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The Booming Business of Cutting Babies’ Tongues

By The New York Times

In a shocking exposé by The Daily, speakers Sabrina Tavernise, Katie Thomas, and Lauren Lavelle, along with Yulia Navalnaya, divulge the disturbing trend of unnecessary and potentially harmful medical procedures being carried out by doctors for financial gain. This investigation, conducted by The Times, sheds light on how compensation structures within the healthcare system are incentivizing doctors to perform more surgeries, thereby putting profits over patient well-being, as seen at Bellevue Hospital's controversial bariatric surgeries.

The troubling revelation is further personified by the painful journey of a Boise family, whose baby girl, June, experienced serious complications following a tongue-tie procedure. With an emphasis on medical ethics and the exploitation of patient trust, this episode highlights the lack of stringent oversight that allows such dangerous practices to flourish, and questions the effectiveness of legal deterrence in the face of the lucrative business of medicine. Join The Daily for a deep dive into these murky waters of the healthcare industry, revealing a domain where the line between healing and harming becomes dangerously blurred.

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The Booming Business of Cutting Babies’ Tongues

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The Booming Business of Cutting Babies’ Tongues

1-Page Summary

Doctors increasingly performing unnecessary, harmful medical procedures

The Times has conducted an investigation revealing a significant increase in unnecessary and harmful medical procedures carried out by doctors for profit. These practices are not only endangering patients but also lining the pockets of healthcare providers. Doctors' compensations are often linked to the volume and complexity of the procedures they perform, creating a financial incentive to conduct more surgeries. Bellevue Hospital has been spotlighted for its high rate of bariatric surgeries, often on patients who may not fit the criteria for such an intensive medical intervention.

Medical device companies are accused of encouraging unnecessary surgeries to boost sales of their products. They provide loans for equipment and sponsor events to recruit doctors into performing profitable surgeries. For example, a Boise dentist is using a laser from a device company for tongue-tie procedures, raising ethical concerns over medical decision-making. Misinformation and fear of litigation also contribute to this trend, as seen with Dr. Jihad Mustafa, a proponent of atherectomies. His advocacy and practice have led to numerous patients experiencing severe outcomes such as limb loss, igniting debates on the need for stricter regulations and oversight.

Story of Boise family whose baby endured harmful tongue-tie procedure

Lauren Lavelle from Boise experienced distressing complications with her baby June after being advised by a lactation consultant and a dentist to undergo a tongue-tie procedure. Following unsatisfactory breastfeeding, lactation consultant Melanie Henstrom diagnosed June with a tongue-tie and recommended a deeper cut with a dental laser. Dr. Samuel Zink then performed the procedure, also diagnosing June with a lip tie, leading to the baby's severe mouth sore and further feeding issues.

Despite the alarming outcome and a $600 expenditure for treatment, Lauren's concerns were not adequately addressed. Henstrom defended her practices by citing satisfied customers but evaded further inquiry. Dr. Zink did not respond to requests for comment and stated to the Dentistry Board that the procedure on June was uneventful, contrasting the complications that June suffered.

Doctors exploit lack of oversight and patient trust

The increase in surgeries for profit demonstrates a concerning exploitation of the lack of oversight and the trust patients place in their doctors. There is often an assumption that doctors have the necessary and appropriate training for the surgeries they perform; however, the reality is that oversight and regulation of this training is not as robust as many expect. Furthermore, while the threat of medical malpractice lawsuits is thought to hold doctors accountable, limitations within the legal system, including statutes of limitations, weaken this form of deterrence.

Even when doctors such as Dr. Jihad Mustafa are held accountable, the financial penalties they face, like a $25,000 fine, may be insignificant compared to the profits generated from the surgeries they promote and perform. Such nominal fines pose a limited financial deterrent relative to the income these procedures can yield, potentially encouraging healthcare providers to continue unsafe medical practices driven by profit rather than patient care.

1-Page Summary

Additional Materials

Clarifications

  • Bariatric surgeries are medical procedures performed to help manage obesity and related conditions by altering the digestive system to promote weight loss. These surgeries can involve reducing stomach size, changing gut hormone levels, or limiting nutrient absorption to aid in weight reduction. Common types of bariatric surgeries include Roux-en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. They are typically recommended for individuals with a high body mass index (BMI) who have not achieved significant weight loss through other methods.
  • Atherectomies are minimally invasive procedures used to remove blockages caused by atherosclerosis in blood vessels. They involve cutting plaque from the artery walls, different from angioplasty which pushes plaque aside. Atherectomies are controversial due to their cost and lack of clear evidence supporting their superiority over other treatments. These procedures are commonly performed to address narrowing in arteries affected by conditions like peripheral artery disease and coronary artery disease.
  • Tongue-tie and lip tie procedures involve correcting conditions where the tissue under the tongue (tongue-tie) or upper lip (lip tie) restricts movement. These conditions can affect breastfeeding, speech, and oral health. Procedures to address tongue-tie and lip tie typically involve releasing or cutting the tight tissue to improve function and alleviate associated issues. It's essential for these procedures to be carefully evaluated and performed by qualified healthcare professionals to ensure the best outcomes for patients.
  • The lack of oversight and regulation in doctors' training for surgeries highlights gaps in monitoring and enforcing standards in medical education and practice. This can lead to variations in the quality and depth of training among healthcare providers, potentially impacting patient safety. Stricter oversight and standardized guidelines are essential to ensure that doctors receive comprehensive training and maintain proficiency in performing surgeries. Inadequate regulation can contribute to situations where doctors may lack the necessary expertise or experience to conduct certain procedures safely.
  • Statutes of limitations in medical malpractice lawsuits are laws that set a time limit on when a patient can file a lawsuit against a healthcare provider for alleged malpractice. These time limits vary by state and typically start from the date the malpractice occurred or was discovered. Once the statute of limitations expires, the patient loses the legal right to sue for damages related to the malpractice. These laws aim to promote timely resolution of legal claims and protect healthcare providers from facing lawsuits for incidents that occurred long ago.

Counterarguments

  • The investigation may not represent the practices of all doctors or hospitals, and there could be a selection bias in reporting primarily on negative outcomes.
  • Some bariatric surgeries at Bellevue Hospital might be justified based on a comprehensive evaluation of the patient's health and not solely on the established criteria.
  • Medical device companies could argue that they are providing innovative technologies that can benefit patients when used appropriately.
  • The fear of litigation might sometimes lead to more cautious medical practices, which can be in the patient's best interest.
  • Dr. Jihad Mustafa and other doctors might believe in the efficacy of the procedures they advocate based on their clinical experience or interpretation of medical data.
  • The case of Lauren Lavelle's baby June could be an outlier, and the tongue-tie procedure might generally have a high success rate with minimal complications.
  • There may be robust oversight and regulation in place for doctors' training and surgeries, but these systems are not foolproof and can always be improved.
  • Medical malpractice lawsuits can still serve as a significant deterrent, even if there are limitations within the legal system.
  • Financial penalties, while they may seem nominal, could be part of a broader range of consequences that doctors face, including reputational damage and loss of license.
  • The focus on profit in healthcare is a complex issue that involves the entire healthcare system, including insurance companies and hospitals, not just individual doctors.

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The Booming Business of Cutting Babies’ Tongues

Doctors increasingly performing unnecessary, harmful medical procedures

An investigation by The Times has highlighted a worrying trend in the medical field where doctors are performing unnecessary medical procedures that not only harm patients but also generate substantial profits for the physicians and hospitals involved.

Financial incentives driving doctors to conduct unnecessary surgeries

The probe revealed how financial incentives are playing a critical role in the uptick of unwarranted medical procedures. A problematic pay system ties doctor's compensation to the volume of procedures, their complexity, and ultimately their profitability.

Bariatric surgery assembly line at Bellevue Hospital

Specific instances include Bellevue Hospital, which has been likened to an assembly line for bariatric surgery, a serious surgical intervention designed for weight loss. Despite claims by Bellevue Hospital that their practices are extending care to patients who would otherwise not have access, findings show the program processes an unusually high number of surgeries, including on patients who do not meet the qualifications for the procedure.

Medical device companies promoting surgeries to sell more products

Medical device companies are also implicated in the push for unnecessary surgeries. They stand to benefit significantly by creating a demand for procedures that require their products, thereby boosting their sales. Tactics used by these companies include offering loans to doctors for surgical equipment purchases and funding clinics to expand the services they offer. On the marketing front, companies sponsor trainings and conferences like "Tongue Ties and Tequilas" to educate and recruit dentists into performing lucrative procedures.

Boise dentist using laser from device company to conduct tongue-tie procedures

In Boise, a dentist has taken to using a laser obtained from a device company to perform tongue-tie procedures. These practices raise serious questions about the ethical underpinnings of medical decisions and the integrity of patient care.

Misinformation and fear of litigation enable unnecessary surgeries

In addition to financial incentives, misinformation and fear of l ...

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Doctors increasingly performing unnecessary, harmful medical procedures

Additional Materials

Clarifications

  • Bariatric surgery is a type of weight loss surgery that involves altering the digestive system to help manage obesity and related health conditions. Procedures like Roux-en-Y bypass and sleeve gastrectomy are common types of bariatric surgery that can lead to significant weight loss by changing gut hormone levels and reducing stomach size. It is considered the most effective treatment for weight loss in severely obese individuals and can also improve conditions like type 2 diabetes and cardiovascular risk factors. The American Society of Metabolic and Bariatric Surgery recommends considering bariatric surgery for adults with specific criteria related to body mass index (BMI) and metabolic syndrome.
  • Tongue-tie procedures, also known as frenectomies, are surgical interventions to address ankyloglossia, a condition where the lingual frenulum restricts tongue movement. These procedures aim to improve tongue function, particularly in cases where the restricted tongue motion causes issues with breastfeeding, speech, or other oral functions. Tongue-tie procedures are typically performed by healthcare professionals like dentists or ENT specialists and involve releasing the tight band of tissue to allow for better tongue mobility. The decision to undergo a tongue-tie procedure is based on the evaluation of the individual's symptoms and the potential benefits of improving tongue function.
  • Atherectomies are minimally invasive procedures used to remove atherosclerosis from blood vessels, commonly performed to treat peripheral artery disease and coronary artery disease. Unlike angioplasty, which pushes plaque into the vessel wall, atherectomy involves cutting plaque from the artery wall. The procedure is controversial due to its cost and the lack of clear evidence supporting its superiority over other treatments. Atherectomy is a type of percutaneous revascularization, typically performed through the common femoral artery near the groin.
  • Bellevue Hospital is a prominent medical institution in New York City, known for its comprehensive healthcare services and historical significance as the oldest public hospital in the United States. It serves as a safety net hospital, offering care to individuals regardless of their insurance status or ability to pay. The hospital has a large staff and handles a significant number of patient visits annually.
  • Financial incentives in the medical field refer to the various ways in which healthcare providers, such as doctors and hospitals, can be motivated by financial rewards. These incentives can influence the decisions made by healthcare professionals, potentially leading to practices like performing unnecessary medical procedures to increase revenue. In some cases, payment structures may reward doctors based on the volume or complexity of procedures they perform, rather than the actual medical need of the patient. This can create a conflict of interest where financial gain becomes a driving factor in medical decision-making.
  • Dr. Jihad Mustafa is a physician known f ...

Counterarguments

  • Financial incentives are a common feature in many sectors and can be aligned with good patient outcomes if structured appropriately.
  • High volume of procedures at a facility like Bellevue Hospital could be indicative of a center of excellence that attracts more patients due to its reputation and expertise.
  • Bariatric surgery can have significant health benefits for patients, and broader access could be seen as a positive development in public health.
  • Medical device companies contribute to technological advancements that can improve patient care and outcomes.
  • Professional training and conferences are standard practices for continuing education in the medical field and can enhance the skills of healthcare providers.
  • The use of new technologies, such as lasers for tongue-tie procedures, may represent an advancement in care that offers benefits like reduced healing time.
  • Fear of litigation can also drive improvements in patient care by encouraging thoroughness and adherence ...

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The Booming Business of Cutting Babies’ Tongues

Story of Boise family whose baby endured harmful tongue-tie procedure

A lactation consultant and a dentist were involved in a tongue-tie procedure for a Boise family's baby, leading to serious complications.

Lactation consultant and dentist pushed tongue-tie procedure using dental laser

Lauren Lavelle from Boise sought help from a lactation consultant named Melanie Henstrom for her baby June's difficulty breastfeeding. After a simple initial procedure suggested by a pediatrician didn't improve June’s breastfeeding, Henstrom diagnosed over the phone that June needed a further tongue-tie procedure involving a deeper cut using a dental laser. The consultant claimed that not correcting the issue could lead to a multitude of health problems.

The Lavelles were then advised by Henstrom to visit Dr. Samuel Zink, a dentist who diagnosed June with not only a severe tongue tie but also a new issue, a lip tie. Dr. Zink insisted that both needed to be cut with the laser surgery.

Baby suffered serious mouth sore and feeding problems

Post-procedure, Lauren Lavelle noticed June was inconsolable, screaming, and gagging, which Lauren instinctively feared. Despite paying $600 for the treatment, Ju ...

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Story of Boise family whose baby endured harmful tongue-tie procedure

Additional Materials

Clarifications

  • A tongue-tie procedure, also known as a frenotomy or frenectomy, is a medical intervention to address a condition where the lingual frenulum (the tissue that connects the tongue to the floor of the mouth) restricts the movement of the tongue. This restriction can impact breastfeeding, speech development, and oral hygiene. The procedure involves cutting or releasing the frenulum to improve tongue mobility and alleviate associated issues. In some cases, a laser is used for precision and minimal bleeding during the procedure.
  • A dental laser procedure for tongue-tie and lip tie involves using a specialized laser to precisely cut the tissue that restricts the movement of the tongue or lip. This procedure is often recommended when traditional methods have not been effective in addressing feeding or speech issues caused by these ties. The laser allows for more accuracy and less bleeding compared to traditional methods like scissors or scalpels. It is typically performed by dentists or healthcare professionals trained in laser dentistry.
  • Tongue-tie is a condition where the strip of skin beneath the baby's tongue is shorter than usual, potentially affecting breastfeeding by limiting the baby's tongue movement. This can lead to difficulties in latching onto the breast properly, causing pain for the mother and inadequate milk transfer for the baby. Addressing tongue-tie through a procedure like a frenotomy can help improve breastfeeding by allowing the baby to latch more effectively and nurse more efficiently. Failure to address severe cases of tongue-tie can result in ongoing breastfeeding challenges and potential issues with the baby's oral development.
  • After a tongue-tie procedure, a baby may experience mouth sores due to the healing process, which can cause discomfort an ...

Counterarguments

  • The lactation consultant's diagnosis over the phone may not have been as reliable as an in-person assessment.
  • The necessity and efficacy of tongue-tie procedures using dental lasers are debated within medical communities.
  • The claim that not correcting a tongue-tie could lead to a multitude of health problems may be an overstatement, as the evidence linking tongue-ties to serious health issues is not conclusive.
  • The dentist's diagnosis of both a severe tongue tie and a new issue, a lip tie, could be questioned for thoroughness or accuracy without a second opinion.
  • The cost of the procedure ($600) might be considered high, especially if the outcome was not benefic ...

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The Booming Business of Cutting Babies’ Tongues

Doctors exploit lack of oversight and patient trust

The financial incentives and prevalence of surgeries pose concerns about doctors potentially exploiting both a lack of oversight and patient trust in the medical community.

Lack of Regulation and Vetting of Training

Despite hospitals sometimes having rules about the required education for doctors performing surgeries, there tends to be less regulation and vetting of the training materials they use than is commonly expected. This discrepancy may give rise to situations where trust in a doctor's qualifications and the assumption of thorough oversight might not be as well-founded as patients believe.

Insufficient Malpractice Deterrence

The fear of medical malpractice lawsuits is often believed to hold doctors accountable for their actions. However, this accountability is not always realized due to factors such as statutes of limitations, which can undermine the effectiveness of legal deterrents. Consequently, clinicians may continue practices that are not in the best interest of patients without facing significant repercussions.

Minimal Financial Penalties

When accountability does occur, such as in the case of Dr. Jihad Mustafa being fined $25,000 by state investigators, the penalty ma ...

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Doctors exploit lack of oversight and patient trust

Additional Materials

Clarifications

  • Atherectomy is a minimally invasive procedure used to remove plaque buildup from arteries affected by conditions like peripheral artery disease and coronary artery disease. It involves cutting or shaving off the plaque from the artery walls, unlike angioplasty which pushes the plaque aside. Atherectomy is a controversial technique due to its cost and the lack of clear evidence supporting its superiority over other treatments like angioplasty. The procedure is often performed using disposable devices and can have higher physician reimbursement rates compared to alternative treatments.
  • Statutes of limitations in the context of medical malpractice are laws that set a time limit on when a patient can file a lawsuit against a healthcare provider for alleged malpractice. These time limits vary by state an ...

Counterarguments

  • Oversight and regulation in the medical field are often stringent, with multiple checks and balances in place, including peer reviews, hospital committees, and medical boards that work to ensure patient safety and high standards of care.
  • Many doctors are motivated by a strong sense of professional ethics and a commitment to patient care, rather than financial incentives, and they work within a system that supports these values.
  • The process of medical training and continuing education is rigorous and involves regular assessment and accreditation by professional bodies, ensuring that doctors maintain up-to-date knowledge and skills.
  • Medical malpractice lawsuits serve as a significant deterrent, and the fear of litigation, along with the desire to maintain a good reputation, encourages most doctors to adhere to best practices.
  • The legal system provides mechanisms for patients to seek redress in cases of malpractice, and while not perfect, it often works to compensate victims and penalize negligent healthcare providers.
  • Financial penalties for malpractice are only one aspect of the consequences faced by doctors; they may also face profession ...

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