"Docs Ditched After Undesirable Diagnosis"

From the Johannesburg, South Africa Star, this story, entitled "Docs Ditched after Undesirable Diagnosis," has some eerie echoes of the past:

When medical specialists diagnosed at least 10 cases of manganese-specific illnesses at a factory in Cato Ridge, KwaZulu Natal, the Assmang manganese company dumped them 'like hot potatoes'.

They replaced them with a new team of doctors that revised the diagnoses to suggest the sick workers might be alcoholics, drug abusers or victims of Aids.

All 10 workers had also been certified previously by the Compensation Commissioner as being permanently disabled as a result of manganism, an occupational disease caused by exposure to excessive levels of toxic manganese.

Another 27 workers, also earmarked by doctors as possibly suffering from manganism, were also 'cleared' by the new team of medical doctors and some were put back to work.

This emerged on Wednesday during the testimony of Dr Susan Tager to the Department of Manpower inquiry into worker sickness and toxic dust exposure at the factory.

Tager, a senior Johannesburg neurologist who heads the movement disorders clinic at Wits University, expressed surprise that Dr Murray Coombs, a new member of the Assmang expert panel, had rubbished her diagnoses - even though Coombs had not seen or physically examined any of the 10 workers and based his opinion on a review of their medical files. Coombs, from Elixir Corporate Health Solutions, is employed by Assmang as an occupational health consultant.

We have often discussed how health care organizations may try to shut up doctors who might say something that goes against their vested interests. In particular, we have frequently discussed how corporations that sponsor clinical research on their own products have suppressed research unfavorable to these products (see relevant posts here). But it seems like all sorts of organizations now feel free to try to shut up physicians who say things counter to their interests, whatever these may be.

We have also often discussed how health care organizations cultivate physicians who might help them market their products. Again, we have most often discussed how biotechnology, device, and pharmaceutical corporations may cultivate "key opinion leaders," who seem happy to to promote the organization's line, at least while wined, dined and paid well. But it seems like all sorts of organizations now feel free to recruit compliant physicians happy to say what the organizations want.

The eerie echo is of the case of Dr David Kern, fired from his academic position after he tried to present an abstract on a new occupational disease, now called flock workers' lung,(1) in a way that offended leaders of the company whose workers acquired the disease (see summary on the Scientific Misconduct Blog here).(2) That company also recruited a new physician to investigate the disease outbreak,(3) but as far as I can tell, he never put anything on the public record about the results of his investigation, and what happened to the patients with flock workers' lung is unknown.

Thus, both these cases illustrate how directly patients may be affected by companies eager to shut up physicians, especially physicians warning of occupational disease.


1. David G. Kern, Robert S. Crausman, Kate T.H. Durand, Ali Nayer, Charles Kuhn III. Flock Worker's Lung: Chronic Interstitial Lung Disease in the Nylon Flocking Industry. Annals of Internal Medicine 1998; 129: 261-272 (Link here.)

2. Shuchman M. Secrecy in science: the flock workers' lung investigation. Ann Intern Med 1998; 129: 341-344. (Link here.)

3. Fulks JR. Intimidation of researchers by special interest groups. N Engl J Med 1997; 337:1314-1319. (Link here.)

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