Ep 76-Nonconsensual Studies: Dr. Halikas and Marginalization of a Hmong Community

A patient walks into a hospital for help with opioid withdrawal, accepts a medication offered by a doctor, and later learns that dose was part of an experiment. That single shift, from treatment to research, is where trust can break for good.

This story  forces a bigger conversation about clinical research ethics, vulnerable populations, interpreters, and the power dynamics inside detox units. We explore how the sponsor-investigator role concentrates responsibility, how an IRB (institutional review board) is supposed to function as a barrier between scientific ambition and human rights, and why teach-back and community-engaged research are now seen as essential safeguards rather than optional extras. Trigger warning: substance use disorder, opioid withdrawal, medical experimentation, informed consent failures, and exploitation of vulnerable patients.

If you care about informed consent, FDA oversight, and what patients are owed when medicine turns into research, listen now, then share this episode and leave a review so more people can find the show.

Resources:

U.S. Food and Drug Administration

Commissioner’s final decision disqualifying James A. Halikas, M.D., from receiving investigational drugs, January 17, 2001.

U.S. Food and Drug Administration

Presiding officer’s detailed summary decision addressing the informed-consent violations, Halikas’s defenses, and the unresolved allegations involving language, coercion, and dosing.

Halikas v. University of Minnesota, 856 F. Supp. 1331 (D. Minn. 1994)

Federal court decision describing the GHB Opium Study, the University’s Institutional Review Board investigation, Halikas’s due-process arguments, and the court’s refusal to prevent dissemination of the investigation’s findings.

FDA Clinical Investigator Disqualification Proceedings Database

Public listing showing James A. Halikas as disqualified effective January 17, 2001.

University of Minnesota Clinical and Translational Science Institute

Information about SoLaHmo and community-driven research involving Somali, Latino, and Hmong communities.

Transcript

Cold Open And Soundboard Chaos

SPEAKER_03 0:42

Or not.

SPEAKER_00 0:45

Okay, let me grab that pop. Are you still recording?

unknown 0:53

Yeah.

SPEAKER_03 0:54

Oh, okay. That's fine. I'll just cut all this up. No, that's no, don't stop. I'll I'll keep going here. Let's see.

SPEAKER_00 1:03

I was like, oh shit.

SPEAKER_03 1:05

Why is that not working? I did. I thought I did. I mean, as long as we're burning airtime. Oh, wrong channel. Okay. Ready? One, two, three, go. Amanda.

SPEAKER_01 1:40

Hey hello. How the heck are you? Good. I um, so apparently her soundboard is fixed, which I'm sure she's gonna tell us about, but actually, I couldn't hear it, so I don't know if everybody else can.

SPEAKER_03 1:51

Maybe it's not. So ignore that if it doesn't turn out that we have our opening applause. But I I uh spent some time on my little machine. I don't know how it's gonna work out, but I think we have some applause back in our lives. And who doesn't need a little bit of applause?

SPEAKER_00 2:10

Applause, applause. Look for the applause.

SPEAKER_03 2:14

Yeah. And meanwhile, Amanda was trying to help me out. That was very blues clues again. Oh, it was. Oh, I was like, that sounds really familiar. Yes. All you parents out there remember blues clues and the clues. So how's it going with uh baby Ellie cat? Because last week I may have let the cat out of the bag, but I said, you know, we have family things, and then people were worried about you, and I was like, Oh no, it's just being beauty.

SPEAKER_01 2:49

I actually haven't listened to that episode yet. So Jenna texts me like people were worried about me, and I was like, Why? Like, very kind, but what happened? Yeah, no, we're fine. You weren't there any. My husband was out of state for work, so I had told Jenna that it was gonna be just tough to record, so you know, she she took care of it, so yeah.

SPEAKER_03 3:14

That's right. It's my job taking care of business.

SPEAKER_01 3:19

Second camera, but yeah, no, I'm thriving, baby's good, like we're all good. Just uh like uh I was just uh by myself. Actually, shout out to my mom. She came over to help me on bath nights, so I didn't have to do that whole routine by myself. So go because you know he's getting big, he likes to play in the bathtub now.

SPEAKER_03 3:37

Oh, he's a water baby, that's so fun.

SPEAKER_00 3:40

Oh, yeah.

SPEAKER_03 3:41

I used to love to get we had this massive thing of water toys, and then it was like at some point hard to get them to to say, okay, bath is over, the water's cold, you're turning into a little little human sausage. It's time to get out. They're like, Yeah, I want to play. You know, it's like, okay, I made it too fun.

SPEAKER_01 4:00

I read one time like why your fingers get wrinkly like that. And I don't remember the answer. It's something about like your body being submerged in so much water, so it's like preserving. I'm gonna look into it.

SPEAKER_03 4:11

Okay. I don't remember. Hey, that's neat. That's a great chart note. Future chart note. Pruny Prunie fingers, how do we get them? And why? Why? Because your body's so smart. Your body's smarter than our brains because we don't know why it happens.

SPEAKER_01 4:30

Yeah, I read that once. That file drawer is stuck open right now. I can't get it all the way. It's like something's jammed, you know, when you're like trying to get the drawer, like so. I'll have the drawer open by the next episode.

SPEAKER_03 4:42

Sounds good. All right. Well, in my area, I was I put a little note down to remember to tell everybody because I don't know if this is gonna be interesting to everybody. I hope so. But it's definitely something audiologists think about when our patients come for the first time to us and we are taking them a history and we're asking them, you know, noise exposure history in particular. People go, nah. Well, I mean, I shot a gun once and you're like, okay, so well, actually I go hunting. Okay, well.

SPEAKER_01 5:17

Yeah. And the story just evolves from there.

SPEAKER_03 5:20

And we always ask people, you know, okay, so you're a hunter or you use firearms, are you right-handed or

Gunfire Stories And Hearing Risk

SPEAKER_03 5:26

left-handed? Because if you have a difference in your hearing, it's usually the ear opposite to the hand you're using to hold the gun that is more exposed to the blast, right? So we expect maybe perhaps that that will be the weaker ear. So keeping this in mind, I had a patient recently, you know how I'm all about bears and the fact that there's a lot of them this year, apparently. So I asked this patient, you know, do you shoot firearms? And he was like, Yes. And I said, Oh, okay. So, like hunting or whatever. And he said, Well, I shoot, I shoot bears. And I said, Oh, okay. Are you right-handed or left-handed? I mean, I'm just going down my list. Yeah. And he goes, Neither. I said, Well, what are you shooting it with your feet? Like, we gotta be using something. He goes, No, no, no, no. I'm just shooting up into the air to scare the bears away. Bless his heart. I thought he was killing bears, but he they're just coming onto his property, so he shoots up in the air to scare him. I was like, I hope there's nobody else around. So then I was like, as an audiologist, I don't know. Are both ears exposed at that point?

SPEAKER_00 6:36

Should we I'm like, what's the head shadow effect when the bullet is going up into the air? Is your arm fully extended, sir?

SPEAKER_03 6:43

But also, yeah, do you favor one side? But also, like, where that bullet, what goes up has to come down. Like, are we worried about Do you do like shoot and go? Do you back up after this? Oh my gosh. So it just brought up a whole slew of internal questions, and it's just another delightful little segment, little tidbit from my life up north. So anyway, I thought I'd bring that up. But I do have a correction section. It's not to do with last week's episode, but a listener reached out and said, You know, I really like your podcast, but like, are you guys done or what? And I said, excuse me. And she says, Well, there's only 15 episodes. Do you have plans to do more? And I was like, What? We have 75 episodes. Well, 74 at the time. So she's like, Oh, I said, Where do you listen? She goes, Oh, well, something about data on her phone or something. Anyway, YouTube doesn't count against her data or something. So she's been listening on YouTube. So I go to our account and I forget we had a count there, so I go there. Someday we might need to do a little video or something,

The Missing YouTube Backlog Fix

SPEAKER_03 7:50

something. Because we have listeners on YouTube. Did you know that? I did not. Yeah. So I go on there and I'm thinking, sure enough, there's 15 published episodes. And I thought, what the heck? So I go through all my settings. Yeah. And it apparently af on episode 16 onwards, it went into like a private audience only mode or something. So I just had to change some settings. So now it's public. So if you think we've only got 15, whoo, you got a backlog. So have at it and thank you. Yeah, happy listening. Thank you to the listener. Her name is Crystal for letting us know. Because that would have gone into eternity without me realizing. So so there we go.

SPEAKER_01 8:32

Yeah, I don't YouTube, so you would not have known.

SPEAKER_03 8:35

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Sponsor Break And Candle Air Quality

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SPEAKER_01 10:16

I'll just do a quick plug for HVAC folk out there. My husband always tells me, I can tell when you've been burning candles more because the filter is black.

SPEAKER_02 10:26

Oh, okay.

SPEAKER_01 10:27

So I thought that was an interesting point. Yeah. That these don't compromise air quality because truly the others do. You did like you're not seeing black smoke, but they do turn the air filters black.

SPEAKER_03 10:39

Oh wow. All right. Well, insider insight from yours truly, Amanda Dr. House. Thank you. So this episode today is based primarily on public records from the United States Food and Drug Administration and a published federal court decision involving the person we're going to talk about, Halakis, and the University of Minnesota. The FDA proceeding was administrative, not criminal. So we're going to distinguish carefully between what the FDA formally found, what investigators alleged, and what the agency ultimately chose not to decide. The remaining sources are going to be cited as usual in our show notes. So trigger warnings, this episode discusses substance use disorder, opioid withdrawal, medical experimentation, failures of informed consent,

Trigger Warnings And The Case

SPEAKER_03 11:30

exploitation of vulnerable patients, and allegations involving coercion in clinical research. So, Alley Cats, we're going back to the University of Minnesota in the early 1990s to a chemical dependency treatment program, an experimental medication, and nine Hmong patients who entered a hospital looking for help with opiate addiction. The psychiatrist directing the study was Dr. James A. Halicus. He was not an obscure physician working at the edge of medicine. He was a tenured professor at the University of Minnesota Medical School, the director of its chemical dependency treatment program, and a researcher with roughly two decades of experience, which just takes me back to my last episode where we talked about the other dude, Abu Zahab, who also wasn't on the fringe. He was somebody who was highly published, highly acclaimed, had respected positions in within his field. So here we go. Here's another one. At the same place. At that same place. I know. So the drug we're talking about was gamma hydroxybuterate, which is known as GHB. But this story isn't really about GHB. It's about the moment when ordinary medical treatment became research and whether or not the patients understood, the line had been crossed. Years later, the Food and Drug Administration concluded that legally effective informed consent had not been obtained from five of the nine participants, and three more signed consent forms only after they'd already already received the drug. So that's five without legally effective consent, and three whose consent came too late. And this is eight out of nine subjects. But before there was an FDA order, before the court filings and the arguments over regulations and responsibility, there was simply a patient trying to stop using opium. We don't know his name. The public record protects his identity as it should. We don't know his age or how long he lived in Minnesota and how his addiction began and what finally persuaded him to seek treatment. We only know that he was Hmong and that he entered the University of Minnesota's chemical dependency treatment program and that he was given an experimental medication. I mean, imagine the setting. You're sick, your body's demanding a drug that you're trying to stop taking, you're sweating, aching, restless, nauseated, unable to sleep, and desperate for relief. You enter a large American medical institution where nearly everyone seems to know more than you do. A physician offers you medicine. Perhaps someone says it will help you with your withdrawal symptoms. Maybe there's an interpreter nearby. Perhaps the explanation is brief because the unit's busy and everyone believes that the details have already been covered. So you take the medication because that's what patients do in hospitals. You trust your doctor, you trust a university. You may not realize that the medication is not simply treatment. You may not realize that the dose is part of a research protocol. You may not realize that the physician is collecting information about what happens to you. Years later, according to the FDA's account, one participant said that he'd never been told he was part of a drug study. He knew he was receiving medicine, but he didn't know that he had become a research participant. So that single distinction between receiving treatment and volunteering for research is the center of this entire case. To understand why the FDA treated these patients as particularly vulnerable, we have to step back from the hospital and look at the history that brought many Hmong families to Minnesota. The Hmong are an ethnic group with roots in the mountainous regions of Southeast Asia. During the war in Laos, which ran alongside the Vietnamese War and remained hidden from much of the American public, many Hmong people assisted U.S. operations. They gathered intelligence, they rescued downed American pilots, and fought communist forces along the Ho Chi Minh Trail. When the United States withdrew, families who'd supported American forces became targets for retaliation in their home country. Many had to flee

Hmong History And Medical Vulnerability

SPEAKER_03 15:38

through the mountains and cross the Mekong River into refugee camps in Thailand. Some spent years in those camps before they were able to resettle in the United States. Minnesota eventually became home to one of the largest Hmong communities in the country. By the early 1990s, Hmong families were building lives in Minneapolis and St. Paul while carrying the consequences of war, displacement, persecution, family separation, and resettlement. I mean, that's so much trauma. I can't imagine. They were also navigating institutions that were often poorly equipped to communicate across language and culture. American medicine depends on forms, technical vocabulary, individual signatures, scheduled conversations, and the assumption that patients will interrupt when they don't understand. But that assumption is fragile. Even when a doctor and patient speak the same language. And I know I've spoken about this with my mother before, how in England she was raised like you don't question a doctor's authority, you know, how dare you? Who do you think you are? So even when you speak the same language, there's a barrier there. But it comes, it becomes even more fragile when the patient's relying on an interpreter. And when medical research is unfamiliar, they don't even know what that means, or when respect for physicians makes direct questioning feel uncomfortable. So this doesn't mean that Hmong patients were incapable of informed decisions. It means that the institution had a greater responsibility to make those decisions possible. Vulnerability should trigger more care, not lower expectations. By the time these patients entered the university program, James Halicas had already built the kind of resume that commands trust. He was a psychiatrist and a tenured professor at the University of Minnesota Medical School's Department of Psychiatry. He directed the chemical dependency treatment program. His work focused on addiction treatment, medical education, and drug research. According to the FDA, he had 20 years of clinical research experience and served as principal investigator on 21 studies. He also served on a university committee dealing with the use of human participants in research. I mean, in other words, this wasn't a physician discovering informed consent rules for the first time. He was well familiar, he worked inside that system that created, reviewed, and enforced them. So in this study, his authority was unusually concentrated. The FDA described him as the sponsor and the principal investigator. Usually those are two different people taking on those two different roles because the sponsor initiates and oversees the investigation and then the principal investigator conducts it. But Halakus had both roles. Other members of the team could perform tasks. I mean, there was a coordinator that managed forms, a nurse administered medication, there were interpreters that could translate, a resident could speak with a patient, but the delegation didn't move the final responsibility because the prior, the principal investigator was responsible for ensuring that the study followed the approved protocol and that legally effective consent was obtained before the first research intervention. What makes the case more troubling is that Halicus already identified the danger. In correspondence with the FDA, he described the Hmong population that he hoped to enroll as having limited English comprehension and limited acculturation and vulnerable to intimidation by Western authority figures. He recognized the imbalance before he even began recruiting them. He knew these patients might be reluctant to question physicians, and I would say were likely reluctant to question physicians or challenge a major institution. So that recognition should have produced an unusually careful consent process, but instead, it later became part of the evidence that he understood exactly why care was necessary. Every medical scandal begins with someone believing that they found an answer to something. For Helicus, that answer may have been gamma hydroxybutyrate. Today, most people know GHB through stories of recreational intoxication, overdose, and drug-facilitated sexual assault. But that later reputation can obscure why a physician might once have considered it a legitimate subject of medical research. GHB is a central nervous system depressant. It's been investigated as an anesthetic, a sleep medication, and possible treatment for alcohol dependence and withdrawal. A pharmaceutical form of sodium oxibate is used today under tightly controlled conditions for certain sleep disorders. In the late 1980s and early 90s, however, the drug occupied an unstable space between medicine and the recreational market. Reports of poisoning and loss of consciousness were increasing, while researchers continued to ask whether the same sedating and neurochemical effects might have therapeutic value. Halicus initially submitted an investigational new drug application involving alcohol withdrawal, but that project wasn't initiated. He later amended the application to propose a phase one open label dosing study involving Hmong patients with opiate addiction. So a phase one study is generally concerned with safety, tolerability, and dosage. Open label means that the researchers and participants are not blinded to which drug is being given. They're given full disclosure. A dosing study involves adjusting the amount and observing what happens. So the description sounds clinical and controlled, but it also reveals why informed consent was indispensable. These patients weren't merely receiving a standard med selected from accepted treatment protocol. Their responses are going to help answer a scientific question. So the uncertainty was part of the study itself. Informed consent is often reduced to a signature. In a busy clinic, the form can start to look like one more thing to sign here, date there, place the document in the chart and move on. But the signature isn't the consent, it's the evidence that a process was supposed to have occurred. So real consent is a process of explaining what's being proposed, why it's being proposed, what is known, what remains uncertain, what alternatives exist, and what will happen if the person says no. And that last part matters enormously in a treatment setting. A patient who agrees to enter a detox program has not automatically agreed to participate in research. A patient that accepts meds isn't hasn't automatically agreed to help test them. A general

GHB And The Treatment Research Line

SPEAKER_03 22:12

hospital bill of rights is not a clinical trial consent form wearing a different title. Patients are trained by the structure of medicine to cooperate. They arrive when they're told to. Hopefully, not always on time, but yeah. They answer intimate questions and sometimes obnoxious questions. I mean, the amount of questions that we have to ask people is a crazy. It's crazy and sometimes intrusive.

SPEAKER_01 22:36

I understand why, but like then they veer off into a whole different bucket of worms. We didn't also need to go there either. But yeah, some people are very open.

SPEAKER_03 22:48

So they hold out an arm when they need an injection or a draw or lab draw. They swallow the pill they're offered. And in ordinary care, that's the cooperation that keeps moving, turning and burning. But in research, that behavior can be dangerously misread as permission. So the researcher has to stop and ask a separate question. Do you understand that this is an experiment? And do you choose to take part of it? The question must be understandable. The answer must be voluntary. And it must come before before. I mean, I can't believe we're talking about this, but apparently we need to. It must come before the experiment starts.

SPEAKER_01 23:26

Because once exactly right.

SPEAKER_03 23:31

Duh, Dr. Halagas. Once the first research dose has been administered, there's not a signature that can travel backwards in a time machine and authorize it. So okay. Calm down, Jenna. I get mad. This study began in rolling Hmong patients in June of 1993, and nine people ultimately entered the protocol. The public record doesn't give us a cinematic moment where someone opens a drawer and discovers the nasty truth. What it gives us is a trail of charts, staff statements, correspondence, interviews, and missing forms. So for the first five participants, there were no signed research consent forms. Halakist argued that missing paperwork did not necessarily prove missing consent. In theory, he was right. A discussion might have occurred and simply gone undocumented. The regulation required legally effective, informed consent, not merely a piece of paper. So the FDA looked beyond the empty spaces in the files. Investigators reviewed Halicus' statements and letters. They considered information from employees in the chemical dependency treatment program. They examined what could be established about the patient's actual experiences. The evidence did not reveal a robust oral consent process that had simply failed to make it into the chart, as I'm sure Halakas hoped. According to the FDA, program staff confirmed that informed consent had not been obtained from the first five participants. One participant reportedly said he'd never been told that he was part of a drug study. The next three patients eventually signed forms, but only after they already received one or more doses of the investigational drug. By the time the signatures appeared, the research had already started. So whatever those patients later agreed to, you can imagine the bias and the caution that even well-intended people would probably pressure these patients into agreeing. But anyway, they couldn't consent retroactively to what had already been done. Five patients without legally effective consent, three more whose consent came after dosing. The significance is not merely that eight forms were missing or late. Eight separate decisions that belonged to eight separate people were not protected before the drug was administered. As FDA investigators continued interviewing people who worked inside the chemical dependency treatment program, the problem began to look larger than just a handful of missing forms. Investigators wanted to understand how a study involving nine participants could move forward without anyone stopping to ask whether research consent had actually been obtained. Experienced physicians, nurses, trainees, counselors, and other staff members have been working around these patients. If the absence of consent was simply a clerical mistake, someone should have noticed it and quickly. According to interviews summarized in the FDA records, several staff members described an environment in which the GHB project was not consistently presented as research, requiring a separate consent process. One program leader reportedly recalled Halicus describing the project as an open trial for which informed consent was unnecessary. Another staff physician told investigators that Halicus had characterized the substance as something like a vitamin that was openly available in Europe and suggested the ordinary hospital consent process was enough. A medical student reportedly said the drug wasn't presented to the patients as experimental and that treatment alternatives were not offered or explained. A fellow described directly asking whether consent was needed and receiving the impression that routine hospital paperwork was considered sufficient. And I had a little giggle there because I said a fellow, and so I'm not like an old-timey person referring to a male. This was like doctor on his residency. Anyway, so these were accounts provided during an investigation. Even with that caution, the statements help explain why the same failure could happen repeatedly. The problem may not have been that one person forgot to place a completed form in the chart. Several people appeared to have understood that research-specific consent wasn't required at all. So that distinction changes the nature of the case, because a misplaced form is a weak doc it suggests weak documentation and maybe a systemic problem, but a shared belief that no separate consent was necessary shows that the failure began before the patients ever received drugs. It began with the way the project was described to the people expected to carry it out. So if members of the treatment team believed they were providing an ordinary therapeutic option rather than administering an investigational drug under a research protocol, obviously they would have little reason to stop the process and ask whether each patient knowingly volunteered. So ultimately, the FDA placed responsibility on Halicus because he was the sponsor investigator. He designed and oversaw the research, and he was responsible for ensuring that everyone working under him understood where treatment ended and research began. The staff interviews did not merely fill in gaps in the charts. They offered a possible explanation for why the line between care and experimentation became so blurred throughout

Missing Consent And Team Confusion

SPEAKER_03 29:08

the program. So the study didn't continue indefinitely. In August 93, a member of the university's medical faculty raised concerns in writing. And I could I tried to figure out who this was, but bless them because the the study started in June.

SPEAKER_01 29:24

So I mean I was gonna say two months only, at least.

SPEAKER_03 29:28

Yeah, yeah. Who knows how many more could have been affected by this? So this letter questioned whether informed consent forms had been signed and raised concerns about coercion and whether patients have been offered standard methadone treatment to come off of opium. The letter was forwarded to the university's institutional review board and Halakis received a copy. So soon after he stopped his study and formally

IRB Concerns And The Study Stops

SPEAKER_03 29:52

notified notified the IRB of the fact that he canceled it. So stopping the study was absolutely correct and should have been the immediate response that it was. But it prevented more because it prevented more patients from being enrolled under the same conditions, but it couldn't return the earlier participants to the moment before their first dose. The medication had already been administered, the data had been collected, the decision that should have come first was already bypassed. So the university's institutional review board began to investigate. An IRB is supposed to serve as an independent barrier between scientific ambition and the rights of participants. It reviews risk, recruitment, consent, and protections for vulnerable populations. It can also suspend a study when something goes wrong. The inquiry expanded beyond the missing forms. It examined language access, possible coercion, whether methadone had been offered, and whether the dosing regimen departed from the approved protocol. The university eventually suspended Halakus' human subject research and notified the FDA. Federal investigators started their own inspection in October of 1993. The university investigation didn't proceed quietly. Halicus argued that the process was unfair and that the university publicly damaged his reputation before giving him a meaningful opportunity to challenge the evidence. And I know I'm supposed to be professional here and report just the facts, Jack, but I imagine him going, no fair. That's so unfair, man. A little worm. I don't like him. Anyway, he objected to the use of testimony from multilingual counselors that he said had not actually interpreted during the GHB study, and he maintained he hadn't been allowed to confront or qu question certain witnesses. He argued that the institution announced the investigation prematurely and then refused to provide the legal support that he believed should be available to a university researcher facing federal scrutiny. In 1994, he took the dispute to federal court. He asked a judge to stop the university from distributing the IRB's conclusion to require a retraction and reimburse his legal expenses.

SPEAKER_01 32:13

Oh wow.

SPEAKER_03 32:15

Ooh, the cojones on this dude. So, I mean, we shouldn't dismiss those arguments just because the consent findings were serious. I mean, institutions have been known to conduct flawed investigations, and universities have reputations and liability to protect. So a physician accused of misconduct is still entitled to a fair process. But Halicus was asking the court to prevent a public university from communicating the results of an investigation involving vulnerable research participants. So the judge rightly refused, in my opinion. The rightly was my opinion. He did refuse. The court concluded that Halicus had not shown a sufficient likelihood of success and emphasized the university's responsibility to protect human subjects. Thank you, University, Minnesota.

SPEAKER_01 33:06

What a concept.

SPEAKER_03 33:07

The lawsuit reveals the imbalance at the center of the story, though. I mean, Halicus had lawyers, the university had committees, council, public relations. Patients had neither of these, none of these things. The dispute became a contest between a tenured professor and a major institution, but the people whose consent was missing, well, they remained anonymous. When the FDA presented its case, Halicus didn't deny that signed forms were missing for the first five patients. He challenged what that absence meant. He argued that other members of the treatment team would have discussed the study. I mean, there were physicians, residents, nurses, counselors, social workers, and interpreters that were involved in the patient's care. The team met regularly. The Minnesota Patients' Bill of Rights was part of the admission process. Patients would have received information. They would have been asked whether they wished to continue. But that repeated phrase was some version of would have. I mean, the FDA want to know, well, I don't want to know what would have, what actually happened. Who spoke with each patient? What did they say? Was the dug the drug described as investigational? Was the person told this was research? Did they explain alternatives? Did the patient understand that saying no would not automatically end all treatment? Well, who was which interpreter was present? Did anyone verify comprehension? Did the conversation occur before the first dose? Not surprisingly, Halicus did not produce statements from the relevant staff members showing that these specific discussions had occurred. General procedures could not prove a patient susp suspicious. I just want to say suspicious. Patient suspicious, they should be suspicious before they consent. But it didn't prove a patient-specific consent process. Evidence that staff usually talked about medications didn't prove that the patients understood they were in a study. The FDA also rejected the idea that responsibility had shifted to other members of the team. I mean, tasks could be delegated, but accountability could not. As sponsor investigator, Halakis remained responsible for ensuring that legally effective consent was obtained before the investigational drug was administered. Language was another major concern. The few consent documents that were actually used in the study were written in English, even though some of the Hmong participants could not read English. Interpreters or bilingual staff appeared to have been involved in the treatment program, but investigators couldn't establish that each patient actually received a complete explanation of the research in a language that they understood. In fact, in one of Halakas's own letters, he referred to a consent form that wasn't even understood by the interpreter. The FDA eventually brought a separate charge, alleging that four Hmong participants had not been provided consent information in understandable language or through a suitable interpreter. But now, let us break. It's time for a why'd you why'd you crap out on me?

SPEAKER_01 36:10

Was it that bad? I could hear both the notes we were producing and they did not go together.

SPEAKER_03 36:15

Isn't that the point? Aren't we the Ellie cats for a reason? Welcome to the chart notes segment where we hurt your ears before we step away from the misconduct and look at what's changing in medicine and healthcare. So before we start, I want to invite listeners to revisit episode 40, which is the episode where I covered Dr. Robert Liston, who was a surgeon in the early 1800s. Do you remember his career started before there was any anesthesia? So he was known for his speed, and speed was important when you're conscious and your leg is getting chopped off. I'm sorry, amputated. So surgeons of that time period knew something about the, I know you were trying to forget about that episode, weren't you? It's pretty grisly. But I mean, if there wasn't any anesthesia and you were gonna die or lose your leg, you want them

Chart Notes On Real Understanding

SPEAKER_03 37:06

to be fast, right? And so consent was pretty much like, okay, well, the patient's screaming, so you know, they're still alive or they're in pain. But the emergence of anesthesia in the mid-1800s, the mid-1800s brought with it an ethical dilemma that hadn't been an issue before. Because while the patient was asleep during a surgery, they couldn't react or provide feedback. And so this led to the development of the concept of pre-procedure consent. So go back and listen to that episode if you have the stomach for it. Today's chart note is directly connected to the Halicus case, the move from simply translating consent documents toward building genuine understanding and community partnership. Modern research programs increasingly use professional interpreters, translated short-form consent procedures, comprehension checks, community advisory boards, and teachback methods. Teachback doesn't mean asking, do you understand? Because patients will say yes, because obviously they're embarrassed, intimidated, eager to cooperate, or they're afraid that admitting confusion will delay care. So instead, the researcher asks the person to explain the study in their own words. Why is this medication being offered? Is this ordinary treatment or research? What happens if you say no? Can you stop later? Will refusing the study affect your regular care? Those are the questions that reveal whether information was actually understood. Researchers are also paying greater attention to community engaged research. One Minnesota example is Solomon, the Somali, Latino and Hmong Partnership for Health and Wellness, which has worked to involve community members in identifying research questions, shaping methods, reviewing recruitment language, and deciding how findings should be shared. Community engagement doesn't replace individual consent. No community leader can volunteer another person for a study, but community participation can expose language that sounds threatening, assumptions that do not translate, historical reasons for mistrust, and recruitment methods that create pressure. Good research does not treat consent as a form standing between the investigator and the data. It treats consent as an ongoing conversation with the human being whose participation makes research possible. So years after the university study, Halicus continued working in clinical settings. And we received, we, Doctoring the Truth, received a firsthand recollection from a former former social worker who says she worked with him at a small clinic during the late 90s, where he served as I know, right? Where he served as a contract psychiatrist. Her account isn't part of the FDA findings, and it shouldn't be treated as independent proof of the regulatory violations that we discussed. But it is fascinating because it's a former colleague's memory of what it was like to work around this guy. And it's pretty rare that we have a listener right in, like firsthand experience. So anyway, the the email starts, dear Jen and Amanda. When I listened to last week's

A Colleague’s Account Of Halicas

SPEAKER_03 40:16

episode about the nefarious psychiatrist from University of Minnesota, I was totally expecting you to cover Dr. Halicus. What an absolute shock to the system that there were more than one unethical psychiatrist employed by the same university. I thought I'd write in because I have a hunch you're going to cover him next. Well, you are right. She goes on to say, I knew Dr. James Halicus in the late 90s when he and I worked for a small clinic together. I was a social worker for this clinic, and James Halicus was a contract psychiatrist. Compared to the other psychiatrists, he was odd. The rest of the providers had their respective day of the week that they would work, but Halicus came every two weeks. In a small clinic, the doctors, nurses, office staff, and social workers mingled and met to discuss clients, as those of us who were out in the community saw these clients weekly. Dr. Halicus was not a mingler of sorts, but rather a comment dropper as he walked through social worker space to and from his office. He could not remember any of our names and routinely acted like he was meeting us for the first time. I hate that.

SPEAKER_01 41:21

That's so annoying.

SPEAKER_03 41:24

For instance, we would stand in the doorway of his office and ask to discuss a client. He was cordial enough, but every time he would ask us what our name was. This guy sees us every two weeks and maybe even every week, but still can't remember that he ever met us before.

SPEAKER_01 41:41

I mean it's also like equally annoying when people have to like reference your name tag. But I'm like were they wearing a name tag? Could he at least cheat and like look at a name tag?

SPEAKER_03 41:52

I think he was above being subtle. Anyway, I I mean this is allegedly, allegedly. So the writer goes on to say, I knew Dr. Halicus fairly well, in my opinion. I was a senior social worker and had been in the clinic the longest in my department. He would walk through the social workspace multiple times a day and make comments about the conversations that we were having amongst ourselves. Listening in on someone else's conversation is pretty tacky, but to weigh in on a conversation that he wasn't part of was pretty rude. Dr. Halicus obviously said sorry, this sentence cracks me up. Dr. Halicus obviously felt he had great contributions and shared them indiscriminately and often. My favorite encounter with him was very revealing. This happened to me while I was discussing with a coworker a drama that one of my clients was having. While client drama isn't funny, the events surrounding it are often humorous. After all, us healthcare providers rely on lovity every so often. It helps avoid burnout and can bring much-needed comic relief to an emotionally draining job. I get that. So I'm sharing over-the-top drama that my client's having, and I'm talking to my coworkers when Dr. Halicus goes walking through the area on the way to his office. He's listening in and he weighs in that I need to be on an antidepressant for my mood. Wow. I don't have a mental health disorder diagnosis and have never had one. So I said back to Dr. Halakus that I didn't need to be on an antidepressant since I didn't have depression. And he said, Well, then I needed mood stabilization.

SPEAKER_01 43:32

Jeez, guy.

SPEAKER_03 43:34

He couldn't remember my name on any given day. He had no idea what I did, who I was talking about. But he can tell that I need my moods regulated. Dude. Most days we all just took the crap that he dished out and waited for him to walk out so we could make faces and roll our eyes at each other about how weird he was. But I didn't feel like taking his snide egotistical comments that day. The only person go, Queen. The only person who had a problem with my mood was him. So I told him, with all due respect, I don't come to work from my own mental health assessment. And I certainly don't need you to tell me I need medication without even so much as an armchair diagnosis. If I wanted your advice, I'd ask for it. Get it, Sess. He grunted and walked on. So two things happened shortly after that encounter. He was busted by the University of Minnesota for prescribing investigational drugs to Hmong and Laoshin patients who didn't speak English and had no interpreters. Gone were the days of the nice young social workers engaging him in conversation over the all expense paid trips to Greece that. He frequently took for him to educate Grecian doctors on the benefits of whatever medication company he was working for. His satisfaction amongst patients was dropping, and the clinic could not keep patients willing to see him. So you can probably tell I'm not a big fan of Halicus. I found him to be an arrogant jerk who made real doctors look bad. He preyed on patients who were too ill to advocate for themselves. Tell us how you really feel. No, I love it. Stay safe and stay suspicious of sleazy psychiatrists. Love Anonymous.

SPEAKER_01 45:15

Thank you so much for sending that in. That's so cool that we have a firsthand account of this guy.

SPEAKER_03 45:20

Absolutely. And you know, there is there are some qualifiers. I mean, her I love it. I love that she shared her experiences and, you know, it it it gives us a little flavor of what it was like a day in the life to work with him. But uh to be fair, other coworkers might have had different experiences. So we don't have personnel records or independent witness accounts that would allow us to evaluate every part of her description. I did search for documentation that a pharmaceutical company paid for all expense travel or that those trips involved an improper exchange, but I couldn't verify that allegation through the stuff, the research that I have from the FDA decisions, et cetera. So I'm not presenting the Grease story as an established fact, but even if industry-sponsored travel occurred, that alone doesn't prove a kickback, the ethical and legal significance would depend on who paid who paid, what was disclosed, what services were provided, and whether anything was offered in exchange for prescribing referrals, study enrollment, or favorable research conclusions. So that remains open-ended. And again, I included this email because personal recollections add texture to a story without carrying the same evidentiary weight as a court decision or regulatory finding. But back to the story. Regulatory violation alone wasn't enough for the FDA to disqualify Halicus. They also had to determine that the violations were repeated or deliberate. And of course, Halicus winged and argued that repeatedly should mean misconduct occurring across more than one study. And the FDA said, uh-uh, if the term required multiple studies, then any investigator could violate the same protection again and again within a single protocol and still argue that conduct wasn't repeated. So every patient represented a separate obligation. Each first dose was a separate point at which someone could have stopped and verified consent. So five without legally effective consent and three more without timely consent was

FDA Disqualification And Reckless Disregard

SPEAKER_03 47:26

not one mistake. This was repeated conduct and met that definition, but deliberately required more explanation because the FDA did not find that Halleck has set out to injure Hmong patients or that he wanted them to suffer. Instead, the agency concluded that reckless disregard could satisfy the regulatory standard. So the decision returned repeatedly to his experience. This guy had 20 years in clinical research, 21 studies as principal investigator, service on a committee that was concerned with human rights with human subjects, and prior recognition that the intended participants could be vulnerable to language barriers and Western authority, which he said himself. These credentials had given Halicus professional authority. They also made the failure harder to explain as an innocent misunderstanding. He obviously knew what he was doing. So the agency concluded that he acted with reckless disregard for the patient's right not to participate without first giving legally effective consent. So that's a significant finding. It protects ownership of the decision. A person can survive an intervention without lasting medical harm and still experience a profound violation if someone else decides their body's going to be used for research. So the FDA initially pursued five charges, but the final disqualification rested on the first two: the absence of legally effective consent for five participants and the failure to obtain consent before dosing three more. The third charge raised concerns about whether information had been presented in language that they could understand. But the FDA chose not to decide that charge because they'd already met the criteria for disqualification. And the same thing for the fourth charge of coercion and the fifth charge of changing the dosing regimen. He'd already met the criteria for disqualification. I'm probably not going to be able to cut out that noise, but my corgi has decided to have a little episode of zooming and back rubbing on the couch. Can you settle down? Lie down.

SPEAKER_01 49:44

Thanks for coming, Winnie.

SPEAKER_03 49:47

And one more thing. At least one participant received more GHB than the maximum amount permitted by the approved protocol. She tried to jump on the couch and she wasn't long enough or tall enough to get on there.

SPEAKER_00 50:06

Short legs, sad. Yeah. You are corgi, okay? Lie down.

SPEAKER_03 50:11

During oral argument, Halakas' attorney acknowledged that at least one participant received more GHB than the maximum amount permitted by the approved protocol. The court treated that departure as significant. I mean, he overdosed somebody, especially in a study where participants didn't even understand they were receiving investigational drugs. So we don't know if that patient suffered an injury and the FDA didn't issue a final ruling because I don't know. I don't know if I agree. I feel like they should have got through all the charges and maybe something more drastic could have been done. But anyway, he'd already been disqualified. So we can't say the FDA found that he deliberately overdosed patients or that he proved coercion. But the first two findings were strong enough without turning unresolved allegations into verdicts. So by the way, the FDA investigation began in 93, and the final decision didn't arrive until January 17th, 2001. Oh, wow. I know. So during those years, the case moved through inspections, written responses, motions, findings, legal arguments, administrative review. Halakis requested hearings. Administrative due process matters. I mean, he needed, he was a physician facing a major professional sanction. So he he needed to be allowed to review allegations and present a defense, but the delay carried its own cost. By the time the FDA issued its final order, the patients had lived for more than seven years, with whatever consequences followed the study. The public record doesn't tell us whether they received an apology or anyone explained the investigation to them, whether they were offered independent follow-up, or whether they were involved in changing the university's research procedures. FDA Commissioner Jane Henney concluded the helicopter had repeatedly, deliberately violated federal informed consent requirements, and he was disqualified from receiving investigational drugs. I mean, it's kind of like anti-climax, but it was like the most they could do. It was a specific sanction, not a criminal conviction. So it didn't automatically revoke his medical license. It just restricted his participation in FDA-regulated investigational drug research. So this narrowness illustrates how fragmented medical accountability is. The FDA oversees investigational products. A state medical board oversees the license. A university controls employment and research privileges. Hospitals control clinical privileges. Each authority sees a different part of the professional life. There's no quarterback like bringing it all together. But you know what? Patients don't experience those divisions. Patients aren't lucky enough. They get one doctor and one institution. The system divides responsibility into lanes, and the patient's the only one who has to travel the entire road. One of the things that stayed with me long after I finished researching this case wasn't the legal argument or regulatory definition. It was the realization that I knew almost nothing about the nine people whose lives made the entire investigation possible. I learned way too much about James Hallicas from the public record, from our friend listener who wrote in the university, the attorneys, the regulars. They were all in the historical record. Every institution produced letters, findings, motions, decisions, explanations. But when I try to determine what happened to the nine Hmong patients, the story just drops. The available records don't tell us whether they recovered, whether they relapsed or remained connected

The Patients Vanish Into Paperwork

SPEAKER_03 53:38

to treatment. They don't tell us whether they had side effects like drowsiness, vertigo, nausea, sedation, or other effects from GHB. They don't identify anyone who suffered a permanent injury, required intense medical treatment, or died because of the study. So I found no reliable public report of a participant's death or a later injury lawsuit, but that doesn't mean that there weren't adverse effects. It just means the documents that survived don't follow the patients. We also don't know whether the patients were told what the university and FDA eventually concluded. The record doesn't explain whether anyone sat down with them in a language they understood and told them that investigators believe the consent process had failed. It doesn't tell us whether the university apologized or independent follow-up care was offered. The only direct glimpse we receive is a short statement attributed to the one participant that I mentioned earlier. And according to the FDA, he said he'd never been informed that he was participating in a drug study. That single sentence briefly restores a human voice to a record otherwise dominated by institutions. He knew he was receiving medicine, but he didn't know that the medicine was part of an experiment. And after that his statement, his voice disappears again. The public record tells us what happens to Halakha's research privileges. It tells us how the university defended its investigation and how the FDA interpreted the governing regulation. And as I said, it doesn't give us a meaningful ending for the patients, unfortunately. They entered the story through their bodies and disappeared into paperwork. And that absence should remain part of how this case is remembered. A vulnerable population should not be seen as an available population or a convenient population. The people who make research possible are not merely the evidence used to discipline a professional afterwards. They're the reason the protections exist in the first place. One of the strangest turns in the story came years after Halicus's study ended. GHB didn't disappear from medicine. In fact, in 2002, just nine years after the U of M study began, the FDA approved sodium oxibate, the sodium salt of GHB under the brand name Xyrum. Today, oxybate medications are legitimate prescription drugs used to treat narcolepsy, including cataplexy and excessive daytime sleepiness. And one formulation is also approved for idiopathic hypersomnia. So Halekus wasn't necessarily wrong that GHB might have legitimate medical value. What never received FDA approval was the use that he was studying in particular, treating opioid withdrawal or opioid

When GHB Returns As Oxybate

SPEAKER_03 56:18

addiction. And none of GHB's later medical successes changes the fundamental problem in his study. A promising drug still has to be studied ethically, and an experimental treatment still requires the patient's informed consent.

SPEAKER_01 56:48

Maybe I guess what I was thinking the whole time is now you have mentioned it. I just wanted to know about the people. You know, did anyone ever die? What happened? Where are they? How are they doing? Did it help? Did it make things worse? Like that stinks that we still have all those good questions. Yeah. Like you said, it it started with the humans, but they got lost in the paper trailer. However, you had said that. So the story started with their bodies and disappeared in the paperwork. That's sad. Yeah. I love that we have the firsthand account of Halicus. Because I I was kind of thinking right away, like devil's advocate, maybe of okay, well, I mean, he didn't get consent form, but like you said, there were all these other people like that could have confirmed. Did we do this? And you know, moving through the process of it. And then I'm like, No, because you held the seats of the PI and the uh I'm failing the other word. Principal, investigative. Investigator, and the sponsor, sponsor. Yeah, sponsor, sponsor. Like it's your responsibility.

SPEAKER_03 57:59

Yeah. He wanted so basically there should be checks and balances, but he took over like the executive branch and the yeah. Yes, yes. He was the judicial branch and the executive branch of this particular tiny little government and didn't communicate with his people.

SPEAKER_01 58:16

So he's like, I will be the ruler of the study. Yeah. What a weirdo. Also, also, like, just to underline, like, what a weirdo by this account from the person that wrote in. Like you say, we don't have any other accounts, but yeah, that sounded pretty habitual.

SPEAKER_04 58:33

Uh yeah, he sounds like a narcissist.

SPEAKER_01 58:37

I wonder what he's up to these days. Yeah, I well, this was 93, and he's he's presumably he must have been at least.

SPEAKER_03 58:47

I can give an update next week because I think I I um wanted to look at that and I went down a rabbit hole and it was like almost time to record.

SPEAKER_01 58:57

I know I know I know how that goes.

SPEAKER_03 59:00

He didn't lose his medical license, he just lost the ability to do trial like research. So yeah, I you know what? We can do a correction section where I because I also want to know is he still around doing his thing?

SPEAKER_01 59:16

I wonder if he's at the U. You think like if he only had Well I don't think he's at the U.S. ability to because I'm like, did he get fired from the U?

SPEAKER_03 59:27

I don't think he I I just I don't know. I'll look into it, but my thought is we'll see if I'm right. If you're hired there to and part of your job as tenure is to produce research, and you're not allowed to participate in research anymore. I would think he might have had to quietly slip out the back door. But we'll we'll come back to that next week.

SPEAKER_01 59:48

And I guess is it that he cannot participate in any part of research or he cannot be a PI or sponsored?

SPEAKER_03 59:57

It's an interesting question. He he can't do anything with investigational drugs. So maybe he could do a you know a research study on this on this um like that he does like a questionnaire with patients or something.

SPEAKER_01 1:00:10

I was gonna say that. But like nothing with, yeah, okay.

SPEAKER_03 1:00:12

Yeah. That was my understanding anyway. But yeah. Sure. So yeah.

SPEAKER_01 1:00:18

Interesting. Well, very well done. Thank you. Also, specifically, because I know these cases that are not like huge national worldly news, it can be kind of hard to find information sometimes. So excellent job covering to give us a full case here. You did really good.

SPEAKER_03 1:00:33

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SPEAKER_01 1:01:10

And now we're all we're all out here like ashwagandas, like just for our regular name.

SPEAKER_03 1:01:15

Yes, it's a household name. Anyway, it's good

Sponsors And A Listener’s Urgent Care Mishap

SPEAKER_03 1:01:18

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SPEAKER_01 1:02:08

Okay. Thank you. Time for a medical mess happen. My vocal folds feel very dry.

SPEAKER_03 1:02:20

You need some coffee.

SPEAKER_01 1:02:21

Okay. I know I gotta go get my 20% off. Oh, it's time for a medical mess hemp. This week's story comes from a listener named Sarah.

SPEAKER_03 1:02:34

Sarah writes Excuse me, Sarah writes, yeah, medical mishap happened while she was attempting to record a podcast and fell asleep.

SPEAKER_01 1:02:56

Sarah, I'm so sorry. It's just like you just gotta get out. Oh, you can't fight it, you know? Sarah writes, Hi Jenna and Amanda. My medical mishap happened half on after I injured my ankle while attempting to show my teenage daughter that I could still do a cartwheel. Ow, ow, ow, ow. Oh, I feel that so hard. Yep. My ankles are cringing. Okay, for the record, I could not, Sarah writes. My daughter drove me to urgent care where I was asked to rate my pain from zero to ten. I said it was probably a six unless anyone touched it, looked at it, or asked me to move it, in which case it was most definitely a 12. The nurse gave me an ice pack and told me to keep my foot elevated. I was wearing wide-legged sweatpants, and I apparently did not notice that part of the disposable paper covering on the exam table had become had become tucked into the back of them. Oh no. After the x-rays, I decided that I needed to use the restroom. I limped through the entire urgent care clinic. Girl, the way I would have asked for a chair ride.

SPEAKER_02 1:04:01

What?

SPEAKER_01 1:04:02

I limped through the entire urgent care clinic, dragging approximately six feet of exam table paper behind me like a very sad bridal train. Nobody stopped me, not the x-ray tech, not the person at the front desk, not the family of four in the waiting room. I finally noticed when a small child pointed at me and asked, his mother, why the toilet paper was following that lady. It's like, damn, that's a monstrous one. I returned to the exam room where my daughter was laughing so hard that she could no longer speak. The good news was that my ankle was only sprained. Which I'm like, is that good news? Because I feel like a sprain takes longer. I don't know. Oh, oui, oui, oui. The bad news is that my dignity required surgical intervention and was determined to be beyond. Please remind your listeners that cartwheels are a privilege, not a right. Stay safe and stay suspicious of people in the lobby. Sarah. Sarah! Sarah. Oh man. Ow, Sarah.

SPEAKER_03 1:05:07

Oh, Sarah. Like, you know, you got a great story. You put in a valiant effort, but you damn teenagers, man. They always get the upper hand. They do. I love that. Sarah, a right, not a privilege. Wait.

SPEAKER_01 1:05:24

You're a privilege.

SPEAKER_02 1:05:25

Privilege, not a right.

SPEAKER_01 1:05:31

Everybody need to go to bed. Are you guys on your way to work? If you're on your way to work, sorry about that. I hope you have your call.

SPEAKER_03 1:05:35

If you're on your way to work, you know, strong coffee company. Okay. But okay, before you fall asleep, what can our listeners expect to hear next week, Amanda?

SPEAKER_01 1:05:48

So it's going to be a surprise again because per usual I'm working on several cases at once. Which I don't know if I've actually said this to you or not, but I'm just going to say it here now. I saw this really funny thing recently. It was like, imagine that you were murdered and somebody skips your podcast because it's not interesting. Because I'm like, oh, this one's boring. That can't do this one. This one's boring. And then I saw that and I was like, oh my gosh. No. They're not boring. They're all important.

SPEAKER_03 1:06:20

Everyone deserves, I know, right? I want my

Next Week Tease And How To Reach Us

SPEAKER_03 1:06:23

murder to be up there. Like, I want it to be one of those, like, oh yeah. Have you heard about the such and such Tanel murder? Yeah.

SPEAKER_00 1:06:30

They're like, oh read the description, like boring murder next. Like who have we become?

SPEAKER_02 1:06:40

I know. Totally like that. So immune.

SPEAKER_01 1:06:43

Oh man. Okay. So I'm not dropping any cases anymore. If I started them, I'm gonna see them out. I'm I'm I just might have got, you know, a little yawny, so I had to start a new one.

SPEAKER_03 1:06:53

Oh but I won't finish it. Listen, ADD is a thing. We embrace it. It's it's it's a superpower, right?

SPEAKER_01 1:07:01

It is, honestly. Yeah. You guys, it's like you're welcome that we can tell 47 stories at one time.

unknown 1:07:06

Okay.

SPEAKER_01 1:07:08

So anyway, I don't know what's coming next. It's whatever one of the three gets finished first. So there's one that I thought I was gonna drop, but I will never drop one again now after I saw that. One that's pretty heavy that I needed to take a break from, and then one that a listener sent in of a pediatrician that they used to work with. Ooh! Yeah. So uh we'll see what gets finished first. But well, they all sound intriguing. Can't wait. Can't wait. So don't miss a beat. Subscribe or follow Doctoring the Truth wherever you enjoy podcasts for stories that shock, intrigue, and educate. Trust, after all, is a delicate thing. You can text us directly on our website at doctoringtruth at buzzroute.com. Email us your own story ideas, medical mishaps, and comments at DoctorTheTruth at Gmail. Oh so sorry. Be sure to follow us on Instagram at Doctoring the Truth Podcast, which I need to make when we have stories, Mary Beth stories. I need to make like a little cartoon or something for those. I didn't social media posts. I'm so sorry. Whatever. I'm gonna blame being a mom. And we're also on Facebook at Doctoring the Truth. We're also on TikTok, Doctoring the Truth, and at oddpod. Don't forget to download rate and review so we can be sure to bring you more content next week. Until then, you guys, Ali Cats, stay safe and please always stay suspicious. If you're still here, thank you. Goodbye. Bye. Bye. Sorry, Domitco's going down the hatch.