(Caution – mildly graphic content; unethical surgery)
This is the second of two blogs written by B4G Founding Partner David (Daven) Morrison, MD. on an historic example of medical fraud based on fear. The first blog is In the Pandemic, (see link in next paragraph) dated July 28, 2020 on this blog site. The blog below explores more on how the perpetrator did what he did, how it ties to victims, regulatory agency (the AMA) and fear.
(By Daven Morrison, MD) In our previous blog , we explored how frauds and cons in general are common in people who have serious illness, and or fear of serious illness. The current pandemic makes for an environment vulnerable to many frauds as the emotions around contagion are high. We described COVID-19 contact tracing as an activity ripe for securing fraud-enabling information, and offered tactics for avoiding that risk. And we explored an older and truly tragic story of fraud from 100 years ago. It originated in the Midwest, had its greatest run in Kansas, and then played out like a classic cops and robbers pursuit, but with the robber being a sham surgeon and the cops being the AMA. The fraud was surgical. The surgery was inserting goat gonads into the gonads of men. The surgeon was John R. Brinkley, and the man who pursued him was Morris Fishbein M.D.
There were several tragic elements to this evolving catastrophe. First, Brinkley knew how to find weak points in middle-aged people. Second, he did this surgery poorly. Third, his surgery had serious consequences including death. And lastly, he advertised – he did this part really well. He did this gruesome surgery in poor conditions with poorly trained staff and a marketing machine to hide his mistakes. Mistakes which today would result in lawsuits and prison. This came together as a curious mix of events. After some early “successes” in which sexual function did return, he claimed them effective, turning them into true marketing successes. And, so, his procedure became extremely popular. His hospital filled to capacity and multiple additional sites and procedures were filled. Sadly, women were added for their fertility needs. Fertility fears stoked the demand. Again there was an early success story. Again, it was to be a scam.
Yes, of course, it didn’t work in the long term, either. As Shakespeare put it, “but at the length truth will out,” and incompetence eventually gets exposed.
And “yes,” unfortunately, many were maimed and some even lost their lives due to the procedures. The men and women were operated on in a similar manner with no evidence for the intervention to work; their families were unable to hold him accountable. In addition, he was very popular and his riches grew and grew. In fact, he was able to acquire a very powerful radio station: KFKB “Kansas First Kansas Best” which was heard across the Midwest. The ACFE RTTN notes one of the reddest of the red flags of fraud behavior is living beyond one’s means. He did definitely follow this pattern.
Enter the American Medical Association (AMA).
Needless to say, other physicians in the country came to be suspicious as they were not able to reproduce what this “Doctor” had done. The evidence for harm also became harder and harder to ignore. At the time, there was no set of standards strong enough to enforce revoking his license. Word of the consequences ultimately reached the ear of Morris Fishbein MD, and he leveraged the full power of the AMA (during his tenure as President of the AMA from 1924 to 1950.
Dr. Fishbein’s career began as a physician and because of his interest in all things including “quackery,” an opportunity developed for him to have a leadership role as an editor of the Journal of the AMA, also known as JAMA. First becoming aware of Brinkley in 1920, Fishbein was quite alarmed. And the more Dr. Fishbein learned, the more concern he had.
The Chicago medical establishment became alarmed when Brinkley openly made plans to move his enterprise to Chicago after a successful publicity debut there in1920. Although popular with the public, there were too many medical questions. And so, in near unison, Chicago turned him away and the Journal of the AMA (JAMA), kept writing skeptically about the new wonder therapy.
The battle was subsiding, but Fishbein wasn’t. Via JAMA, Fishbein pursued him for what Pope Brock describes as “the greatest cause of his career: the professional extermination of John Brinkley, MD (1)” . Out of Chicago, over time, AMA investigations began which ultimately led to a very public case of medical license revocation.
Taking place over a series of hot days in 1930 in Topeka, Kansas, Dr. Brinkley’s own testimony did himself in. He was unable to explain how his surgery worked or how it made a difference in the health of his patients. So, he panicked when William Smith, the attorney representing license removal, did the following:
(From Charlatan (2), Pope Brock, Three Rivers Press)
Brinkley reaffirmed that this surgery held “no danger”—whereupon Smith snatched up a fistful of documents and held them high. They were death certificates signed by Brinkley, all belonging to patients who had succumbed at this clinic—men and women, young and old. Forty-two people, some of whom weren’t ill when they arrived, had died either by his own hand or under his supervision. Six at least were victims of goat-gland operations gone awry. The others were variously dead of nephritis, peritonitis, appendicitis, “syptic thrombus,” and gangrene. If in 1930 that didn’t make Brinkley a murderer in the eyes of the law—and it didn’t—well, wasn’t that a scandal in itself? The man was running a corpse factory.
In fact, Brinkley did more than panic. In a fit of hubris he offered to show his professional colleagues his hospital and his procedure. They accepted. They saw what he was doing. And they immediately shut him down. His license was revoked.
In the case of his surgeries, eventually “Dr” Brinkley was found guilty of malpractice, forced to pay stiff financial penalties, and his operation shut down. Sadly, but perhaps justly, he died penniless. In the long term the law won.
Today his infamous hospital lies at the bottom of a manmade lake near Milford Kansas.
Let’s hope the efforts of those defrauding people currently during COVID-19 reach similar ends.
Summary Thoughts:
What was not noted in this story above was that Brinkley had a tragic life. Born poor, out of wedlock, he was essentially raised by elderly parents who died young of preventable illnesses. His biological mother also died young. He knew he wanted to be a physician, and as he pursued a degree, he learned early on the power of people’s desires to be relieved of their suffering. To this point, his story is similar to many who enter health care.
Unfortunately, he also learned about how vulnerable people are to anything pushed by an expert. He also learned early on about the vulnerability of those losing their sense of self in middle age. In men, it is fear of losing their virility; in women, fertility. Brinkley preyed on this common fear of loss.
In discussion with our team, Dr. Joe Koletar noted the con man works on the psychological makeup and doesn’t reverse engineer. He has a point. I would argue Brinkley reversed engineered a “too good to be true” story for everyone based on his early life experiences. Adding the authority of being a physician brings more gravitas, and surgery, which leaves a scar, clearly documents that the doctor did something. As Koletar says, by merely bringing the authority of the law, every traffic cop readily gets license and registration as a result of a traffic stop: “everybody provides that” he notes.
Dr. Koletar adds more to consider in our current times. As the con turns, Koletar warns the fraudster may add on a sense of guilt. In our original story of releasing personal information for tracking the pandemic, the fraudster may say: “Well most folks in Lake County Illinois are helping their neighbors. Won’t you?” Koletar knows what he’s talking about. This would also be an emotional ploy: More sophisticated than playing to raw biological affects, this plays to higher more complex emotions of altruism, community, and guilt. But it’s a bright shiny thing intended to distract.
Unfortunately, the CDC and other groups are currently at risk of being politicized as data is altered and leadership is weak and inexperienced. Most outrageous to me, as someone who trained in the era of AIDS, is how Dr. Anthony Fauci, perhaps the best resource in the world for this kind of problem, is vilified. Tragically, he and his family regularly receive death threats. All of this blends with impatience to return to normal, hyper-partisan politics and politically-based distrust of the intentions of the public health experts. It becomes a tragic stew of ongoing contagion. The Rand Corporation has effectively reviewed this in an analysis called Truth Decay . They note the consequences reach beyond fraud and into the undermining of democracy itself.
The corpse factory has returned but on a national level.
Notes:
- Charletan, p 61. The full title: Charlatan: America’s Most Dangerous Huckster, The Man Who Pursued Him, and the Age of Flimflam. It is a delightful book to read for those interested in this curious era of con men, their victims, and medical history.
- Charletan, p. 154. The book was adapted into a documentary featured at Sundance entitled, Nuts!
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