Bill Gleason

Bill Gleason is an Associate Professor at the University of Minnesota in the Department of Laboratory Medicine and Pathology. He's also a fellow at the U's Supercomputer Institute. Read more about Gleason.

Markingson Case: Has the Gordian Knot puzzle been solved at the University of Minnesota?

Posted by: Bill Gleason under Violence, Disasters, Education and literacy, Government, Politics Updated: December 7, 2013 - 10:39 AM

 

Alexander cuts the Gordian Knot, Jean-Simon Berthélemy
(source) 
 
Preface
 
The Gordian Knot is a myth or legend associated with Alexander the Great. When the peasant Gordias rode into Telmissus on an oxcart on which an eagle had alighted, he was declared king in accord with with oracular prediction.  Midas, son of Gordias, in gratitude to the god Sabazios immobilized an oxcart with an intricate knot. 
 
The oxcart still stood in the palace of former kings when Alexander arrived. He at first attempted to untie the knot, but failing upon using conventional methods, he sliced it in half with his sword in what has become known as the Alexandrine solution.
 
There is not total agreement on this matter. Some - Plutarch for example - relate that Alexander solved the knot problem by sliding it off the oxcart pull pole, exposing the ends of the knot, and then unravelling it. 
 
The legend of the Gordian knot has been widely used as the symbol of an apparently insoluble problem that some unusual men or women can solve either by the method of brutal force or by some novel insight into a problem.  As Shakespeare - who never missed a trick - put it: 
 

"Turn him to any cause of policy,
The Gordian Knot of it he will unloose, 
Familiar as his garter"
                                                              Henry V, I-1 45-47

Background (Short Version)

Dan Markingson died by committing suicide in a clinical trial at the University of Minnesota approximately ten years ago. The university has steadfastly maintained that there was no wrongdoing, that the matter has been thoroughly investigated, and that whiners and complainers should please go away. 

The University of Minnesota Faculty Senate last Thursday afternoon passed a resolution (by a vote of 67-23) that an outside investigation of clinical research at the university should be done.

Not coincidentally, a petition was delivered Thursday morning to the office of Minnesota Governor Dayton (endorsed by approximately 3500 people) that the Markingson situation should be investigated by an outside body.

For those wishing to read more, I suggest:

1. Send in the Wackos - my Community Voices post of two weeks ago

2. Jeremy Olson's excellent, fair, and balanced piece in the Star-Tribune: U faculty calls for investigative review of controversial drug study. 

It should be noted that Jeremy Olson and Paul Tosto received the University of Minnesota Premack award for investigative journalism for their work in this area while both were at the Pioneer Press. This is an example of why I am such a fan of real journalists. 

3. Susan Perry's excellent and fair summary on MinnPost: Faculty Senate votes for inquiry into U's clinical-trial practices

In summary: after years of trying to avoid an outside review of clinical trial practices at the University of Minnesota, the faculty stimulated administration has agreed to an outside review. This is definitely progress and something those of us who have been pushing for it are deeply gratified by.  I checked Markingson on my blog, and note that I found 87 posts on it dating back to 2009. Others, especially Drs. Carl Elliot and Leigh Turner have far more time invested as has Mike Howard, Mary Weiss's friend. 

Concerns

At this point what will happen next remains a matter of conjecture. Technically this is in the hands of the President Eric Kahler. The governor may - or may not - respond to the petition since the president has agreed to an inquiry.

But apparently the university administration would like to restrict the investigation to present day cinical practices and would prefer not to go into the Markingson matter.  Calling the proceedings the Markingson investigation induces bad vibrations in the administration.  

There is also the usual question at the university of conflict of interest.  Should someone who's possible negligence in stonewalling an earlier investigation be involved in both charging and selecting panelists for an inquiry?

I've made a suggestion for one panelist, Dr. Atul Gawande, a Harvard faculty member who is a surgeon, a McArthur foundation fellow and an author of several books that have been influential in the medical profession. As far as I know, he has taken no position on the Markingson matter.  He is a down in the trenches doc, with both humanity and empathy. Truly the kind of doc we'd like our sons and daughers to be. For more information about Dr. Gawande please see his biography.

By an odd coincidence an extremely interesting interview of Gawande has been posted just today. See: Atul Gawande on the Secrets of a Puzzle-Filled Career  (Medscape). 

Now Dr. Gawande is a busy man. He very well might decline to participate for a variety of reasons. But he is the kind of man or woman we need. We should invite someone like him to head the outside investigation and allow him to pick anyone he likes to assist in this matter. 

Conclusion

The Gordian Knot of the Markingson matter can be solved, crudely speaking, in two ways. One is the "Alexandrine solution."

But simply "give them an investigation of things as they are now" may solve the problem at one level, but will it will simply intensify questioning and even outrage at another. The time for stonewalling is over.

The alternative is to take the knot apart. Follow the unravelled rope from one end - the Markingson case - to the other end: clincal practices in the present.  What was wrong - if anything - in the Markingson case?  What has changed as a result of it - for example Dan's Law? And where do we stand now, has anything actually changed? Is there a difference between what is ethical and what is legal?  Are we now following clinical practices in accord with  the highest ethical standards not just the law? 

"Profiles in courage" should not only be an exemplar for politicians. It is time for the University of Minnesota administration to step up to the plate and demonstrate some courage.

I'll write again as things develop. We all love our university. Some day I'd like to be #umnproud again. 

Bill Gleason
U of M faculty and alum 

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