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Johns Hopkins Pathology, Surprising development

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Posted 10/22/2023 12:32 PM (GMT 0)
https://apple.news/apkmcolaqsf-si_6snz5zcq

"The internationally regarded pathologist Jonathan I. Epstein has been accused by other doctors of pressuring them to give second opinions that agree with diagnoses made by his wife, who also is a pathologist, said four people who have knowledge of the situation and spoke on the condition of anonymity to discuss an ongoing probe."

Apparently Dr Epstein has been on leave since May, so I guess this isn't new news, maybe just coming out, unless I missed it.
Posted 10/22/2023 2:11 PM (GMT 0)
Well, everyone makes mistakes, even the best in the world. Maybe Epstein doesn't do every analysis of every biopsy that comes to his department. Hopefully, pathologists that he trained sometimes examine the samples, maybe that's good enough. I don't know what difference it makes if the pathologist is his wife.

**The report directed the Baltimore hospital to address long-standing concerns among physicians and others “regarding a culture of bullying and intimidation in the surgical pathology department**

Doctors, with gigantic egos, are sometimes bullies and intimidating? How shocking! I'm guessing the four unnamed doctors are pretty young. Maybe Epstein is old school and didn't know that you are not allowed to make people uncomfortable any more.

Is it possible some jealousy is involved?
Posted 10/22/2023 3:32 PM (GMT 0)
Pretty shocking IMHO!
There's a story (with juicy details if you want to believe them) in the Washington Post.

https://www.washingtonpost.com/health/2023/10/22/johns-hopkins-jonathan-epstein-pathology/

I suggest, for the time being, that we stop recommending Johns Hopkins pathology (and Dr Epstein in particular) for second opinions...

Post Edited (Sr Sailor) : 10/22/2023 7:35:00 AM (GMT-8)

Posted 10/22/2023 4:04 PM (GMT 0)
I keep running into paywalls with links. The link below is open but also take with a grain of salt..

https://www.dailymail.co.uk/news/article-12658983/johns-hopkins-hospital-cancer-doctor-jonathan-epstein-suspended-misdiagnosis-wife.html

I might suggest the story is far from over at this point. This may make him human and not the god some make him out to be. None of it indicates that he is not technically competent nor his department at Hopkins.
Posted 10/22/2023 7:09 PM (GMT 0)
Wow, this is interesting. I've always been a big advocate of the second opinion on biopsy slides since I was hanging my treatment decision on it. I was diagnosed a G8 and my thinking was going with the triple play if I stayed G8, but having surgery in the event I was downgraded to a G7.

This clearly still needs to play out, but I guess nothing is as cut and dried as it seems.
Posted 10/22/2023 8:06 PM (GMT 0)

Sr Sailor said...
Pretty shocking IMHO!
There's a story (with juicy details if you want to believe them) in the Washington Post.

https://www.washingtonpost.com/health/2023/10/22/johns-hopkins-jonathan-epstein-pathology/

I suggest, for the time being, that we stop recommending Johns Hopkins pathology (and Dr Epstein in particular) for second opinions...

Actually, it might be a good place to ensure a pathologist will feel free not to go along with others on their team if they disagree.
Posted 10/22/2023 9:47 PM (GMT 0)
From the wapo article, my bold font.

Somebody said...
A prominent cancer-detecting doctor at Johns Hopkins Hospital is on administrative leave after a misdiagnosis led to a patient’s bladder removal , and as allegations have surfaced that he bullied or intimidated others in his department, according to interviews and an accreditation report obtained by The Washington Post.

The internationally regarded pathologist Jonathan I. Epstein has been accused by other doctors of pressuring them to give second opinions that agree with diagnoses made by his wife, who also is a pathologist, said four people who have knowledge of the situation and spoke on the condition of anonymity to discuss an ongoing probe.

In some instances, those people said, Epstein himself gave second opinions that agreed with diagnoses made by his wife. And in one such case, a man underwent a radical procedure to remove his bladder, only to have a post-surgery analysis indicate a different diagnosis according to the interviews and a report by the Joint Commission, a private, nonprofit organization that accredits hospitals.

Posted 10/22/2023 11:33 PM (GMT 0)
He does 10,000 biopsy pathologies a year and one turns up a problem. How ridiculous. Let’s just toss him out and then who is the next best? Any if you want to state by name who is the very very best at PCa biopsy by name and institution? Several years ago a similar movement took out John Bostwick. He was the first in the US that included DNA and genetic considerations and found himself in the wrong camp after some 40 years of being gold standard.

This is not good for any of us of us or the millions that follow us in the future, like our sons and grandsons. What is going on? You need to follow the money, not the allegations.
Posted 10/22/2023 11:35 PM (GMT 0)

Sr Sailor said...
Pretty shocking IMHO!
There's a story (with juicy details if you want to believe them) in the Washington Post.

https://www.washingtonpost.com/health/2023/10/22/johns-hopkins-jonathan-epstein-pathology/

I suggest, for the time being, that we stop recommending Johns Hopkins pathology (and Dr Epstein in particular) for second opinions...

I would respectfully disagree, there's little doubt that Epstein did not do all the second opinions himself, how could he? He may have signed off on them but I'm guessing the other pathologists in the department who look at Prostate slides are well trained. Of course its up to each individual how to proceed, and if you are not comfortable then don't recommend Hopkins Pathology.
Posted 10/22/2023 11:40 PM (GMT 0)
I still have high regard for Johns Hopkins pathology. I also have high regard for Epstein, if this is totally factual, which I have no reason to doubt, then ok, Epstein made a mistake and tried to "protect?" his wife. Maybe bad judgement. Maybe there's more to the story. None of us have any way of knowing for sure.

With that said, I would feel equally comfortable, going to MSKCC, NYU Langone, MD Anderson or any number of other nationally recognized cancer centers for a second opinion on pathology

Just my two cents
Posted 10/22/2023 11:47 PM (GMT 0)
No matter what, a 2nd opinion is wise to get from somewhere other than your own hospital, I think. The decisions to be made are too important not to.
Posted 10/23/2023 6:02 AM (GMT 0)
For purposes of full disclosure, my prostate biopsy slides sent to Dr Epstein's lab, matched the reading results from the local pathologist. I am in favor of using AI to read pathology slides and radiology films. There are fewer errors. See Dr. Eric Topol's book: "Deep Medicine: How Artificial Intelligence Can Make Medicine Human Again"
Posted 10/23/2023 10:42 AM (GMT 0)
Sometimes pathologists get it wrong. So what? I'm wrong on a regular basis. So is everyone else.
Posted 10/23/2023 10:42 AM (GMT 0)
Sometimes pathologists get it wrong. So what? I'm wrong on a regular basis. So is everyone else.
Posted 10/23/2023 11:49 AM (GMT 0)
Hal - you are not a former pathologist, are you?
Posted 10/23/2023 1:27 PM (GMT 0)
Nope
Chemist. Not retired yet (7 months but who's counting?)
Posted 10/23/2023 3:17 PM (GMT 0)
I see Hal is actually giving us his second opinion on his history of being wrong. The good news is that both posts result in the same conclusion. LOL 🧐😉
Posted 10/23/2023 3:45 PM (GMT 0)
A follow-up to Tim G's comment: "my prostate biopsy slides sent to Dr Epstein's lab, matched the reading results from the local pathologist."

I do something like that every year, re my PSA.

In September, I get my annual general purpose physical (CBC, lipid panel, comprehensive metabolic panel, etc. -- everything other than urological, basically) at my family doctor's clinic.

Then in October I meet with my urologist (just did) for my annual urology exam, including a PSA test.

However, during my annual exam in September, I also include a PSA test as a check on the PSA test I get in October.

It seems to work out. The September PSA test is done at the UF Pathology Lab on the University of Florida campus here, while the October one is done at a local Quest Diagnostics lab.

I have been doing this for several years now, and the results have always been consistent.

Never identical, of course, but close enough to be considered about the same.

For example, this year:

UF lab: 1.01
Quest: .96

(I'm a radiation guy, hence numbers not closer to zero).

In fact, another indicator that these tests are consistent is that the results from the UF lab have always been a little bit higher, but not by much, than the ones from Quest, as has happened this year.

This "double check" practice I have been following has made for some satisfaction on my part that my PSA for any given year probably is about what these two tests, together, say it is.
Posted 10/23/2023 5:38 PM (GMT 0)
All of this will moot in a few years when Artificial Intelligence will take over reading pathology slides and radiology slides. This scares the liver and a few other organs out of people, but it will be much more accurate than humans reading them, even experts like the good doctor Jonathan Epstein.
Posted 10/23/2023 6:47 PM (GMT 0)
A thought.

Slide reading and maybe PSA tests done in the future by AI imply use of some kind of machine-with-software, that does sample-reading-analysis-results-display in rapid sequence.

Likely done at computer speed?

So that results are displayed/printed out in just a few minutes following entry of sample into machine?.

And these machines would be available fur use in every clinic and uro's office?

How neat would that be if it ever becomes possible.
Posted 10/23/2023 6:59 PM (GMT 0)
Jack's mention of Dr. Bostwick got me to Googling, https://www.justice.gov/opa/pr/former-owner-bostwick-laboratories-agrees-pay-375-million-resolve-allegations-unnecessary

Bostwick subsequently left Bostwick Labs for a startup, then returned, then Bostwick Labs declared bankruptcy, then was acquired.

I was interested in Bostwick since that's where my biopsy was sent. When I questioned by urologist about getting a second opinion he told he that there were two expert labs in the USA, Bostwick and JHU (Epstein) and since my sample were already sent to one of the best there was no need for another opinion. 15 years out so far, so good...

In fact, in the old days of HW, we used to recommend either Bostwick or JHU and then we went to JHU only - I guess I now recall why. I'm thinking JHU is still a great lab even w/o Epstein but it does raise the question of whom I should recommend from now on. I'm thinking that Pratoman's advice to get a second opinion from a center of excellence might be the approach I will use.

Jim
Posted 10/23/2023 7:02 PM (GMT 0)

Tim G said...
All of this will moot in a few years when Artificial Intelligence will take over reading pathology slides and radiology slides. This scares the liver and a few other organs out of people, but it will be much more accurate than humans reading them, even experts like the good doctor Jonathan Epstein.

As scary as it may seem, Tim, I agree that AI will be the new Dr. Epstein. Like you, I follow Dr Eric Torpor, both on Twitter and on Substack. Very smart guy, and does a lot of commentary on Medical AI.
Posted 10/23/2023 7:04 PM (GMT 0)

81GyGuy said...
A thought.

Slide reading and maybe PSA tests done in the future by AI imply use of some kind of machine-with-software, that does sample-reading-analysis-results-display in rapid sequence.

Likely done at computer speed?

So that results are displayed/printed out in just a few minutes following entry of sample into machine?.

And these machines would be available fur use in every clinic and uro's office?

How neat would that be if it ever becomes possible.

Just a wild, uneducated guess... not in every Drs office, more likely in a central location, but with every Dr having the ability to transmit the samples electronically.
Posted 10/23/2023 8:17 PM (GMT 0)
I don't think the potential issue is that Epstein made a mistake (unfortunate, but understandable), but that he allegedly pressured people to make a specific reading that matched his wife's reading. I think this still needs to play out to see if he allegation is correct or not.
Posted 10/23/2023 9:22 PM (GMT 0)
I’ve always thought that for two pathologists to have exactly the same report, they have to have coordinated. There’s just too many ways to interpret things slightly different. That’s not a bug, it’s a feature.

JHU required a copy of my initial pathology review, which I thought shouldn’t be necessary. I guess all labs do this?

My G3+3 was upgraded by Epstein to G3+4, just a wee bit of 4. So it was different.
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