Time to fess up, Hopkins: Open letter to their Chief Medical Officer regarding The Epstein Affair
From: Howard Wolinsky, Editor, TheActiveSurveillor.com
To: Redonda G. Miller, M.D., M.B.A. President – Johns Hopkins Hospital
Dr. Miller, I am writing to you as Johns Hopkins’ Chief Medical Officer on behalf of the more than 1,000 readers of my newsletter and of 3 million others in the U.S, living with the full spectrum of prostate cancer, the most common cancer in American men after skin cancer.
The American Cancer Society estimates this year that nearly 300,000 American men will be diagnosed with prostate cancer,
Up to now, about 12,000 of us per year have opted to have preeminent uropathologist, Jonathan I. Epstein, MD, director of surgical pathology at Hopkins, review our slides. I was among those who sought Dr. Epstein’s second opinion in 2010 when I was diagnosed with low-risk prostate and opted to go on Active Surveillance.
Dr. Epstein is an important figure in the prostate cancer community, but also at Hopkins. Hopkins has received approximately $45 million in fees for Dr. Epstein’s coveted opinions since 2013.
More than 120,000 patients in the past decade or so and our urologists have put our faith and trust in Dr. Epstein and Hopkins for what has been considered the best uropathology program in the world.
We have turned to Dr. Epstein for first opinions and also your popular second opinion program and have taken his reports as gospel in determining our fate, whether we opt to treat our cancers or to monitor them with Active Surveillance.
Has our faith and trust been misplaced?
We have had a lot riding on Dr. Epstein, a true pioneer in this field. But we have seen dark clouds on the horizon for almost six months.
We have known since last May, as reported in TheActiveSurveillor.com, that Dr. Epstein was on administrative leave. We did not know the reasons why he was on leave, but many have continued to see the impressive team Dr. Epstein has built at Hopkins.
But now, thanks to a report in the Washington Post on Sunday, what many of us have feared has come to be. The other shoe has dropped. And the picture isn’t pretty.
Dr. Epstein has been charged with creating a “culture of bullying” and intimidation as he allegedly leaned on his colleagues and residents to support pathology reports by his wife Dr. Hillary Ross Epstein. He is considered innocent until proven guilty, but anxiety levels are rising in this patient population as doubts have been cast on some of his work and also on your institution.
The case will go through further adjudication. No doubt, there will be lawsuits and further reviews.
Meanwhile, tens of thousands of patients are wondering what this all means to them now. Can we trust those pathology reports from the Epstein lab? Can we trust Johns Hopkins?
Dr. Miller, Hopkins owes these patients a full explanation and an apology for apparently poor judgment in allowing a lead doctor in effect to supervise his pathologist-wife’ and her reports.
Dr. Jonathan Epstein is a legendary figure in the prostate cancer world. The Epstein affair is reverberating among prostate cancer patients, who have relied on Dr. Epstein and Hopkins for answers at a time in their lives when they are most vulnerable: Do I have cancer? Will I be able to live with it? Do I need surgery?
Patients have written to me asking if pathology reports overseen by Dr. Jonathan Epstein can be accepted or whether the information is somehow contaminated. I assume the best case, but I can’t answer for Hopkins or Dr. Epstein.
We need to know: Which reports are in question? Over what time period? Does this concern impact only Dr. Hillary Epstein’s work? Are there any concerns about Dr. Jonathan Epstein’s work product?
Hopkins is being confronted with a loss of confidence in your pathologists’ work product as well as in your entire organization.
Hopkins needs to put at ease the minds of these patients, provide an accurate description of the scope of the problem, and offer to reread their slides as a matter of good faith. Likewise, Dr. Epstein needs to explain his position in this affair.
I urge Dr. Epstein’s patients to contact you directly to share their concerns:
Dr. Redonda Miller, president of Johns Hopkins: can be reached at:
—Email: mailto:rgmiller@jhmi.edu
—Phone: (410) 955-0620
—Fax: (410) 614-1195
Dr. Epstein can be reached at mailto:jepstein@jhmi.edu
Dr. Miller, please do the right thing for these patients and restore our faith in Johns Hopkins.
Meanwhile, vote, OK?
By Howard Wolinsky
Can you weigh in on my survey on what otherwise healthy men should do about Active Surveillance once they reach their mid-70s?
I have had 90 responses, but I’m greedy and would like more by the time I close voting on next Friday.
There’s still time to answer a couple of questions on AS and related topics: https://forms.gle/oFvfH3rPdgJmEbiQ7
Can we can get a dialogue going with the urologists and develop guidelines to help us decide what to do about AS in older men?
See more:
The old man and AS
OCT 21
You’ve got questions? They’ve got answers.
By Howard Wolinsky
Starting in November, a panel of experts will answer your questions about Active Surveillance and lower-risk prostate cancer right here at TheActiveSurveillor.com.
These top docs will respond to your questions about pathology, urology, radiology, and sex and surveillance.
Please send questions via email to mailto:pros8canswers@gmail.com
Keep the questions short and sweet. They should be of general interest. Sign with your real name, initials, where you live, how long you have been on AS. Or sign with a wistful anonymous name, like “Lost in Flossmoor,” or “Stranded on a Desert Island.”
(We cannot offer medical advice. Go to your personal physicians for that.)
Join ASPI in celebrating AS support pioneer Thrainn Thorvaldsson
By Howard Wolinsky
Icelandic support group trailblazer Thrainn Thorvaldson, who started the world’s first support group for Active Surveillance, is being honored with ASPI’s for Patient Advocacy Award on Saturday, October 28, 12 pm-1:30 p.m. ET.
Thrainn changed my life when he heard about how I ranted about the bad treatment of AS patients at a major medical meeting, and we decided to work on reforming things. We plus Mark Lichty and Gene Slattery started ASPI in 2017.
Following the Active Surveillance Patients International ceremony, they will open the floor for discussion from the audience.
Register here: https://zoom.us/meeting/register/tJMrcuuqrTgiH9WrrznAmLJvh-xOcZT6Fg2q
ASPI’s prior award programs have included The Gerald Chodak Award, named for ASPI’s first medical advisor and AS pioneer, the late Dr. Gerald Chodak, honoring Dr. Laurence Klotz, the father of AS in 2022 and Dr. Peter Albertson, who led some of the earliest research on AS, in 2023. The ASPI AS Advocacy Award went to the MUSIC (Michigan Urological Surgery Improvement Collaborative this year.
You’ve got questions? They’ve got answers.
By Howard Wolinsky
Starting in November, a panel of experts will answer your questions about Active Surveillance and lower-risk prostate cancer here in TheActiveSurveillor.com.
These top docs will respond to your questions about pathology, urology, radiology, and sex and surveillance.
Send questions via email to pros8canswers@gmail.com. You have to copy and paste the email address.
Please keep the questions short and sweet. They should be of general interest. Sign with your real name, initials, or a wistful anonymous name, like “Lost in Flossmoor,” or “From a Desert Island.”
(We cannot offer medical advice. Go to your personal physicians for that.)
Questions will be answered once a month by these experts:
—”The Pathology Report.”Dr. Ming Zhou is pathologist-in-chief at Tufts Medical Center in Boston. He has served on the Cancer Committee of the College of American Pathologists and is the primary author of the genitourinary cancer protocols, the guidelines for practicing pathologists on diagnosis and reporting genitourinary cancers. He serves on the editorial board of several pathology journals, including Modern Pathology and Pathology International. He is the president of the Genitourinary Pathology Society (GUPS), an international urologic pathology organization.
—”Sex and Surveillance.” Dr. Anne Katz is the certified sexuality counselor and Clinical Nurse Specialist at.CancerCare Manitoba in Winnipeg, Canada. She is the immediate past editor of the Oncology Nursing Forum, the premier research journal of the Oncology Nursing Society. She was recently appointed as Associate Editor of CA: A Cancer Journal for Clinicians (American Cancer Society). She was inducted into the American Academy of Nursing in 2014. She is the author of 15 books for healthcare providers and healthcare consumers on the topics of illness and sexuality as well as cancer survivorship.
—”The Urology Report.” Dr. Michael Leapman is an Associate Professor of Urology; Clinical Program Leader, Prostate & Urologic Cancers Program, Yale Cancer Center; and Assistant Professor, Chronic Disease Epidemiology. His special interests include low-risk prostate cancer and Active Surveillance.
—”The Radiology Report.” Dr. Antonio Westphalen is Section Chief of abdominal imaging at the University of Washington and UW professor of radiology. Dr. Westphalen’s research interests are centered on the use of advanced imaging technologies to diagnose and treat patients with prostate cancer.
SEND YOUR QUESTIONS TO: pros8canswers@gmail.com. You have to copy and paste the email address.
Join ASPI in celebrating Thrainn Thorvaldsson
By Howard Wolinsky
Icelandic support group trailblazer Thrainn Thorvaldson, who started the world’s first support group for Active Surveillance, is being honored with ASPI’s for Patient Advocacy Award Saturday, October 28 at 12 pm-1:30 p.m. ET.
Following the ceremony, we will open the floor for discussion from the audience.
Register Here https://zoom.us/meeting/register/tJMrcuuqrTgiH9WrrznAmLJvh-xOcZT6Fg2q
ASPI’s prior award programs have included The Chodak award, named for ASPI’s first medical advisor and AS pioneer, the late Dr. Gerald Chodak, honoring Dr. Laurence Klotz, the father of AS in 2022 and Dr. Peter Albertson, who led some of the earliest research on AS, in 2023. The ASPI AS Advocacy Award went to the MUSIC (Michigan Urological Surgery Improvement Collaborative this year.
Researcher talking to Orange County prostate group on AI
By Howard Wolinsky
Dr. Daniel Spratt, chair of radiation oncology at University Hospitals Seidman Cancer Center and a professor at Case Western Reserve University School of Medicine in Cleveland, Ohio, one of the leaders in AI biomarkers and prostate cancer.
He said: “The real immediate use is that this biomarker can be an adjunct, or it can be something to assist in making the shared decision making with patients [with prostate cancer].” He is using AI in deciding whether to use Androgen Deprivation Therapy (ADT) in some patients.
The next step with this technology is helping men make decisions on AS.
Spratt will be speaking on AI in prostate cancer treatment at 8 p.m. Eastern/5 p.m. Pacific on Thursday, Oct. 26, on Zoom to the Prostate Forum of Orange County:
https://us02web.zoom.us/j/85477749453
Meanwhile, check out a Q&A I ran in August with a researcher from ArteraAI:
Artificial Intelligence arrives for intermediate PCa--coming soon for low-risk patients
By Howard Wolinsky Editor’s note: Artificial Intelligence is the topic of everyday discussion—at my house, anyway. I have covered AI in this blog and elsewhere for years. AI is finding its place throughout medicine, from answering our queries in portals to forecasting our risks for various disease and potential benefits for treatments.
(Portion of an AI test for a patient with intermediate-risk prostate cancer.)
San Francisco-based ArteraAI, the developer of multimodal artificial intelligence-based predictive and prognostic cancer tests, has started evaluating these men with localized intermediate-risk PCa,].
I arranged an email Q&A with Dr. Felix Feng, Scientific Advisor to ArteraAI.
Feng stresses below: “The ArteraAI Prostate Test is the first test that can both predict therapy benefit, particularly in the context of who should receive hormone therapy, and prognosticate long-term outcomes in localized prostate cancer. The long-term goal is to enable personalized care for patients.”
excellent letter they all knew what was going on, makes us look like fools for sending so many men for second path opinion.