An Open Retraction Request to the Editors of the New England Journal of Medicine: On Longo and Rosenbaum’s False Editorials on Morcellation in Gynecology
To: NEJM editors and staff
As you know, your office has been previously informed about the incorrect and dangerous editorial opinions expressed by Dr Lisa Rosenbaum in 2016, and now one of your editors, Dr. Dan Longo, as they pertain to the FDA action (and public health campaign) to end morcellation in Gynecological practice.
My public message to you, now, is specifically prompted by a shocking and incorrect statement in the recent NEJM editorial by Dr. Dan Longo:
https://www.nejm.org/doi/full/10.1056/NEJMe1912943
The false statement by Dr. Longo reads:
“This practice is based on an anecdotal case and a potent patient advocacy movement, similar to the one that eliminated morcellation as a tool for hysterectomy, a change that harmed many thousands of women.”
Of note, this editorial was published on Thanksgiving Day 2019. I had the displeasure of reading Dr. Longo’s outrageous and false statement on that day.
Despite the fact that this statement is buried in a seemingly unrelated editorial article on Breast Cancer screening in NEJM, two issues make it extremely dangerous for your institution as a whole — and speak to the incorrect and unscientific prejudice being sustained at NEJM (and within the Harvard community) regarding gynecological morcellation:
1) Most physicians know that NEJM is a widely read and powerful publication in clinical medicine. A vast number of clinicians’ opinions and “prejudices” are influenced or formed by the topics broadcast by NEJM. Thus, for a recognized NEJM editor to make a floridly unsubstantiated and false statement, which is not only incorrect, but also serves to defame the public health advocacy of a now deceased physician, is a surreal failure of your organization as a prominent professional press outlet. “FAKE NEWS” and propaganda, I suppose, are real phenomena even in academic medicine…But at NEJM?!?
2) This dangerous prejudice expressed by a Brigham Professor and Dana Farber oncologist, Dan Longo, likely represents the prevailing incorrect “expert opinion” driving the continued protectionist posture CRICO and BWH have sustained towards litigation of Dr. Reed and Mrs. Kaitz’s legal complaints in Suffolk County, MA. The trouble is that because the whole institutional defense premise is floridly incorrect (and dangerous) the Harvard defendants are highly likely to find themselves publicly humiliated for their professional negligence and protectionism in open trial. In as much as you all are Harvard and Brigham Professors and physicians, perhaps it is time to look at the data and be honest with yourselves, instead of being prejudiced and protectionist — at least in the interest of your institutional image and integrity, if not in the interest of justice and doing right by the families your institution has done deadly harm to.
Let me be clear again, when a Power Morcellator grinds up a “missed” uterine cancer and spreads it in the peritoneal cavity of a woman, the cause of death is an iatrogenic compartment syndrome from sarcomas or carcinomas filling the abdominal cavity and choking off all renal, vascular and GI function — it is quite troubling that none of you see this clinical fact with clarity!
Of course, this cognitive, ethical and analytical error at NEJM, vis-a-via the morcellation disaster in women’s health, has been a long-standing problem. It first reared its head formally in Lisa Rosenbaum’s shockingly incorrect editorial analysis, “N-of-1 policymaking”, in 2016:
https://www.nejm.org/doi/full/10.1056/NEJMms1516161
But given that almost 4 years later now, Professor Longo and the NEJM editors seem to still be comfortable re-broadcasting an identical falsehood with the added decoration, now, of “many thousands harmed”, I am compelled to dissect this Longo absurdity in NEJM and educate you on the data — for the record. The three elements of Professor Longo’s error are dissected below:
A) Longo states, “This practice is based on an anecdotal case”. Of course, this is a synopsis of Rosenbaum 2016 falsehood expressed in the “N-of-1 policymaking” editorial. I make this correction not as a subjective statement, but rather as a point of fact based on now many well designed and published epidemiological studies. As recently as this week, a paper from the Mayo Clinic puts the incidence of “missed” uterine sarcomas in women with symptomatic fibroid tumors at one in 256 — do read this article with care and be assured that there are many others now that come to an identical conclusion— “missed” and iatrogenically disseminated uterine cancers in gynecology are not “anecdotal”, they are “epidemic”:
https://www.ncbi.nlm.nih.gov/pubmed/30447212
Of course, this latest highly credible epidemiological analysis from Mayo is now just one of a collage of credible and independent studies demonstrating that GYNs are routinely “missing” more than one in 250 sarcoma diagnoses in the hundreds of thousands of women who annually present with symptomatic uterine fibroids for surgery across the world. I urge you to do a comprehensive literature review — the number is one in 150–400 Sarcomas preoperatively “missed”. This incidence, very literally, translates into a surreal number of women falling to iatrogenic disaster from uterine cancer dissemination by general GYNs across the world.
Not to mention the FDA’s own re-analysis in 2018 in the face of a specialty-wide attempt at recovering Power Morcellators only served to re-affirm the agency’s 2014 decision:
https://www.fda.gov/medical-devices/surgery-devices/laparoscopic-power-morcellators
The bottomline is that NEJM editors and the Harvard community seem confused about the facts. You ought to comprehensively study the literature on this topic with more expertise, and less prejudice — and far less “Harvard Hubris”. Because the notion that FDA’s action was based on “N-of-1 policymaking” or on the “anecdote” provided by Dr. Amy J. Reed (and the many others) is floridly incorrect and ethically despicable — Rosenbaum’s article in NEJM is an absolute falsehood. NEJM editors’ sustenance of this idea is concocted, fake and embarrassing to you all.
Of course, the fact that BWH Gynecologists, including Dr. Jon Einarsson and Robert Barbieri, knew this information for at least several years but never bothered to inform patients or the FDA represents both state and federal level legal violations — in addition to being a major breach of ethical conduct in their role as physicians, and in particular ones leading corporate GYN practices at a major Harvard affiliated Hospital.
B) In drawing what he seems to believe is a smart analogy, Longo almost mockingly characterizes a “potent patient advocacy movement, similar to the one that eliminated morcellation as a tool for hysterectomy”. In so doing, Professor Longo is specifically pointing a finger to the role Dr. Amy J. Reed, of Harvard Medical School and Beth Israel Deaconess Medical Center, played in informing the FDA of a serious public health hazard, and subsequently working closely with the lay press to inform the public itself. Given that Longo clearly views this patient advocacy campaign as being”harmful” to women (see below), his words as editor represents a clear attack on the legacy of a, now deceased, woman physician who is considered a public health hero in the vast majority of informed public health, bioethics and surgical communities. Professor Longo is, indeed, deliberately defaming a woman physician, who rose in defense of a specific subset of women, like her, in harm’s way — as is Rosenbaum when she accuses Dr. Amy J. Reed and myself of being “availability entrepreneurs” in her 2016 NEJM editorial.
Of course, it is needless to say that Dr. Amy J. Reed and her advocacy were not the reasons for Power Morcellators being eliminated from Gynecology. It was rather FDA action, after a multi-disciplinary expert panel deliberated and FDA public health experts studied the problem, that led to the FDA action in 2014 — as well as the agency’s reiteration of it action in 2018 after even more solid data emerged.
Longo, Rosenbaum and the NEJM editors, including Professor Jeff Drazen, seem to believe that the 2014 FDA action was somehow a political “publicity stunt”, simply because Dr. Amy Reed rose up to speak publicly. You have it wrong Professors: Yes, FDA acted — and, yes, Dr. Reed waged a publicity war to inform the public….BUT these are “True, true and unrelated!” FDA action was science based — as the data are repeatedly bearing out!
It is shocking to see that NEJM editors remain so ignorant on a deadly iatrogenic women’s health hazard, nearly 6 years later now. I suspect it is because they are being played by the politics of their local institution and insurer, and by what can only be attributed to “Harvard Hubris” — rather than being swayed by the truth and by science.
One would fashion NEJM as being more than a platform for professional falsehoods (and defamation) promoted by protectionist institutional/professional interests. One would fashion NEJM to be an arbiter of clear scientific facts — not a platform for pseudo-clinicians and scientific non-entities opining unchecked!
C) Perhaps in the most shocking and dangerous aspect of his statement, Longo says in a factual voice, that the FDA action to eliminate Power Morcellators from gynecology was “a change that harmed many thousands of women.” This statement is simply untrue and radically dangerous, in as much as it is published in a visible NEJM editorial. Not only is it defamatory of the legacy and public health efforts of Dr. Amy J. Reed, it also undermines the very real and scientific basis for FDA’s action in the interest of women’s health.
But perhaps most tellingly of the continued ignorance of NEJM editors is that fact that you seem unaware of the following study from Columbia University — the elimination of Power Morcellators from GYN has NOT led to a rise in peri-operative complications:
https://jamanetwork.com/journals/jama/fullarticle/2545671
I strongly suspect that in the coming months to years, even more studies will debunk Longo’s assertion that “many thousands” have been harmed. STUPID and FALSE!
Longo’s confidently stated claim that “many thousands of women” have been harmed, is not only at a subjective guess (at best), it goes in the face of scientifically demonstrated facts! Is this the standard a Professor of Medicine at Harvard, an oncologist at Dana Farber and a NEJM editor is held to? Is this the standard he holds himself to? I for one, believe that in their approach to Dr. Reed and myself, NEJM, its editors, CRICO and most of the Harvard Medical community are exercising protectionist malice and professional hubris.
Some will ask me: “why harp on NEJM now? Let the court decide. After all, Longo’s is only one sentence buried in an unrelated editorial piece — and the litigation of Negligence, Liability and Causation will speak definitively to the court and to the public.”
My answer is that the words we use matter. Even ONE FALSE SENTENCE broadcast from a position of institutional power, like NEJM, could do awesome damage and harm many. Because, the words we use reveal our prejudices and our knowledge, or lack thereof — especially as leading professionals. When a leading institution, like NEJM and Harvard Medical School, with MASSIVE broadcast power and a powerful audience get it dead wrong, they serve to perpetuate falsehoods and to cause real, not hypothetical, harm to unsuspecting patients. The ABSOLUTE ACCURACY OF YOUR WORDS MATTER, Professor Longo!
I know that there are those at Harvard (and at NEJM)who understand everything Dr. Reed and I have been stating, and the basis for the FDA action to be justified and true — but, these men and women have been too silent and political for too long. I still maintain hope that professionals of reason, and friends, within Harvard’s medical community will rise up to correct NEJM and demand correction and retraction of the Rosenbaum and Longo statements. These are embarrassments to you all!
Here, I write to request that Professor Longo and NEJM editors, immediately revise and retract the incorrect statement about GYN morcellation in last week’s editorial — and, again, that NEJM editors retract Lisa Rosenbaum’s 2016 “N-of-1 Policymaking” article. These are truly embarrassments to your Journal and for the entire Harvard Medical School academic medical community.
It should not be the civil (or criminal) court system that adjudicates and controls your professional behavior at the Brigham, at Dana Farber, and at Harvard — you are better than that. At least you ought to be!
I look forward to your response and to your retraction of all false statements that are now contradicted by scientifically gravid data on the “non-anecdotal” incidence and catastrophic consequences of morcellating “missed” uterine cancers in Gynecology. I write for the historic record and in hopes of awakening editorial reason at NEJM.
Sincerely,
Hooman Noorchashm MD, PhD (For Amy)
