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Legal Issues

(Don’t) Forget to Take Your Vitamins

This Opinion piece in The New York Times earlier this month makes some interesting – and disturbing – points on the vitamin industry.

Several studies over the past two decades indicate that some consumers have suffered adverse health effects from the over-consumption of vitamins: In a study published in The New England Journal of Medicine in 1994, 29,000 Finnish men, all smokers, had been given daily vitamin E, beta carotene, both or a placebo. The study found that those who had taken beta carotene for five to eight years were more likely to die from lung cancer or heart disease.

Two years later the same journal published another study: 18,000 people who were at an increased risk of lung cancer because of asbestos exposure or smoking received a combination of vitamin A and beta carotene, or a placebo. Investigators stopped the study when they found that the risk of death from lung cancer for those who took the vitamins was 46 percent higher.

If over-consumption of vitamins is as dangerous as these and other referenced studies suggests, what’s the Food and Drug Administration’s stance on regulating intake? Well, in December 1972,  the F.D.A. announced a plan to regulate vitamin supplements containing more than 150 percent of the recommended daily allowance. Vitamin makers would have to prove that these “megavitamins” were safe before selling them. However, legislation was introduced preventing the FDA from regulating megavitamins; it became law in 1976. Read more…

Kennedy, Vaccinations, Autism, and Junk Science

It’s been quite a while since MCNtalk has posted on the subject of childhood vaccines—since our February 12, 2012 post, “More Doctors ‘Fire’ Vaccine Refusers.” But the issue has not gone away. As this article in Slate points out, there are still those who argue publicly that there is a link between autism and childhood vaccinations, specifically that a vaccine preservative called thimerosal causes autism when injected into children.

It is important to understand that the original study in 1998 linking childhood vaccinations and autism has been thoroughly debunked multiple times using rigorous standards of scientific evidence. (Read “Vaccinations and Autism—Junk Science Is Not a Victimless Crime” for a summary.)

Robert F. Kennedy Jr. gave this year’s (May 24) keynote address at the Autism One/Generation Rescue Conference in which he strongly argued for a link between childhood vaccination and autism. The Slate article touches upon the speech and subsequent conversation between Slate and Kennedy as well as neatly summarizing pertinent facts on the issue. Why is this important? Because when people are not vaccinated, they needlessly put not just themselves at serious health risk, but their entire community as well.

We refer to people who say vaccines cause autism with the shorthand “anti-vaxxers” or say that they are part of the “anti-vaccine movement.” Kennedy said that he is “very much pro-vaccine” and that “vaccines have saved millions and millions of lives.” They will save even more lives if he and his colleagues stop spreading fear and misinformation about them. Kennedy is a passionate guy with practically unique name recognition, powerful connections, and the ability to command attention. He could reverse the course of the anti-vaccine movement today if he announced that his concern about vaccines had been well-intentioned, but that research has shown that vaccines don’t cause autism after all. It would be a proud legacy, one worthy of his name.

Read more…

Medical Expert Witness Qualifications

Recent rulings have addressed requirements for experts who testify against physicians. The central issue: Should witnesses and defendants have the same or similar medical specialty? This recent article in American Medical News explores the topic.

More than 30 states set professional standards, and in the past year and a half, at least 13 different states have addressed the question in court; outcomes have varied.

“Obviously, not all judges are medically sophisticated, and it’s also possible that a judge can be taken in by” assertions that a witness is qualified, noted Louise B. Andrew MD, a medical liability attorney and founder of MD Mentor. “It’s very possible for someone who is a skilled speaker — and, therefore, probably a ‘good’ expert witness — to convince a jury that they are the real experts. It’s possible that judges are misled just like juries are misled.”

“The plaintiffs’ bar is going to do whatever it can to make it easier to bring a tort case,” noted Darren McKinney of the American Tort Reform Association. “Of course, the less exacting a state’s standards, the easier it is to bring a potential meritless case and to continue to [pressure] defendants to settle.” Read more…

Sentencing in the Long Island Railroad Disability Fraud Scheme

What is missing in this New York Times article is any reference to the consequences for those many claimants who engaged in the fraud, and the management and employees of the Long Island Rail Road, who clearly were aware that such fraudulent claims were the norm. Perhaps they were only counting the days until their own disability retirements. How many of those who Dr. Ajemian helped obtain benefits have been criminally charged for fraud and how much of the millions of dollars of ill-begotten compensation has been returned to the public from which it came?

What this doctor did, based upon the article, was reprehensible, but let’s not kid ourselves. The culture of disability is alive and well in the public and private sector. Well intended efforts to addresses excesses and distortions in the system may lead to personal attacks on those who try.

Modern Love

It is not often that a reader contribution column from The New York Times called—“Modern Love”—has something of relevance to the work that we do at MCN.

In this column, the writer, Sarah Kishpaugh eloquently conveys the impact of a work injury on her husband, herself and their lives together. Rarely does one have the opportunity to hear from a fine writer how a significant injury can impact their life, as well as an interaction with the workers’ compensation system. Read more…

Hospital Mergers and Restrictions on Health Care Offerings

This recent New York Times article focuses on the impact of hospital mergers in Washington State, where increasingly, Catholic systems are taking over hospitals both small and large. The Church has a venerable history of leadership in providing health to the region since pioneer days, and what started as small missions, have evolved into very large systems.

The responsiblity to serve all people with compassionate care underscores the Catholic health mission and in so many ways inspires all, regardless of background – especially those who decry the increasingly profit-driven nature of the system.

While the vast majority of the work done in these hospitals are unaffected by the ownership structure, positions on procedures including abortion and assisted suicide between the hospitals and many patients and practitioners are at odds. Concerns exist that a physician working at such institutions on the medical staff is specifically precluded from a full discussion of legal options, when such options run counter to Catholic teachings, regardless of the personal beliefs of the physician or the patient. As a source in the article notes:

“If you go to a Catholic medical institution, you’re going to get medical advice that is in keeping with the moral norms of that institution”…“We think Catholic medical advice is the best medical advice to give.”

When a Catholic institution takes over the only hospital in a rural region, physicians and patients have little choice but to adhere to the dictates and restrictions imposed by the institution, unless they choose to travel a long distance to another facility. In many cases, the institutions have been supported with public funds via bonding, tax treatment and other benefits. Expect this conflict to widen in the context of individual cases where a clash of values conflicts with care desired vs. care available.

Should California Workers’ Comp Cover Pro Athletes from Any Team?

Workers’ Compensation has a clear place in society.

Professional athletes, especially football players, often sustain chronic injuries from their play.

The Los Angeles Times article, “Athletes Cash In On California Workers’ Comp,” addresses how many California workers’ compensation judges have held that any professional athlete who plays in the state is eligible to receive benefits from employers.

“Over the last three decades, California’s workers’ compensation system has awarded millions of dollars in benefits for job-related injuries to thousands of professional athletes. The vast majority worked for out-of-state teams; some played as little as one game in the Golden State.

All states allow professional athletes to claim workers’ compensation payments for specific job-related injuries — such as a busted knee, torn tendon or ruptured spinal disc — that happened within their borders. But California is one of the few that provides additional payments for the cumulative effect of injuries that occur over years of playing.” Read More…

California’s particular workers’ compensation regulations appear to have created coverage for players from any team that played in California during their career. Is this good policy?

Will the NFL Brain Injury Lawsuits Change the Game?

With the Super Bowl a receding memory, we are reminded about the physical nature of football in this Business Week article.

Many players and their families believe that football has been a source of permanent brain damage resulting from multiple head injuries in the course of play for some. A former Princeton quarterback in the 50s, Gene Locks, and a group of allied plaintiffs’ lawyers are taking up the cause and the league is on the defensive.

While Locks and other lawyers say they have no interest in putting the NFL out of business, they will represent more than 4,000 former players and their wives who accuse the $9.5 billion-a-year business of covering up life-altering brain injuries.

A protracted battle could provide the plaintiffs’ lawyers with an opportunity to reveal sordid details about a period during which they allege the NFL intentionally obfuscated evidence of the long-term brain damage suffered by its willing gladiators.

If this is true, and if the ugly particulars are played out in depositions, internal documents, and court testimony, such a legacy could alienate fans already uneasy about the suicides of former players such as Dave Duerson, Andre Waters, and Junior Seau, all of whom suffered from neurodegenerative brain disease linked to concussions.  Read More…

The outcome is far from decided and will be determined in part by public opinion, the courts, and hopefully additional meaningful scientific studies.

Gag Law Prohibits Doctors from Doing their Job and Protecting Patients

Physicians have multiple roles. In addition to treating illness and injury, they have a public health duty to address risk factors in individuals and society that contribute to morbidity and mortality.

Responsible gun owners know how to behave around guns, including proper storage and use. In the same way that responsible parents use car seats and seat belts for their young passengers, responsible parents who are gun owners must secure their weapons to avoid accidental misuse.

A recent Slate article, “Pediatricians vs. the NRA,” demonstrates the ability of the NRA to successfully introduce legislation that suppresses a physicians ability to do their jobs and to exercise their free speech rights.

The “Privacy of Firearm Owners” law passed in Florida in 2011 prohibits doctors from “making written inquiry or asking questions concerning the ownership of a firearm or ammunition by the patient or by a family member of the patient.”

Fortunately, the law is under attack and being challenged. Hopefully, it is also being ignored by many physicians who understand that there are bigger issues at play here – and that those who write such laws should be confronted with the obligation of enforcing it by trial and punishment. There are times when civil disobedience may be called for. This would appear to be one of them.

Risks and “Dangers” of Marijuana Legalization?

Overall evidence for dangers of marijuana do not support continued criminalization.

Steadily it appears that its use will be permitted, though there remains a disconnect between state laws liberalizing possession and growing, vs. federal standards that at least as written, continue to criminalize use and distribution.

As the matter evolves, we should not be naïve to the potential risk of users abusing and developing an addiction to marijuana and its potential impact on cognition, and youth, especially when not used in “moderation.”

A New York Times article, “Legalizing of Marijuana Raises Health Concerns,” states:

“While marijuana can be addictive, scientists generally agree that fewer than 10 percent of marijuana smokers become dependent on the drug, compared with 15 percent for alcohol, 23 percent for heroin and 32 percent for tobacco.

Marijuana does contain carcinogens, including tar and other toxins similar to those found in tobacco, but people generally do not smoke marijuana in the same amounts as cigarettes. Still, legalization takes health consumers into murky territory. Even though marijuana is the most commonly used illegal drug in the United States, questions about its health effects remain.”

Sounds like the same risks, more or less, of many other legal substances, consumed in excess or misused, including alcohol, prescription drugs, and/or firearms. Whether society should outlaw substances and products that can be used with little risk or high damage is a question that is increasingly being answered at the ballot box.