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Angels of Death: 7 More Medical Murderers

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In part one of Angels of Death, you saw the stories of eight medical professionals who killed their patients. That's just scratching the surface of the many cases of medical murders. Here are seven more.

Nightmare Nurse

Jane Toppan admitted to first eleven murders, then later to 31. Despite recklessness with drugs, unusually high patient deaths, and charges of theft, she managed to find employment over and over again in Massachusetts between the years of 1885 and 1901. In 1901, Toppan moved in with the Davis family after the death of the elderly mother she had cared for. Within a short time, the father and two daughters were dead. She also killed her foster sister before an investigation, which found the victims to be poisoned, led to her arrest. Toppan was found not guilty by reason of insanity, and was held in a mental institution for the rest of her life. Toppan was said to have been proud of the killings.

The Angel of Death

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Two of the people profiled here are very different from the rest in that they did not hide their actions at the time. One was Joseph Mengele, who had free rein under the SS to conduct experiments on inmates at Auschwitz. The doctor was also largely responsible for selecting prisoners for the gas chambers. Mengele had a special interest in twins. Thousands of twins were subjected to horrific surgical procedures and injections. Only a few survived World War II. Mengele also "experimented" with electric shock, castration, radiation, and removal of limbs and organs without anesthetic on manner of prisoners. Mengele escaped to Argentina after the war under a false identity. The records he kept on his experiments were destroyed by a colleague. Mengele died in 1979 in Brazil. A grave was exhumed in 1985 and DNA tests in 1992 confirmed that it was Mengele's.

The Job-hopping Nurse

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Charles Cullen worked as a nurse at ten different hospitals in New Jersey and Pennsylvania and admitted killing 45 patients between 1988 and 2003. He administered overdoses of drugs (usually digoxin) by injection or through intravenous lines. He was fired from job after job for erratic behavior, incompetence, or breaking rules, but Cullen continued to find work because of a nationwide nurse shortage. Suspicious deaths at Somerset Medical Center in New Jersey finally led authorities to look into Cullen's background. He was arrested for one murder and one attempted murder in 2003. He later confessed and pled guilty to the charges. In later investigations, Cullen pled guilty to 13 murders at Somerset and three more at other hospitals in New Jersey. He also pled guilty to killing six patients in Pennsylvania. Cullen is serving 18 life sentences and will be eligible for parole in 395 years. The nurse explained that he killed because he couldn't stand to see his patients suffer, although he seemed unaware that in many cases, he caused their suffering. As a result of the Cullen case, most states adopted laws that provided legal immunity to employers who give poor performance ratings or referrals to medical professionals.

Dr. Death

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There are many who would not consider Jack Kevorkian a murderer, but he was convicted and served eight years in prison for second-degree homicide. Kevorkian was an activist who published and spoke on the ethics of euthanasia. He pushed the idea that terminally ill patients and even those with a limited quality of life, should have the right to commit suicide, even those who are not physically able to do so. Kevorkian developed at least two devices that allowed patients to deliver their own death with a simple push of a button. The doctor, whose license was revoked in 1991, says he assisted in over 100 suicides. He was arrested numerous times, but wasn't convicted until 1998 because the patient had made the ultimate move in each death. However, Thomas Youk was completely paralyzed due to ALS (Lou Gehrig's Disease), so Kevorkian, with the patient's permission, administered a lethal injection. The event was videotaped and shown on the TV show 60 Minutes in 1998, which led to murder charges for Kevorkian. He was denied parole until 2006, when he finally promised not to involve himself in any more suicides. At the time, Kevorkian was expected to die of Hepatitis C within a year. However, he was healthy enough to run for a Michigan congressional seat in 2008. He did not win the election.

The Veteran Murderer

220_gilbert.jpgWhen nurse Kristen Gilbert moved to the evening shift at the VA Hospital in Northampton, massachusetts, the death rate tripled. Other nurses noticed patients dying of cardiac arrest when there was no history of heart trouble. They also noticed epinephrine, a drug that can cause heart attacks, sometimes went missing. And they noticed Gilbert's affair with security guard James Perrault, who was always called when an emergency arose on the ward. It was thought that the nurse would induce a heart attack solely for the opportunity to summon her lover to the scene. Authorities investigated in 1996, Gilbert was suspended, and the death rate immediately dropped to normal levels. Perrault broke off the affair, and Gilbert tried to kill herself. She landed in a psychiatric ward, where she admitted to  Perrault that she killed patients. Her former lover then aided the investigation against her. Gilbert called in a bomb threat to the hospital, asking to speak to Perrault. She was arrested for the act, and later charged with four counts of murder and two counts of attempted murder. She was convicted in 2001 and sentenced to life in prison.

The Compassionate Killer

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Stephan Letter was convicted of murdering 16 patients and causing the death of 13 more, although the line between the two charges seems blurry. Letter was a nurse at a clinic for the elderly in Sonthofen, Bavaria, Germany. Police investigated around 80 suspicious deaths in 2003 and 2004. 43 victims were exhumed and another 38 had been cremated. The exhumations showed the patients had been killed by a lethal combination of drugs. Letter admitted killing twelve of the patients. The 27-year-old nurse told the court he had acted out of compassion for the dying. In 2006, he was found guilty of 29 murders and sentenced to life.

The Most Prolific Ever

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British physician Harold Shipman may have killed as many as 400 of his patients during his medical career, which would make him the most prolific serial killer of all time. An official audit estimates the number of victims at 236 over 24 years, but the exact number will probably never be known. Shipman was abusing drugs and forging prescriptions early in his career, but went on to treat patients in Hyde, Greater Manchester. Eventually, funeral directors and medical examiners were concerned about the number of deaths under Shipman's care, but an inquiry went nowhere because the doctor had changed medical records after the fact to explain that the patient had been ill. In reality, almost all the patients had been healthy just prior to death. After Kathleen Grundy died in 1998, a suspicious-looking will was produced that left £386,000 to Dr. Shipman. Mrs. Grundy was found to have died of an overdose of morphine. Police investigated the deaths of previous patients, and found many had died of overdoses. Mrs. Grundy's will was linked to Shipman's typewriter, and an examination of Shipman's computer revealed evidence of medical records that were amended after the deaths. He was convicted of 15 murders in 2000 and sentenced to life for each, plus four years for forgery. Shipman proclaimed his innocence until the day he hanged himself in prison in 2004.

Most of the entries in this post were people mentioned in the comments of the previous post on the subject. I have a long list of obscure medical murderers, so there may well be a third installment.

Update: Part three of this series is now available.

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Beyond the Label: How to Pick the Right Medicines For Your Cold and Flu Symptoms
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The average household spends an annual total of $338 on various over-the-counter medicines, with consumers making around 26 pharmacy runs each year, according to 2015 data from the Consumer Healthcare Products Association. To save cash and minimize effort (here's why you'd rather be sleeping), the Cleveland Clinic recommends avoiding certain cold and flu products, and selecting products containing specific active ingredients.

Since medicine labels can be confusing (lots of people likely can’t remember—let alone spell—words like cetirizine, benzocaine, or dextromethorphan), the famous hospital created an interactive infographic to help patients select the right product for them. Click on your symptom, and you’ll see ingredients that have been clinically proven to relieve runny or stuffy noses, fevers, aches, and coughs. Since every medicine is different, you’ll also receive safety tips regarding dosage levels, side effects, and the average duration of effectiveness.

Next time you get sick, keep an eye out for these suggested elements while comparing products at the pharmacy. In the meantime, a few pro tips: To avoid annoying side effects, steer clear of multi-symptom products if you think just one ingredient will do it for you. And while you’re at it, avoid nasal sprays with phenylephrine and cough syrups with guaifenesin, as experts say they may not actually work. Cold and flu season is always annoying—but it shouldn’t be expensive to boot.

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Medicine
This Soft Artificial Heart May One Day Shorten the Heart Transplant List
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ETH Zurich

If the heart in the Functional Materials Laboratory at ETH Zurich University were in a patient in an operating room, its vital signs would not be good. In fact, it would be in heart failure. Thankfully, it's not in a patient—and it's not even real. This heart is made of silicone.

Suspended in a metal frame and connected by tubes to trays of water standing in for blood, the silicone heart pumps water at a beat per second—a serious athlete's resting heart rate—in an approximation of the circulatory system. One valve is leaking, dripping onto the grate below, and the water bins are jerry-rigged with duct tape. If left to finish out its life to the final heartbeat, it would last for about 3000 beats before it ruptured. That's about 30 minutes—not long enough to finish an episode of Grey's Anatomy

Nicolas Cohrs, a bioengineering Ph.D. student from the university, admits that the artificial heart is usually in better shape. The one he holds in his hands—identical to the first—feels like taut but pliable muscle, and is intact and dry. He'd hoped to demonstrate a new and improved version of the heart, but that one is temporarily lost, likely hiding in a box somewhere at the airport in Tallinn, Estonia, where the researchers recently attended a symposium.

Taking place over the past three years, the experimental research is a part of Zurich Heart, a project involving 17 researchers from multiple institutions, including ETH, the University of Zurich, University Hospital of Zurich, and the German Heart Institute in Berlin, which has the largest artificial heart program in Europe.

A BRIDGE TO TRANSPLANT—OR TO DEATH

Heart failure occurs when the heart cannot pump enough blood and oxygen to support the organs; common causes are coronary heart disease, high blood pressure, and diabetes. It's a global pandemic, threatening 26 million people worldwide every year. More than a quarter of them are in the U.S. alone, and the numbers are rising.

It's a life-threatening disease, but depending on the severity of the condition at the time of diagnosis, it's not necessarily an immediate death sentence. About half of the people in the U.S. diagnosed with the disease die within five years. Right now in the U.S., there are nearly 4000 people on the national heart transplant list, but they're a select few; it's estimated that upwards of 100,000 people need a new heart. Worldwide, demand for a new heart greatly outpaces supply, and many people die waiting for one.

That's why Cohrs, co-researcher Anastasios Petrou, and their colleagues are attempting to create an artificial heart modeled after each patient's own heart that would, ideally, last for the rest of a person's life.

Mechanical assistance devices for failing hearts exist, but they have serious limitations. Doctors treating heart failure have two options: a pump placed next to the heart, generally on the left side, that pumps the blood for the heart (what's known as a left ventricular assist device, or LVAD), or a total artificial heart (TAH). There have been a few total artificial hearts over the years, and at least four others are in development right now in Europe and the U.S. But only one currently has FDA approval and CE marking (allowing its use in European Union countries): the SynCardia total artificial heart. It debuted in the early '90s, and since has been implanted in nearly 1600 people worldwide.

While all implants come with side effects, especially when the immune system grows hostile toward a foreign object in the body, a common problem with existing total artificial hearts is that they're composed of hard materials, which can cause blood to clot. Such clots can lead to thrombosis and strokes, so anyone with an artificial heart has to take anticoagulants. In fact, Cohrs tells Mental Floss, patients with some sort of artificial heart implant—either a LVAD or a TAH—die more frequently from a stroke or an infection than they do from the heart condition that led to the implant. Neurological damage and equipment breakdown are risky side effects as well.

These complications mean that total artificial hearts are "bridges"—either to a new heart, or to death. They're designed to extend the life of a critically ill patient long enough to get on (or to the top of) the heart transplant list, or, if they're not a candidate for transplant, to make the last few years of a person's life more functional. A Turkish patient currently holds the record for the longest time living with a SynCardia artificial heart: The implant has been in his chest for five years. Most TAH patients live at least one year, but survival rates drop off after that.

The ETH team set out to make an artificial heart that would be not a bridge, but a true replacement. "When we heard about these problems, we thought about how we can make an artificial heart that doesn't have side effects," he recalls.

USING AN ANCIENT TECHNIQUE TO MAKE A MODERN MARVEL

Using common computer assisted design (CAD) software, they designed an ersatz organ composed of soft material that hews closely to the composition, form, and function of the human heart. "Our working hypothesis is that when you have such a device which mimics the human heart in function and form, you will have less side effects," Cohrs says.

To create a heart, "we take a CT scan of a patient, then put it into a computer file and design the artificial heart around it in close resemblance to the patient's heart, so it always fits inside [the body]," Cohrs says.

But though it's modeled on a patient's heart and looks eerily like one, it's not identical to the real organ. For one thing, it can't move on its own, so the team had to make some modifications. They omitted the upper chambers, called atria, which collect and store blood, but included the lower chambers, called ventricles, which pump blood. In a real heart, the left and right sides are separated by the septum. Here, the team replaced the septum with an expansion chamber that is inflated and deflated with pressurized air. This action mimics heart muscle contractions that push blood from the heart.

The next step was to 3D-print a negative mold of the heart in ABS, a thermoplastic commonly used in 3D printing. It takes about 40 hours on the older-model 3D printers they have in the lab. They then filled this mold with the "heart" material—initially silicone—and let it cure for 36 hours, first at room temperature and then in an oven kept at a low temperature (about 150°F). The next day, they bathed it in a solvent of acetone, which dissolved the mold but left the printed heart alone. This process is essentially lost-wax casting, a technique used virtually unchanged for the past 4000 years to make metal objects, especially bronze. It takes about four days.

The resulting soft heart weighs about 13 ounces—about one-third more than an average adult heart (about 10 ounces). If implanted in a body, it would be sutured to the valves, arteries, and veins that bring blood through the body. Like existing ventricular assist devices and total artificial hearts on the market, it would be powered by a portable pneumatic driver worn externally by the patient.

FROM 3000 TO 1 MILLION HEARTBEATS

In April 2016, they did a feasibility test to see if their silicone organ could pump blood like a real heart. First they incorporated state-of-the-art artificial valves used every day in heart surgeries around the world. These would direct the flow of blood. Then, collaborating with a team of mechanical engineers from ETH, they placed the heart in a hybrid mock circulation machine, which measures and simulates the human cardiovascular system. "You can really measure the relevant data without having to put your heart into an animal," says Cohrs.

Here's what the test looked like.

"Our results were very nice," Cohrs says. "When you look at the pressure waveform in the aorta, it really looked like the pressure waveform from the human heart, so that blood flow is very comparable to the blood flow from a real human heart."

Their results were published earlier this year in the journal Artificial Organs.

But less promising was the number of heartbeats the heart lasted before rupturing under stress. (On repeated tests, the heart always ruptured in the same place: a weak point between the expansion chamber and the left ventricle where the membrane was apparently too thin.) With the average human heart beating 2.5 billion times in a lifetime, 3000 heartbeats wouldn't get a patient far.

But they're making progress. Since then, they've switched the heart material from silicone to a high-tech polymer. The latest version of the heart—one of which was stuck in that box in the Tallinn airport—lasts for 1 million heartbeats. That's an exponential increase from 3000—but it's still only about 10 days' worth of life.

Right now, the heart costs around $400 USD to produce, "but when you want to do it under conditions where you can manufacture a device where it can be implanted into a body, it will be much more expensive," Cohrs says.

The researchers know they're far from having produced an implantable TAH; this soft heart represents a new concept for future artificial heart development that could one day lead to transplant centers using widely available, easy-to-use design software and commercially available 3D-printers to create a personalized heart for each patient. This kind of artificial heart would be not a bridge to transplantation or, in a few short years, death, but one that would take a person through many years of life.

"My personal goal is to have an artificial heart where you don't have side effects and you don't have any heart problems anymore, so it would last pretty much forever," Cohrs says. Well, perhaps not forever: "An artificial heart valve last 15 years at the moment. Maybe something like that."

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