Dr. Gustin's Blog

Methamphetamine and New Legislation

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.

Methamphetamine damages the brain, central nervous system, heart and other organs.  It not only destroys the life of the user, but often seriously impacts those closest to the person including friends and family.  Methamphetamine has become a serious public health problem in the U.S., and state legislation will be a big step in helping to curb access to this substance.

The Emerging New Superbugs

An article appeared in a recent Forbes Magazine about the dangers of superbugs.  The WHO (World Health Organization) has said that these bugs, which have appeared in Britain, India, and Pakistan, are immune to our current battery of antibiotics.  In the U.S. alone, infections kill about 100,000 patients a year.  

So what is the FDA doing?  Nothing.  In fact, quite the opposite.  They have said, as an official statement, that the approval policy will be lengthened, not shortened, and that there will be more hoops to jump through in order to conduct R&D.  In fact, new FDA rules are now retroactive to existing clinical trials.  The FDA has no plan to revamp its slow and deadly approval process.  Drug companies like Pfizer, has dumped its antibiotic research pipeline because of this.  Other pharmaceutical companies are sure to follow.

This should be an issue of the greatest urgency; yet it's received hardly any attention from our leaders in Washington, and even less attention by the usually sensation-seeking media.  The dearth of new antibiotics in the pharmaceutical R&D pipeline is a omnipresent scandal that should justify focused and persistent media attention.  Sadly, it may take the entrance of a few of these superbugs into our communities for the FDA to alter their policies.  But by then, it might be too late.

Medical Malpractice Statistics

In its 2002 comprehensive report titled: "Medical Malpractice: Verdicts, Settlements and Statistical Analysis, Jury Verdict Research (JVR) details nationwide statistics regarding medical malpractice cases.

 

JVR reports that between 1994 and 2000, the most frequently claimed injury in a medical malpractice case was death (23%), followed by brain damage (9%), genital injuries (7%), leg injuries (5%), Cancer, spinal nerve and eye injuries (each at 4%), paralysis, amputations, intestinal tract and foot injuries (each at 3%). All other injuries accounted for 3%.

 

JVR also reported on the probability of a plaintiff verdict for medical malpractice with regard to specific type of theories alleged. For instance, the probability of a successful plaintiff case involving an alleged diagnosis error was 37% in 2000, down from a high of 39% in 1994. Similarly, the probability of a plaintiff verdict in a negligent surgery case was reported as 48% in 2000, up from the 1999 figure of 32%. In childbirth cases, the probability of a plaintiff verdict was 38%, down from a high of 46% in 1995 and 44% and 43% respectively for the years 1998 and 1999.

 

The lowest probability of success were claims involving an allegation of lack of informed consent. In these cases, JVR reported that plaintiffs prevailed only 26% of the time.

The Dangerous Irradiation of Infants

A controversy has arisen over the irradiation of infants, pre-mature and full-term.  Several facilities have noted this and the Federal government has taken up the cause.  These errors raise broader questions about the competence, training and oversight of technologists who operate radiological equipment that is becoming increasingly complex and powerful. If technologists could not properly take a simple chest X-ray, how can they be expected to safely operate CT scanners or linear accelerators?

With technologists in many states lightly regulated, or not at all, their own professional group is calling for greater oversight and standards. For 12 years, the American Society of Radiologic Technologists has lobbied Congress to pass a bill that would establish minimum educational and certification requirements, not only for technologists, but also for medical physicists and people in 10 other occupations in medical imaging and radiation therapy.

Yet even with broad bipartisan support, the association said, and the backing of 26 organizations representing more than 500,000 health professionals, Congress has yet to pass what has become known as the CARE bill because, supporters say, it lacks a powerful legislator to champion its cause.

Read more about this terrible situation by clicking:  Here

Adverse Drug Reactions: Terbutaline and Preterm Labor

Normally, I would put information like this in my "Latest News" section, but this is too important not to be on my front page where my blog is located. Terbutaline, given orally or intravenously, is routinely used to treat preterm labor.  It has now been shown to significantly increase the risk of maternal heart problems and sudden death.  You can read more about this by clicking my link, and you can also read more about this on the FDA website: http://www.fda.gov/Drugs/DrugSafety/ucm243539.htm

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About Medical Expert Reports

Medical experts are often requested by attorneys or insurance claims adjusters to write medical expert reports. This is true for both retained medical expert witnesses and non-retained expert consultants.  Here are some general steps medical experts should take to properly construct an expert report.

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Lawsuit Loans Add New Risk for the Injured

An interesting article appeared recently in the NY Times about lawsuits, plaintiffs, and lending.

The business of lending to plaintiffs arose over the last decade, part of a trend in which banks, hedge funds and private investors are putting money into other people’s lawsuits. But the industry, which now lends plaintiffs more than $100 million a year, remains unregulated in most states, free to ignore laws that protect people who borrow from most other kinds of lenders.

Unrestrained by laws that cap interest rates, the rates charged by lawsuit lenders often exceed 100 percent a year, according to a review by The New York Times and the Center for Public Integrity. Furthermore, companies are not required to provide clear and complete pricing information — and the details they do give are often misleading.

A growing number of lawyers, judges and regulators say that the regulatory vacuum is allowing lawsuit lenders to siphon away too much of the money won by plaintiffs.

To read the entire NY Times article:  Click Here

Medical Expert Witnesses Approved in Avandia Lawsuits

US District Judge Cynthia M. Rufe of the Eastern District of Pennsylvania has recently ruled that three plaintiffs' medical expert witnesses meet the Daubert standard for scientific validity in Avandia lawsuits currently before the court. Avandia lawsuits are numerous, with some 3,500 cases filed in California state courts, and 1,200 in Pennsylvania, with all but 250 of those having been settled with GlaxoSmithKline – the maker of the diabetes medication.

The allegation with Avandia is that the drug can cause pathologic bone fractures, stroke, liver damage, and a myriad array of heart disorders that can result in a permanent disability or death.

Code of Ethics for Expert Witnesses

Recently, I came across a useful code of ethics proposal for expert witnesses on an expert services website (IME) which was carefully thought out and crafted.  It should stimulate some interested discussion.  Please see below.

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