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Rehab Recruiters; Lilly the Cannabis King; Feds Pin Blame in Child Deaths

It’s time for this week’s edition of Investigative Roundup, gathering some of the best investigative reporting on healthcare from around the country.

Rehab Recruiters

After a 9-month investigation, Mother Jones reports on the world of patient brokering during the current opioid epidemic. Their report focuses on instances when people addicted to drugs are recruited and “shuffled” among so-called rehab facilities where operators allegedly keep patients addicted — allowing them to keep billing insurance — and pay kickbacks to brokers who send even more patients. Many times, the brokers are in recovery themselves. They recruit on social media away from the eyes of concerned family and loved ones.

Would-be patients are incentivized with not only the promise of recovery but free trips to the facility and cash incentives to bring more people in. Mother Jones found facilities were often lacking medical professionals on staff. Using cash as a lure is problematic because access to money means access to more drugs, creating a cycle of readmission. And to the shadier rehab owners and brokers — relapse means revenue.

Unfortunately, according to the report, regulators’ hands may be tied. For example, once a facility closes, clinic owners can move to another state with less stringent oversight.

Eli Lilly’s Pot-Growing Past

Fred Pfenninger, stockholder and a former diversification analyst at Eli Lilly and Company, wants you to know that the company was a major producer of cannabis-based medicines early in the 20th century. But Lilly would just as soon forget about it, reports the Indianapolis Monthly.

According to Pfenninger’s research, the drugmaker was once at the forefront of marijuana research and manufacturing from the late 1800s until cannabis was criminalized in the 1930s. On a farm in Indiana, where Lilly is still based, the company grew a potent strain of marijuana for myriad maladies, including sleep, nerves, and pain. Pfenninger says that Lilly had 23 cannabis-infused products at one point. In 1907, young Eli Lilly — grandson of the company’s founder who later became CEO — published a doctoral thesis on cannabis.

But the company line appears to be: keep mum on the marijuana. Last year, Pfenninger embarrassed Lilly by bringing up this history at the annual shareholders meeting. One scholar told Indianapolis Monthly, “They don’t want to admit that cannabis was a historically mainstream, legitimate medicine, and they were involved.” And, he said, the company doesn’t want any part of marijuana legalization because it would threaten its current drug business.

Poor Care Killed 11 Kids, Report Finds

By the fall of 2018, 33 children had been diagnosed with and 11 died from adenovirus-7 at New Jersey’s Wanaque Center for Nursing and Rehabilitation, about 30 miles northwest of New York City. The total case count eventually reached 36. According to a 114-page federal report obtained by the North Jersey Record, a systematic breakdown at the center led to the fatal outbreak.

Infection control and outbreak planning were lacking, the report said, but it also assigned blame to the pediatric medical director at Wanaque for the facility’s sluggish response after the outbreak started. Maged Ghaly, MD, was not named in the federal report, but was identified by the Record through other means. He admitted to not recognizing the outbreak’s seriousness until children were already dying. “I knew we had a problem after the fourth death,” he told inspectors who issued an immediate-jeopardy violation on the facility. Only five other U.S. nursing facilities received this violation in 2018.

Last week, the federal government imposed a $600,000 fine on the Wanaque Center, which disputed the inspectors’ findings and is appealing.

Canadian Rx Company Crackdown

As part of an ongoing investigation, Canadian drug distributor CanaRx received a warning letter from the FDA telling the firm to “immediately cease causing the distribution of violative drugs to U.S. consumers.”

CanaRx is accused of selling mislabeled or unapproved drugs to Americans, including city and county governments, looking to cut drug costs after the FDA reviewed the company’s websites. The FDA named 14 especially problematic drugs in CanaRx’s catalog, including Gleevec, Truvada, CellCept, and Tracleer — all for serious conditions in which substandard medications could have fatal consequences.

FDA Commissioner Scott Gottlieb, MD, told the New York Times, “Such operations take advantage of unsuspecting Americans, by purporting to distribute safe and effective imported drugs, at least some of which are instead expired, mislabeled, subject to recalls or potentially counterfeit.”

CanaRx’s general counsel told the Times that investigators may have been confused when they looked at 123 websites in their investigation — “27 were CanaRx programs that were terminated, and 15 were not affiliated with the company.”

‘Right to Fail’ in NY

If you have free time this week, Frontline and ProPublica released an hour-long documentary investigation about those with mental illness who the system failed in New York.