Day or night, Marc Cohen, a major donor to Dana-Farber Cancer Institute, had a direct line to one of its leading oncologists. No question was too big or too small, and almost no hour was off limits for a consultation.
Cohen and his doctor, Kenneth C. Anderson, exchanged hundreds of emails and texts over two decades about Cohen’s disease, multiple myeloma, a rare and incurable blood cancer that is Anderson’s specialty. It was no problem for the physician to pause a Sunday morning walk with his wife to weigh in on test results, respond to a 5:50 a.m. email on a Saturday to suggest medication for insomnia-inducing leg pain or jump on the phone at short notice.
So after Cohen died in 2022 of complications from Covid-19 at a hospital near his suburban Washington, D.C., home, it came as a shock to his brother when, he said, a lawyer for Dana-Farber claimed Anderson was not Cohen’s doctor and never had been. Rather, he offered advice out of friendship.
As a result, Dana-Farber said it did not have any medical records of Anderson’s cancer care to share with Cohen’s family, records that could shed light on the treatment he received in his final days.
Now Cohen’s brother has filed a complaint against the esteemed oncologist with the Massachusetts Board of Registration in Medicine, contending that Anderson’s failure to keep medical records violated state regulations and ethical standards for physicians. Medical records are crucial for safe patient care because they allow doctors to track progress, monitor allergies, and recall failed treatments.
The unraveling of the Cohens’ relationship with Dana-Farber — where Marc was also a trustee and both he and his brother invested in hospital start-ups — has not only created possible legal problems for the hospital and Anderson. It also illustrates the potential risks for institutions when star doctors give special off-the-books access to trustees, donors, and other VIPs — a not uncommon arrangement at prestigious academic medical centers.
If Anderson believed he was providing informal advice to a key supporter and close friend, was he as vigilant as he would befor an official patient? Was he responsible if mistakes were made? And who exactly was in charge?
Marc Cohen had a team of doctors looking out for him. His primary care physician was near him in the D.C. area, and he received cancer treatment from Robert Siegel, an oncologist affiliated with George Washington University School of Medicine.
But Siegel was not an expert specifically in multiple myeloma. For that, Cohen depended on Anderson, his brother said.
To be sure, Cohen was far from a typical patient.
A venture capitalist who made his fortune as a technology entrepreneur, he became a multimillion-dollar donor to Dana-Farber and to Anderson’s research lab after he developed possible signs of cancer in the early 2000s. The institute appointed Cohen a trustee in 2004. And he and his brother, Alain, invested in five startup companies grounded in Dana-Farber research between 2008 and 2021 in hopes of creating marketable cancer treatments — one of Dana-Farber’s most prolific partnerships.
Marc Cohen knew he was fortunate to have unfettered access to Anderson, a widely published researcher and practicing physician who has garnered many top national awards for his contributions to the treatment of multiple myeloma. But, given their connection to Dana-Farber, he and his family also expected a certain level of attention from Anderson.
“Is he his doctor or is he not his doctor?” Alain Cohen asked, speaking of Anderson in a recent interview with the Globe. “You can’t give the impression and act like you’re the doctor and even make decisions and give advice and tell the patient to do things and give direction and then say, ‘But I’m just a friendly adviser.’ It’s a gray area of care.”
Anderson did not respond to requests for an interview. His lawyer, John Faggiano, said in an email, “There will be no comment at this time.” Dana-Farber executives also declined to answer questions about the dispute, including whether Anderson’s relationship with Marc Cohen was typical for its doctors and VIPs.
Dana-Farber spokeswoman Ellen Berlin said in a statement that all patients “get the same world-class care” there “no matter their zip code or their relationship to the institution.”
Berlin said Dana-Farber officials would not comment on the medical board complaint “to protect the integrity and confidentiality of an ongoing process.”
Alain Cohen’s lawyer, Stephen Pierce, shared with the Globe the 275-page complaint that he filed with the medical board in November 2023. It included dozens of emails between Anderson and Marc Cohen as well as medical records from his hospitalization for Covid and doctors’ appointments that list Anderson as part of his treatment team.
The medical board would not comment on its investigation.
Marc Cohen was first diagnosed with an abnormal protein in his blood, a condition called monoclonal gammopathy, which later developed into multiple myeloma. At the time he swore his brother to secrecy. Not even his parents knew he had cancer until he was admitted to the hospital for Covid January 2022. Alain Cohen said he does not know exactly where or when his brother was diagnosed, but that it was sometime in the early 2000s.
In an interview with the Globe in 2021, Marc Cohen said he got interested in Anderson’s work because he had relatives with cancer. He did not mentionhis own illness.
Over the years Cohen’s donations to the hospital totaled about $4 million, his brother said, with the vast majority supporting Anderson’s lab. The amount does not include investments Marc and Alain made in companies formed from Dana-Farber research.
Alain Cohen said he wasn’t sure exactly when or how Anderson began advising his brother on his cancer treatment. But he said the purpose of his brother’s donations was twofold. “Not only do I want to be Ken Anderson’s patient, but I want to help Ken Anderson get some of his research out into the world.”
For years, Marc Cohen felt pretty good, his brother said. He married a veterinary neurosurgeon in 2016 and the couple had three children. (Marc Cohen’s wife did not respond to requests for an interview.) In the decade before the pandemic, he worked incredibly long hours at the investment firm he owned with his brother, launched companies, and played tennis until he began to experience pain and numbness in his legs. A series of medications, including chemotherapy, kept his cancer mostly in check.
Then the coronavirus tore through the world, a disastrous development for someone with a weakened immune system from cancer. Marc Cohen tested positive on Jan. 7, 2022, and the next day, his brother drove him to the emergency room at Virginia Hospital Center.
The following months were a roller coaster. He was transferred to a bigger hospital, George Washington University Medical Center. He was on and off a ventilator and contracted infections in the hospital four separate times, his brother said. His kidneys shut down, and he required dialysis. He developed seizures. For the last several months in the intensive care unit, he was so sedated he couldn’t talk or move, his brother said.
“Marc was trapped in his body,” Alain Cohen said. In June 2022,doctors advised Alain, who was legally empowered to make medical decisions for his brother, to remove life support. “They said he might be in a lot of pain, so I felt I had to follow their advice.’’
Days after Marc Cohen died on June 28, 2022, Alain and Marc Cohen’s wife wrote Anderson a couple of long emails, charging that doctors had failed him. Despite Marc Cohen’s immense resources, “he fell between the cracks in the medical system,” they said, because “nobody took the bull by the horns.”
Five physicians and an attorney, all of whom specialize in medical ethics, told the Globe that the threshold for a doctor-patient relationship is an area of frequent debate.
“It is not at all unusual for VIPs, donors, and others who are important to request things that are not normally done for people,” said Susan Dorr Goold, an internist and health policy professor at the University of Michigan.
A casual conversation in a restaurant about a rash or cold symptoms would not count as a doctor-patient relationship, ethicists said. Neither would a so-called “curbside consultation,” when a doctor gives a colleague advice on a case. But the connection between Anderson and Marc Cohen clearly went far deeper.
In a September 2020 email to doctors at Johns Hopkins Hospital, Anderson wrote, “Marc Cohen is my patient with multiple myeloma” and stated he is medically cleared to undergo hernia surgery. The following January, Anderson wrote a letter saying Cohen had been his patient since 2014 and requested he receive priority for a Covid vaccine. The email and letter were provided to the Globe as part of the medical board complaint.
“If he wrote letters for the patient speaking as the patient’s doctor, to me, that’s evidence of a doctor-patient relationship,” Goold said. “He is rendering an opinion based on his knowledge of the patient.”
The American Medical Association Code of Ethics simply states that “a patient-physician relationship exists when a physician serves a patient’s medical needs,” generally by mutual consent.
Alain Cohen said he does not believe Anderson billed his brother, and it’s unclear if he ever examined him in his office at Dana-Farber. But doctors interviewed by the Globe said that an in-person exam is not necessary to meet the criteria of a doctor-patient relationship, especially with the rise of telemedicine.
Siegel said he saw Marc Cohen regularly and considered himself to be in charge of his care, but that he collaborated with Anderson because of his considerable expertise in multiple myeloma.
But he said Anderson and Marc Cohen were also friends, and “that’s where it gets a little murky. Is this a doctor-patient relationship or is this a friend? It’s a unique thing that I haven’t seen elsewhere.”
Pierce, Alain Cohen’s lawyer, said a Dana-Farber attorney, Christina Lau, told him during a May 2023 phone call that Anderson was acting as a “good friend” and adviser to Marc Cohen due to their friendship and because he was a trustee.
Dana-Farber officials disagreed with Pierce’s characterization of the conversation but would not specify why.
In her statement, Ellen Berlin at Dana-Farber seemed to draw a distinction between when the hospital’s doctors share their expertise with other physicians and when Dana-Farber doctors treat patients on-site.
“It’s not unusual for our medical teams to interact with doctors across the country and globally to offer our expertise,“ Berlin wrote. ”It does not matter if the patient previously received care here, does now, or has never stepped foot in our clinic.”
“Dana-Farber requires appropriate record keeping for care provided at or through our clinic,” she added.
The medical board would not comment on why its investigation is still open 16 months later. Whether Anderson faces disciplinary action for not keeping medical records could hinge on whether the board believes he and Marc Cohen had a doctor-patient relationship.
“I could see how this could happen, where it builds over time starting as a cocktail party conversation and ends with these emails where he is literally directing care without ever formalizing the relationship,” said Dr. Matthew Wynia, director of the Colorado University Center for Bioethics and Humanities. “We teach medical students to be a little careful.”
In their emails to Anderson after Marc Cohen died, his brother and wifeaccused Anderson and the other doctors of not working hard enough to get Marc Cohen a certain monoclonal antibody to fight the Covid infection. Marc Cohen, they said, should have gotten the level of care afforded to the US president, but he did not. President Trump received an experimental antibody when he became sick with Covid in 2020.
Anderson responded about an hour later that he did everything he could. He said he asked Dana-Farber’s pharmacy for a newer antibody but was told it was not available there.
“I helped you both convince Marc he needed emergent care and helped you get Paxlovid,” an antiviral medication, Anderson wrote in an email that was included in the medical board complaint.
Siegel also took exception to the criticism, saying Marc Cohen had many doctors focusing on his care, especially once he entered the hospital. “Marc Cohen was an extremely generous guy. He was a significant donor here as well. Everyone involved wanted to do their best for his care.”
Anderson’s email did not clarify what has become an essential question of whether he and Cohen were doctor and patient.
“I have tried my best each day ever since I met him 20 years ago to care for him as I would a cherished friend and family member,” Anderson wrote. “We were partners and brothers in myeloma and in life.”