Another physician punished for her good work

Dr. Anna Pou and 2 nurses who stayed to help care for patients during Hurricane Katrina have been charged with homicide for the deaths of some patients under their care.

The charges against Dr. Pou and the nurses caring for patients during Katrina appear little more than grandstanding and scapegoating, as has been done with Dr. Thomas Butler and Michael/Terry Schiavo.

I applaud these health care workers for their dedication to their patients and their tough decision to stay with the patients. The drugs found are commonly used to help patients be more comfortable. It is unfortunate if occasionally patients die—perhaps in larger part due to the appalling and stressful conditions they were under, including the extreme heat.

In a related, timely article, Dr. Daniel Sokol discusses the ethics of healthcare workers “duty of care” in responding to virulent epidemics. While no clear conclusion can be made, I appreciate Dr. Sokol’s discussing the multiple roles that physicians have that may be in conflict. For while a doctor has an obligation to patients, they also have

“a duty to care for their own children by protecting them (and hence themselves) from infection. So a further problem with the duty to care, aside from its vagueness, is that it fails to consider the holder of the duty as a multiple agent belonging to a broader community. Doctors, in such situations, play several incompatible roles—doctor, spouse, parent, for example—and they must deal with them as best they can. The limits of the duty of care are thus also defined by the strengths of competing "rights and duties.”

The irresponsible charges brought against Dr. Pou and her colleagues will have a chilling effect on other health care workers in the future, who will be loathe to respond to disasters. First, there is the risk of malpractice for caring for patients outside our specialties or beyond our experience. Now there is the risk of prison and reputation/career destroying attacks from Monday morning quarterbacks.

Dr. Pou and her nurse colleagues should be hailed for their heroism and devotion to their patients.

Who will care for you during the next disaster or epidemic?

Patriot Act warning to researchers

In January, Dr. Thomas Butler lost his appeal of his felony conviction.

Why should you care?

Dr. Butler was a leading researcher who, most recently, was studying treatments for plague, bearer of the "Black Death," a bacteria that might be weaponized and used for bioterrorism. When he reported vials missing from his lab, federal agents descended on his Lubbock, Texas lab, and he was charged--and ultimately acquitted--of 69 felony counts related to bioterrorism. He ultimately served 2 years on minor unrelated charges.

Dr. Butler is also the leading researcher responsible for developing "oral rehydration solution," an inexpensive powder that has saved millions of lives in developing countries. This treatment, which replaces intravenous therapy for severe dehydration "is credited by the World Health Organization for saving between 2 and 3 million lives of under-4-year-olds each year around the planet," according to Dr. William Greenough, professor of medicine at Johns Hopkins University.

Dr. Butler's trial was apparently intended to serve as a warning to researchers that the Patriot Act concerns extended to them.

It has done that. It has also resulted in many researchers losing their willingness to study agents of concern, lest their lives be similarly destroyed.

I would recommend John Mangel's recent thoughtful series in the Cleveland Plain Dealer for an excellent review of this tragic story.

"Destroying the Life and Career of a Valued Physician-Scientist (pdf) Who Tried to Protect Us from Plague: Was It Really Necessary?" reflects the analysis by many of Dr. Butler's colleagues, including:

"Reactions in favor of Butler and expressions of concern about the handling and impact of the case have been strong, including comments from the Human Rights Committee of the National Academy of Sciences (NAS), the Institute of Medicine (IOM), the National Academy of Engineering, and the New York Academy of Sciences. The presidents of the NAS, the IOM, and the European Society of Clinical Microbiology and Infectious Diseases, as well as many prominent scientists and physicians, wrote to then Attorney General John Ashcroft to express their concern about the impact of the prosecution of Dr. Butler (the presidents of the NAS and the IOM had written only once before to an attorney general, Janet Reno, and their letter was concerned with the prosecution of Los Alamos National Laboratory scientist Wen Ho Lee).

Four academy members who are Nobel Laureates wrote, on behalf of themselves, that "this respected colleague has been subjected to unfair and disproportionate treatment." . . .many other news sources have run stories suggesting that Butler may have been a victim of the widespread fear about (bio)terrorism and may have been singled out, presumably to serve as an example, as part of a flawed strategy to fight bioterrorism.

We think it makes very little sense to have removed from action such a knowledgeable and active clinician and clinical investigator who was working to protect us from plague--such removal is akin to shooting ourselves in the foot…

Dr. Tom Butler, a physician-scientist and member of the IDSA, respected by all colleagues who know him and his work, has been stripped of his professorship, tenure, salary, and medical license and has spent his life savings and retirement to defend himself. . . He and his family have no sources of income. His situation is a cautionary tale to all of us, especially those who work with biological agents with potential for use in bioterrorism, even if in collaboration with governmental laboratories and scientists."

Dr. Butler's colleagues have gotten the fed's message.

Dr. Peter Agre, was a co-recipient of the 2003 Nobel Prize in chemistry, and is a member of Duke University's faculty, recently said, "many scientists are reluctant to study these organisms because their best attempts to know and to obey applicable regulations still might land them in prison, might cost them their faculty positions, their licenses to practice medicine, or their right to vote."

Dr. Stanley Falkow, an expert microbiologist from Stanford University, echoed Dr. Agre's concerns, noting, "In my letter to Ashcroft, I said I couldn't imagine why I would let my students work in this area when a simple mistake can lead to incarceration," and "they took one of the only experts on plague in the U.S. and totally muzzled and incapacitated him."

Dr. Butler is currently working in a Lubbock warehouse, instead of continuing his valuable research or developing other life-saving therapies, as he had in the past.

Do you feel safer now?