The National Survey on Doctor-Industry Relationships reports the last two decades has seen a flurry of writing and research about the relationship between doctors and pharmaceutical, medical device, and other medically related industries. The authors of this survey mention a review of 16 studies published between 1982 and 1997 that suggests doctors and industry reps, on average, met four times a month, and accepted six gifts a year from them. Dr Eric Campbell at the Institute for Health Policy, Boston, and colleagues, used information about the doctors' financial links with industry and then tried to predict the factors that influence them. They surveyed 3,167 doctors from six specialties: anesthesiology, cardiology, family practice, general surgery, internal medicine, and pediatrics. The response rate was over 50 per cent. The study authors review the results of a survey of US doctors that was conducted by the Institute on Medicine as a Profession (IMAP) and address three questions:

(1) What do doctors actually receive (including financial incentives) from industry reps and their companies?
(2) How often do they meet with industry reps?
(3) What characterizes the relationship between doctors and these industries?

The results showed that:

-- 94 per cent of doctors reported some type of relationship with the pharmaceutical industry.
-- 83 per cent said these relationships involved receiving food in the workplace.
-- 78 per cent said they involved receiving drug samples.
-- 35 per cent received reimbursement for costs of going to professional meetings or continuing medical education (CME).
-- 28 per cent received payments for consulting, giving lectures, or enrolling patients in trials.
-- Cardiologists were more than twice as likely to receive payments as family doctors.
-- Family doctors met with industry reps more often than did doctors in other specialisms.
-- Doctors who practised on their own or in group practices met with reps more often than those working in hospitals and clinics.

In conclusion, the researchers said these results show that: "Relationships between physicians and industry are common and underscore the variation among such relationships according to specialty, practice type, and professional activities."

Posted by Scott J. Eldredge at 11:52 AM | Permalink | Comments (0) | TrackBacks (0)

A woman who says she suffered life-threatening blood clots from a birth control medication wants the Ohio Supreme Court to declare the state's cap on pain-and-suffering awards unconstitutional. The court planned to hear arguments in the lawsuit filed by Melisa Arbino of Cincinnati over the Ortho Evra Birth Control Patch, which she contends caused permanent physical damage and threatens her ability to have children in the future. The challenge to a 2005 law limiting pain-and-suffering awards is the first to reach the court. It is being closely watched by companies who support the concept of caps and attorneys representing injured people. The GOP-controlled Legislature approved the caps two years ago, limiting pain-and-suffering awards at between $350,000 and $500,000 for less severe injuries. The bill also put limits on jury awards meant to punish companies for wrongdoing in faulty product cases. Businesses long said they needed such a bill in part because of rising insurance rates as a result of high jury verdicts. Attorneys for Arbino contest that argument, saying insurance companies have raised their rates because of investment losses, not expensive jury verdicts. "Is it constitutional to deprive someone of their right to a trial by jury simply to promote the private economy?" said Janet Abaray, a Cincinnati attorney representing Arbino. Johnson & Johnson, makers of the patch, countered that companies need the predictability that caps bring to doing business in Ohio.

Arbino, 26, said she first used the patch shortly after her son was born in 2005. Within days she suffered from severe headaches and was throwing up and was hospitalized with a blood clot on her brain. She was discharged, only to return two weeks later with blood clots in her lungs. She must still be treated by a doctor. She still has a blood clot lodged in her brain and would have to go on blood thinners if she ever became pregnant again.

Posted by Seth A. Katz at 11:47 AM | Permalink | Comments (0) | TrackBacks (0)

In October of 1996 an accident changed Sandra Shampang's life. She was driving to work when she was struck by a large truck 100 feet from her employer's driveway. She hit her head on the headliner while she was wearing an automatic shoulder seat belt and a lap belt. After being transferred to the hospital she was examined by a physician's assistant and was sent home. The physician's assistant said, "Take the rest of the week off and we'll see you on Monday." Shampang didn't go back to the hospital and her symptoms worsened. She couldn't get out of bed and she wasn't able to walk well. After four weeks of Tylenol for headaches and sleeping all the time, she was in a fog. Her then-husband insisted she see a neurologist, so she made an appointment. "He immediately put me on medication and got me into physical therapy. His diagnosis was post-concussive syndrome or traumatic brain injury." The injury was caused on impact during the accident. Shampang spent six years in recovery. "I had a long working history. I was very frustrated. I had been a business owner and business manager. I couldn't remember anything." Her organic brain damage resulted in a seizure disorder, anxiety and panic disorder and obsessive-compulsive disorder. She improved after her doctor prescribed the right meds. Six months afterward, she was able to drive. She hadn't driven in six years because she couldn't concentrate.

The Center for Independence invited Shampang to a meeting. The agency had two job openings. She applied for the position of outreach peer counselor and got it. "I so wanted to give back for what the agency had done for me." Since November 2001, she has worked for the agency from her home. A normal working environment is too loud, too distracting and has too much input for her. Her work includes benefits advisement, providing advice and education to people with disabilities who are considering pursuing paid employment. "There are individuals wanting to transition back into the community. We're giving them the information they need to do that."

Posted by Kerry N. Jardine at 11:43 AM | Permalink | Comments (0) | TrackBacks (0)

Researchers at the University of Rochester Medical Center have made an alarming discovery that may affect millions of Americans who suffer from migraine headaches. Approximately 26 million Americans suffer from migraines and researchers have studied the severe headaches for years in search of better treatment options.

In search of the cause of migraine headaches and treatment options, the Rochester researchers found that migraines cause symptoms that are commonly associated with strokes and traumatic brain injuries (TBI's). They found that migraines leave certain areas of the brain depleted of oxygen - a common characteristic of transient strokes. As the brain is deplete of oxygen, signs of brain damage can be seen.

"Normally, the focus of migraine treatment is to reduce the pain. We're saying that migraines may be causing brain damage, and that the focus should be on prevention, which will stop not only the pain but also minimize potential damage," said Maiken Nedergaard, M.D., Ph.D., the neuroscientist who led the research team.

The research team used imaging technology to study the events that occur in a mouse's brain during a migraine episode. They found that the brain develops an unusually high demand for energy as it tries to restore the chemical imbalance that is lost during the onset of a migraine. During this time, the brain's arteries expand and make more oxygen rich blood available to the brain, but some parts still do not receive sufficient amounts of oxygen. The lack of oxygen leads to hypoxia (extreme oxygen shortage) which leads to brain cell deterioration similar to what is found in strokes and TBI's.

"It's long been known that patients having a migraine attack are functionally impaired from the pain. It's also been shown recently that with repeated migraines, a person's cognitive abilities decrease. But actually doing damage to the brain - that is a surprise," said Takahiro Takano, author of the study's first paper.

The study's researchers hope that their study will shift migraine research toward more prevention of migraines, as opposed to treatments.

Posted by Kerry N. Jardine at 11:36 AM | Permalink | Comments (0) | TrackBacks (0)

Three papers published recently examine ties between industry and doctors in the US. They suggest that drug and other companies invest heavily in encouraging doctors to use and recommend their products and that despite recently published ethical guidelines by various professional bodies, many doctors are overstepping the mark when accepting reasonable favors, education and "freebies", ostensibly in the interests of patients. One paper, by a former drug rep and a physiology professor who researches drug marketing, looks at how drug reps are trained to influence doctors to buy their drugs and is published in PLoS Medicine. Another paper in the same edition of the journal looks at the impact of sales visits for one drug in particular. A third paper publishes the results of a national survey on doctor-industry relationships and suggests these are very common and vary according to specialists, type of practice and professional activity. It is published in the New England Journal of Medicine (NEJM).

The first article describes in great detail the type of training that a drug rep goes through to learn how to change the prescribing behavior of the doctors in their sales territory. The tactics for how to relate to each doctor depends on the physicians' category. For instance with the outgoing and friendly types the emphasis is on friendship development; with the aloof and skeptical, the emphasis is on collecting and presenting journal articles that counter the doctor's view on the drug. It describes how reps are trained to "assess physicians' personalities, practice styles, and preferences, and to relay this information back to the company. Personal information may be more important than prescribing preferences. Reps ask for and remember details about a physician's family life, professional interests, and recreational pursuits." In conclusion, the authors say that: "Every word, every courtesy, every gift, and every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs." Their recommendation to the medical profession is: "In the interests of patients, physicians must reject the false friendship provided by reps. Physicians must rely on information on drugs from un-conflicted sources, and seek friends among those who are not paid to be friends."

Posted by Scott J. Eldredge at 10:57 PM | Permalink | Comments (0) | TrackBacks (0)

Popular belief in medical communities is that juries in medical malpractice cases tend to side with plaintiffs, even where the case against a doctor is a weak one. However, jurors actually tend to believe doctors more than they do plaintiffs, says a law professor who examined numerous data on medical malpractice litigation, including cases in New Jersey. Philip Peters Jr., of the University of Missouri-Columbia School of Law, concluded that juries treat doctors favorably, "perhaps unfairly so," and are more likely than even fellow physicians to defer to a doctor's opinion. In an examination of win rates, Peters found that 27 percent to 30 percent of filed medical malpractice suits end in a plaintiff's verdict, the lowest success rate of any type of tort litigation. Peters researched the data to test the assumption that juries lack capacity to evaluate medical malpractice suits fairly, an assumption implicit in legislation pending in Congress that would create specialized courts for such cases. "Politicians and critics of jury performance should think twice before concluding that doctors will be treated more favorably in health courts," wrote Peters, whose report will be published in May in the Michigan Law Review.

The New Jersey study compared jury verdicts in individual cases with independent findings by medical or legal experts. The result was that the odds of a plaintiff's verdict increased in cases with greater evidence of negligence. The correlation was not perfect, especially where the independent expert believes the patient was injured by physician negligence. Plaintiff wins were in the minority even in the most meritorious cases. New Jersey's study showed generally that patients whose claims were deemed weak by reviewers were unlikely to win a jury verdict; that patients with borderline cases were twice as likely to win as those with weak cases; and that patients with claims deemed strong were most likely to prevail before a jury. Juries were surprisingly deferential to doctors, Peters said. While they were very likely to find for the defendant in cases where the reviewer felt the plaintiff's evidence was weak, they were just as likely to return a defense verdict when the evidence was deemed strong. Peters concludes that juries may be skeptical of patients who sue their doctors, and finds that doctors have a significant advantage in front of juries.

Posted by Scott J. Eldredge at 10:55 PM | Permalink | Comments (0) | TrackBacks (0)

The common wisdom in "shaken-baby'' cases was that the last person with the child before symptoms appeared was the guilty party. A Wisconsin jury convicted babysitter Audrey Edmunds, a mother of three young girls, of first-degree reckless homicide and sentenced her to 18 years in prison. In the decade since her conviction, Edmunds' lawyers say, many experts have studied the physics and biomechanics of shaken-baby syndrome and have concluded that shaking alone could not have produced the baby Natalie's injuries without leaving other evidence of abuse. Among those now questioning the diagnosis is Dr. Robert Huntington, the forensic pathologist whose testimony helped put Edmunds away. If the trial were held today, Huntington said recently, "I'd say she died of a head injury, and I don't know when it happened . . . There's room for reasonable doubt.''

The American Academy of Pediatrics declares shaken baby syndrome to be a "clearly definable form of child abuse.'' The National Institute of Neurological Disorders and Stroke says SBS bears a "classic triad'' of signs; brain hemorrhaging, retinal hemorrhaging and brain swelling., which can lead to permanent, severe brain damage or death. An estimated 1,500 cases of shaken baby were reported in the United States last year. More than 30 years after the term was first used, there are still skeptics within the medical community. "It doesn't exist,'' contends Dr. John Plunkett, a pathologist who began openly questioning shaken-baby syndrome 10 years ago.”You can't cause the injuries said to be caused by shaking, by shaking.'' Pediatrician Robert Reece, who is on the international advisory board of the National Center on Shaken Baby Syndrome, says while he believes shaking alone can cause death, the term has no place in a courtroom. The term "implies a mechanism of injury that I don't think we can prove in court,'' says Reece, who uses terms such as "abusive head trauma'' or "inflicted traumatic brain injury'' in court testimony. In a 2001 article in the American Journal of Forensic Medicine & Pathology, Plunkett concluded that an infant could suffer a fatal head injury from even a short fall, and that symptoms might not immediately follow the injury. He also concluded that there were other, accidental sources for one of the "classic'' signs of shaken baby syndrome. In a 2003 study at the University of Pennsylvania, researchers found that vigorous shaking of a "biofidelic'' model of a baby produced "statistically similar'' results to a fall from 30 centimeters onto concrete, or concrete with a carpet pad. Other studies have suggested that the hemorrhaging and swelling thought to prove shaking can have myriad causes, from dehydration and infection to oxygen deficiency.

Some judges in other cases have broadly agreed. Last year, a judge in Manatee County, Fla., barred use of the term "shaken baby syndrome'' because of its possible prejudicial influence on jurors. In two separate cases, Circuit Judge Lewis Nicholls of Kentucky decided he could not admit expert testimony on a theory whose foundation may amount to "merely educated guesses'' about the cause of death. "The best the court can conclude is that the theory of SBS is currently being tested, yet the theory has not reached acceptance in the scientific community,'' Nicholls ruled. "To allow a physician to diagnose SBS with . . . no other evidence of manifest injuries, is to allow a physician to diagnose a legal conclusion.''

Posted by Kerry N. Jardine at 10:50 PM | Permalink | Comments (0) | TrackBacks (0)

John Mackey was a tight end for the Baltimore Colts (1963-1971) and San Diego Chargers (1972), five-time Pro Bowler, Member of the National Football League (NFL) 1960s All-Decade Team and the second tight end to enter the NFL Hall of Fame. He has frontotemporal dementia, a degenerative disease caused by the rapid deterioration of the frontal and temporal lobes of the brain, which Mackey injured on a goal post while playing professional football. Each year in the United States, about 300,000 athletes experience sports-related traumatic brain injuries. In the NFL, approximately 100 players suffer concussions resulting from collisions averaging 98 times the force of gravity. The issue of safety, brain injury, and athletics is in the spotlight, much due to action by the families of NFL veterans. The league has begun to take responsibility for the declining health of its players. When Mackey's wife, Sylvia, wrote to then-NFL commissioner Paul Tagliabue about the financial burden that can result from the rapid decline of retired players'health, the league and the NFL Players Association responded by creating the "Number 88 Plan." Named after John Mackey's jersey number, the plan will pay up to $88,000 for each former player's treatment of assorted types of dementia.

Facing a growing number of football veterans with deteriorating health, the NFL is beginning an extensive study of the connection between sports-related concussions and chronic brain dysfunction. Currently there are plans in place to address the devastating side-effects of a professional football career. After former Philadelphia Eagle Andre Waters, whose extreme brain damage was caused by repeated concussions, committed suicide, was when the NFL promised to begin studying retired players later this year. Embarking on a study that may cost as much as $3 million over several years co-chairman of the NFL's Mild Traumatic Brain Injury (MTBI) Committee, Dr. Ira Casson, said the study aimed to determine "whether or not a career in the NFL results in any kind of chronic brain injury." This plan is a noteworthy step on the part of the NFL to help remedy the consequences of an NFL career, but it appears that the league neither has been nor is being as proactive with regard to encouraging and protecting the safety of players on the field. Past and current players suggest that playing despite injury is implied and expected. The league has historically resisted admitting the dangers exposed by predominant scientific findings. Yet a 2003 study of 2,905 National Collegiate Athletic Association players by North Carolina's Center for the Study of Retired Athletes found that 91.7 percent of repeat injuries came within ten days of the first injury, and 75 percent came within seven days. Dr. Kevin Guskiewicz, the research director for the Center, states, "Some say we're trying to paint this ugly picture... My goal is to help improve the game to make it a more safe game, regardless of what level it is."

Many fear that if the NFL's attitudes toward safety do not change, the reverberations will be felt not just by professional football players, but by athletes of every sport and level. The NFL finds itself in the powerful position to set an example that can improve the quality of life of many a future athlete. Many insist that the game of football must fundamentally change to ensure safety. Possible initial policies as simple as requiring follow-up examinations after injury and sending players off the field long enough for thorough treatment and recovery, in accordance with research findings and physician recommendations, make a difference. The league should seize this opportunity to reconsider and revamp its approaches to athlete safety.

Posted by Kerry N. Jardine at 10:48 PM | Permalink | Comments (0) | TrackBacks (0)

As the war in Iraq continues to intensify, more and more veterans are returning with devastating mental health issues. There has be a marked rise in mental health issues in Iraq veterans because of the war's signature injury - traumatic brain injury (TBI).

The parents of an Iowa vet who committed suicide urged the Senate to improve the VA's efforts in TBI and mental health care. Their son spent 11 months in Iraq and shot himself in front of his mother a few months after his return. Joshua suffered from post-traumatic stress disorder - a disorder that went undetected upon his return. During their plea in front of the senate, the veteran's parents voiced their disappointment in the VA's lack of a preventative treatment program to deal with devastating mental health issues.

"We need to give all veterans the opportunity to live the best life they possibly can," Randy Omvig said, the veteran's father.

Jan Kemp, a VA associate director for education who works on mental health, said that there are up to 1,000 suicides a year among veterans within the VA system, and as many as 5,000 a year among all living veterans.

She said the VA is developing ways to prevent suicide. Efforts include an education campaign aimed at making sure all providers identify veterans who are at risk. Newer veterans are coming in with PTSD and traumatic brain injuries that both carry a high suicide risk rate. Kemp hopes that her educational campaign and the VA's recent efforts to improve TBI detection and treatment will help lower the number of veteran suicide.

Posted by Kerry N. Jardine at 10:35 PM | Permalink | Comments (0) | TrackBacks (0)

The U.S. Consumer Product Safety Commission (CPSC) has received hundreds of complaints concerning magnets that have fallen out of a number of toys. There have been at least 33 reported cases in which children have swallowed a loose magent and had to receive emergency surgery. There has been one reported fatality of a 20-month-old-boy from Seattle, Washington. In nearly all of the cases reviewed by CPSC, each child had suffered intestinal perforations.

Magnets pose a unique danger to children because most magnets will not pass through the digestive system as most loose objects do. When 2 or more loose magnets and/or metal objects are swallowed, the objects are attracted to one another in the intestinal walls. The attraction causes the magnets to become trapped inside the body and cause blockage, infection, or blood poisoning. All these conditions can lead to a child's death.

The threat of loose magnets must be taken seriously, and the CPSC has recalled with more than eight million products containing magnets that could come loose and fall out of the product. Even though products such as Magnetix Magnetic Building Sets have been recalled since March 2006, several children are still being admitted to ER's across the nation due to loose magnets. The CPSC urges all parents to beware of any toys or products that may have magnets that can become loose.

The CPSC is working with manufacturers in the toy industry to protect children from the dangers of magnets. New voluntary standards requirements were approved on March 15th. Additional requirements will be considered by the voluntary standards group over the next year.

Posted by Kerry N. Jardine at 10:32 PM | Permalink | Comments (0) | TrackBacks (0)

Drug therapies are an obviously important segment of medical care, and the increasing complexity of today's drug therapies heightens the risk for prescribing errors and other drug-related problems. Physicians are faced with the enormous challenge of trying to keep up with a growing and ever-changing array of prescription drugs. Fortunately for doctors and their patients, however, there are specialists who focus solely on drugs and their role in healthcare--pharmacists.

Well-trained pharmacists do much more these days than just dispense medications; one quarter of them work in hospital settings, participating in patient care and complex clinical issues. Many studies have shown that pharmacists can improve patient safety and outcomes by recommending optimal therapies and dosages, thereby minimizing adverse events.

Unfortunately, pharmacists' critical role in patient care is not always acknowledged by physicians, and their expertise remains underutilized. A recent article emphasized this problem when a panel of doctors discussing resources on prescription drugs neglected to even mention pharmacists!

From the pharmacy profession's perspective, interdisciplinary collaborations would be highly desirable; but physicians remain unconvinced. Medscape (www.medscape.com) is one place where pharmacists are learning alongside physicians and other healthcare professionals. They complete many of the same continuing education programs as physicians and share an interest in many of the same topics, such as pain management and clinical treatment guidelines.

Everyone, most especially patients, reap benefits when pharmacists and physicians combine their respective knowledge bases and skills, complementing each other for the benefit of the patients who trust and rely on them both.

Posted by David P. Hersh at 10:40 PM | Permalink | Comments (0) | TrackBacks (0)

New rules within the F.D.A. will prohibit an expert adviser from voting on whether a drug gets approved if the adviser has been paid $50,000 or more in the prior year from the drug's maker or competitor.

The F.D.A.'s acting deputy commissioner Randall W. Lutter, said that "a significant number" of the F.D.A.'s current advisers would be affected by the new rule, though he wouldn't say how many. Dr. Lutter explained, "The $50,000 threshold is something that we think strikes an appropriate balance between" getting competent advisers and reassuring the public that their advice is not biased. This rule is one of the first major changes made by the FDA's new commissioner, Dr. Andrew C. von Eschenbach.

The new rule responds to critics who contend that drug companies have hijacked the FDA's approval process by payments to its expert advisers. In a famous example from 2005, 10 of 32 advisers who voted to allow Bextra to stay on the market, and allowed Vioxx to return to the market in spite of safety concerns, had received payments from those drugs' manufacturers. Had the new rule been in place at that time, their votes would not have counted, and the committee would have voted to keep those drugs off the market.

Responses from Congress were mixed. Representative Maurice Hinchey (D-NY) was delighted with the change, saying "The F.D.A. is now moving back to where it was supposed to be, a principled agency that protects the people." But Representative Rosa DeLauro (D-CT) was more cautious, stating "I am skeptical, given their recent track record of putting political and corporate interests above science."

Past versions of conflict of interest rules have been ineffective because most conflicts were subject to waiver, and were commonly waived, by the FDA. Disclosures were private, and the public never knew whether the expert had received $10 or $10,000. Although the new rule still allows waiver of conflicts, such waivers now have to be approved by the F.D.A.'s commissioner, which some feel will be rare. Many advisers are likely to welcome the clarity this new rule brings, even though it may mean dropping off their committees.

Daniel Troy, a former F.D.A. general counsel, said "F.D.A. is trying to strike a balance here, and they would rather strike it themselves than have it struck for them."

Posted by Seth A. Katz at 10:09 PM | Permalink | Comments (0) | TrackBacks (0)

A recent study at Fort Carson in Colorado found that 18 percent of troops serving in Iraq suffer at least some one traumatic brain injury (TBI) brain damage from the blasts of improvised explosive devices. In response, Fort Carson has announced that it will implement new scanning cameras at their post to detect brain injuries in returning soldiers. "They are taking head injuries seriously," said Dr. P. Stephen Macedo, a Washington, D.C.-based neurologist and former doctor with the Veterans Administration.

Currently, doctors at Army post must rely on questioning soldiers to determine if they've suffered brain damage in battle. Many experts believe that the current questioning process is not good enough. Many injured soldiers show no symptoms of TBI's, and other symptoms often mirror other conditions.

Past studies have shown that verbal tests are effective in diagnosing TBI's. They are subject to failure for many reasons: the soldier may not remember, may deliberately withhold information to avoid being discharged, or may not yet be feeling the effects of an injury.

Fort Carson plans to use soldiers who have already been diagnosed with TBI's to test the new scanning camera's accuracy and effectiveness. An Army review board will review the results.

The announcement comes after Veterans Affairs Secretary Jim Nicholson released a report Tuesday saying injured soldiers and veterans will get more screenings for TBI's.

Posted by Kerry N. Jardine at 10:06 PM | Permalink | Comments (0) | TrackBacks (0)

Looking like a battering ram, a helmeted dummy crashes headfirst into a steel plate at 13 mph, barely the speed of a bicycle. Sensors embedded in the dummy's head and neck show that the helmet would have saved a person from head trauma. What about the spinal cord? Even at these speeds, St. Louis University biomechanist Jack Engsberg said, it would have snapped. Engsberg and researchers in the university's physical therapy department are designing a shield that would protect both the head and neck. With motorcycle deaths on the rise, the shield could be a boon for the safety conscious. However, it's unclear how many self-respecting Harley riders would don the unwieldy device, a rigid exoskeleton that runs from head to waist. The shield is a molded fiberglass sheath, reinforced with steel rods that shepherd impact forces from a skullcap to the shoulders, bypassing the neck.

There are some benefits to the design. Most helmets tightly wrap the head and, moreover, require the head to hold up the helmet. With the shield, on the other hand, there's about an inch of space separating the head and the skullcap, offering greater freedom of movement. Engsberg said a refined version could be made more breathable with an apple-pie lattice of fiberglass strips. The researchers say the shield also could help horse riders. In a 1995 equestrian event, actor Christopher Reeve was thrown from his horse and landed on his head. He broke his neck and suffered a severe spinal cord injury even though he was wearing a helmet and protective vest. It was also a horse-riding accident that motivated Washington University neurologist William Landau to design the shield, after his granddaughter was paralyzed in a fall. Landau was awarded a 1998 patent for a brain and spinal cord protector. Landau later approached Engsberg, who runs a motion analysis laboratory at St. Louis University. The researchers recently smashed up eight Bell Zephyr motorcycle helmets, collecting data that would be compared with earlier tests on their prototype shield.

Motor vehicle accidents cause nearly half of the estimated 11,000 annual spinal cord injuries in the United States, according to the National Spinal Cord Injury Database. Those who die from spinal cord injuries at the scene of an accident are not counted.

Over the last decade, motorcycle deaths per vehicle-mile traveled have almost doubled, even as automobile death rates have declined, according to the National Highway Transportation Safety Administration.

Posted by Kerry N. Jardine at 10:01 PM | Permalink | Comments (0) | TrackBacks (0)

In Farmington, New Mexico it's almost time to see how several local attorneys perform in a different court during the upcoming 21st annual Doctors vs. Lawyers basketball game. Each year, several local health care officials and attorneys compete against each other to help benefit Friends Helping Friends, Inc., a support group for people with traumatic brain injuries, spinal chord injuries and those who suffer from strokes. The friendly competition always gathers a considerable crowd of nearly 500 to 800 people. It's a straight basketball game with the typical rules. Local dance companies will also provide entertainment during the game's halftime show. Everything is volunteered and the proceeds from the game benefit an upcoming disabilities conference in Albuquerque.

The Southwest Disabilities Conference allows people associated with Friends Helping Friends, Inc., to learn about coping and living skills, facts and fallacies, rehabilitation resources, therapy following brain injury, legislative issues, Social Security and Disability issues and advocacy. Friends Helping Friends, Inc., originally was created as a support group for people with brain and spinal chord injuries.

Posted by Kerry N. Jardine at 09:58 PM | Permalink | Comments (0) | TrackBacks (0)

Life changed for the Chiefari family last October. Mary's 29-year-old son David flipped his car and hit a pole head-on. David suffered a traumatic brain injury. He fractured his left temporal bone and right frontal lobe. Mom Lynn Lettieri said, "He was bleeding from both ears, and he had tubes down his mouth, and they had put a chest tube in because his lung had collapsed." Brother Jim Chiefari said, "They were doing certain tests, and they didn't get responses from him, and at the time he was not showing them reflex responses." The coma lasted two and a half months. The recovery is a traumatic process in itself. Shock and disbelief changes to coping before the final stage of moving on. The biggest challenge is understanding the healing time.

Traumatic Brain Injury Program Director Brenda Nixon said, "In that frontal lobe area, unfortunately that is the area where we have a lot of the qualities and characteristics to make up who we are, our ability to have inhibition and our ability to have self control. David still has bouts of confusion, some bouts of memory loss and of course minimal amount of agitation that comes along with that."

David's getting stronger and working at getting more of his memory back. For a few more weeks he will get more physical and cognitive rehab and then he will head home and will get outpatient rehabilitation. His brother sees David as a source of inspiration as he overcomes so many challenges. Chiefari said, "There are answers I won't get for asking why things happen. So what can I do to make it better? To make myself stronger and appreciate that I have to make a life to live and make it the best that I can." Chiefari said, "I know that he is still in there. I know he is getting stronger, so I want to see him pursue his interests again." Before the accident, David was applying for his Ph.D. A full recovery is hopeful.

Posted by Kerry N. Jardine at 09:56 PM | Permalink | Comments (0) | TrackBacks (0)

Senators Joe Lieberman and Barbara Boxer introduced The Mental Health Care for our Wounded Warriors Act of 2007. This legislation addresses two significant challenges facing the Department of Defense (DoD): the absence of designated, centralized facilities called "Centers of Excellence" to research and coordinate all aspects of military mental health policies and services, and the shortage of mental health professionals to provide care to members of the Armed Forces. "We have no greater obligation than to care for our wounded service members," Lieberman said. "This legislation would designate Centers of Excellence to coordinate military mental health services and research efforts, and would address the shortage of mental health professionals to provide high quality care to our service members." Senator Boxer said, "Our troops are risking their lives for this country, and we owe them nothing less than the best care in return. These Centers of Excellence will be hubs of scientific research where professionals can determine how best to treat mental health conditions and traumatic brain injuries afflicting combat veterans."

The bill would establish Centers of Excellence within the DoD to research and guide the development and implementation of comprehensive strategies to prevent, identify, and treat combat-related mental health conditions, emphasizing Post-Traumatic Stress Disorder (PTSD) and traumatic brain injuries. The centers would also develop, identify, and disseminate best practices for treatment of combat-related mental health conditions and brain injuries and develop measures to reduce the stigma surrounding mental health illnesses. The bill would also require the DoD to report back to Congress within 45 days on the need for Congressional intervention to provide financial incentives to reduce mental health workforce shortages, Congressional intervention to amend the duration of service obligation to increase the recruitment of mental health professionals, and increasing the use of scholarship and financial assistance to recruit qualified mental health professionals.

An estimated one in six returning service members has a diagnosable condition of post-traumatic stress disorder (PTSD) and one in ten service members involved in the Iraq and Afghanistan conflicts may suffer a traumatic brain injury. Over one-third of the Iraq and Afghanistan veterans treated by the VA have been diagnosed with a mental health condition, including PTSD, depression, and substance abuse, among others.

Posted by Kerry N. Jardine at 09:53 PM | Permalink | Comments (0) | TrackBacks (0)

Despite a flawed police investigation and a justice system that caused her grief, a teacher, Nadia McLean-Gagnon has transformed being the victim of a horrendous crime into a positive experience she wants to share with others. On Jan. 29, 2006, Nadia McLean-Gagnon's life was altered forever when a 13-year-old boy dropped a piece of concrete through her car windshield. She shared her healing story with delegates to the Manitoulin Northshore Victim Crisis Assistance and Referral Service conference. In her presentation, entitled Putting all the pieces back together, she detailed how she has overcome her catastrophic injuries, which included a broken nose, split palate, broken teeth, major muscle and nerve damage, as well as how she has come to embrace the young offender who is now a part of her life. The night of the overpass attack, the youth and an 18-year-old accomplice had been out stealing speakers. When he targeted the car, the youngster was acting on a dare from his older friend. "I almost died for a set of speakers," she said. "Kids often do things for the smallest reward."

Bringing the perpetrator to justice was not easy. Although she harbors "no ill feeling" against the police in general, she criticizes one individual for not doing a proper job. "In the first five days, valuable time was lost. The officer did not take the proper measures to collect evidence. No effort was taken to find the aggressor. DNA samples were not taken until one-and-a-half months after the incident and many people had handled it by then," she pointed out. When the OPP finally took over the case, more progress was made. The suspect was turned in by an informant. He was charged with five counts of mischief endangering life and one count of aggravated assault. After plea bargaining, the youth pleaded guilty to one count of criminal mischief.

Because the teenager was the same age as her own students, McLean-Gagnon opted to participate in the victim/offender rehabilitation program. However, she felt frustrated in her efforts to make the process meaningful. The workers initially refused to let her show the youth photographs of her injuries. She felt victimized again because she thought it was important for him to see the pictures of her injuries and to understand the extent of the damage caused by his actions. Eventually, she was able to confront her attacker. In the 2.5-hour session, she discovered he came from a disadvantaged background. In fact, his mother had coached him to lie about the true facts of the case. "He did feel bad," she said. "He looked at the pictures and he was trembling. He looked like he was going to be ill. He did accept what he had done. "But he wasn't the big thug I had expected him to be. I don't think he's a bad kid; I just think he made a bad choice. I wanted to hug him." McLean-Gagnon said it is counterproductive to send youngsters to jail where they are surrounded by criminals. She believes it only makes them continue on a criminal path, and is convinced errant teens can be saved. "I want the offender to better himself and to become a productive member of society. He's part of my life now and I want to be an inspirational pointer in his life so he can learn from the experience." Today, McLean-Gagnon counsels victims to talk openly about their struggles and to convert trauma into an opportunity for personal growth.

Posted by Kerry N. Jardine at 09:48 PM | Permalink | Comments (0) | TrackBacks (0)

According to an annual national ranking of state civil justice systems, California's class action law ranks 46th in the nation in fairness and reasonableness. The rankings were released by the U.S. Chamber of Commerce's Institute for Legal Reform. John H. Sullivan, president of the Civil Justice Association of California says, "Simply put, California has the fifth-worst class action law in the country and it's time for the Legislature to install balance and clarity and make this part of the civil justice system work for all Californians. Until the Legislature does, consumers will continue to pay for these lawsuits through higher prices of everyday goods and services." CJAC claims other states and Congress have passed reforms to improve their class action laws, yet California statutes have remained largely unchanged, giving neither judges nor lawyers clear guidelines for handing these cases. California is increasingly seen as a safe haven for opportunistic class action lawsuits, the group said.

CJAC is sponsoring bill AB 1505 to better protect the rights of discrimination victims and harmed consumers. The group says the bill, which is scheduled to be heard in the Assembly Judiciary Committee on May 8, will make class action law more fair, predictable, and efficient, and would give judges clear statutory rules for handling class action cases and greatly reduce the legal uncertainty that makes these lawsuits expensive and time-consuming. The U.S. Chamber of Commerce's Institute for Legal Reform was based on a poll conducted by Harris Interactive Inc. "The 2007 State Liability Systems Ranking Study" was conducted for the U.S. Chamber Institute for Legal Reform among in house general counsel and other senior litigators to explore perceptions of state liability systems.

Posted by Kerry N. Jardine at 09:45 PM | Permalink | Comments (0) | TrackBacks (0)

A class action lawsuit involving hundreds of Labrador City women who were exposed to tainted gynecological instruments appears to be resolved. The suit involved 327 women and was launched after they were told they would need to be tested for diseases such as HIV and hepatitis A and C. Lawyer Ches Crosbie says it's not certain that participants in the class action suit would have received more compensation. The women were informed in 2003 that they may have been exposed to infectious diseases while they underwent tests at the gynecological clinic at Capt. William Jackman Memorial Hospital in Labrador City. Brenda Rideout, a Labrador City resident who joined the action, said it's important for women to not be complacent about the care they receive. "We should make sure this kind of thing shouldn't happen," she said. "Just going and getting a simple test done isn't something where you should be putting yourself at risk for losing your life."

Under the terms of the agreement, which must still be approved by a judge in a hearing expected in June, each woman in the action will receive $450. Her spouse will receive $100. Ches Crosbie, the St. John's lawyer who represented them, said he anticipated he may receive some complaints about the monetary settlement. However, he said the maximum amount in such cases is only $1,000. "We got about half that, and in order to get that, you were probably looking at another year or two, with things like a psychiatrist being hired by the defendant," Other terms of the settlement include publication, in a local paper, of changes in policy and procedure at the Jackman hospital. As well, a woman from the community will be allowed to join a team that keep an eye on such procedures.

Posted by Kerry N. Jardine at 09:42 PM | Permalink | Comments (0) | TrackBacks (0)

A man who suffered serious brain injuries when his head struck an overpass while on the roof of a Kansas State football fan bus spoke publicly this week to thank his supporters. Christian Orr suffered a brain injury so severe doctors gave him almost no chance of survival. Orr and another man were standing on the upper deck of the Cat Tracker double-decker bus Nov. 18 on the way to a Kansas State-Kansas football game in Lawrence when their heads struck a pedestrian bridge under which the bus had driven. Orr was in critical condition and in a coma for a month, and John Green, 27, died at the scene. Now, Orr's going through rehabilitation three times a week and has been at home with his wife. Orr said he's picking up and moving on. His brain injury is getting "a heck of a lot better," but there are still some things he can't do, such as maintain his balance and his memory is spotty at times. His rehabilitation includes speech therapy, physical therapy and occupational therapy.

Orr said his wife, Stacey, his two sons, and the rest of his family have been an inspiration for him through his rehabilitation. "My wife, who is seeing me through all this, has been beside me and has been awesome," he said. "My little boys are behind me 100 percent. They come up and give me hugs, and that is very meaningful. He said he wants to be a sports writer again. He had previously worked for the Dodge City Daily Globe and The Salina Journal newspapers. "When all this gets behind me, I would love to be a sports writer again."

Posted by Kerry N. Jardine at 09:37 PM | Permalink | Comments (0) | TrackBacks (0)

A bill being considered by the Colorado General Assembly would either provide more transparency about medical malpractice insurance for consumers or would drive doctors out of Colorado. Senate Bill 248 is known as the "disclosure bill" to the Colorado Trial Lawyers Association, which is supporting the bill. It would require insurance companies that serve more than 65 percent of the market to publicly announce rate changes of more than 5 percent. "Any qualified person" could request a public hearing at the Department of Insurance to challenge the rate adjustment. The Trial Lawyers Association said the bill will benefit doctors, making medical malpractice premiums more transparent. But most doctors oppose the bill, said John Suits, associate administrator of business and government affairs at Memorial Health System. "Physicians haven't asked for this bill," he said. "And the majority of physicians at Memorial are opposed to it. My opinion is that they want to encourage litigation."

Only one insurance company, Colorado Physicians Insurance Co. (COPIC), has that large of a market share. "They might as well have said COPIC. It would have saved paper," said COPIC President Ted Clarke, who also is a physician. COPIC says the lawyers are targeting it because the company aggressively defends clients in malpractice suits. COPIC said it has not been ordered to pay damages in about 62 percent of the cases filed against its clients. COPIC was created in the early 1980s andthe board is made up enirely of doctors and since COPIC has no shareholders, it operates more like a nonprofit than an insurance company. Last year, the company gave more than $10 million in refunds to its clients, and has returned more than $112 million since its inception. COPIC insures 6,000 of the roughly 13,000 licensed doctors in Colorado. Colorado is one of eight states ranked as "stable" by the American Medical Association. Since it has enacted tort reforms it has seen malpractice premiums stabilize.

The trial lawyers deny they are targeting COPIC. "This bill makes sure that consumers, doctors, and the insurance industry can all see how rates increase, and why," said Sara Odendahl, communications director for the Trial Lawyers Association. "It's intent was not to target COPIC, it targets any Type 1 insurance provider controlling more than 65 percent of the market." Odendahl denies the bill is designed to affect competition between insurance groups. "Everyone should be aware of why insurance malpractice premiums are going up," she said. Additionally, she said the bill will have no effect on recruitment or retention of specialists. "This bill will prevent this insurance industry from fleecing doctors with excessive premiums," she said. "Secondly, it will not increase insurance rates or drive doctors out of state. It's not designed to do that."

Posted by Scott J. Eldredge at 10:18 PM | Permalink | Comments (0) | TrackBacks (0)

The President of Oregon Health & Science University made an unprecedented acknowledgment, admitting that $200,000 is simply not enough compensation in some malpractice cases. "We believe it is too low," said Dr. Joe Robertson, OHSU President. "We believe it should be raised." OHSU has a state-legislated tort liability cap of $200,000 in malpractice cases because they receive a portion of their funding from the state.

Last year, KATU News investigated the case of Jordaan Clarke, a Longview boy who was treated at OHSU as an infant for a heart defect and left the hospital permanently disabled after an admitted medical mistake. Today, Clarke requires a feeding tube and around-the-clock care. It is estimated that the cost of his lifetime care will be $11 million, but OHSU is only liable for $200,000. His case against OHSU was argued two months ago before the Oregon Supreme Court.

Currently, lawmakers are taking up the issue of the legal protection that shields OHSU and state agencies from such lawsuits, trying to decide whether to raise the cap and if so, how much. Current proposals on the table include increasing the cap from $500,000 to $875,000. Other agencies, such as individual cities and counties, are concerned that raising the cap would overexpose them to lawsuits they cannot afford. Also, OHSU doctors would be forced to pay malpractice insurance just like doctors at private hospitals. Sen. Vicki Walker, D-Eugene, calls into question the very idea that OHSU deserves this kind of protection, given its $1 billion plus operating revenue and the only 3 percent of its budget that comes from state funding. "You expect you are going to a high quality institution, which they are, but they make mistakes like every other institution," she said. "Yet they are able to hide under that veil of sovereign immunity because they get a teeny weeny portion of their budget from the state." There will obviously be a lot more discussion before any changes are made, but one thing OHSU is already doing differently is that they are notifying patients about the tort liability cap before they begin treatment.

Posted by Scott J. Eldredge at 10:14 PM | Permalink | Comments (0) | TrackBacks (0)

According to the National Highway Traffic Safety Administration, sleepy drivers are responsible for at least 1,500 deaths every year and cause more than 100,000 accidents. "A drowsy driver on the road can look a lot like a drunk driver," said AAA's Justin McNaull. "They have trouble keeping their car between the lines. Speed will vary." The danger exists long before drivers fall asleep; nodding off even for three seconds at 70 mph equals traveling the length of a football field with your eyes closed.

At a gas station and convenience store in Danville, W.V., a driver fell asleep at the wheel and his car went out of control, causing an explosion at a gas pump. No one was seriously hurt. Even professional drivers are not immune. Two-time Daytona 500 winner Michael Waltrip nodded off and crashed a mile from his home. "I guess I relaxed a little bit and looking forward to getting here and ran off the road," he said. "I woke up [with] the gravel hitting under my tires."

New Jersey is currently the only state with a law to combat drowsy driving, something other states are now considering. States are also looking into high- and low-tech solutions. Rumble strips, or ruts in the pavement that rattle drivers awake if they veer off the road, have dramatically reduced crashes. Computerized lane departure warning systems are also in development to keep drivers inside the lines. Engineers are also developing devices that sound an alarm after tracking driver's eye and facial muscles to detect driver fatigue.

Posted by Kerry N. Jardine at 09:32 PM | Permalink | Comments (0) | TrackBacks (0)

Saving human memory is one of highest level of care sought by modern medicine. The concept is integral in the treatment and care of individuals suffering from a traumatic brain injury or Alzheimer's. New research suggests the discovery of a protein that controls the odds of memory formation may lead to an entirely new approach for preserving memory. The finding, by scientists from UCLA/University of Toronto is important because until now, scientists knew little about how the brain assigns cells to participate in storing memories. As reported in the April 20 edition of Science, a new approach for preserving memory in people suffering from Alzheimer's or other brain injury may be forthcoming. "Making a memory is not a conscious act," explained Alcino Silva, principal investigator and a professor of neurobiology and psychiatry at the David Geffen School of Medicine at UCLA. "Learning triggers a cascade of chemicals in the brain that influence which memories are kept and which are lost. Earlier studies have linked the CREB protein to keeping memories stable," added Silva, a member of the UCLA Brain Research Institute. "We suspected it also played a key role in channeling memories to brain cells that are ready to store them." Silva and his colleagues used a mouse model to evaluate their hypothesis. They implanted CREB into a virus, which they introduced into some of the cells in the animal's amygdala, a brain region critical to emotional memory. Next they tested the mouse's ability to recall a specific cage it had visited before. To visualize which brain cells stored the mouse's memories about the cage, the scientists tracked a genetic marker that reveals recent neuron activity. When the team examined the animals' amygdalas after the experiment, they found substantial amounts of CREB and the marker in neurons.

"We discovered that the amount of CREB influences whether or not the brain stores a memory," said Silva. "If a cell is low in CREB, it is less likely to keep a memory. If the cell is high in CREB, it is more likely to store the memory." Human implications of the new research could prove profound. "By artificially manipulating CREB levels among groups of cells, we can determine where the brain stores its memories," he explained. "This approach could potentially be used to preserve memory in people suffering from Alzheimer's or other brain injury. We may be able to guide memories into healthy cells and away from sick cells in dying regions of the brain." "A memory is not a static snapshot," he said. "Memories serve a purpose. They are about acquiring information that helps us deal with similar situations in the future. What we recall helps us learn from our past experiences and better shape our lives."

Posted by Kerry N. Jardine at 09:28 PM | Permalink | Comments (0) | TrackBacks (0)

Researchers have recently discovered that heart patients who have stents implanted to keep their arteries open have no lasting benefit compared to those treated only with drugs. The five-year study found that patients treated with stents in addition to statins and other drugs did have a better blood flow to the heart than patients treated only with drugs, but they did not live longer or have fewer heart attacks. This study confirmed the results of previous, smaller studies.

Implanted stents are shown to reduce symptoms such as shortness of breath and chest pain, but the effects don't last, and the advantage disappears over time. In fact, one surprising finding in the new trial was that after five years, more than 70 percent of the patients in both groups (stent-plus-drugs and drugs-only) were free of angina pains, the common symptom caused by reduced blood flow to the heart.

The study included about 2,300 patients who all had a relatively stable form of coronary artery disease that usually progresses slowly. Dr. William E. Boden, a cardiologist at the University of Buffalo School of Medicine and Biomedical Sciences, was a lead author of a report on the study, and said that a majority of Americans who receive stents are in the same category of relative stability. "When I saw the results, I was incredulous," said Dr. Boden.

In the past, doctors have believed that stents performed better than drugs at relieving symptoms over the long run. "It's very intuitive that fixing the narrowing with a stent will yield important long-term benefits, but it didn't," said Dr. Steven E. Nissen, past president of The American College of Cardiology.

Posted by Kerry N. Jardine at 09:25 PM | Permalink | Comments (0) | TrackBacks (0)

Traumatic brain injury (TBI) is one of the leading causes of death in the children ages 0-14. Each year, approximately 475,000 children ages 0-14 suffer from a TBI. Although there have been great improvements over the years in the area of TBI treatments, there have not been significant advances in treatments options available for children.

The majority of serious injuries found in pediatric TBI patients are related to the increase in intracranial pressure (ICP) found in the brain. The increase of intracranial pressure is mostly due to blood clots, swelling of the brain, and intracerebral hemorrhages that result from severe brain trauma. Medical experts have proposed a method to relie