Fraudulent Interpretation of Lab Results

In this edition, we offer an example of how clinicians and patients can be fooled and/or injured by fraudulent healthcare practitioners and their services. The clinical care team must be sure that the references it provides to patients are safe and reliable. Keep a list of reliable references and a list of those practitioners and services/treatments that should be avoided. Maintain an open door policy with your patients designed to encourage questions and exchange such information.

Patients often rely on your expertise in many more ways than just the provision of care.

Joanne, 49, was diagnosed with early breast cancer and treated with a lumpectomy, radiation therapy, and chemotherapy. Now post-treatment, she is seen every 3 months at her regional cancer center. At the onset of her diagnosis and treatment, Joanne weighed 185 lb. At the end of her intensive regimen, she had dropped to 165 lb. Pleased with her weight loss, Joanne consulted the cancer center nutritionist on how to best continue her weight loss program. The nutritionist developed a meal plan for Joanne and provided references to resources outside of the hospital.

At her first 3-month check-up, Joanne weighed 155 lb. Both Joanne and the clinical staff were pleased with the results. However, Joanne still considered herself overweight and decided to consult a local nutritionist on the cancer center resources list for her area. The nutritionist had excellent credentials and a strong community reputation.

This nutritionist wanted Joanne to get tested for food allergies and toxins that might influence or interfere with a diet design, and recommended an internist in the next county to administer the tests. Joanne had never heard of this internist but was comfortable with the reference because of the local nutritionist's reputation. Joanne neglected to ask her family doctor for his opinion or ask her insurer whether such tests were covered.

The consulting internist performed the following tests: blood, hair analysis, and a series of provocative chelation tests to help identify toxins. Based on these tests, the internist determined that Joanne had heavy metal toxicity. Her insurer denied Joanne's subsequent request for coverage of the tests.

Joanne's employer was the owner of a pottery shop that uses chemicals in different development, processing, and finishing procedures. Her employer was concerned that if Joanne did have heavy metal toxicity, it could be related to her work. Therefore, the employer wanted to assess his liability and take safety measures if needed.

Joanne's employer was part of a local cancer patient support group and had previous experience with the MCOP volunteer program. With the employer's encouragement, Joanne decided to use MCOP's volunteer services to assist with her appeal of the coverage denial.

Appeal Strategy

After reviewing Joanne's medical records, MCOP said she needed to repeat the testing with a local toxicologist. MCOP also asked the consulting internist for additional records related to Joanne's visits. Then MCOP assembled a four-member panel of experts with specialties in medical toxicology, occupational medicine, allergy and immunology, and internal medicine with a sub-board in critical care medicine.

MCOP's medical toxicologist recommended an environmental testing firm to evaluate and test Joanne's work environment. The result was conclusive that there was no danger of untoward toxicological exposure, given the safe manner in which the business was conducted.

The additional records included descriptive information about the consulting internist's practice, test results, and supporting rationale. Each panel member provided a separate review according to specialty; the internal medicine member, serving as the panel coordinator, merged all of the opinions, rationales, and determinations into one report.

The additional records indicated that the consulting internist had informed Joanne that the chemicals and radiotherapy she received to treat her breast cancer had suppressed her immune system, and that her work environment and food preferences, such as fish, exposed her to "toxins" that had poisoned her now-compromised immune system.

The consulting internist further indicated that these "toxins" could lead to neurological and kidney toxicity, GI distress, kidney failure, and CNS problems. He further said these toxins could be removed via a course of chelation therapy and a change in diet and employment. He recommended chelation therapy every 3 weeks with at least 30 sessions.

The basis for the consulting internist's conclusions/recommendations was the hair analysis and a dimercapto-propane sulfonic acid (DMPS) challenge test for urine toxic chemicals. These lab results indicated that Joanne's levels of mercury, arsenic, aluminum, lead, nickel, thallium, antimony, and cadmium were at least three times above the normal range.

After reviewing the consulting internist's lab results and recommendations, the MCOP panel concluded:

•The value of hair analysis as used in this case for determining the need for chelation treatment is not supported by credible clinical evidence.

•The tests performed are not sup-ported by scientific studies in the peer-reviewed medical literature.

•Many normal individuals have detectable levels of mercury in their blood, urine, and hair, at the same level as found in Joanne, but do not require chelation therapy.

•The levels of chemicals reported for Joanne were within the normal range on accepted analytic tests.

•The urinary tests performed were nonspecific, not standardized, and did not demonstrate physical or organ dysfunction compatible with heavy metal poisoning.

•The tests in question would support chelation therapy for virtually any person being tested.

The MCOP panel concluded that the consulting internist's findings were unsupported by valid clinical evidence. Joanne was retested for metal/chemical toxicity using accepted, proven tests, and received a clean bill of health. She also was seen by an allergy and immunology practice at the cancer center, which found several food allergies, and these were considered in devising her weight control program. She is now back at work and has continued to lose weight.

Lessons Learned

•Monitor health fairs for marginal or outright fraudulent schemes to prevent or treat cancer or to revitalize a damaged immune system, and share this information with patients as appropriate.

•Bring the local media into the fray—provide the media with information and indicate that patients will provide commentary and analysis, good and bad, regarding the claims made and information provided.

•Check with the local American Cancer Society chapter to see if they are monitoring threats to cancer patients and survivors, and ask what can be done to help.

•Patients should ask the clinical care team for references. The clinical care team or cancer center should regularly review and update these references.