U
C Davis Investigates “Egregious Academic Freedom Violation”
On June 8, the UC Davis Academic Senate unanimously criticized several UC Davis Administrators for curtailing the right “of academic freedom of Professor Michael Wilkes and all other faculty to publish scholarly articles and professional expert commentaries that address ethics and societally relevant critiques” and expressed “severe disapproval of the notion that the University of California may take legal action against professors whose scholarly publications or professional expert commentaries may be perceived by University administrators to be injurious to University interests.”
They called upon Medical School Dean Claire Pomeroy, Executive Associate Dean Frederick Meyer, and Campus Health System Counselor David Levine to “promptly and publicly take responsibility for serious errors in judgment,” write individual letters of apology, and “rescind all disciplinary actions that have been stated, proposed, or taken against Professor Wilkes.”
UC Davis Provost and Executive Vice Chancellor Ralph Hexter issued a statement last Friday in support of the adopted statement by the Association of American Universities (AAU) with a statement articulating, “The Rights and Responsibilities of Universities and Their Faculties.”
He noted that that statement included the following words: “A university must … be hospitable to an infinite variety of skills and viewpoints, relying upon open competition among them as the surest safeguard of truth. Its whole spirit requires investigation, criticism, and presentation of ideas in an atmosphere of freedom and mutual confidence. This is the real meaning of ‘academic’ freedom.”
The resolutions also condemn Levine and the Davis campus’ chief legal counsel, Steven Drown, “for drafting inappropriate and apparently threatening letters that violated a faculty member’s right to academic freedom.”
“A committee of our campus’s Academic Senate has devoted considerable time and effort to examining an assertion by a faculty member of the UC Davis School of Medicine that his academic freedoms were compromised by school administrators. Our Senate’s Representative Assembly earlier today heard and ratified the committee’s findings,” Provost Hexter wrote.
He added, “Academic freedom is sacrosanct at UC Davis, and the underlying assertions in this matter are deeply troubling. My office will review this case and take appropriate actions.”
In a report from the Academic Senate dated May 18, 2012, The Committee on Academic Freedom and Responsibility (CAFR) unanimously found “that the faculty member’s academic freedom was violated by precipitous and inappropriate retaliatory statements of disciplinary sanction and legal action in the hours and days following the publication of a professional expert commentary perceived by some to be against University interests.”
Furthermore, “The violation persists such that the professor works in fear for his job and has to withhold his professional knowledge from students and society for fear of further retaliation.”
In their findings, they argue that the university administrators who were involved in this case “misunderstand the University’s policy and procedures regarding academic freedom and shared governance.”
Chronicle of Critical Events
The CAFR report documents that “On November 22, 2010 a faculty member formally wrote an email to CAFR on the subject of ‘request for senate review’ in which he sought advice about what he described as his being subjected to intimidation, threats, and harassment.”
On December 21, 2011, the faculty member wrote to CAFR, “I would like to formally request a review of what I believe has been a blatant breach of my academic freedom.”
Professor Michael Wilkes of the Medical School is a distinguished faculty member who won a teaching award in 2010, he has been a medical reporter for both the New York Times and ABC News, as well as for numerous other publication.
According to the CAFR report, he “is widely credited with originating ‘doctoring’ courses that are now used by 33 medical schools” and in 2010, he was serving as Chair of the Consensus Committee for the Centers for Disease Control and Prevention.
Professor Wilkes appears to have gotten into trouble when he criticized a medical school event that was promoting a specific procedure. He sent out an email that “noted a concern about the presentation and suggested a lack of objectivity by the American Urological Association with regard to the prostatespecific antigen (PSA) test.”
“Prof. Wilkes suggested it was contradictory for UCDMS to teach evidence-based medicine and concurrently host an event promoting the use of PSA, which he characterized as ‘far away from evidence-based,’ ” they write.
The Executive Associate Dean wrote back the same day stating, “We cannot impinge academic freedom. maybe you need to be more interactive internally.”
While Professor Wilkes did not attend the September 2010 event, two medical students did and recorded it with an audio recording device.
According to the report, one student wrote that a video was played that the student deemed to be “unabashed marketing” and the student reported that “the urologists mentioned having a baseline PSA at age 40 for predicting lifetime risk of prostate cancer.”
On September 30, 2010 the San Francisco Chronicle printed an “Op Ed” article entitled “PSA tests can cause more harm than good” co-written by Professor Wilkes.
According to the report, “The Executive Associate Dean says that he received ‘multiple faculty complaints’ about the article, but the timing of those complaints is unclear, so they are not assigned a sequence in the numbered chronology.”
The same day as the article appeared in print, the Associate Dean indicated “that (a) Prof. Wilkes would not be invited to continue as doctoring Instructor Of Record (IOR) after the academic year and (b) resources to support Prof. Wilkes’ Hungarian student exchange would be ceased after completing commitments to date. In a meeting with CAFR, the Executive Associate Dean acknowledged that he had read the San Francisco Chronicle article before he wrote this email.”
A few days later, the Associate Vice Chancellor wrote the professor indicating that the Executive Associate Dean “is clearly upset that the Men’s health issue is being played out in the paper and through the students rather than an academic debate or issue specific seminar as he would expect in a University.”
The report indicates, “The Health System Counsel wrote a letter to Prof. Wilkes in which he expressed the University’s concern about factual inaccuracies pertaining to UC Davis in the online version of the article. To CAFR’s knowledge, the Health System Counsel was not present at the event. The letter alleges that there are five false statements in the article, provides the statements, and describes reasoning as to why the statements are false.”
“The origin of the scholarly analysis is not stated and there is no indication that a scholarly review was conducted,” CAFR writes.
They quote the letter which concluded: “The purpose of this letter is not to stifle legitimate public debate, academic freedom or policy advocacy about the role of PSA screening or broader issues- far from it. I am simply pointing out that there are numerous errors of fact in your article, that they were injurious to the University interests and reputation and thus potentially actionable under the law of defamation.”
“Prof. Wilkes alleges that his academic freedom has been violated and that he has been subjected to threats and harassment by the University as a direct response to the publication of his article in the San Francisco Chronicle,” CAFR continues.
The fact that the University has not carried out the actions against him to date is irrelevant to the point in question they argue, “in that the threatening proposed actions, including the threat of legal action against him, have not been withdrawn and there has not been any apology by the University for inappropriate behaviors that violated his academic freedom.”
Professor Wilkes therefore remains concern that this will impact his employment status and he remains concerns about his right to be able to continue his scholarly research and professional expert commentary about ethics in medicine.
“The fear he feels and expresses has resulted in him have turning down opportunities for commentaries out of fear of further intimidation and loss of his job,” they write.
Reports Findings
CAFR believes unequivocally that Professor Wilkes’ academic freedom was violated by the actions of key administrators within the university. He was told that he would lose a number of positions, his work space and his directorship.
“That is undisputed,” they write. “We can never know with 100% certainty that the actions by the Executive Associate Dean were a direct response to the San Francisco Chronicle article, but there is a very strong appearance of impropriety on the basis of several lines of evidence.”
They argue that the timing of events is highly suspicious, particularly since the Executive Associate Dean admitted that the email was written after reading the article.
They write, “The Executive Associate Dean agreed the email has an appearance of impropriety, based upon its close proximity to the timing of the article, even though he denies that the timing is connected. He characterized the email as ‘reflexive’ and said if he had it to do over again, he would not have sent the email.”
Furthermore, they cite the fact that there is no evidence that suggests that his space was under review for reassignment prior to the date of the article. And in fact, none of the actions taken against him were contemplated prior to the article.
Some of the information is highly conflicting and complex, however. CAFR writes, “On one hand, Prof. Wilkes won an award for his outstanding teaching in 2010 and is highly lauded by his students.”
The Executive Associate Dean described Professor Wilkes as “a gifted educator who uses technology well.”
On the other hand, they write, “some faculty and administrators had concerns in 2010 that pre-dated the San Francisco Chronicle article.”
The strongest evidence seems to be: “The fact that the Executive Associate Dean and the chairs of internal medicine, family medicine, and psychiatry abruptly decided to supersede the normal procedures of faculty shared governance and faculty oversight of administrative actions related to IORs is peculiar.”
They write, “Taking a decision on such a conflicted matter without faculty consultation and doing so on the very day a controversial article was published is at best very poor leadership, but more reasonably evidence of direct retaliation against Prof. Wilkes.”
They add, “The fact that none of the stated disciplinary actions has actually been carried out demonstrates that they were taken precipitously in the heat of the moment as a retaliatory action. The desire to act out against Prof. Wilkes at that moment trumped due process according to University policy and procedures for disciplining faculty for their conduct.”
Furthermore, none of the above actions have been formally withdrawn in writing and they argue that this “demonstrates that they are intended as a persistent threat.”
CAFR finds that the University violated Prof. Wilkes’ academic freedom by acting precipitously to threaten potential legal action prior to a full and fair assessment of the facts or any establishment of “actual malice” with respect to the letter by the Health System Counsel.
“The stated purpose of the Health System Counsel’s letter was to take issue with the truth of statements made in the article. That is inherently a scholarly discussion, not a legal one,” they write. “By circumventing the required venues for oversight and discipline of intellectual honesty, the University violated Prof. Wilkes’ academic freedom by sending him a threatening letter on legal affairs letterhead in place of pursuing appropriate investigation and potential discipline.”
They conclude, “The fact that the University would take the position that it is appropriate to take legal action against a professor whose scholarly writing or professional expert commentary is perceived as injurious to University interests and reputation is an unprecedented affront to academic freedom and the people of California.”
Campus General Counsel, Steven Drown, issued a letter that backed what David Levine, the health system’s attorney said, characterizing it as offering information rather than posing a threat.
The resolution therefore condemns Mr. Levine and Chief Counsel Steven Drown “for drafting inappropriate and apparently threatening letters that violated a faculty member’s right to academic freedom.”
In a way, given the gravity of these charges, it seems if anything recommendations are relatively lenient, though the Dean is directed to within six months take “concrete steps to prevent future violations of academic freedom rights, including training administrators, their staff, and faculty on academic freedom rights” as well as being asked to report back to the Academic Senate within six months to report about what training has taken place.
—David M. Greenwald reporting
I would love to hear medwoman’s comments on this one! Sounds like the University overstepped its bounds, and did not afford Prof. Wilkes any due process rights to explain his position, but just wanted to stifle a dissenting voice to whatever the University decides is appropriate medical procedure…
Here is a link to download the CAFR committee’s report:
http://studentunitymovement.org/CAFR_wilkesreview_20120518_FINAL.pdf
What I see here is that the concern that the administration had was him taking what they saw as an internal disagreement and putting it in the paper.
Nevertheless, their response violated their own policies and procedures as Elaine mentions.
Most concerning is the use of legal counsel to do it.
Steven Drown now needs to be more thoroughly examined in light of his role in this but also in the November 18 Pepper Spray Incident.
Brian-For some reason I couldn’t make your link work, so re-pasted from AGGIE .
http://studentunitymovement.org/CAFR_wilkesreview_20120518_FINAL.pdf
It would be interesting to know who sponsored the event in question and whether YCD received money or in kind services/gifts for hosting it. Lab company, pharmaceutical?
UCD not YCD tho am sure they wish it was.
Not trying to defending the treatment of the Wilke but here’s the article ([url]http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/09/30/EDET1FLK3B.DTL[/url])
Worth noting he specifically references the conference:
[quote]UC Davis just announced a seminar for the public on “men’s health.” That title notwithstanding, the program appears to be entirely about prostate cancer and in particular about the prostate specific antigen screening test.[/quote]
Criticizes both the topic and the participants:
[quote]The UC Davis course doesn’t even acknowledge a problem with prostate cancer screening. Its expert presenters – including two urologists and a professional football player (!) – will tell you that you need to “know your (PSA) statistics” beginning at age 40.[/quote]
And accuses the university of wrongdoing:
[quote]We can’t say why UC Davis offers this course that ignore scientific evidence, but we wonder whether it just might have to do with money.[/quote]
Probably the wrong forum and tactic to take and yes, he’s probably correct and the university not only violated their own rules but used legal council to threaten and attempt to intimidate him.
The CAFR report that there was nothing wrong with Dr. Wilkes choosing the forum that he did because he is an expert on medical ethics and also an expert on protate cancer (also importantly, he’s an expert on academic program development.
In fact, not only is it a matter of him doing nothing wrong, but he did actually the right thing. There’s no caveat here. The only thing Dr. Wilkes said is that some of his language might have been a little on the edgier side, but even then, that’s not really a major issue and pales in comparison to everything else. The University is a agency of the State of California, so there really isn’t such a thing as “internal” in that sense.
Typo: prostate cancer
Good points, I was not really attempting to defend the university so much as show what it was he had written.
Don’t care what Dr. Wilkes wrote. If the University had a problem w it, they have due process procedures to deal w it that they did not follow. Dr. Wilkes had a right to explain his point of view, in writing whatever it is he wrote, and he was never given that opportunity as required.
And that is entirely separate from the issue of what Dr. Wilkes specifically wrote. I would have to know what the university’s specific policies are concerning anything that is published by faculty. Are there any restrictions on written speech by faculty, such as it must not denigrate the University, or it must do nothing to harm the University’s reputation, or it must further the mission of the University, or whatever. Worse yet, wasn’t this an opinion piece in the media? What, Dr. Wilkes is not entitled to express an opinion as an expert commentator but private citizen not necessarily representing the University in any way?
As far as I can tell Professors have explicit freedom to speak their mind.
That said: “What, Dr. Wilkes is not entitled to express an opinion as an expert commentator but private citizen not necessarily representing the University in any way?”
This is the identifier: “Michael Wilkes is a professor of medicine at UC Davis”
That certainly identifies the professor with the university. Again doesn’t change the basic point here.
@Elaine: That’s the issue. By making a public criticism, Dr. Wilikes *was* promoting the long-term interest of the University. He’s supposed to do what he did. He should be applauded, not denigrated. There’s no wriggle room here.
There will be no university at all if we give it over to the corrupt sectors of the legal profession and corrupt sectors of the medical industry.
Typo: Dr. Wilkes is the correct spelling.
Before people spend too much time hammering “the university” or “UCD Administration” over this, this was an issue at the medical school. I have not seen anyone at the main campus in Davis (as opposed to UCDMC in Sacramento) support Fred Meyers on this, except possibly Steve Drown. The Representative Assembly (which is not the entire Academic Senate) was indeed unanimous, and I don’t know that there will ever be much distance between the Academic Senate and the main campus administration on this issue.
By the way, like many other medical faculty, Wilkes makes plenty enough to be a scapegoat for UC’s budget problems. He makes more than Drown does, and Drown has already been portrayed as a “top executive”. They each make 10-12 milliRomneys.
Wow ! It isn’t often, as I am sure you all are aware, that I am rendered nearly speechless, but that is the case here.
I will buffer my subsequent comments by saying first that I, like Elaine, do not know the details of any specific agreement that may exist between the university and the physician faculty. I will say that as volunteer faculty, I have always had the expectation that I had the right, and obligation, to inform my students and colleagues of what I perceive to be the best evidence based medicine and to expose any idea being promoted by anyone, be it university, private company, lab, pharmaceutical company…. whomever, whose practices do not reflect the best evidence model of care. I hope that my patients, and the patients of the next generation of doctors would expect nothing less. I also want to make clear that I am not personally acquainted with Dr. Wilkes or any of the other principles involved.
Now on to my thoughts about this case:
1) First, if it is true, it is, in my opinion, unethical to offer a seminar on “mens health” and then focus on
the issue of prostate cancer and especially a test of disputed value, the PSA
2) If it is true that at this seminar, the statement was made, or implied that there is value to a “baseline” PSA
at 40 without an extensive discussion of the limitations, pros, cons and recommendations for ongoing
surveillance, this is an egregious bit of advocacy for a test of limited value that certainly does not “predict
one’s lifetime risk of prostate cancer”.
3) If these ideas were indeed advocated in a University sponsored event, my feeling is that it was the duty of
someone to point out in a public manner, the inadequacy of this presentation. I do not know whether or
not Dr. Wilkes’ article was the best format, but the criticism needed to be made.
4) Whether or not Dr. Wilkes picked the best forum for his discussion, it is my opinion, based on the
information
presented in David’s article, that this would appear to represent intimidation, attempts to limit academic
freedom, retaliation, and possibly an attempt to cover up a biased presentation for economic advantage and/
or protection of the reputation of the university.
My suggestions:
1) A full and public apology to Dr. Wilkes
2) Complete and unequivocal documented revocation of any threats and assurance that this action on his
part will not result in any loss of space, position, financing, or any other form of status or privilege previously
earned through his academic activities.
3) A full review, perhaps in the form of a seminar or panel open to students, residents, and the community
designed to address the full range of opinions on the appropriate use of this test.
4) A seminar designed to truly address men’s health issues since that was what was being ostensibly offered.
5) Complete and public assurance to members of the faculty that this was an error, and that retaliation is not
an acceptable response to academic disagreement or to statements about the ethical responsibility to
present balanced presentations based on an evidence based model of medicine rather than the opinons
of a handful of individuals regardless of their academic status.
Sorry that you got more than you bargained for Elaine, but I was frankly shocked and find this very sobering if the information as reported bears even a rough resemblance to the truth.
Not sure what you’re saying Greg. In some universities it’s called the “faculty senate.” Would you say in those cases that the “faculty senate is not the whole senate”?
The Representative Assembly _is_ the senate, in the sense of a democratic body. The faculty as a whole are a constituency group, not a senate per se.
Brian – I know that it’s confusing terminology and it took me a while to get used to it. The “Academic Senate” is all tenured and tenure-track faculty, e.g., me. The “Representative Assembly” is a (limited) legislature for the faculty that convenes in person with roughly 60 members.
medwoman – It had to look truly egregious to get a [b]unanimous[/b] vote from the Representative Assembly. On the other hand, it is very much a med school issue; it is a step removed from academic freedom for non-medical faculty. See my comments above.
Greg
I agree that this is a medical school issue. However, I feel that the issue of academic freedom transcends which department you happen to belong to. The principle is the same regardless of discipline. If you see an error, whether it is mathematical in the sciences, a misrepresentation in the social sciences or in literature or the arts, you as an academic have the right and in the case of medicine, the obligation to point out the error or at least put forward your best evidence to the contrary. I believe that all faculty in all disciplines have a vested interest in the outcome of a situation like this.
Greg: I appreciate the explanation as well. So I have a question: how does the difference between the Med School and the university compare to the Law School, or the Schools of Letters and Sciences, or other schools. If something happened involving comparable figures at the law school or letters and sciences, would your reaction be similar?
medwoman – I certainly agree that it made sense for the whole Representative Assembly to vote on it, and not just medical school faculty. Yes, all faculty should stick together on the issue of academic freedom.
But let’s go back to what this post says at the top: “UCD Administration and Counsel Hammered for Violating Academic Freedom”. Let’s not exaggerate the number of nails that were hit by this hammer.
Greg
Fair enough. I never was in to carpentry as witnessed by my rapid rejection of Orthopedics as a specialty.
David – No, because revenue brings autonomy, and because hospitals are a large and sophisticated business, every medical school in the UC system has a lot more autonomy than other campus units. UCSF is even a separate UC campus, but the other UC medical centers have something comparable even if it doesn’t go that far. Another related fact is that top medical center administrators are paid a lot more than UC chancellors and provosts, who are nominally their superiors.
L&S has relatively less autonomy than other UC colleges because its mission is the closest to the job definition for a provost or a chancellor. But it’s not that different from agriculture or engineering or biology; mainly the medical school is different and to a lesser extent business and law. Actually the administration of any research university is fairly decentralized.
So yes, L&S is a different case, but one common principle to all cases is to lay blame where blame is due. It wouldn’t make sense to blame Jerry Brown for things that Mayor Kevin Johnson does wrong.
Well, in some ways, in particular in most cases pertaining to academic freedom, research universities are extremely decentralized. Even when a faculty member does overstep academic freedom, the dispute should stay at the lowest reasonable bureaucratic level.
But in other ways, universities are as centralized as you might expect. One department can’t switch from quarters to semesters, UCOP (sort of) decides all of the faculty pay scales, etc.
Greg, no, no. It’s not “one step removed.” Michael Wilkes has PhD from UCLA and this is a higher education issue. The UC Davis medical school is not any kind of lesser step-child to institution of UC Davis as a whole. This is a genuine issue in academic freedom per se.
Brian – Yes, I understand that, I only meant one step laterally. Anyway, if I were in the Representative Assembly, I’m sure that I would have voted the same way as everyone else. The case looked over the top.
OK, Greg, but you talk about too many “nails” being hammered, but I disagree. Steven Drown is counsel for the whole campus and works at the behest of Katehi. Some people behind the scenes thinks Drown is even guiltier in this than Levine is.
*think
Brian – Really this case has Fred Meyers’ name all over it. Levine’s involvement (the UCDMC counsel) looks bad, but it’s peripheral; and Drown’s words also look dubious, but his involvement looks even more peripheral to me. I guess there could be “some people behind the scenes” who think that Drown is “guiltier” than Levine, but I don’t know who they are, much less what they really have to say. There’s also a general feeling that med schools have a different dynamic with a lot more micromanagement than L&S departments — which is not necessarily the way that things should be, but the way that they seem to be.
If I were Katehi or Hexter, I probably would ask Drown to show better judgment. But there is no evidence that Katehi or Hexter instigated this fiasco. And everyone involved — Meyers, Levine, Drown, and even Wilkes — was appointed before Katehi and Hexter showed up.
Greg, you should try to do a little more research before you jump in so quickly with your comments. Hexter did not even start at UC Davis until January 2011, which is after Meyers, Levine and Drown did whatever they did.
Brian – That’s right, that’s my point. Hexter didn’t do this. Neither did Katehi, even though Drown is “answerable” to her. You can’t expect her to stalk him through his whole job, or to purge everyone hired under Vanderhoef.
But he is answerable now. Which means that Hexter and Katehi should act on the Committee report and the Representative Assembly vote. I see no evidence that they don’t want to.
Greg, you are conflating two issues together in your first two sentences. Katehi was here and was chancellor when Dr. Wilkes’ academic freedom was violated. It’s not out of the question that Fred Meyers was being prompted by people above him. Katehi is not off the hook on that.
Brian – In this case, you’re using a pretty loose meaning of the word “above”. Meyers is already paid more than Katehi, while his boss Claire Pomeroy is paid twice as much as Katehi. Besides, why would Katehi, who is trained in mechanical engineering, get caught up in PSA tests?
So, you’re imagining a chain of command that is not known to exist at Davis, that is not known to exist at most universities with medical schools, that has no particular reason to exist, and that totally escaped the attention of a committee that investigated the incident pretty thoroughly.
To be sure, there is no way to disprove a conspiracy, so who knows, maybe there is a secret chain of command and kickbacks or something. But why not wait for evidence before claiming that people are “on the hook” or “off the hook”.
Greg, your comments are simply factually incorrect. Pomeroy serves under Katehi in the organizational hierarchy of UC Davis, as clearly shown in this organizational chart.
http://www.ucdavis.edu/local_resources/downloads/ucdavis_organization.pdf
Brian – Yes, I know that, but that’s just a chart on paper. Katehi can’t actually reach through Pomeroy and tell Meyers and Wilkes how to do their jobs. Do you think that Chancellor Birgenau can tell Tedford how to coach the Cal Bears? Even though Tedford is paid 5 times as much as Birgenau? How often do you think it happens that people are paid huge salaries, only to take orders from nominal superiors who are paid vastly less?
Nevertheless, Katehi is legally and professionally responsible, and she is not off the hook.
Please check page 19 of the Administrative Responsibilities Handbook, which is the official policy involved:
“Delegation of Authority and Responsibility — Major responsibilities that cannot be delegated: A. Accountability for the implementation of a system or systems that effectively manage conflict of interest activities.”
http://accounting.ucdavis.edu/refs/AdminHandbook.pdf
That means, she *should* have been keeping tabs on Pomeroy and Meyers beforehand, in this regard, and I find it difficult to imagine that she had little contact as you attempt to portray. If that’s true, then she would be incompetent on that account.
Greg – 6/1512 – O9:39 PM
…
Brian – Yes, I know that, but that’s just a chart on paper. Katehi can’t actually reach through Pomeroy and tell Meyers and Wilkes how to do their jobs. Do you think that Chancellor Birgenau can tell Tedford how to coach the Cal Bears? Even though Tedford is paid 5 times as much as Birgenau? How often do you think it happens that people are paid huge salaries, only to take orders from nominal superiors who are paid vastly less?”
Greg, I do not know how this works in the UC system, but I can tell you that in my large medical group, it is not unusual for a person with a significantly lower salary telling much higher paid individuals what to do, and how to do the portions of their job that do not rely specifically on
specialized medical knowledge. This is due to two separate factors. 1) Subspecialists in the surgical fields, for example,neurosurgery or Gyn oncology, are compensated more highly than are generalists in primary care. 2) Until you reach the very highest levels of the organization, our group has made the decision ( a wise one in my opinion) to offer fairly nominal stipends for taking on management positions rather than significant increases in pay or compensation package. What this has done is to encourage those who will find personal inspiration, motivation, and reward in seeing improvements in the functioning of the group rather than purely their own financial success.
The outcome is that it is not unusual in our group for a much lower paid individual in primary care rising to the institutional level of Physician in Chief or Medical Director, and as such, telling a Neurosurgeon “what to do” outside the operating room.
medwoman – Well okay, I overstated that point. But it’s part of a much broader piece of common sense. No evidence has surfaced in this case that anyone at the main campus was involved. Nor that anyone at the medical center presented this case as a “major” policy that would require decisions from the main campus administration. Yes, they wanted Drown’s legal support, but that’s not the same thing. Assuming that there is some connection just from an organizational chart is a theoretical argument that doesn’t fit the existing facts.
Greg
Point taken, which is why I prefaced my comment with not knowing the University system except from the very peripheral status of volunteer faculty.
Greg, as I clearly stated, the connection, as a matter of supervisorial responsibility, is an uncontroversial fact.
Brain – Well all right, they’re taking that responsibility now. The major part of this story is at the level of Meyers. You can’t expect administrators in Davis to reach down through Claire Pomeroy to watch over people under her — almost all of them doctors — ahead of time.
Actually we can indeed expect that. That’s their job!
Greg and Brian,
I think you are both making valid points. I am technically responsible for the non medical errors of the group I supervise as assistant chief of our department. So, when one of them acts in a manner that deserves investigation, I am expected to play a well defined role in the process depending on what the specific behavior is. I am anticipated to monitor improvements in their behavior and hold them to agreements for correction that have been made.
I am not anticipated to be prescient and head off an error of judgement before they make it if there has not been clear cut evidence of similar error in the past.
I do not know the details of the chain of command at UCD but cannot imagine that it is that different from
the structure of my group.
[quote]Sorry that you got more than you bargained for Elaine, but I was frankly shocked and find this very sobering if the information as reported bears even a rough resemblance to the truth. [/quote]
Thanks for your very thoughtful response. It reinforced my opinion that simply put: Dr. Wilkes probably had a right to say what he had to say; and the university did not follow its own protocols if they had a problem w what Dr. Wilkes said. What is most unfortunate is that people’s lives are virtually at stake here. It is important that citizens are told “the truth, the whole truth and nothing but the truth” by the medical profession. Half truths or misleading statements or disguised sales pitches just don’t seem professional to me in the medical profession, just as they are not professional nor ethical in the legal profession. I really appreciated your thorough and expert analysis on this issue…
Elaine
[quote]What is most unfortunate is that people’s lives are virtually at stake here. It is important that citizens are told “the truth, the whole truth and nothing but the truth” by the medical profession. Half truths or misleading statements or disguised sales pitches just don’t seem professional to me in the medical profession, just as they are not professional nor ethical in the legal profession. I really appreciated your thorough and expert analysis on this issue…[/quote]
You are completely correct about the significance this has in people’s lives. While no one is likely to die from having too many unnecessary PSA tests done, what is at stake is:
1) Needless biopsies and surgeries with the potential for complications including infection, incontinence and
impotence
2) The financial and emotional costs behind these tests and procedures
3) The inadvertent support lent to other tests of somewhat guarded value such as the controversial uses of the
Ca 125 marker for certain types of ovarian cancer in women by the generalized idea so widespread in our
society that more testing and more intervention is necessarily better.
These are the specific reasons that I specified in my suggested remedies that the Medical Center host a program widely available to the public to present not only a balanced view of the PSA test, but also a balanced view of
men’s health issues of which prostate cancer should be on the list, but not near the top of the list of priorities especially when, as a society, we are looking down the barrel of an epidemic of obesity and obesity related diseases including diabetes, high blood pressure, stroke, heart attack …..as you well know as an advocate for seniors.
To medwoman: Very, very well said! Just to share, a friend of mine in her seventies was being subjected to repeated colonoscopies (one every few weeks), to the point where she felt sicker and sicker. The repeated procedures were literally draining the life out of her. Normally, as a nonmedical professional, I do not intervene in anyone’s medical decisions, nor should I. But things had gotten so out of hand, I felt compelled to advise her she had the right to say “no” to a test ordered by the doctor. She decided to call a halt to the repeated procedures, and within a very short time began to feel much, much better. I realize the doctors were trying to find out what is wrong, but at some point doesn’t the doctor have to weigh how harmful the procedure itself can be? Geeeeeeeeeeze…
This is off on a tangent from the original question of academic freedom, but the fact is that public opinion acts in powerful ways on medical care, and not always for the better. A doctor who orders an unnecessary test on a patient is just a doctor who ordered an extra test to be sure. A doctor who didn’t test a patient who turned out to have cancer is a doctor who killed a patient. Now you could say, what harms would a test do if it doesn’t cause pain, it’s just extra information. But if the test comes back “might be very bad” and the doctor takes no action and the patient dies, then it’s a doctor who outrageously killed a patient. Testing sets treatment in motion, and doctors quietly understand that some types of testing and treatment have escalated too far. Some doctors can be quite bitter about hair-trigger blame from patients on exactly these issues.
I recently read about Gilda Radner, who died a cruel and tragic death from ovarian cancer. She might have been saved if she had been tested earlier for CA125, and her widower Gene Wilder is convinced that she didn’t have to die. (Yes, this is the famous Gilda Radner and the famous Gene Wilder.) Now, maybe Wilder is correct and maybe not; the case is not my business. But the case has poured about 1000 tons of guilt onto the system and there is nothing to stop it from erring in the opposite direction.
So ironically, in Wilkes’ original professional stance, he bravely argues against a strong current of patient sentiment, even though he’s the underdog and moral victor against the system in an academic freedom case.
medwoman – As for the issue of “chain of command”, basically I agree with you. The case has been referred to Hexter, who will exert some form of authority over the medical center. As he should. The only difference between that and your medical clinic experiences is that Hexter, most of the Representative Assembly, and most members of the academic freedom committee aren’t doctors. If it gets to the point that people with no medical training need to tell doctors what to do, then something has gone very wrong.
It’s not exactly as you say, Greg. Actually the chain of responsibility goes up through Yudof, through the Board of Regents, through the governor and the California Senate to the People of California, many of whom are physicians (not to mention other types of responsibility having to do with federal grant money). Physicians have ample opportunity to be involved at the state level in influencing the formation of the laws of the State of California that pertain to their activities, and also at the institutional level in how the specific policies of the University of California that pertain to their activities are formed and applied.
I find it ironic that you, as someone who is not a specialist in higher education per se, continually makes claims, assertions and conclusions here on this blog about higher education per se, now one of which entails the idea that non-specialists might not have a role in making determinations involving people outside their field. The point is, you can make such claims and assertions sometimes with credibility because there is overlap in the relevant domains. There are no ontological firewalls, so to speak, which separate phenomena into atomistic events. All events in the universe bear some relationship to other events in various ways, and your relationship to those events is different according to the multifaceted characteristics of your activities and qualifications.
Brian – But that’s not what I’m saying. I’m saying that non-medical officials shouldn’t have to intervene in a medical dispute. I agree that they have the authority to intervene. I also agree that they have some general “role” that goes beyond stepping in to rectify a fiasco — ultimately, doctors are here to treat patients, not just to satisfy each other.
Anyway, in this case Hexter said that he would act on the Representative Assembly vote, and that’s exactly what should happen.
Brian
[quote]Physicians have ample opportunity to be involved at the state level in influencing the formation of the laws of the State of California that pertain to their activities, and also at the institutional level in how the specific policies of the University of California that pertain to their activities are formed and applied. [quote]
I agree with your statement that there is opportunity to influence the formation of laws. Unfortunately, doctors, although as individuals tend to be well compensated, do not command the kind of lobbying power that rests with the big money players such as pharmaceutical companies and as a group, our financial interests tend to diverge with some of us still very invested in a fee for service model which favors more testing and procedures over a less lucrative but more efficient and in my opinion, safer, prepaid model. We are not very effective as a group in safe guarding the best interests of our patients through the legal system on any level.
Oops, still learning, hang in there all.
Greg, you need to read the CAFR report more closely. The report explains clearly that it’s not the job of the CAFR committee to get involved in settling the medical issue qua medical issue. The report clearly indicates that the matter that has come before the Academic Senate is an academic freedom issue.
Additionally, I think you’re on very shaky ground here, trying to rope off medical science as a field from science (and research) generally. It doesn’t work that way.
Brian – I did read that in the CAFR report and it is a bit of a copout. Yes, it is an academic freedom issue and not a medical issue. But one reason that the the Representative Assembly vote was outright unanimous was that it didn’t look like Wilkes had said anything crazy, in fact, he makes a strong case. That contradicts the stance of the medical school administrators (and the lawyers) that Wilkes was so wild and accusatory that he had abused academic freedom. So again, the main UC Davis campus has every right to step in at this point. But it does take some very basic medical sense to wade through the issue, and what the medical school did had to be truly egregious for it to come to this.
It’s an interesting contrast with Joshua Clover. He has said a lot of entirely unaccountable things, and basically played academic freedom to the max. Nonetheless, unlike with Wilkes, the university has not attempted any action against him based on its own rules. Clover has been indicted for blockading US Bank, but that’s state law, not campus rules. On one other point, I would say that he has abused academic freedom: it’s unprofessional for a faculty member to encourage students to break the law. But the Academic Senate and its committees apparently aren’t ready to say anything about that.
Small point Greg. Josua Clover has NOT been indicted. Grand Jury’s indict. The bank blockers will go through a process most go through, a preliminary hearing where the prosecution puts on evidence and a judge determines whether there is significant evidence to hold them to the charges. That has not occurred yet.
[quote]This is off on a tangent from the original question of academic freedom, but the fact is that public opinion acts in powerful ways on medical care, and not always for the better. A doctor who orders an unnecessary test on a patient is just a doctor who ordered an extra test to be sure. A doctor who didn’t test a patient who turned out to have cancer is a doctor who killed a patient. Now you could say, what harms would a test do if it doesn’t cause pain, it’s just extra information. But if the test comes back “might be very bad” and the doctor takes no action and the patient dies, then it’s a doctor who outrageously killed a patient. Testing sets treatment in motion, and doctors quietly understand that some types of testing and treatment have escalated too far. Some doctors can be quite bitter about hair-trigger blame from patients on exactly these issues. [/quote]
I think you are missing a huge point here, and part of the issue Dr. Wilkes was trying to get across. Any medical procedure comes with risks and tradeoffs. The patient needs to be fully informed of those risks and tradeoffs to make a decision whether to have one test, an entirely different procedure, or to forgo any testing at all because of the risks involved. Yet it appears the University was doing a disguised sales job for one particular type of test where there is some controversy as to its efficacy. All Dr. Wilkes was trying to point out was all the risks/tradeoffs, so the patient would be more fully informed – and he was essentially criticized for it. I don’t particularly care who did the criticizing – the UCD Med Center or UCD as an institution. It should not have happened, based on what I am reading in this article and assuming the details are accurate.
[quote]It’s an interesting contrast with Joshua Clover. He has said a lot of entirely unaccountable things, and basically played academic freedom to the max. Nonetheless, unlike with Wilkes, the university has not attempted any action against him based on its own rules.[/quote]
I’m not following you here. UCD did do something about Joshua Clover – they turned him over to the DA’s Office for prosecution…
Digressing a bit here to address of issues of academic freedom. The pepper spraying of students on Nov. 18, 2011 can be viewed as a violation of_students’_academic freedom. We students are covered by the concept of academic freedom in the sense of having the “right to learn.” This goes back to higher education practices in Germany in the 19th century which were adopted here.
It’s impossible to exercise that right if one has to keep in mind the possibility of arbitrary and unjustified use of force on the part of campus police.
As for the US Bank protest, that’s a separate and more complicated issue. I wasn’t involved, so I won’t try to speak for the bank protesters.
I meant: Digressing a bit here to address other issues of academic freedom.
Elaine – The PSA test is just a blood test. The test in and of itself carries very little risk of anything. The whole issue here is about protecting patients, and protecting the system, with [i]less[/i] information. It’s counterintuitive for that to ever be a good idea. But the fact is that the dynamic of patient anxieties, and doctors and hospitals who don’t want to be blamed, means that certain types of information leads to overreactions.
In other words, if you’re an older, male patient, then if you learn that you have prostate cancer, you might well live a better and equally long life if you simply block it out of your mind and do nothing, even though there is some small chance that the cancer will kill you. But blocking out that information is very hard to do for patients and doctors. Hence the new advice, as explained by Wilkes, is not to find out in the first place.
There is another side to this as well that is harder to discuss in public. There will be patients who are on average slightly helped by very expensive treatment. But, if the system spends $50,000 on you only to extend your life expectancy by 3 weeks, then that is $50,000 that is not spent on other patients who could be helped more. So instead the “sell” is that the treatment is painful or debilitating, which is often true but sometimes an exaggeration.
That’s not accurate, Greg. It’s not a simple issue of the PSA test supposedly providing helpful information. It’s an issue of the test not really showing that harmful cancer is present. Here’s a relevant article which shows that you are not giving the full information:
http://www.nytimes.com/2011/10/07/health/07prostate.html?_r=2