Speaking up to save patients’ lives

By exposing practices dangerous to public health, numerous medical whistleblowers have saved lives — and encouraged others to speak out too.

Chinese doctor Li Wenliang didn’t just expose COVID-19. He was punished for blowing the whistle on the authorities’ cover-up, and his death from the disease sparked widespread demands among China’s people for freedom of speech. By speaking out about wrongdoing, Li became a hero in China and beyond.

But he’s not alone in exposing malpractice linked to COVID-19. In May 2020, Dr Rick Bright, former head of the US Biomedical Advanced Research and Development Authority, filed a 63-page complaint with the US Office of Special Counsel detailing undue political pressure by the Trump administration. When COVID-19 swept the country, he says he was urged to approve plans to source unproven doses of chloroquine from uninspected factories in Asia. He also says that he had previously been pressured to invest in treatments lacking scientific merit and to acquire drugs for the country’s essential medicine reserves based on political connections and cronyism.

In retaliation for resisting the chloroquine plan, Bright claims, he was fired and officials have smeared his name, accusing him of undermining COVID-19 preparation. Filing his complaint, he described his “moral obligation to the American public” to speak out.

As Bright prepares to testify before Congress, he joins Dr. Li and the many healthcare whistleblowers — most less well-known — who have saved countless lives by exposing dangerous medical practices driven by corruption. Among them is Dr Soe Maunglay, who joined the practice of star oncologist Dr Farid Fata in Michigan in the United States in 2012. Checking patients the following year, Maunglay met a woman back in hospital with a broken leg hours after receiving the first of many costly chemotherapy sessions scheduled with Fata.

Reviewing the patient’s records, Maunglay realised that she was highly unlikely to have cancer. He urged her to get a second opinion, and examined Fata’s other patient files. Discovering widespread evidence of unnecessary treatment, he reported his findings to the hospital’s practice manager, who contacted the FBI, leading to Fata’s arrest.

Fata, aged 50, admitted mistreating patients so he could defraud insurance companies. Once one of Michigan’s most respected doctors, he was sentenced in 2015 to 45 years in prison and agreed to pay back US$17.6 million. The charges included intentionally prescribing over 9,000 unnecessary chemotherapy treatments to at least 553 patients over six years.

The treatments amounted to nearly US$35 million in insurance billings and caused profound suffering. Some patients never recovered. Fata also pressured dying patients into staying at a hospice that gave him kickbacks and urged others to use the services of businesses he owned.

After Fata’s scheme was uncovered, the US government tried to tighten loopholes that enable medical corruption. Legislation passed in 2014 requires drug and medical product manufacturers reimbursed by federal health programmes to report any payments or services they provide to doctors and hospitals. This makes it easier to see potential conflicts of interest — and could have helped raise suspicions about Fata earlier.

Without witnesses like Dr Maunglay, corruption can go unchallenged. Yet he was lucky to receive support when he spoke out. Many whistleblowers aren’t so fortunate. UK nurse Helene Donnelly raised more than 100 complaints about patient mistreatment while working at Stafford Hospital. In response, she suffered threats and bullying from senior colleagues. After one night-shift, afraid to walk to her car alone, she called her family to fetch her.

Despite such intimidation, Donnelly became a key witness during a public inquiry into reports of abuse and neglect at Stafford. Between 2005 and 2008, the hospital saw a total of between 400 and 1,200 more deaths than normal. Donnelly testified that nurses were expected to break rules in order to meet targets, including falsifying records. She later became an ambassador for cultural change in Britain’s National Health Service, helping staff report concerns, and received a national award for her work to support whistleblowing.

But the outcome could have been different. If managers had succeeded in silencing her, many more lives could have been lost. Donnelly’s case shows that whistleblowers are essential and need protection.

To encourage them, employers and regulators need to offer visible, safe reporting channels. Countries must provide legal protection against retaliation, and effective, confidential investigation. To work properly, these mechanisms need to be backed by a culture of public support, so whistleblowers feel confident to speak up.

In France, whistleblower Dr Irene Franchon has helped build that support by reporting concerns about deaths linked to Mediator, a diabetes and weight-loss drug. Mediator was widely prescribed to healthy women, despite risks to heart and lungs allegedly known by the manufacturer, Servier. The drug remained available in France long after being banned in other countries.

Linked to over 5,000 cases of irreversible harm, including 500 deaths, Mediator was withdrawn in 2009, two years after Franchon raised her concerns. A decade later, Servier and France’s drug watchdog were put on trial, in a high-profile case with 2,600 plaintiffs. Although proceedings were suspended due to coronavirus, Servier has already paid out almost €132m (US$145 million) in compensation and the scandal has helped drive regulatory reform. Pharmaceutical financing has been restructured, with industry figures removed from decision-making processes.

Each time whistleblowers like Franchon speak out, they’re helping build a culture of support that encourages future whistleblowers — which could save lives.

When Dr Li posted his COVID-19 diagnosis, he received thousands of supportive comments. “A safer public health environment… requires tens of millions of Li Wenliang,” read one reply. China’s people clearly understand whistleblowers’ vital role in saving lives and want witnesses of corruption to feel confident to report it. Even the state-affiliated Economic Observer posted its approval: “In the eyes of the people, Dr Li was the hero who bravely told the truth.”

From procurement to laboratory analysis, corruption can undermine every stage of a health system. It includes bribery for the delivery of medical care — sometimes even in emergencies — and manipulation of clinical research so new treatments appear safe and effective. Globally, it results in the loss of up to 25 per cent of health procurement spending and is estimated to cause 140,000 child deaths a year. Even when it has no immediate human impact, corruption weakens health systems and reduces their efficiency, undermining their capacity to provide decent health care for all.