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We are quite troubled and feel impelled to raise again with Loyal Readers the vexing issues that surround -- no, engulf is a better word -- Dr. Anil Potti. We wish to outline why we believe that the state of North Carolina should conduct a new review of his medical license, and South Carolina should re-visit its decision to grant him a multi-year license that allows him to practice in that state with no supervision.
We also believe that Duke University should obtain a court order stopping Potti from trading on the name of our school, for we now know that his entire six-year career here was replete with dishonor. Such an order would have prevented his hiring a PR firm to flood the internet with favorable press releases mentioning Duke, pushing the terrible news deep down in search engines. And it would have prevented the latest chutzpah, with Potti attaching Duke's name to a new "research" paper he has just published in a respected medical journal, the Annals of Surgical Oncology.
Potti's subject was ovarian cancer -- the same research that has resulted in several other journals retracting his publications. With eight retractions for ovarian and breast cancer under his belt so far, the prolific Potti will experience more, perhaps 20 before the end of this sordid affair.
While it is incredulous that Potti's latest paper survived the peer review process that preceded publication in the Annals, the editors share responsibility and should be ashamed. The court order we suggest would have planted a brighter flag of caution.
And before we return this essay to Potti's license, we note that Duke apparently never checked any of Potti's resume. President Brodhead has stated the policy Duke follows in taking these things at face value is working just fine. We think not.
As for Dr. Potti, we call for stern action; we do not write lightly. Here's how we reach our critical conclusions.
Potti's North Carolina medical license.
The North Carolina Medical Board says that in July, 2010, it received "information concerning possible misconduct related to Dr. Potti's oncology research work at Duke Medical Center." The Board investigated and reached what amounts to a plea bargain with Potti, giving him a reprimand, one of the lightest of punishments that might have escalated to revocation of his license.
In its reprimand order, the board states that simultaneously with the receipt of the first information -- and apparently not linked at all the problems alleged, but just a coincidence -- "Dr. Potti voluntarily suspended all of his clinical activities at Duke Medical Center on July 16, 2010."
That word certainly leaves a different impression than a lengthy memo sent by Chancellor Victor Dzau to the faculty of the Medical School, which tersely makes clear there was nothing "voluntary" about it:
"I felt it important to provide you with an update on our actions in response to allegations regarding Dr. Potti... Dr. Potti was placed on administrative leave at the end of the day Friday, July 16."
That's one dimension of the errors from the board: a fundamental misunderstanding of the rupture of Potti's relationship with Duke.
There is more. As part of its reprimand, the Medical Board read materials submitted by Duke Medicine wrong, the reprimand order stating "while there were some inaccuracies on the biographical sketch and curriculum vitae, they were largely the result of carelessness and honest errors with no clear intention to mislead."
Those words do appear in Duke materials that the Medical Board examined -- but they are ripped out of context. Those words apply to one narrow segment of Potti's work at the University. Looking at how the Medical Board employed the key words broadly in its reprimand order, Duke had a one word characterization: "inaccurate."
In a new statement to the Board, Duke called attention to the earlier words of Provost Peter Lange:
“... in a publicly released statement that followed the University’s investigation into Dr. Potti’s curriculum vitae and biosketches, ‘issues of substantial concern were identified’ and have resulted in corresponding sanctions. In fact, the inquiry committee evaluating the research misconduct matter also noted that ‘the sheer number of errors’ in Dr. Potti’s biosketches and CVs was a ‘serious concern.’ To suggest in the Consent Order that Duke concluded there were some inaccuracies, all the result of carelessness and honest errors with no intention to mislead, is inaccurate.”
With this new material in hand, lawyers for the Board, Duke and Potti went to work. And they sandpapered out a new version for a revised reprimand order:
"Dr. Potti's curriculum vitae and Duke Medical Center biographical sketches contained inaccuracies. Dr. Potti used the inaccurate curriculum vitae and biographical sketches in connection with obtaining funding for his medical research. Dr. Potti failed to correct those inaccuracies in a timely fashion. However, the Board has no evidence from which it could conclude that Dr. Potti received funding for medical research as a result of the inaccuracies that he would not otherwise have received."
Loyal Readers, we are not only talking about a faked Rhodes Scholarship. We are talking about a list of honors that simply were not tendered, a procession of lies. And we must wonder if the Board -- which says it has no evidence that this chicanery played role in getting the well-financed Potti grants -- actually looked for evidence.
Certainly, the American Cancer Society -- which demanded a refund of three quarters of a million dollars in research grants and got it from Duke -- might have evidence.
The sandpapering by attorneys is not enough.
The Board, in saying that Duke considered Potti's lies "honorable mistakes," built upon a foundation that was cracked. The plea bargain that Potti made with the Board resulted in a November 22nd order for a reprimand. Had the Board used valid information, it might well have reached for a sterner punishment for "professional misconduct," perhaps a suspension or even a revocation.
We note too that as one division of the Medical Board was preparing the reprimand order, another was receiving information that Potti and Duke had settled 11 malpractice claims, one dating back to 2007. These were patients who were enrolled in his faked clinical trials (which is to say human experiments) and the Board reports each received a monetary settlement. We only know the money involved in each case was more than $75,000, which is the only bracket the board uses.
And the 11 settlements are only the tip of the iceberg. Potti and Duke are being sued -- and it is likely more plaintiffs might emerge, with a federal lawsuit in West Virginia a distinct possibility.
The Medical Board notes that it is now reviewing each of these instances.
Fortified by the unfolding malpractice mess, the Board should have followed a better route: made it clear that the reprimand is an interim order pending full consideration of the many facets of this still unfolding scandal.
And now Potti's South Carolina license
His Duke career over, Potti quickly and amazingly found a physician's position with the Coastal Cancer Center, a small chain headquartered in Mrytle Beach. He works principally in the pint-sized town of Loring, which is quite close to the Atlantic Ocean and southeast corner of North Carolina.
Coastal Cancer does clinical trials, and has in the past contracted with Duke. We are assured by the Principal Investigator that a trial mentioned on the Coastal website is not active, the one Coastal patient involved in the Duke study having completed his involvement several years ago.
In applying for a South Carolina license -- which was granted on April 6, 2011 -- Potti sent an extraordinary letter on January 15. He describes the situation at Duke as "a past controversy" that was "in no way related to my abilities, performance or conduct as a physician or care giver."
Does he have responsibility now to update that, revealing the continuing questions surrounding him?
Potti states he made the error about a Rhodes Scholarship because as a poor boy from India, he did not realize the honor involved study at Oxford University. He says he got confused because an association of winners of the Rhodes awards from Australia (who go to England for study) helps a graduate student to study in that Down Under country every year.
Potti slurs through the fact that he was merely mentioned for this award, was not made a full fledged candidate and was never awarded the honor. His resume had no nuances: it said he was a Rhodes Scholar.
And it says Rhodes Scholar - Australia, and Rhodes Scholar (Australian Board) shaking his poor boy assertion that he did not know the real Rhodes was at Oxford.
While Potti contends the Rhodes was his only problem, he never mentions, for example, that at the same time he was supposedly on his Rhodes Scholarship, he said he was mentored at an Australian university that does not exist by a distinguished professor who never heard of him. To merely begin the list.
The Rhodes was his only problem. This statment also ignores very substantial issues in his clinical trials and treatment of patients.
This gets pretty deep.
--The North Carolina board says it learned of issues involving Potti in July, 2010. While it is not known when the pending charges were brought to Potti’s attention, he certified to South Carolina authorities in applying for a license he did not face any disciplinary charges. The timeline needs careful review.
– Potti also certified to the South Carolina board that there was never a period of 30 days or more that he did not engage in the practice of medicine. What we know is that he says he voluntarily stopped practicing at Duke on July 16, he was suspended on July 18, and he resigned on November 19, with Duke letting him, inexpicably, stay on until December 1st. We think there is a decent question here as to whether 30 days passed.
-- The South Carolina Medical Board considered Potti's application with the benefit of a rather preposterous letter sent by Dr. Jeffrey Crawford, the chief of Duke Medicine's oncology staff, that praised Potti to the hilt. This letter was actually addressed to the Coastal Medical Center as a recommendation for employment -- and not submitted directly by Crawford.
Crawford used these words:
"...Honesty, integirty and humility."
"...great admiration and respect.."
And the kicker, "Anil developed an impressive research program..."
This was written on official Duke University Medical Center stationery. And we understand Crawford got into hot water because of it.
Crawford, to his credit, responded immediately on two occasions to our challenge of his praise of Potti. He stated unequivocally that his letter was a mistake. Unfortunately, he diluted this confession by saying that he -- Duke's #1 cancer doc -- did not know of the extent of Potti's troubles at the time he wrote the effusive letter.
Crawford has also taken the position that his letter went to Coastal Cancer Center; that it became a central document in the application for a South Carolina license does not seem to drive him to contact the South Carolina board about his own reevaluation.
We believe he should.
We note that in his South Carolina application, which we obtained via a Freedom of Information Request, Potti stated he had never received psychiatric treatment. Meaning that whatever demons drove him to ruin at Duke may well be still alive in his head.
Those demons could easily once again cause him to falsify his credentials, to dream up theories about crazy treatment, and to fudge research to show his theories held water. And there is no saying what he might do in the privacy of an examination and treatment room one on one with a patient.
Patients who are seriously ill, who seek out a doctor in hope, should not find hell. That is our paramount concern, not to repeat what happened at Duke. At the very least, Dr. Potti should be on probation, required to undergo analysis, and have another doctor looking over his shoulder and affirming every important decision for a period of years.