Nurse in Anti-Vax Conspiracy Is Alive; Fat-Freezing Side Effect; Horizon's Strategy

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

#WheresTiffanyDover? Right Where She Started

A Tennessee nurse at the center of an anti-vaccine conspiracy theory is alive and well, according to NBC News. Tiffany Dover, RN, who worked at CHI Memorial Hospital Chattanooga, fainted on camera after receiving one of the first COVID-19 vaccines -- and then went silent on social media. A viral theory spread that Dover had died from the injection and been replaced by a body-double planted by pharmaceutical companies and the hospital.

Videos about her story circulated the world. A Facebook group and a website were dedicated to her story and the invented "cover-up." People called the hospital incessantly, interfering with their operations. They hacked into her social media accounts. They harassed Dover, her husband, her friend, and extended family members. A man even came to Tiffany's house. The silence from Dover only made things worse.

But what really happened, NBC reported, was this: Dover had fainted in reaction to pain -- something that had happened to her before. She was perfectly fine afterwards, and wanted to quiet the viral theories.

"That would've been a perfect moment for us to speak out," she told NBC. "The silence is what flamed this."

But she told NBC the hospital asked her not to answer calls or post to social media. They said they would handle the response, and posted a short video on Facebook of Tiffany and her co-workers, which only fueled conspiracies further.

When Tiffany did decide to post some vacation photos to Instagram, she was formally reprimanded by the hospital, who said calls to the hospital had escalated again. Tiffany finally posted a video of herself to Instagram earlier this month.

"People have said I'm responsible for people not getting the vaccine," Dover told NBC. "That was hard to process. If people are using my name and my story to say, 'Don't get the vaccine,' how many people didn't receive it because of me? That's hard."

CoolSculpting Complications Downplayed for Years?

A popular treatment to "freeze" unwanted fat without surgery may be responsible for more complications than previously thought, the New York Times reported.

Allergan Aesthetic's CoolSculpting machines have generated more than $2 billion in revenue, using what's called cryolipolysis to freeze fat cells, which then die and are absorbed back into the body. But in some cases, the fat can grow and harden, sometimes in the shape of the applicator, and can take multiple surgeries to fix, the Times reported.

AbbVie, which owns Allergan, said the side effect -- called paradoxical adipose hyperplasia (PAH) -- happens in only 0.033% of cases (1 in 3,000). But the New York Times found that CoolSculpting's leadership settled with patients who experienced the side effect in exchange for their silence. The company also stopped reporting cases of PAH to the FDA after an auditor told them it wasn't serious enough to report.

The company that developed the device (Zeltiq, which was sold to Allergan in 2017) and its consultants originally calculated the risk of PAH based on the number of overall treatments or sessions, instead of the number of patients, who usually undergo more than one treatment, the Times reported. This risk-per-treatment approach would make the risk much lower than if calculated per-patient. Allergan's current estimate (1 in 3,000) is almost 7 times the initial estimates -- but it still calculates risk based on treatments sold (some of which go unused).

A plastic surgeon told the New York Times his patients often feel they caused the PAH disfigurements by not dieting or exercising enough. Doctors have argued in medical journals that the incidence of PAH is higher than what the company reports -- as high 1 in 100 patients, according to one study. Massachusetts General Hospital, where the technology was developed, has benefitted from the sales of CoolSculpting treatments, the Times reported.

Horizon's Growth Strategy

Horizon Therapeutics has thrived without licensing a single product it developed itself in its 15 years of existence, according to KFF Health News.

Horizon started out by combining generic drugs into single pills and charging insurers high prices for them, according to KFF. Then, it picked up interferon gamma-1b (Actimmune) and glycerol phenylbutyrate (Ractivi), which had no generic versions, and hiked the prices. It also halved its tax rate by moving headquarters to Ireland.

According to KFF, CEO Tim Walbert "mastered a particular kind of industry expertise: taking drugs invented and tested by other people, wrapping them expertly in hard-nosed marketing and warm-hued patient relations, raising their prices, and enjoying astounding revenues."

From 2012 to 2016, Horizon's net sales rose from $20 million to $981 million. It says it now has 20 drugs in development, and has attracted the attention of Amgen, which announced last year that it will buy Horizon for $27.8 billion.

Walbert will get $135 million when the sale goes through, KFF reported.

"He did it backwards,"Annabel Samimy, an analyst at Stifel Financial Corp, told KFF. "Horizon built commercial platforms before they got into drug development."

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