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A little compounded woo on the side turns deadly

Geoffrey Wiss is an emergency medicine doctor working for Kaiser Permanente in Portland, Oregon. Until recently, he also had a side business called “The Center for Integrative Medicine”. If you do a quick web search, you won’t find a website for that particular business, though there are a number of places throughout the U.S. by the same name. They all share the concept of integrating alternative medicine with evidence based medicine.

He shut it down because three patients under his care in that clinic were killed by an error in medication.

This is what I’ve gathered so far from the news articles available. Dr. Wiss treated a patient for back pain with an injection of colchicine that he acquired from Apothecure.  This person died on March 20th and was determined to have died from a toxic dose of colchicine. It is not clear how much involvement Dr. Wiss had with this person’s hospitalization and diagnosis, but there are indications that he may have been aware of the death.

He treated a second and third patient with the same batch of colchicine. They died on March 30th and April 2nd. He had concerns about the third patient, contacted Poison Control and sent them to the emergency room. Unfortunately, there is no antidote nor an effective treatment for the dose they had been given.

Colchicine is a drug that has been used to treat gout, but that use is becoming rarer now. It works by stopping cells from dividing which reduces inflammation. Obviously, too much of this stuff is bad: all cells stop dividing, leading to organ failure and death. Too much of this stuff is what the three patients had been given.

The drug had been compounded for Wiss by Apothecure.  A mistake in the mixing lead to it being ten times more potent than it should have been.

Apothecure is a large compounding pharmacy that advertises services such as mesotherapy, bio-identical hormones, individual lyophilized growth factors with an exclusive line of growth factor cosmeceuticals, and chelation/heavy metal detox. Being a compounding pharmacy removes them from the control of regulatory organizations that manufacturers must answer to. Compounding pharmacies prepare medicines for specific, individual patient use. Usually they are small local businesses that mix drugs into unique dosages or put them in other forms (tablet to liquid, for instance). Mixing batches of drugs for use by professionals, such as what Apothecure did for Wiss, technically makes the company a manufacturer. Oregon, where the drug was purchased and shipped, also requires compounded pharmacies to have a state license. Apothecare is not licensed in Oregon.

Gary Osborne, a pharmacist and certified clinical nutritionist, is the founder of ApotheCure. According to him, it was nearly two weeks before the first death was reported. They were in the middle of the recall process when the second death occurred. What about the third death? One thing I don’t know that might put this into better perspective is how long it takes to die from a toxic dose of colchicine.

An Associated Press article quotes Osborn as saying “We are kind of the leaders in the industry. But you know what people say, stuff happens.”

Whatever problem lead to the mistake in compounding would have been limited to one person had Apothecure actually acted as a compounding pharmacy, mixing medication for a single patient, rather than a manufacturer of batches of medicine for the use of doctors like Wiss.

Medical mistakes happen all the time, and people die from them. But the lack of scientific integrity that accompanies trained and licensed medical professionals getting involved in such activities indicates an overall lack of integrity that can prove harmful to patients.

The first death is forgivable on the part of Wiss. Though the treatment is only somewhat effective, (A search in pub med showed studies for its use were abandoned in the mid 90s) it is a medication that has been safely in use for a long time. But the second and third deaths can be attributed to negligence and a lack of integrity that manifested itself here as a tendency towards rationalization and denial of personal involvement in the circumstances that surrounded the death of the first patient.

Even though Dr. Wiss is cooperating with authorities in the investigation, it is troubling that “The Center for Integrative Medicine” was closed immediately and permanently. The place of business was completely cleared out on Friday.

It may not be alternative medicine exactly that killed these people, but it is the disconnect from reality that always accompanies any dabbling in alternative medicine. Whether it comes from ignorance, wishful thinking, the lure of money, or the desire to make patients happy, whenever one leaves the integrity of practicing evidence based medicine they are entering a risky territory. It becomes too easy to be caught up in the emotion and to let that emotion rule when faced with difficult circumstances. And that can be deadly.

*note: I’ve had to turn comments off on this post because of spam. If you’re reading this and actually want to comment, then go ahead and mention something in the most recent post.

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  1. Compounding pharmacies are trouble. But not according to former member of sane society Susanne Sommers. Her bioidentical hormones tend to come out of them as well. Anyway, colchicine is still the treatment of choice in my neck of the woods for patients with familial mediterranean fever. Just a little trivia tidbit for ya.

  2. Ahh, I guess I left out “its use for back pain”. My research did show that it was good for the familial mediterranean fever, though now I’m wondering what the heck that is.