What I'm Reading (Apr. 8)

By Chuck Dinerstein, MD, MBA — Apr 08, 2021
Conflicted interests in Boston healthcare, gene sequences powering a change in medicine, inheriting more than genes from our parents, and the cancel culture comes to medicine.
Image by 2081671 from Pixabay

Remember a few years ago Dr. Baselga and charges of conflicts of interest at Memorial Sloan Kettering? New York seems to have cleaned up its act, Boston not so much. 

As chief of Boston Children’s Hospital, one of the most esteemed pediatric hospitals in the world, Sandra Fenwick had outsized influence. After the pandemic struck last spring, she used that clout to lobby Massachusetts legislators for more money for telemedicine, a suddenly essential alternative to in-person visits.

She also spoke glowingly about remote care during an online forum last September, saying that satisfaction among patients and staff was hitting “eight, nine, and 10.’' The hospital, she told a Harvard public health professor, would objectively study the best uses of telemedicine, but she predicted it “is absolutely here to stay.”

What she did not say on both occasions was that she had a highly paid side job: She has, since 2019, had a seat on the board of directors of a major, for-profit telemedicine company.”

An expose from The Boston Globe, on the medical executives of their many powerful health systems, Boston’s hospital chiefs moonlight on corporate boards at rates far beyond the national level

“Some of the grandest hopes for sequencing have arisen from the notion that our genes are deterministic — and that by understanding our DNA’s code, we might limn our destiny. When an early reading of the human genome was unveiled in 2000, President Bill Clinton noted that we were getting a glimpse of “one of the most important, most wondrous maps ever produced by humankind.” But the map has often proved hard to read, its routes unclear. The past 20 years have demonstrated that inherited genes are just one aspect of a confounding system that’s not easily interpreted. The progress of using gene therapy to treat diseases, for instance, has been halting; it wasn’t until last year that physicians had a resounding success with a treatment on several patients with heritable genes for sickle-cell anemia. In the meantime, scientists have come to realize something else: A complex overlay of environmental and lifestyle factors, as well as our microbiomes, appear to have interconnected effects on health, development and behavior.”

From the NY Times, Unlocking the Covid Code. It is time to learn a bit more about sequencers and sequencing – the machines and the ability to read and report genetic sequences rapidly. A tool that is opening up new vistas of investigation. 

“First, we exposed mothers and fathers to predators. Then we looked at their offspring and measured behavior as well as how genes were expressed in their brains. We found that the sex of the parent exposed to predators matters, but surprisingly, the sex of the offspring also changed how the information influenced behavior.”

While the study was done on fish, significant research shows how stress, in the case of the Holocaust, was transferred to the children and grandchildren of survivors. An interesting introduction to how we inherit more than our parents’ genes. From The Conversation, In fish, parents’ stressful experiences influence offspring behavior via epigenetic changes

“Personally, I think taking ‘racism’ out of the conversation would help,” Livingston said on the Feb. 23 show, titled “Structural Racism for Doctors—What Is It?” “Many people like myself are offended by the implication that we are somehow racist.” Online, the journal promoted the podcast with a tweet that said, “No physician is racist, so how can there be structural racism in health care?”

Those statements sparked a furious outcry from the medical community. Doctors and researchers flooded Twitter and the journal’s inboxes with demands for explanations and complaints pointing out that racism very much exists in healthcare. The Institute for Antiracism in Medicine, a Chicago advocacy group, circulated a Change.org petition that now has more than 7,400 signatures.”

I have considered writing about this controversy for some time. But I always felt it was a little too “inside-baseball” for a general audience. But BuzzFeed’s article covers the entire controversy, a “cancel” culture moment for a premier medical journal. I find myself torn because it is hard for me to reconcile how I view my beliefs and behavior with those so vocally pointing our “structural racism” – it creates a dissonance that makes me uncomfortable. A Top Medical Journal Said “No Physician Is Racist.” Now Scientists Are Boycotting.


Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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