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Angels of Death: 7 More Medical Murderers

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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Health
The First Shot to Stop Chronic Migraines Just Secured FDA Approval
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Migraine sufferers unhappy with current treatments will soon have a new option to consider. Aimovig, a monthly shot, just received approval from the Food and Drug Administration and is now eligible for sale, CBS News reports. The shot is the first FDA-approved drug of its kind designed to stop migraines before they start and prevent them over the long term.

As Mental Floss reported back in February before the drug was cleared, the new therapy is designed to tackle a key component of migraine pain. Past studies have shown that levels of a protein called calcitonin gene–related peptide (CGRP) spike in chronic sufferers when they're experiencing the splitting headaches. In clinical trials, patients injected with the CGRP-blocking medicine in Aimovig saw their monthly migraine episodes cut in half (from eight a month to just four). Some subjects reported no migraines at all in the month after receiving the shot.

Researchers have only recently begun to untangle the mysteries of chronic migraine treatment. Until this point, some of the best options patients had were medications that weren't even developed to treat the condition, like antidepressants, epilepsy drugs, and Botox. In addition to yielding spotty results, many of these treatments also come with severe side effects. The most serious side effects observed in the Aimovig studies were colds and respiratory infections.

Monthly Aimovig shots will cost $6900 a year without insurance. Now that the drug has been approved, a flood of competitors will likely follow: This year alone, three similar shots are expected to receive FDA clearance.

[h/t CBS News]

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Medicine
The 98.6℉ Myth: Why Everything You Think You Know About Body Temperature Is a Lie
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When you were kid, you probably knew that to score a magical sick day home from school, you needed to have a fever. When the thermometer came out of your mouth, it had to read higher than 98.6℉—the long-accepted "normal" human body temperature. (If you wanted to really seal the deal, you may have hoped to hit 100℉.) Since then, you may have used a temperature above 98.6℉ as a metric to work from home (or call out sick entirely).

But here's the thing: The average body temperature isn't actually 98.6℉—a fact that we've known for more than 25 years. The myth originated in the 19th century with a single doctor, and despite evidence to the contrary, it's persisted ever since.

THE GIANT—AND FAULTY—ARMPIT THERMOMETER

In 1851, Carl Wunderlich, the director of the hospital at Leipzig University, began going from room to room with a comically large thermometer in tow. He wanted to understand how body temperature is affected by different diseases, so in each room, he would hold the foot-long device in patients' armpits for a full 20 minutes, waiting for a temperature to register. Once it did, he'd note the temperature on the patient's chart (Wunderlich is thought to be the first physician to do so). He and his staff did this for years, repeatedly taking the temperatures of some 25,000 patients and logging them on their charts, until he had millions of readings. In 1868, he finally published this data in Das Verhalten der Eigenwarme in Krankheiten (On the Temperature in Diseases: A Manual of Medical Thermometry). He concluded that the average human body temperature was 98.6℉, underscoring the idea that fever is a symptom of illness, not a cause.

No one questioned Wunderlich's methods, or his average, for about 140 years. Then, in the early 1990s, internist Philip Mackowiak—a professor of medicine at the University of Maryland, a medical historian, and, apparently, a clinical thermometer junkie—saw one of the physician's instruments at the Mutter Museum in Philadelphia. He told the Freakonomics podcast that he'd always had doubts about the 98.6℉ standard. "I am by nature a skeptic," he said. "And it occurred to me very early in my career that this idea that 98.6 was normal, and then if you didn't have a temperature of 98.6, you were somehow abnormal, just didn't sit right."

Getting his hands on Wunderlich's thermometer—which the museum let him borrow—only deepened his doubts. The huge thermometer was unwieldy and non-registering, meaning, Mackowiak explained, "that it has to be read while it's in place." Not only that, but Wunderlich had used the device to measure temperatures in the armpit, which is less reliable than temperatures taken in the mouth or rectum. The instrument itself also wasn't terribly precise: It measured up to 2 degrees Centigrade higher than both ancient and modern instruments.

In 1992, Mackowiak decided to test Wunderlich's average. Using normal-sized oral thermometers and a group of volunteers, he determined that the average human body temperature actually hovers around 98.2℉. Mackowiak found that body temperature tends to vary over the course of the day, with its lowest point around 6 a.m. and its highest in the early evening. Body temperature can also fluctuate monthly (with the menstrual cycle) and over a lifetime (declining decade by decade with age), and may even be differentially linked to sex and race assignments. He concluded that normal body temperature is so unique to each person that it's almost like a fingerprint and, given that wide variation, not actually a very reliable indicator of illness.

As a result of his study, Mackowiak proposed raising the threshold for fever to 98.9℉ for temperatures taken in the morning (and 99.9℉ at other times). While it's a relatively minor change in terms of actual degrees, this fever threshold is actually lower than the CDC's, which is a temperature of 100.4℉ or higher.

There are potential real-life consequences in this gap, for everyone from students (who'd have to attend school with what would be considered a low-grade fever by Wunderlich's 98.6℉ standard) to employers and daycares (who use temperature to set attendance policies). What's more, anyone who is actually sick but ignores a low-grade fever—one that meets Mackowiak's threshold but still falls under the CDC's—could pose a risk to people with compromised immune systems trying to avoid unnecessary exposure to illness in public places.

THE BALANCING POINT

There's a reason the average trends near 98℉ instead of 92℉ or 106℉. As endotherms, mammals expend a great deal of energy maintaining body temperature when compared with cold-blooded creatures. To find and conserve a just-right body temperature, central nervous system sensors gather data (too warm? too cold? just right, Goldilocks?) and send that information to the pebble-sized hypothalamus near the base of the brain. There, the data is converted into action: releasing sweat and widening the blood vessels if too warm; raising metabolism, constricting the blood vessels, and inducing shivering if too cold.

According to a study by Aviv Bergman and Arturo Casadevall in the journal mBio, the precise balancing point for ideal body temperature is the sweet spot where the metabolic cost for all this thermoregulation balances with the evolutionary advantage of warding off fungal disease. (While warm-blooded animals are prone to bacterial or viral infections, they rarely experience fungal infections because most fungi can't withstand temperatures above 86℉. Cold-blooded animals, on the other hand, are prone to all three.) For Bergman and Casadevall, this benefit even explains what tipped Darwin's scales in favor of mammals, allowing them to edge out other vertebrates for dominance after the Cretaceous-Tertiary mass extinction wiped out the dinosaurs.

Of course, rules call for exceptions, and the one place where human body temperature demonstrates sustained elevation is outer space. Astronauts on prolonged missions clock significantly higher average body temperatures than they do when terrestrial—even up to 104℉. This so-called "space fever" is probably a product of some combination of radiation exposure, psychological stress, and immune response to weightlessness. Researchers believe this phenomenon could yield crucial information about thermoregulation—and may even offer insight into how humans might adapt to climate change.

WHY THE MYTH PERSISTS

It's been 26 years since Mackowiak's study, yet the newer data has not taken hold among medical professionals or the public. What gives?

Mackowiak tells Mental Floss that he finds it a bit mystifying that the myth persists, especially since many people, when pressed, know that the so-called "average" temperature varies. Part of the problem may be psychological: We cling to beliefs despite evidence to the contrary—a phenomenon called belief perseverance [PDF]. It's a significant force upholding a surprising number of medical myths. The idea humans should drink eight glasses of water a day? Not science. Sugar causes hyperactive behavior? Nope. Reading in dim light harms eyesight? Not really.

Unlearning persistent myths—especially ones loaded with the weight of medical authority—is difficult. "Deep down, under it all," Mackowiak says, "people want simple answers for things."

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