Dr. Barry Gustin - Medical-Legal Expert Services

More than 30 years after chemical flame retardants were removed from children’s pajamas because they were suspected of being carcinogens, new research into flame retardants shows that one of the chemicals is prevalent in baby’s products made with polyurethane foam, including nursing pillows, car seats and highchairs.

The research does not determine if children absorbed the chemical, chlorinated Tris, from the products. But in an article to be published Wednesday in the journal Environmental Science & Technology, the researchers suggest that infants who use the products have higher exposure to the chemical than the government recommends.

Earlier research by one of the article’s authors, Arlene Blum, a biophysical chemist, contributed to the elimination of Tris flame retardants, including chlorinated Tris, in children’s pajamas in the 1970s. Although the chemical was not banned at that time, the Consumer Product Safety Commission now says that it “may pose a significant health risk to consumers.”

The new research found that foam samples from more than a third of the 101 baby products that were tested contained chlorinated Tris. Over all, 80 of the products contained chemical flame retardants of some kind, some of which are considered toxic, though legal to use. In one instance, flame retardants represented 12 percent of the weight of the foam in a changing pad; most products were closer to 3 to 5 percent.

Read the full NY Times article:  Click Here

Years ago artificial colorings were thought to be a cause of adverse health and behavioral effects in children.  Organizations such as Center for Science in the Public Interest and the Sidney Wolf's Health Research Group provided much evidence in support of this contention.  In the end, pediatric organizations determined that any connection was at best, tenuous.

Now, it appears that the issue is on the table again.  The FDA has taken up the cause and is leaning towards issuing formal warnings against artificial food colorings.  Why the change of heart?  A growing list of studies has affirmatively linked these food dyes to hyperactivity (ADHD and ADD) in children.

To see the full NY Times article:  Click Here

Several states are considering new legislation that will make decongestants prescription medication requiring a doctor's signature.  The main ingredient of these medications is pseudoephedrine, an essential ingredient in the production of Methamphetamine.  In one state alone, Tennessee, police shut down over 2000 Methamphetamine labs last year, about a 50% increase from the year before.

Methamphetamine is an extremely dangerous street drug.  Once an individual becomes habituated, studies show that their life expectancy is less than 10 years.  Once hooked, because of its effects on dopaminergic receptors of the brain, it is extremely difficult to stop use, and relapse is the rule rather than the exception.

To read the entire NY Times article:  Click Here

January 4, 2011 — The contaminated hands of anesthesia providers are a significant source of patient environmental and stopcock set contamination in the operating room, according to the results of a study by Randy W. Loftus, MD, from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues, reported in the January 2011 issue of Anesthesia & Analgesia.

"As anesthesiologists, we like to think that the surgical drapes protect the patient from tens of trillions of microorganisms that are in and on our bodies," said editor-in-chief of Anesthesia & Analgesia Steven L. Shafer, from Columbia University in New York, NY, in a news release. "Nope! These studies provide evidence that our bacterial flora contribute to surgical site infections."

The hypothesis tested by this study was that bacterial contamination of anesthesia provider hands before patient contact is a risk factor for direct intraoperative bacterial transmission. At Dartmouth-Hitchcock Medical Center, a tertiary care and level 1 trauma center with 400 inpatient beds and 28 operating suites, the first and second operative cases in each of 92 operating rooms were randomly selected for analysis. 

The results of the study were that intraoperative bacterial transmission occurred in 11.5% (19/164) of cases, of which 47% (9/19) were of provider origin. Intraoperative bacterial transmission to the anesthesia environment occurred in 89% (146/164) of cases, 12% (17/146) of which were of provider origin.

The investigators were quoted as saying:  "Although we know that hand-washing is an important step, our compliance is poor, and there is little excuse for hospitals not implementing systems that facilitate compliance with hand-washing guidelines," Dr. Shafer said. "However, as [this report suggests], it is time to look at additional measures to protect our patients from the biofilm that we take into the operating room every day."

Recent reports have linked so-called "green shopping bags" with lead contamination.  This is an important toxicologic issue because once these bags are discarded, the lead could find its way into our water supply.  Also, flaking paint and decals on those bags could conceivably contaminate food in people's homes.

To read the complete NY Times article:  Click here.

At long last a large government-financed study, the National Lung Screening Trial, has definitely shown that annual CT scans of the chests of current and former heavy smokers reduced their risk of death from lung cancer by 20 percent.  As a bonus, and quite surprising, is that these same scans reduce the risks of death from other causes as well including cardiovascular disease, emphysema, and other pulmonary conditions, suggesting that the scans could catch other diseases.

These findings represent an enormous advance in cancer detection that could save tens of thousands of lives annually.  Insurance companies and Medicare have yet to offer to pay for preventive CT scans so people wanting the preventive test will have to pay out of pocket about $300-$500 for each CT scan.  Additionally, it is unclear if the Obama administration will do an "about-face" here.  Obama argued during the debate on healthcare that patient's health was often harmed by getting too many tests and procedures that, if reduced, would improve health while reducing costs.  This study shows that, at least in lung cancer and other cardiopulmonary conditions, spending more on tests saves lives.

To read the NY Times article:  Click Here.

Migraine headaches are one of those medical conditions that afflict people of all ages where there is not a definitive effective treatment.  Every now and then a new drug is developed, but few have had a material effect on ameliorating the condition.  Now there is additional hope for sufferers.  In longitudinal multi-center studies, Botox, the famous anti-wrinkle treatment, has been found to reliably alleviate migraine headaches. 

The reason I am mentioning this on my website is because headaches are not alway due to migraines.  The differential diagnosis for chronic headaches is long, and many of the causes are serious, some quite catastrophic.  These include blood clots, aneurysms, malformations, tumors, vascular insufficiencies and others.  Patients should not simply assume that their headaches are due to migraines, nor should physicians.  A significant percentage of filed medical malpractice claims have misdiagnosis of headaches as their core complaint.

To read the NY Times news article:  Click Here

In the Clots in Legs Or Stockings after Stroke 2 (CLOTS-2) trial, proximal deep venous thrombosis (DVT) occurred more often in immobilized stroke patients who wore below-knee compression stockings than their peers who wore thigh-length stockings, according to the study results published online September 20 in Annals of Internal Medicine.

Although whether the CLOTS Trial 2 results should be extrapolated to other patient groups is debatable, but it would seem sensible that thigh-length stockings should be the preferred option and the new standard of care for prevention of deep blood clots.

The longer stockings "should be used as first-line treatment, and below-knee stockings should only be used where the thigh-length ones turn out to be impractical," chief investigator Martin Dennis, MD, of the Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, in Scotland, was quoted in Medscape Medical News.

In a highly unusual coordinated announcement, drug regulators in Europe and the United States said Thursday that Avandia, the controversial diabetes medicine, will no longer be widely available.

The drug’s sales will be suspended entirely in Europe, while patients in the United States will be allowed access to the medicine only if they and their doctors attest that they have tried every other diabetes medicine and that patients have been made aware of the drug’s substantial risks to the heart.

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