The High Cost of Truth: How Doctors Are Silenced for Speaking Out, By Brian Simpson

In today's world, you'd think speaking the truth, especially when it's backed by science or firsthand experience, would be celebrated, particularly in a field like medicine where lives are at stake. But for some Australian doctors and researchers, raising concerns about medical practices, billing fraud, or unsafe devices comes with a brutal price: vicious online abuse, professional attacks, and even death threats. A recent ABC News article shines a light on this chilling reality, exposing how vested interests and a defensive medical establishment work to keep doctors in line, often at the expense of patients and the public good.

Take Dr. Adrian Traeger, a senior research fellow at the University of Sydney. In 2023, he co-authored a peer-reviewed Cochrane review that dared to question the effectiveness of spinal cord stimulators, devices implanted in thousands of Australians annually to manage chronic pain. The review suggested these pricey gadgets might be no better than a placebo. You'd expect such a finding to spark constructive debate, maybe even push for better patient outcomes. Instead, Traeger and his team were met with a firestorm.

"We received letters of complaint, attacking the review team and asking for the review to be retracted," Traeger told ABC News. Every single attack came from someone with financial ties to the spinal cord stimulator industry. The backlash didn't stop at formal complaints. Traeger's colleagues faced death threats, demands for their dismissal, and relentless undermining of their credentials. Traeger himself began to wonder if he should abandon his field altogether. "It's scary," he said. "All because we highlight scientific evidence that could be damaging to company profits."

Spinal cord stimulators are big business, with tens of thousands implanted globally each year. In Australia alone, the Therapeutic Goods Administration has logged over 2,000 adverse event reports since 2012, citing issues like paralysis, sepsis, burns, and electric shocks. Yet, when researchers like Traeger raise red flags, they're not thanked for protecting patients, they're targeted. It's a stark reminder that challenging profitable medical devices can put a bullseye on your back.

The story doesn't end with medical devices. Margaret Faux, a medical billing expert and founder of Synapse, learned firsthand how vicious the medical establishment can be when you expose systemic issues. In 2022, Faux collaborated with ABC's 7.30 and The Sydney Morning Herald to blow the whistle on widespread Medicare fraud, estimating that misbilling was costing Australians $8 billion a year. Her reward? A barrage of personal and professional attacks that turned her life upside down.

"When I first spoke out about Medicare fraud, the vicious attacks from the medical profession were a shock," Faux recalled. Social media became a battleground, with some doctors ridiculing her credentials and even calling for her higher degree to be revoked. She received threatening mail that prompted a police report, forcing her to install security cameras at home. "I was too scared to go out," she said. "It was hell. All because I spoke the truth about what I had been seeing for decades."

The Australian Medical Association (AMA) didn't help matters, dismissing the media coverage as "rubbish" and an "unjustified slur on the medical profession." Rather than engaging with Faux's evidence, they sought to discredit her claims, framing them as a personal attack on doctors' integrity. For Faux, the real tragedy is the impact on patients, who are often caught in the middle. "If they blow the whistle on dodgy billing, they fear their treatment may be compromised," she explained. "So it's safer for patients to be quiet and complicit. And doctors know that."

Despite the abuse, Faux's work has started to crack open the issue. The Medicare regulator, the Professional Services Review (PSR), now regularly publishes cases of inappropriate billing. For example, in October, a rheumatologist was reprimanded for inadequate record-keeping and improper billing, though the punishment was just a slap on the wrist. In November, a GP was ordered to repay $10,000 for similar violations. Faux sees these outcomes as proof of a deeper problem: the system's reluctance to tackle fraud head-on, leaving patients and taxpayers to foot the bill.

Consultant cardiothoracic surgeon Dr. Jon Ryan faced a similar backlash when he tried to spark a conversation about Medicare billing abuses. In a 2023 medical journal article, he highlighted how cardiac surgeons were misusing a specific Medicare item (45503), which carried a $2,000 rebate. He recounted a disturbing moment at a 2015 conference where a colleague jokingly referred to the item as a "present" for another surgeon, revealing a casual attitude toward non-compliant billing. Ryan argued that without proper training or oversight, senior clinicians' behaviour sets a dangerous precedent for the profession.

The response was swift and harsh. Some AMA members published a rebuttal, accusing Ryan of "unreferenced assertions" and "logical fallacies." Rather than engaging with his call for reform, they dismissed his work as flawed and inflammatory. Ryan's experience underscores a broader issue: the medical community often closes ranks when one of their own questions the status quo, especially when it involves money.

So, why are doctors who speak out met with such hostility? The ABC article points to a few culprits. First, there's the influence of vested interests, whether it's device manufacturers protecting their profits or doctors defending lucrative billing practices. These groups have a lot to lose when their methods are scrutinised, and they're not afraid to play dirty. Second, there's a cultural problem within medicine. The profession prides itself on integrity, so accusations of fraud or incompetence are seen as personal affronts, prompting defensive, sometimes aggressive responses from bodies like the AMA.

Then there's the system itself. Australia's Medicare regulator, the PSR, often issues light penalties for serious violations, which sends a message that non-compliance isn't a big deal. Add to that the lack of formal training on Medicare billing, as Ryan noted, and you've got a recipe for widespread misuse. When whistleblowers like Faux or researchers like Traeger shine a light on these issues, they're not just challenging individual doctors, they're taking on a deeply entrenched system that resists change.

This pattern of silencing dissent isn't unique to Australia. Globally, doctors and scientists who question medical orthodoxy, whether it's about devices, billing, or even public health policies, often face similar pushback. The tactics are familiar: discredit the messenger, question their motives, or drown out their message with noise. It's a strategy that protects profits and power at the expense of truth and patient safety.

For patients, the stakes couldn't be higher. Devices like faulty spinal cord stimulators can leave people in worse pain or permanently disabled. Medicare fraud diverts billions that could fund better care. And when doctors are too scared to speak out, the cycle of harm continues unchecked. As Faux put it, patients are often too afraid to report dodgy billing because they rely on their doctors for care. It's a power imbalance that keeps the system broken.

Reading about Traeger, Faux, and Ryan, I'm struck by their resilience. Despite the threats, the trolls, and the professional sabotage, they keep pushing for change. Faux says the daily evidence of billing abuses fuels her resolve. Traeger continues his research, undeterred by the attacks. Ryan's still out there, trying to start conversations about reform. Their stories are a reminder that progress often comes from those willing to face the storm.

But they shouldn't have to fight alone. The medical profession needs to reckon with its defensive culture and embrace accountability. Regulators like the PSR must impose real consequences for fraud and malpractice. And patients deserve a system where they can trust their care isn't tainted by profit motives or cover-ups. Until that happens, speaking out will remain a risky act of courage, one that too many doctors pay a steep price for.

https://www.abc.net.au/news/2024-12-16/doctors-who-speak-out-face-online-abuse/104728318

"Whether it's "Faux outrage" or online death threats, it's risky speaking out about Medicare and medical procedures. Vested interests have a lot to answer for.

University of Sydney senior research fellow Adrian Traeger says the backlash he and his colleagues receive when they publish negative medical-related scientific research is scary.

"I've had colleagues receive death threats, complaints to the university asking for them to be fired. I've had my published work repeatedly undermined and my credentials attacked. It's scary. All because we highlight scientific evidence that could be damaging to company profits," he says.

"At one point I thought: 'Am I going to get into serious trouble here? Should I get out of this field?' It's not how science should work."

Traeger co-authored an independent, peer-reviewed Cochrane review into spinal cord stimulators in 2023, which raised questions that they may be no better than a placebo procedure.

Calls for action on spinal cord stimulators

After a Four Corners investigation exposed safety issues with spinal cord stimulators, more patients have come forward to share their experiences of complications from the devices or the procedures to install them.

"We received letters of complaint, attacking the review team and asking for the review to be retracted. All the attacks had authors with financial interests in spinal cord stimulators," he said.

Tens of thousands are implanted globally each year, with thousands implanted in Australia. They are implanted near a patient's spinal cord to send electrical impulses through leads, on the premise that they will help ease pain. They are marketed as safe and effective. Some patients say they are better off while others have ended up paralysed or in worse pain.

In Australia, the Therapeutic Goods Administration's database of adverse events has received more than 2,000 reports relating to spinal cord stimulators since 2012. The adverse reports, which are not conclusive, range from paralysis, sepsis, burns, electric shocks and the device not working.

Attacked for speaking out

Medical billing and compliance expert Margaret Faux, is the founder of medical technology company Synapse, understands well what Traeger and his colleagues have gone through.

She blew the whistle on fraud, waste and abuse in Medicare billing in October 2022 in a joint venture with the ABC's 7.30 and The Sydney Morning Herald and was astonished by the vicious campaign that ensued from certain parts of the medical fraternity.

The AMA described the media coverage as an "unjustified slur on the medical profession", "rubbish", "a fantasy" and "staggering in its inaccuracies and its nastiness" and sought to discredit it.

Misuse of Medicare is costing Australians $8 billion a year, expert says

Faux was personally attacked by some medical practitioners on social media.

"When I first spoke out about Medicare fraud the vicious attacks from the medical profession were a shock," she recalls.

She said she had to engage lawyers to deal with online trolls, her higher degree was undermined and ridiculed with some suggesting it be revoked.

"I received frightening mail in my letterbox which led to a police report. We installed security cameras at home and I was too scared to go out. It was hell. All because I spoke the truth about what I had been seeing for decades," she said.

But she says the true victims are patients, who she says are caught between the clinical commitment of their doctor, and the transparency of the deal.

"If they blow the whistle on dodgy billing they fear their treatment may be compromised. So it's safer for patients to be quiet and complicit. And doctors know that."

Since the media investigation, the floodgates have started to open on cases of non-compliance and deliberate misbilling. Faux says what she sees each day has emboldened her to keep going.

Margaret Faux alleged billions of dollars in Medicare money was being misclaimed by doctors en masse. (Four Corners)

Regulator hits back at billing

The Medicare regulator, the Professional Services Review (PSR), sees it too. Each month it publishes case outcomes of inappropriate billing by practitioners.

For instance, in October the PSR determined a rheumatologist who had admitted to inappropriate billing of services and drugs, should only be reprimanded.

This was despite finding the practitioner's record keeping was inadequate, records were at times "vague and included incorrect details about the patient's presentation and management," MBS and PBS requirements not always met and "the practitioner did not provide adequate clinical input when prescribing."

It said the practitioner acknowledged engaging in "inappropriate practice" in connection with claiming Medicare for certain diagnostic procedure services to some patients and prescribing PBS items including certain biological drugs.

In November, a GP working at an aged care facility was found to have engaged in inappropriate practice and was ordered to repay $10,000.

The PSR's findings were extensive. They included inadequate patient records, no date of service, no record of service, history, examination and management "where this was clinically relevant" and Medicare items were claimed which were not met including one where a patient did not need urgent clinical assessment of a condition that may deteriorate before the next in-hours period.

For Faux the PSR's decisions show how hopeless Australia and the government are at tackling the problem.

Surgeon's paper dismissed

Consultant cardiothoracic surgeon Dr Jon Ryan wrote a paper in a medical journal earlier this year in an attempt to get a discussion going about the need to address non-compliant Medicare billing.

The piece, Lessons from the 'legitimate' misuse of Medicare Benefits Schedule item 45503, used an example of a medical conference Ryan had attended in 2015 where a fellow cardiac surgeon greeted a colleague saying: "I have a present for you —45503." That particular Medicare item had a $2,000 rebate attached to it. He then showed how the cardiac surgery community was misbilling this item.

He noted in the paper that clinicians do not receive any formal training in Medicare billing and there is a paucity of professional advisors with expertise in Medicare billing rules.

"Together, this makes the normative behaviour modelled by senior clinicians critical to establishing cultural attitudes toward non-compliant Medicare billing," he wrote.

The paper didn't go down well with some medical practitioners and some members of the AMA wrote a response titled Questionable evidence and argumentation regarding alleged misuse of Medicare, which accused Ryan of "unreferenced assertions, potential logical fallacies, inaccurate representations of referenced material, and unsubstantiated rhetoric.""