of a ground-breaking, but false, study.

But what if the study happens to be published by a plaintiff's expert?

Hardly a peep. In fact, expect a belated attempt to make excuses for misstated data.

That's what just happened in the Viagra MDL. The last plaintiff's causation expert standing turns out to have published a study based upon data that was, at best, misclassified.

Kudos to the defendant for persistence in the face of a published, supposedly peer-reviewed article.

It's results like this that demonstrate why it may be worthwhile to seek discovery of the data that underlie even published studies.

So what exactly happened?

The study was suspicious anyway, since it consisted solely of telephone interviews with cialis users who had been diagnosed with non-arteritic anterior ischemicoptic neuropathy (“NAION”) and a case-matched control group of the same size. Slip op. at 2.

The defendant subpoenaed the underlying data, but the expert, at the direction of the plaintiff's counsel, didn't produce anything. Slip op. at 4. That's one way to confirm suspicions. The defendant deposed the guy anyway, and after that the expert had to write the scientific journal and tell it about the deficiencies in the article. Slip op. at 4-5.

The biggest problem was that a significant portion of the patient data had been seriously miscoded. Specifically, eleven subjects were erroneously listed as "exposed" to Viagra when their telephone interviews indicated that they began taking Viagra after being diagnosed with NAION. As the court explained:

There are eleven instances where the date of first use on the original telephone survey forms is later than the date of NAION diagnosis on the same form. However, each of those individuals was still coded as exposed in Dr. McGwin’s [the expert's] electronic dataset. Dr. McGwin acknowledged that the statistics in the McGwin Study would have been different had those individuals (11 of 27 patients who reported Viagra or purchase cialis use) been coded as unexposed rather than as exposed.

Slip op. at 7.

Eleven of 27 is a pretty high error rate for anything. And every one of those errors just happened to occur in such a way that would bias the study in favor of a supposed association that otherwise has not been proven to exist.

One would think plaintiffs would be content simply to avoid the sanctions that they surely would have sought had the shoe been on the other foot. But they had chutzpah. They tried to explain away these "discrepencies" by arguing that (1) their own expert's survey forms were hearsay, and (2) some phantom researcher (never identified) supposedly went back and recontacted these persons and got differing information from what was recorded on the forms. Slip op. at 7-8.

The court was having none of it. It considered the forms to be admissible business records. Slip op. at 8. As for the supposed recontacting of the survey participants, plaintiffs eventually had to concede that they were pushing a fantasy -- there was not a scrap of evidence to prove that any recontacting had ever happened:

Plaintiffs have failed to produce any competent witness or documentary evidence to verify that such a step [recontacting survey participants] was actually taken. Indeed, as Plaintiffs concede, “Dr. McGwin [their expert] was unable to authenticate any of the underlying documents. . . . Plaintiffs have not cited to any other admissible testimony from [anyone] who is able to verify that patients were recontacted.

Slip op. at 10. With admirable understatement, the court concluded "discrepancies between the dates of first use on the original survey forms and in the electronic dataset raise serious concerns about the reliability of the McGwin Study as originally published." Id.

But wait, there's more.

More than misclassifying more than a third of study participants in a way that biases the results in favor of the conclusion that the expert is paid to reach? More than making up cock-and-bull excuses about phantom recontacting?

Yes.

The published study also misrepresented the type of statistical analysis that had been conducted. "The McGwin Study said that it used a paired t-test; Dr. McGwin admitted that
he in fact used a two sample t-test instead, which he conceded was 'not the most
appropriate.'” Slip op. at 10-11. Beyond that, "the code that Dr. McGwin wrote to produce the numbers in the McGwin Study contained errors that would affect the odds ratios and confidence intervals." Id. at 11.

Once again, with notable restraint, the court concluded, "the fact that the methodologies described in the study were not the actual methodologies used undermines the reliability of the McGwin Study as published." Slip op. at 11.

But wait, there's more!

More than misrepresenting how the study's numbers were crunched?

Yes.

One of the study's "main findings" was "mischaracterized." The study claimed that Viagra users with "personal histories" of heart attack were at significantly greater risk of NAION. But in fact there was no "personal history" data collected. As the court summed up the evidence:

The patients were actually asked whether they had a family history of myocardial infarction; no one was asked about personal history. Dr. McGwin conceded that he mistakenly assumed that the variable “MI” in his electronic dataset referred to a personal history of myocardial infarction.

Slip op. at 11 (emphasis original). This was, as the court held, "yet another layer of unreliability." Id. at 12.

Adding all this together, the published study competely failed Daubert analysis, notwithstanding that it appeared in a scientific journal:

Taken together, the miscodings and errors described above effectively undermine the reliability of the McGwin Study as published. As Plaintiffs concede, there are
“acknowledged inaccuracies in the published study” that need to be corrected. In light of those acknowledged inaccuracies, the Court finds good reason to vacate its original Daubert Order permitting Dr. McGwin to testify as a general causation expert based on the McGwin Study as published. Almost every indicia of reliability the Court relied on in its previous Daubert Order regarding the McGwin Study has been shown now to be unreliable.

Slip op. at 12.

Unfortunately, neither plaintiffs nor their expert knew to quit when they're behind. The expert ginned up an unpublished "reanalysis" - submitted after the fact - that he claimed salvaged the result of the published study, and thus his causation opinion.

Didn't help.

First, the unpublished reanalysis wasn't peer-reviewed. Second, the letter wasn't published. Third, the letter was created "post-litigation." Not only that, upon receipt of the letter, the journal in question "referred the Letter to the Committee on Publication Ethics." Slip op. at 14. In other words, the expert is being investigated for academic fraud.

The moral of this story (if not of certain of the participants) is clear - defendants can't give up the Daubert ship just because the other side comes up with a published, supposedly peer reviewed article. As here, a full investigation may reveal that the peer-reviewer was asleep at the switch, or that the article subverted the entire peer-review process by stating things that were simply false.

In short, there may be a reason beyond statistics why an outlier study is an outlier.

We can only hope that the Committee on Publication Ethics does the right thing.