Fwd: A Black Hole of Patient Safety

Mark Gusack gusackm at COMCAST.NET
Wed Sep 14 01:33:45 UTC 2016

Good Evening Everyone:


I am a pathologist and I can tell you that, because of the way autopsies were supported in hospitals in the past and because of fear of litigation, autopsies are few and far in between.  If we are to restart the use of autopsies as a means of:


Æ  Confirming our diagnoses

Æ  Validating our therapies

Æ  Teaching our students and residents


Then we will need to find:


Æ  The funding – autopsies are very expensive and labor intensive

Æ  The pathologists willing to do them – they’re messy and did I mention labor intensive

Æ  The means of reducing the threat of litigation


If we do this, then I can tell you from experience that the results will be eye opening.  For example, in most of my autopsies where there has been a prior coronary artery bypass graft or two, most are not functional due to organized clots and secondary fibrosis of the pericardium that obstructs flow.  So that raises the question of what is going on with this operation.


Everyone have a good rest of the week.


Mark Gusack

Staff Pathologist

Huntington VAMC


From: Mark Graber [mailto:mark.graber at IMPROVEDIAGNOSIS.ORG] 
Sent: Tuesday, September 13, 2016 10:46 AM
Subject: [IMPROVEDX] Fwd: A Black Hole of Patient Safety


George, I’ve taken the liberty of sharing your email and the link to the article with the SIDM listserv audience.  You’ve raised an extremely important point, that without autopsies we’ll never know if a cancer death was the result of the malignancy or its treatment.  The IOM report “Improving Diagnosis in Health Care” called for more autopsies in the US.  The example you cite is another argument in favor of this recommendation.


Thanks for calling this to attention,




Mark L Graber MD FACP

Senior Fellow, RTI International

Professor Emeritus, SUNY Stony Brook

President, Society to Improve Diagnosis in Medicine





Begin forwarded message:


From: George <gdlundberg at gmail.com <mailto:gdlundberg at gmail.com> >

Subject: A Black Hole of Patient Safety

Date: September 13, 2016 at 10:13:37 AM EDT

To: Elizabeth Burton <ecburtonmd at gmail.com <mailto:ecburtonmd at gmail.com> >, "Dr. Kaveh Shojania" <kaveh.shojania at sunnybrook.ca <mailto:kaveh.shojania at sunnybrook.ca> >, "R.E.Horowitz" <r.e.horowitz at ucla.edu <mailto:r.e.horowitz at ucla.edu> >, robert.wachter at ucsf.edu <mailto:robert.wachter at ucsf.edu> 

Cc: Mark Graber <mark.graber at improvediagnosis.org <mailto:mark.graber at improvediagnosis.org> >, Paul Epner <paul.epner at improvediagnosis.org <mailto:paul.epner at improvediagnosis.org> >

Resent-From: <Mark.Graber at Improvediagnosis.org <mailto:Mark.Graber at improvediagnosis.org> >


Good morning,

Please open this 2012 article. I believe that it is open access, full text.



In my CollabRx role, I attended an all day program on Targeted Therapy vs Immunotherapy in advanced cancer.....all types, last Saturday; many academic hotshots. Large numbers of expensive clinical trials inform the field. Progression free survival PFS and overall survival OS are the holy grail of data. And, in fairness, some PPs did address adverse effects.

Next week I will be publishing a blog at Curious Dr. George by Professor Michael Baum of University College London. He argues eloquently that Quality of Life is co-equal to Length of Life in those  cancer patients who progress beyond curative standard of care (700 000 Americans annually). 

One speaker lamented the difficulty of academically studying frequency/severity of adverse effects in reports of clinical trials.

Why did autopsies in clinical trials fall off the cliff? How can the investigators draw meaningful conclusions about beneficial vs harmful effects of these very powerful new agents without autopsies? Was it the cancer or the treatment that killed the patient?

Considering the cost of current cancer therapeutics, routine autopsy costs would be trivial.






George D Lundberg, MD

Chief Medical Officer and Editor in Chief, CollabRx, a Rennova Health Company

Editor at Large, Medscape

Consulting Professor of Pathology and Health Research and Policy, Stanford

Executive Adviser, Cureus

President and Board Chair, The Lundberg Institute

312 560 0290 cell


gdlundberg at gmail.com <mailto:gdlundberg at gmail.com> 


Sent from my iPad mini





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