The Butler saga, system failure and clean hands

August 2006

My editorial comments this month are on several topics, each relatively brief, but each worth bringing to your attention. These are more on the Dr. Thomas Butler saga and system failure and clean hands.

The Thomas Butler Saga

Many readers will recall an editorial that appeared in the September 2005 issue of Infectious Disease News in which Dr. Lowell Young recounted the investigation, trial, conviction and imprisonment of an accomplished and productive infectious disease physician-investigator, Dr. Thomas Butler. For many years, Dr. Butler had carried out research on plague, both in his laboratories at Texas Tech University and in several Third World countries.

Barbara Murray and a number of colleagues had published an article detailing the entire ordeal in the June 1, 2005, issue of Clinical Infectious Disease. In the July 15, 2006 issue of the journal, there appeared a brief update on Dr. Butler, written by William Greenough III, one of the co-authors of the Murray, et al report.

Dr. Butler was released from federal prison in November 2005, after which he returned to Lubbock, Texas. He had been stripped of his medical license, and, of course, of his faculty appointment at Texas Tech University. For three years, he must still report to a parole officer; he also cannot travel outside of the district without permission. Foreign travel is impossible since he was required to surrender his passport. He was initially employed in a nonmedical setting but clearly was seeking a more medical-related position.

Prior to his faculty position at Texas Tech University, he had been on the faculty of Case Western Reserve University School of Medicine. Thus, he became well-known around the Cleveland area, especially by Mr. John Mangels, a science writer for Cleveland’s daily paper. It is not a total surprise that Mangels got wind of the disaster that had befallen Dr. Butler in Texas; he wrote a serialized narrative story about it that was published in the Cleveland Plain Dealer from March 26 through April 2, 2006. It was obviously written for the lay public and is a bit thin on the medical research details; however, for those who may be interested, it is both a fascinating and revolting story of the persecution of this accomplished scientist in the post 9/11 era by a scientifically uninformed yet highly aggressive FBI and Department of Justice. The story is available at the following web link: www.cleveland.com/plague.

The message sent to infectious disease investigators by this entire saga is worrisome, indeed. Rather than encouraging research of the so-called “select agents” on the CDC’s category-1 list of potential bioterrorism agents, the Tom Butler episode is likely to have the exact opposite effect. If all the regulatory “t’s” and “i’s” are not correctly dotted and crossed, the attorney general might well come after you, and he has an enormous capacity to inflict harm. We will never know the number of promising investigative careers that have been turned away by this episode.

Dr. Butler was and to my knowledge still is a Fellow of the IDSA. Although individual members of the Society have certainly been vocal in their support of Dr. Butler, the Society as such has been strangely mute. I am puzzled and somewhat disappointed that the IDSA, normally so vocal about a number of important issues in infectious disease research, especially bioterrorism preparedness, has chosen to remain silent on this one.

System Failure, Clean Hands

Dr. Don Goldmann’s comments in the editorial pages of the July 13, 2006, issue of The New England Journal of Medicine are a must read for all Association for Professionals in Infection Control and Society for Healthcare Epidemiology of America members, as well as all infectious disease physicians. Don has been an ardent proponent of the “systems” approach to improving patient safety as initially proposed in the Institute of Medicine report To Err is Human. In his editorial comments, Don makes the point that no matter how well-designed the system and no matter how well it is working, there remains the issue of personal accountability. There will be those who frequently, or worse continually, violate the precepts of hand hygiene; there is no “system” that manages such problems.

He points out that repeated violations should have consequences. In other areas of endeavor, eg, computer chip manufacturing, repeated violations lead to disciplinary action, which likely might include termination. Should there not be serious consequences for repeated violations of basic infection control standards? Dr. Goldmann stopped short of suggesting what these might be in the health care setting. Most of us have faced this issue from time to time, and those of us in infection control face it every day. It’s likely we all have our own answers. We all know it is difficult to change physician behavior, but it can be done! Data sometimes are effective, especially in today’s world of evidence-based practice. Peer pressure is effective, as is some pressure from a department chair or a chief of staff. Only rarely might it be necessary to consider more stringent measures.

Staff transitions

Change is a fact of life, and that holds true for the production staff of Infectious Disease News. Last month was Marie Rosenthal’s last as editor-in-chief. Marie has been managing for well over a decade. She is responsible for a number of innovative features that are now a regular part of the publication; recent examples are the Darwin Chronicles and the EIStories. She has now accepted the greater challenge of managing a veterinary publication for a different company. I wish her well and will miss her many talents.

With the next issue, we will welcome Jay Lewis as the new managing editor of IDN. Jay has been a medical writer at SLACK for four years, and was previously a writer for a business publication. Happily, Colleen Zacharyczuk will be staying on as consulting editor of IDN and will help Jay “learn the ropes,” as it were, in infectious disease. Colleen will continue as the managing editor of our sister publication, Infectious Diseases in Children. With these resources in place, I anticipate it will be a smooth transition.