Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
UCSF Regrets Decades-Old, Unethical Experiments on Incarcerated People
UCSF has apologized after an internal investigation found that two faculty members at the institution performed unethical experiments on incarcerated people in the 1960s and 1970s, according to a report from the San Francisco Chronicle.
Two UCSF dermatologists -- Howard Maibach, MD, and William Epstein, MD -- experimented on at least 2,600 people incarcerated at the California Medical Facility, a prison hospital in Vacaville. The experiments did not appear to have approval from the UCSF committee that was supposed to authorize studies on human subjects, and informed consent documentation from the research subjects was sparse, the internal investigation concluded.
Epstein died in 2006, but Maibach, 93, is still part of UCSF's dermatology department.
The internal report was conducted as a part of UCSF's newly created Program for Historical Reconciliation, which aims to "respond to questions and concerns raised by our community about UCSF's history," the Chronicle reported.
UCSF's report cited a few experimental methods used on the prison subjects, including the topical application of herbicides and pesticides, placing small cages with mosquitoes close to the arms of human subjects, and even placing the cages directly onto the skin to observe how the insects bit a person.
Reviewing publications from 1960 to 1980, UCSF found that the majority of studies conducted by Maibach and Epstein lacked documentation for informed consent, although this documentation was required as early as 1966.
"What I believe to be ethical as a matter of course forty or fifty years ago is not considered ethical today," Maibach wrote in a Dec. 12 letter to his colleagues, addressing the report. "I regret having participated in research that did not comply with contemporary standards."
Mystery of Doc Lost at Sea
In October, Marvin Moy, MD, a Manhattan physician, and his friend left on a boat from Long Island for a day-long fishing trip. More than 2 months later, Moy has yet to be found.
The disappearance of Moy, a physician from a humble background who then became the subject of a criminal investigation, has become a mystery. An investigation from the New York Times details the events leading up to the day Moy was lost at sea, and the sparse evidence indicating his whereabouts now.
Almost a year before the fishing trip, Moy was charged with insurance fraud in federal court in Manhattan. The government accused Moy and others of orchestrating a scam that involved bribing emergency responders and hospitals to send car crash victims to his pain management clinic. A conviction could have sent him to prison for years, the Times reported.
In addition to the court case, Moy was in the midst of a divorce from his wife of 14 years. The divorce had already dragged on for 5 years, and was filled with fights over custody of Moy's 12-year-old daughter as well as disputes over money. The physician went through several lawyers, and still owed one firm nearly $70,000, according to a lawsuit obtained by the Times.
On Oct. 12, Moy and his friend Max Wong, a nurse in Queens, left early morning to travel 6 hours to their destination. Around midnight, alarms indicated that the doctor's boat was in distress, and the Coast Guard dispatched rescue teams off the coast of Fire Island to locate him. But the Coast Guard saw only an oil slick, a floating cooler, and one man -- Wong.
"Look, who knows what happened?" Roland G. Riopelle, a lawyer representing another person accused alongside Moy in the insurance fraud case, told the Times. "As I sit here now, I have no reason to know one way or the other whether he died in a boating accident or cleverly created a situation that looked like a boating accident and fled."
Thousands of Patients Get Ketamine Online -- And It's Legal
Scott Smith, MD, a family medicine doctor from South Carolina, obtained medical licenses in 45 states in the last 2 years, all to prescribe ketamine via telehealth. But while Smith has been able to build an entirely virtual ketamine practice during the pandemic, the expiration of public health emergency rules may disrupt his ability to prescribe the substance online, according to the Washington Post.
Smith is one of several doctors and tech start-ups providing ketamine via telehealth during the pandemic, made possible by the public health emergency declaration that waived the requirement for providers to prescribe controlled substances to patients in person. He said the rules have made it possible for him to provide the drug to more than half of his 3,000 patients. "People are beating a path to my door," Smith said in an interview with the Post.
Ketamine, which has shown some potential to treat depression and anxiety, has typically been administered under strict protocols endorsed by the FDA. But Smith prescribes generic lozenges online, which patients can take at home.
At least eight companies have started to provide ketamine via telehealth since the start of the pandemic, the Post reported. Between Smith and two of the more well-known start-ups -- Nue Life and Mindbloom -- more than 10,000 patients have received ketamine in their homes.
While ketamine telehealth companies and providers say that they are removing barriers to care, some psychiatrists are concerned about patients taking ketamine without physician supervision.
Ketamine has been used in hospitals for anesthesiology -- and abused recreationally -- for years. The FDA approved the nasal spray esketamine (Spravato) in 2019 under strict protocols, including that doctors had to be with patients for two hours after they took the medication because of its potential to alter consciousness and cause high blood pressure.
"I'm very concerned about treatments that deviate too far from the standard recommendations given by the FDA," Gerard Sanacora, MD, PhD, director of the Yale Depression Research Program who led a team that pioneered ketamine to treat depression, told the Post. "I really do believe that it is one of the major advances of psychiatry in the past half-century," he said of ketamine, "but we have to be very careful to continue to develop this responsibly."