Federal Doctor Says He Was Removed For Resisting Unproven Coronavirus

[Evo]

This thread meets the GD guidelines for discussing medical policy where politics are concerned, I know, I made that policy.

How can we expect to find cures/vaccines when the doctors capable of doing it are removed?

A high-ranking federal doctor focused on vaccine development says he was removed from his post because of his "insistence" that the government spend funds on "safe and scientifically vetted solutions" to address the Coronavirus crisis and not on "drugs, vaccines and other technologies that lack scientific merit."

https://www.npr.org/sections/corona...doyg0CIEsrGXjDNL-yey80Yo-VR44Kdrui64MHLM9wnIM

 

[hutchphd]

What are we allowed to discuss...how big is the elephant in the room?

 

[Evo]

What are we allowed to discuss...how big is the elephant in the room?

We can discuss allowing critical valid medical work to continue without government interference. But we will not allow discussions of politics, who, etc... We will stay focused on the medicine. No mud slinging.

I do not believe that any politician with no medical background should be allowed to control medicine or give medical advice to the public. "THAT" we can talk about. But we won't point fingers, this isn't politics, it's about the medicine.

 

[hutchphd]

But it is an elephant !...(Your call).

 

[Evo]

But it is an elephant !...(Your call).

We only made it an elephant, we took an ant and mistakenly made it into an elephant. Our fault. Good intentions gone wrong. We didn't want political mudslinging, we had no intention of allowing important issues to be disallowed. I cannot imagine what could be more important right now.

 

[BillTre]

But it is an elephant !...(Your call).

Your use of an elephant instead of something else, say a donkey, further provokes thoughts of politics!

 

[hmmm27]

Am i missing something ? The article can simply be boiled down to "Worker criticizes boss's stupid comment, gets canned".

 

[BillTre]

I do not believe that any politician with no medical background should be allowed to control medicine or give medical advice to the public.

Its difficult to think of much else to say without going into specifics which related to political people and their intentions.

 

[Evo]

Am i missing something ? The article can simply be boiled down to "Worker criticizes boss's stupid comment, gets canned".

Yes, you're missing what the doctor was working on and what he was resisting.

 

[Evo]

Its difficult to think of much else to say without going into specifics which related to political people and their intentions.

I know its hard, but due to high level of reactions of, well, I can't say, due to the high level of reactions, we have to keep it as much about the science without naming names as silly as that is.

 

[sysprog]

I can't stand it when someone in charge does something like that -- especially when lives are in the balance -- and this doc is about to find the vaccine? -- what the heck? We need the freaking vaccine. People are dying way before their time.

 

[BillTre]

Well, it just another example of the extremely poor management of this whole mess by those who do the administrating nationally in this country, reagrdless of its consequences for the health and safety of its citizens.

 

[hmmm27]

North of the 49th, our peerless feeder - after dedicating $120billion to "fight the coronavirus" has pumped a whole $20mil into vaccine research. Woohoo. That buys a decent lab for what, a month ? a week ?

 

[hutchphd]

Am i missing something ? The article can simply be boiled down to "Worker criticizes boss's stupid comment, gets canned".

We can say that. but apparently we cannot say, in this forum, "Worker criticizes stupid boss's comment, gets canned".

 

[sysprog]

North of the 49th, our peerless feeder - after dedicating $120billion to "fight the coronavirus" has pumped a whole $20mil into vaccine research. Woohoo. That buys a decent lab for what, a month ? a week ?

Although we would certainly like a vaccine to be available in less than a month, that mil number, as you seem to be strongly suggesting, doesn't even come close -- we probably should replace that 'm' with a 'b'.

 

[hmmm27]

Although we would certainly like a vaccine to be available in less than a month, that mil number, as you seem to be strongly suggesting, doesn't even come close -- we probably should replace that 'm' with a 'b'.

I don't think there's anybody that doesn't realize that it takes time, either ; so what's the political beef against research ? We (well, not me personally) have managed to knock out most of history's heavyweights.

 

[Vanadium 50]

This will be very difficult to focus on the science, because the document that started this is a statement from a bunch of lawyers. At best this is one-side of the story, but it is not the same as a scientific paper.

There is also one very odd thing about this - that Doctor X (can I call him that?) still has a job with HHS. He is a deputy assistant secretary, which means he is a political appointee (there are a handful who are career, but I did not find this listed as such on the Federal Register) so there is no reason he could not simply be replaced. The current administration has historically not held back on replacing people they would like replaced.

Even odder, Dr. X began his appointment in 2016, which means he was appointed by the previous administration. It is rare, but not unheard of, for political appointees to stay on after a Change of Administration.

And, while not exactly relevant, there is one more odd thing. The particular deputy assistant secretary position Dr. X held appears not to require Senate confirmation. There are only about a dozen of these positions around (there are supposed to be zero).

 

[sysprog]

I don't think there's anybody that doesn't realize that it takes time, either ; so what's the political beef against research ? We (well, not me personally) have managed to knock out most of history's heavyweights.

I was trying to agree with a point that you made -- a few million dollars is not enough -- we should allocate and spend a few billion until we have a fix.

 

[phinds]

I do not believe that any politician with no medical background should be allowed to control medicine or give medical advice to the public. "THAT" we can talk about.

Evo, If all politicians agreed with you the topic would not have come up but since at least one politician, and probably more, disagrees with you, I don't see how we can have "THAT" conversation without bringing in politics.

But we won't point fingers, this isn't politics, it's about the medicine.

But it IS about politics

I wish it were otherwise but I think this thread is doomed (on this forum).

 

[atyy]

A Creator of the Ebola Vaccine Has Hope for Slowing Covid-19
Gary Kobinger says a vaccine targeting groups like the elderly could be ready in less than a year, and control measures are slowing the disease's spread.
https://www.wired.com/story/creator-ebola-vaccine-hope-slowing-covid-19/
"You have to be very careful about creating false hope with therapies. On one hand, if you don’t have a randomized trial, it’s hard to make any claim about their effectiveness. At the same time, it’s important to listen to health care workers who are using those drugs on the front lines. They have a very good sense of what may be worth pursuing and not pursuing in trials, even if they are not using it in a randomized trial. So with drugs like chloroquine and azithromycin that are already approved, let’s put them in the clinic as soon as possible, and at same time design the best clinical study you can." [Bolding by me]

Antimalarials widely used against COVID-19 heighten risk of cardiac arrest. How can doctors minimize the danger?
https://www.sciencemag.org/news/202...-heighten-risk-cardiac-arrest-how-can-doctors
"Evidence of potential harm from these drugs is beginning to trickle out. A clinical trial in Brazil that gave chloroquine and azithromycin to 81 people hospitalized for COVID-19 was halted after investigators found more deaths in the group getting the higher of two doses, according to a preprint the team published on 16 April on medRxiv. Electrocardiography (EKG) readouts indicating increased arrhythmia risk were also more common in the high-dose group. Researchers conducting the trial received death threats on social media, and conservative media outlets accused them of giving patients excessively high doses to purposely smear the drug.
An analysis of data from 368 U.S. veterans treated for COVID-19, posted in a preprint today, found the risk of death from any cause was greater for those who received hydroxychloroquine than for those who didn’t, even after researchers adjusted for the fact that patients with more severe disease were more likely to receive the drug. And a woman in New York died this month after her general practitioner prescribed hydroxychloroquine and azithromycin for coronaviruslike symptoms, NBC News reported last week. (There’s no proof that drug-induced arrhythmia caused her death, Ackerman says, “but it smells awfully fishy.”) Now, researchers are trying pin down the rates of this side effect in COVID-19 patients and are urging diligent heart monitoring during treatment." [Bolding by me]

 

[phinds]

AMAZING COINCIDENCE:

After making post #19, I went downstairs for breakfast and the first article I read was about how the Mayor of Philly, during the 1918 flu pandemic, left to his "health commissioner, Wilmer Krusen, a political appointee with no prior public health experience" as to whether or no to hold a massive war bond rally.

Health officials had warned vehemently that the parade should not be held. Hundreds of cases had already been diagnosed and some dealths as well. It had already become clear that this was a pandemic. but Krusen merely requested that people cover their mouth if they cough. 200,000 tightly jammed spectators watched a 2-mile long parade of boy scouts, marching bands, etc go down the main avenue.

Within days the city's hospitals were swamped and a month later 12,000 were dead.

THEN, to really smack me in the face, the second article was about today in Iran where one of the big guns in their Academy of Medical Science is a "the most trusted adviser"of the head ayatollah of the country and this guy promotes widely debunked alternative medicine a cures for the virus. This Academy of Medical Science requires pharmacists in Iran to study homeopath for a year before getting their license because the politicians don't trust Western medicine.

So, @Evo, how do you have any kind of complete discussion about things like the above and the current situation we are discussing, without any comment on the politicians involved?

Don't get me wrong. I agree w/ your intent but I think you are being naive about the necessary political side of the discussion.

 

[hmmm27]

I was trying to agree with a point that you made -- a few million dollars is not enough -- we should allocate and spend a few billion until we have a fix.

Yes, I was agreeing with your agreeing

 

[phinds]

Yes, I was agreeing with your agreeing

Hey guys, get a room.

 

[hmmm27]

Hey guys, get a room.

Room service menus are bad enough even without restrictions in place. On that note, it's going to be interesting(/horrifying) to see the birth stats in 7-8 months.

 

[russ_watters]

I do not believe that any politician with no medical background should be allowed to control medicine or give medical advice to the public. "THAT" we can talk about.

I know we're in the midst of a crisis, but that would not be practical/possible, and isn't a feature of high level leaders/managers in any context I can think of. High level managers by nature must make decisions on issues they know little or nothing about, because it is impossible to have the expertise/experience of the hundreds or millions of people working for them.

Sure, it would be nice if high level politicians during a health crisis had appropriate medical/scientific backgrounds. It would also be nice if during an economic crisis they had an applicable economics/business background. And when there's judges to appoint, a legal background. And when there's infrastructure decisions to make, an engineering/construction background. Etc., etc. That , of course, is impossible.

Sometimes you can pick the one most important trade skill for a narrowly focused business, but even that will have limited applicability to that person's job as a manager. What's really needed from leaders/managers (except some in very narrowly focused industries) is leadership/management skills, not technical skills. Applied here, what's needed is:

• The ability to identify/select, trust and empower experts in the necessary fields.
• The ability to make decisions on matters in which they are not experts by absorbing information and using appropriate criteria to weigh and select from options provided.
• The ability to communicate clearly, concisely and consistently.
• Decisiveness; Choosing a path and staying with it for long enough for it to develop.
• Flexibility; The ability to change path at an appropriate time in the face of new information.
• A high level of confidence.
• Interpersonal and political skills. I believe the technical term for this is "schmoozing".

 

[Evo]

AMAZING COINCIDENCE:

After making post #19, I went downstairs for breakfast and the first article I read was about how the Mayor of Philly, during the 1918 flu pandemic, left to his "health commissioner, Wilmer Krusen, a political appointee with no prior public health experience" as to whether or no to hold a massive war bond rally.

Health officials had warned vehemently that the parade should not be held. Hundreds of cases had already been diagnosed and some dealths as well. It had already become clear that this was a pandemic. but Krusen merely requested that people cover their mouth if they cough. 200,000 tightly jammed spectators watched a 2-mile long parade of boy scouts, marching bands, etc go down the main avenue.

Within days the city's hospitals were swamped and a month later 12,000 were dead.

THEN, to really smack me in the face, the second article was about today in Iran where one of the big guns in their Academy of Medical Science is a "the most trusted adviser"of the head ayatollah of the country and this guy promotes widely debunked alternative medicine a cures for the virus. This Academy of Medical Science requires pharmacists in Iran to study homeopath for a year before getting their license because the politicians don't trust Western medicine.

So, @Evo, how do you have any kind of complete discussion about things like the above and the current situation we are discussing, without any comment on the politicians involved?

Don't get me wrong. I agree w/ your intent but I think you are being naive about the necessary political side of the discussion.

It's not that I think we can have a complete discussion of the situation without comment of who was involved, but , we're not allowed to, I've asked to have the rule relaxed due to the pandemic and I've been overruled.

The best we can do is show what's happening, maybe people that see it can get involved elsewhere.

 

[Vanadium 50]

Sure, it would be nice if high level politicians during a health crisis had appropriate medical/scientific backgrounds.

The "doctor" in question is not a medical doctor. His bio says he does have a PhD, but normally that does not make someone a "doctor".

His boss, however, is a medical doctor.
His boss is a lawyer.
His boss is an elected official.

 

[Evo]

Sometimes you can pick the one most important trade skill for a narrowly focused business, but even that will have limited applicability to that person's job as a manager. What's really needed from leaders/managers (except some in very narrowly focused industries) is leadership/management skills, not technical skills. Applied here, what's needed is:

• The ability to identify/select, trust and empower experts in the necessary fields.
• The ability to make decisions on matters in which they are not experts by absorbing information and using appropriate criteria to weigh and select from options provided.
• The ability to communicate clearly, concisely and consistently.
• Decisiveness; Choosing a path and staying with it for long enough for it to develop.
• Flexibility; The ability to change path at an appropriate time in the face of new information.
• A high level of confidence.
• Interpersonal and political skills. I believe the technical term for this is "schmoozing".

I'd add
*Know when not to act out in revenge when you feel slighted

 

[gmax137]

I wrote a long response to this thread. Then I deleted it. Now I feel better.

 

[phinds]

I wrote a long response to this thread. Then I deleted it. Now I feel better.

Abe Lincoln used to write long vicious letters to political opponents, put them in a drawer, then take them out a week later and tear them up. He would agree with you.

 

[Dr. Courtney]

My view is that government scientists should have full academic freedom in speaking and publishing on purely scientific matters, but when they are speaking as representatives of government institutions, there can be reasonable restrictions regarding what they say on public policy matters.

If an employee disregards reasonable restrictions when speaking on public policy matters, removal is an option.

If someone is really that good a scientist, there should be available work in the private sector.

 

[phinds]

My view is that government scientists should have full academic freedom in speaking and publishing on purely scientific matters, but when they are speaking as representatives of government institutions, there can be reasonable restrictions regarding what they say on public policy matters.

This thread is not about a pubic health official commenting on policy matters and getting in trouble but on a public official / scientist talking about scientific fact and getting in trouble. There has been a lot of that lately in America.

 

[hutchphd]

My view is that government scientists should have full academic freedom in speaking and publishing on purely scientific matters, but when they are speaking as representatives of government institutions, there can be reasonable restrictions regarding what they say on public policy matters.

If an employee disregards reasonable restrictions when speaking on public policy matters, removal is an option.

If someone is really that good a scientist, there should be available work in the private sector.

I'm sorry but this is so generic as to be cryptic.

1. Scientific and Public Policy matters are almost never distinct.
2. How is reasonable determined? Do we allow the mentally ill to do it?
3. The private sector is almost certainly more restrictive: one of the lures of public service is that it is, well, public

Your final sentence is chilling.

 

[Vanadium 50]

Should a DOE program manager be able to say "Despite the administration's objections, the science of a Chinese high energy pp collider is compelling and the US should participate."?

 

[Ygggdrasil]

Should a DOE program manager be able to say "Despite the administration's objections, the science of a Chinese high energy pp collider is compelling and the US should participate."?

I think this issue is very clearly one of policy, whereas the issue of which treatments for a disease deserve more funding (the issue over which Richard Bright was allegedly removed from his position) is more clearly a scientific issue. Ultimately, the administration has the ability to make funding decisions like these, but if the decision was really made to place the scientific judgement of the President on the effectiveness of chloroquine as a treatment over the scientific judgement of Bright, I believe that this reflects some very bad practices within the leadership of the administration.

Speaking of unproven Coronavirus treatments, here is a selection from the transcript of yesterday's presidential Coronavirus briefing:

THE PRESIDENT: Thank you very much. So I asked Bill a question that probably some of you are thinking of, if you’re totally into that world, which I find to be very interesting. So, supposing we hit the body with a tremendous — whether it’s ultraviolet or just very powerful light — and I think you said that that hasn’t been checked, but you’re going to test it. And then I said, supposing you brought the light inside the body, which you can do either through the skin or in some other way, and I think you said you’re going to test that too. It sounds interesting.

ACTING UNDER SECRETARY BRYAN: We’ll get to the right folks who could.

THE PRESIDENT: Right. And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning. Because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that. So, that, you’re going to have to use medical doctors with. But it sounds — it sounds interesting to me.

So we’ll see. But the whole concept of the light, the way it kills it in one minute, that’s — that’s pretty powerful.

https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-31/

On the broader issue of whether political figures should overrule scientific appointees on scientific issues, I present the above as Exhibit A.

 

[Dr. Courtney]

I'm sorry but this is so generic as to be cryptic.

1. Scientific and Public Policy matters are almost never distinct.
2. How is reasonable determined? Do we allow the mentally ill to do it?
3. The private sector is almost certainly more restrictive: one of the lures of public service is that it is, well, public

1. 
   
   I'm not suggesting any restriction on freedom of speech when a scientist is speaking as an individual, only when they are speaking as a representative of a government institution.
   
   In practice, when I was on the faculty of the Air Force Academy, we submitted papers to the research office for them to read and approve. The final approving authority had a PhD in a STEM field and did a great job separating science from public policy stuff. All one needed to do to publish public policy stuff the research office rejected was remove "United States Air Force Academy" from one's affiliation listed in the paper.
   
   When my wife was on the West Point faculty, the approval process was very similar, as was the freedom to publish anything one likes (other than classified stuff, of course) simply by removing the government affiliation.

 

[phinds]

I'm not suggesting any restriction on freedom of speech when a scientist is speaking as an individual, only when they are speaking as a representative of a government institution.

And apparently you include when he is ONLY speaking about scientific fact. I think a lot of us here disagree with that point of view. I certainly do.

 

[hutchphd]

That is useful to know. Was there any blowback if your affiliation was included in a bibliography for a less formal article or as preamble to a lecture ?

You have also not really commented directly about the situation in question here...was this an assessment of efficacy a scientific adjudication or policy? Doesn't seem so clear cut, and so I am interested in your judgment

 

[Dr. Courtney]

And apparently you include when he is ONLY speaking about scientific fact. I think a lot of us here disagree with that point of view. I certainly do.

Perhaps you missed my logic. I support full freedom of speech for scientists (and everyone else) when speaking as individuals and when they are publishing science.

But I support every employer's exercise of power in limiting the speech of employees when speaking in their capacity of employees. I don't make an exception for government employees, and I don't make an exception for scientists.

The rules on speaking and publishing are usually available and known when one accepts a position as an employee. If they are objectionable, one should exercise one's freedom to find a different job with more acceptable terms.

Every time I accept a job or contract, I carefully review the terms to understand the impact on my freedom of speech. I usually specify a much higher bill rate when I can't publish my results. I tend not to accept jobs or contracts that limit my freedom of speech in areas not directly relevant to the contract.

 

[Stephen Tashi]

How can we expect to find cures/vaccines when the doctors capable of doing it are removed?

The removal of an official is a political act. The only non-political aspects of the situation are whether science supports the doctor's position. The way the topic is posed, that is taken for granted. So, what's left to talk about? - humor? I don't object to that approach!

 

[Stephen Tashi]

Perhaps you missed my logic. I support full freedom of speech for scientists (and everyone else) when speaking as individuals and when they are publishing science.

But I support every employer's exercise of power in limiting the speech of employees when speaking in their capacity of employees.

One form of freedom of expression is to disobey laws, disobey employers, break contracts etc. Whether laws take precedence over other aspects of life gets into philosophy - presumably as prohibited a topic as politics.

 

[Dr. Courtney]

One form of freedom of expression is to disobey laws, disobey employers, break contracts etc. Whether laws take precedence over other aspects of life gets into philosophy - presumably as prohibited a topic as politics.

When one violates a contract or an employer policy, the consequence of that is often termination. The employer or other party to the contract retains their liberty to bring the expected consequences.

When an employee speaks or writes in their official capacity to manipulate policy decisions that are above their pay grade, they can reasonably expect to be fired. I won't judge such terminations to be unreasonable as long as they are in accordance with law and the employment agreement.

Nor will I grant scientists some special exception in such circumstances. Should Ernest Moniz or Steven Chu have had more freedom to publicly disagree with their Commander in Chief as DOE Secretary than Rick Perry, because they are scientists? Of course not. If you publicly challenge the policy decisions of those with a higher pay grade, you may be out of a job.

 

[Vanadium 50]

One form of freedom of expression is to disobey laws, disobey employers, break contracts etc.

That is true. However, this freedom doesn't always mean "freedom from consequences."

 

[Stephen Tashi]

When one violates a contract or an employer policy, the consequence of that is often termination. The employer or other party to the contract retains their liberty to bring the expected consequences.

That's a statement about social and political realities. Laws and contracts do no prohibit things in the physical sense of making them impossible. Laws create certain consequences of certain actions. So the person violating the law can be "right" and the person enforcing the consequences can also be "right", depending on the philosophical point of view used in judging what is right. In fact, both the violation and the consequence could be right!

As far as topic of the current thread goes, it's taken for granted that an employee did something that displeased an employer, and the employee suffered a consequence. Non-philosophical aspects of this event are legalistic questions of whether the employee's contract with the employer legally allowed the consequences. Perhaps social and psychological aspects along the lines of "The employer would have been smarter to ..." or "The employee would have been smarter to..." can be discussed.

 

[russ_watters]

I think this issue is very clearly one of policy, whereas the issue of which treatments for a disease deserve more funding (the issue over which Richard Bright was allegedly removed from his position) is more clearly a scientific issue.

Really? It's nice to say that in principle, but in reality that isn't anywhere close to true. Money spent on disease treatment research is not at all well correlated with scientific concerns. Why is breast cancer so much better funded than other forms of cancer? Because it kills a lot of people? No (it doesn't), because it's a convenient and attractive cause for women and people who want to sell things to women. And maybe because breasts are more attractive than colons.

Nor do I think scientists themselves are immune. The disease treatment most deserving of funding is of course the one *I'm* working on right now.

 

[russ_watters]

That's a statement about social and political realities. Laws and contracts do no prohibit things in the physical sense of making them impossible. Laws create certain consequences of certain actions. So the person violating the law can be "right" and the person enforcing the consequences can also be "right", depending on the philosophical point of view used in judging what is right. In fact, both the violation and the consequence could be right!

Evidently, the employee in question thinks his re-assignment was illegal and intends to file a whistleblower complaint about it:
https://www.bbc.com/news/world-us-canada-52400721

 

[russ_watters]

Should a DOE program manager be able to say "Despite the administration's objections, the science of a Chinese high energy pp collider is compelling and the US should participate."?

...Steven Chu...

I would have liked to see some whistleblower complaints against the scientific, legal and ethical violations of Steven Chu, but that's another topic...

...or maybe not. My whole concern with today's line of discussion is the absolutely laughable idea that scientists are free from personal and political motivations.

 

[BillTre]

It's nice to say that in principle, but in reality that isn't anywhere close to true. Money spent on disease treatment research is not at all well correlated with scientific concerns. Why is breast cancer so much better funded than other forms of cancer?

This is a political decision made at the level of funding and is probably mandated by congress in funding bills.
It is not very relevant to decisions on how the money legally designated for breast cancer research will be best utilized for research or treatment development.
Pushing the inappropriate use of funds designated for such purposes, for perhaps injecting a toxic chemical into a patient, as some kind of political favor, would be a much better comparison.

No (it doesn't), because it's a convenient and attractive cause for women and people who want to sell things to women. And maybe because breasts are more attractive than colons.

Your argument is with the funding bills (therefore congress and the president).

 

[Dr Transport]

I do not believe that any politician with no medical background should be allowed to control medicine or give medical advice to the public.

Isn't that practicing medicine without a license? Most states that is a felony.

 

[BillTre]

Here is a different situation that raises similar problems, but not so much with politicians, but with the business world.

Health care professionals dealing with Coronavirus often lack the reasonably necessary personal protective equipment (PPE), to keep them safe which also protects those they care for (a double health hazard you might say).
Recently, there have been several stories about nurses and others getting fired from hospitals (big businesses with corporate lawyers) for stating publicly that there are PPE shortages and these shortages can have profound consequences (like death of carers, or the more likely infection of patients).
Maybe there is something in their contracts about not saying things (in their official capacity or as a representative of the company or not), or perhaps they just displeased some company dude because it made them look bad (there are many cases of this being reported in the press).
Irregardless, it would seem to be difficult to find any way to ethically support this kind of corporate behavior.

It smacks of trying to keep problems quite that could:

• end up killing people.
• may cause the company problems because they might have to address the issue by spending money in some way that they might otherwise be able to ignore (hard to tell if they prevent transparency).
• scamming (defrauding) the consumer (patient) who is arguably getting into a situation (the hospital) expecting a reasonable amount of protection from disease (not getting sick from their doctor/nurse/other health care provider).