Pushed Into Palliative Care; Shady BioTech Trades; A Statin Surprise

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Pushed Into Palliative Care

HCA Healthcare is facing criticism for allegedly pushing patients into palliative and end-of-life care, an investigation from NBC News revealed.

When a patient is transferred to hospice care and dies, that death doesn't add to the hospital mortality statistics; it's attributed to hospice care, where patient death is expected and not viewed as such a red flag, according to NBC News. The patient could theoretically remain in the same bed and be treated by the same people the whole time, but the care classification directs how their death is counted.

According to NBC's reporting, executives at HCA hospitals allegedly get hefty bonuses depending on metrics such as hospital mortality data, which could add incentive to push patients towards palliative care, though NBC noted it doesn't have evidence to explicitly support this tie.

Marisol Perez was a patient at St. David's North Austin Medical Center, an HCA facility, being treated for COVID and pneumonia. Her case was severe enough that doctors put her on a ventilator and into a coma. Doctors and nurses at the hospital allegedly kept urging Perez's mother, Alma Salas, to pivot her daughter to end-of-life care.

Salas told medical staff, "I don't have the authority to take anyone's life." She advocated for her daughter, who went on to fully recover after being discharged.

Perez told NBC that she thinks she would be dead if not for her mother. "People used as dollar signs and pushed off somewhere else to die -- that is not OK," she said of her experience with HCA.

NBC spoke with more than 30 medical professionals at 16 HCA facilities, and "All said their HCA hospitals pushed palliative and end-of-life care in pursuit of better performance metrics," claims that internal HCA documents provided to NBC support. Data from Service Employees International Union (SEIU) showed that HCA's hospice transfer rate was double the national average from 2017 to 2021. Tales from internal HCA whistleblowers and more patients pushed towards end-of-life care all detailed in NBC's reporting.

Insider Trading Rampant in BioTech

A new deep dive by ProPublica found many instances of insider trading among biotech execs with valuable internal business knowledge.

Take for example David Hung, CEO of Medivation, a biopharma company that develops treatments for diseases without any. Hung's tax records show multiple instances of risky stock trades that paid off big time. For instance, ProPublica details that in 2011 he made a series of large stock purchases in Dendreon, his company's competitor. But when his own company's prostate cancer drug -- a treatment both companies were racing to make -- started to look promising, he sold the shares in Dendreon for a hefty sum.

Years later, Hung pulled a similar move. Before he formally announced his company was acquiring a drug from BioMarin, another competitor, he bought $8 million in stock from a different company also working on the same class of drug. When Hung's announcement was made, the stock value rose for that company, and when Hung sold his stocks a month later, he netted a whopping $1.25 million in profit.

Hung did the same thing again, and ProPublica gave the information and timeline of the trade to professor and insider trading expert Dan Taylor. He told ProPublica that "The trades in question seem at best highly unethical and at worst they may be illegal," Taylor said. "I would caution any and all executives from engaging in the behavior described here. There's significant legal jeopardy if that behavior was brought to the attention of regulators."

Hung's spokesperson denied any wrongdoing.

ProPublica's reporting detailed similar tales from Biogen, AgNovos, and Juno Therapeutics executives that show Hung is far from alone in his shady industry behavior.

Scientists Stumble on Statin Revelation

Millions of Americans take the anticholesterol drug class statins. A significant proportion experience sore and achy muscles as a side effect -- from 5 to 30% -- for reasons unknown: until two separate research teams stumbled upon an explanation while studying something else entirely, according to an article in The Atlantic.

While studying a Bedouin family in Israel and several in the U.S. with histories of limb girdle muscle dystrophy, both teams found mutations in the enzyme HMG-CoA reductase, which is also the enzyme statins block from producing cholesterol. In researching limb girdle muscle dystrophy, they also uncovered that dysfunction in that enzyme causes muscle weakness in both cases.

The Israeli research team also created mevalonolactone, an experimental drug, to treat limb girdle muscle dystrophy. After testing in mice, they gave the drug to patients with the condition who showed improvement. But they don't have enough of the drug to treat everyone in the Bedouin family, let alone people suffering side effects from statins.

"We're not a factory. We're a research lab," Ohad Birk, the lead researcher, told The Atlantic.

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