Big Brains and Big Intelligence

Size is not what counts in the hunt for the most intelligent.  Whales have brains weighing 9 kg (with over 200 billion nerve cells), and human brains vary between 1.25 kg and 1.45 kg (with an estimated 85 billion nerve cells). A honeybee's brain weighs only 1 milligram and contains fewer than a million nerve cells. 
 

Insects may have tiny brains, but they can perform some seriously impressive feats of mental gymnastics.

According to a growing number of studies, some insects can count, categorize objects, even recognize human faces -- all with brains the size of pinheads.

WATCH VIDEO: Take a closer look at the lives of mosquitoes, maggots and other creepy crawlies.

Despite many attempts to link the volume of an animal's brain with the depth of its intelligence, scientists now propose that it's the complexity of connections between brain cells that matters most. Studying those connections -- a more manageable task in a little brain than in a big one -- could help researchers understand how bigger brains, including those of humans, work.

Scientists at Queen Mary, University of London, state that contrary to popular belief, we can't say that brain size predicts the capacity for intelligent behavior.

Research repeatedly shows how insects are capable of some intelligent behaviors scientists previously thought were unique to larger animals.

Research suggests that bigger animals may need bigger brains simply because there is more to control - for example they need to move bigger muscles and therefore need more and bigger nerves to move them.

The entire article is presented in the journal Current Biology.  Read more here.

Neuroeducation: Learning, Arts, and the Brain

The Dana Foundation released Neuroeducation: Learning, Arts, and the Brain, its newest free education resource. The book, the culmination of a summit sponsored by The Johns Hopkins University School of Education's Neuro-Education Initiative, focuses on the convergence of neuroscientific research and teaching and learning, with an emphasis on the arts.
 

 Education and brain experts discuss their experiences, challenges, and potential next steps to allow for the crossover from classroom to lab and lab to classroom. The concerns and hopes of those working in the field are presented in a summary of the roundtable discussions that served as the centerpiece of the summit.

Neuroeducation: Learning, Arts, and the Brain is available free by written request on institutional letterhead. Please make certain your request contains a complete telephone number-including area code-and a full street address. Requests should be mailed or faxed to:

Johanna Goldberg
Dana Foundation
745 Fifth Avenue, Suite 900
New York, NY 10151
Fax: (212) 317-8721

You may also e-mail your request to: jgoldberg@dana.org. Please include your institutional and mailing information.

The book is available online at http://www.dana.org/news/publications/publication.aspx?id=23964.
 

AP Poll: Support for curbs on malpractice lawsuits

According to an AP poll 54% of Americans favor limiting their right to recover from doctors and hospitals for their mistakes.  Nevada passed the Keep Our Doctors in Nevada bill in 2004.

The AP poll found that 54 percent of Americans favor making it harder to sue doctors and hospitals for mistakes taking care of patients, while 32 percent are opposed. The rest are undecided or don't know.

Support for limits on malpractice lawsuits cuts across political lines, with 58 percent of independents and 61 percent of Republicans in favor. Democrats are more divided. Still, 47 percent said they favor making it harder to sue, while 37 percent are opposed.

The survey was conducted by Stanford University with the nonprofit Robert Wood Johnson Foundation.

This study can be seen here.

Migrain Increase Chances of Stoke

A presentation by the American Heart Association's (AHA) annual Scientific Sessions in Orlando revealed the pooling results from 21 studies, involving 622,381 men and women, to conclude that the risk of stroke for those with migraines is 2.3 times those without.

Researchers at Johns Hopkins have affirmed that migraine headaches are associated with more than twofold higher chances of the most common kind of stroke: those occurring when blood supply to the brain is suddenly cut off by the buildup of plaque or a blood clot.

 

Imaging and Diagnosis of Alzheimer's

A new study published in Proceedings of the National Academy of Sciences (PNAS) promises to improve diagnosis and monitoring of Alzheimer's disease.  Scientists at the University of California, San Diego have developed a fast and accurate method for quantifying subtle, sub-regional brain volume loss using magnetic resonance imaging (MRI). 

The general pattern of brain atrophy resulting from Alzheimer's disease has long been known through autopsy studies, but exploiting this knowledge toward accurate diagnosis and monitoring of the disease has only recently been made possible by improvements in computational algorithms that automate identification of brain structures with MRI. The new methods described in the study provide rapid identification of brain sub-regions combined with measures of change in these regions across time. The methods require at least two brain scans to be performed on the same MRI scanner over a period of several months. The new research shows that changes in the brain's memory regions, in particular a region of the temporal lobe called the entorhinal cortex, offer sensitive measures of the early stages of the disease.
 

Beating Brain Injury

Every once in a while I come across an uplifting story about a victim of severe traumatic brain injury making significant recovery.  I came across this story while perusing the Chicago Tribune, by Lisa Pevtzow

Special to the Tribune

November 20, 2009
 

Chicago Police Sgt. Mike Dineen should have died.

That's what his doctors said after Dineen suffered a massive brain injury in a still-unexplained, off-duty incident on New Year's Day
 

On Jan. 1 Dineen was found in a parking lot on the southwest side of Chicago, barely alive with the back of his skull partially caved in. Dineen has no memory of what happened and has no idea of why he was there, although it's believed he may have slipped on a patch of ice or fallen down a flight of stairs, he said. He had his wallet, so he does not believe he was the victim of a crime.

Dineen was taken to Advocate Christ Medical Center, where his face was so unrecognizable that his parents initially thought they were in the wrong room, said his father, Chuck Dineen, a retired Chicago firefighter. Doctors told them that he would probably die, and if he didn't, he likely would be brain-damaged.
 

Dineen suffered the most severe category of traumatic brain injury, as well as contusions on his lungs, said Stacy McCarty, one of his doctors at the Rehabilitation Institute.

Surgeons at Christ operated on his brain to temporarily remove part of his skull to relieve the pressure and drain the large amount of blood. He spent the next three weeks in a coma, on a ventilator and a feeding tube. When he awoke he was transferred to the Rehabilitation Institute, where he spent a month before transferring to outpatient rehabilitation at its center in Willowbrook.

Dineen, who has been cleared to rejoin the force in a week, was clearly a man happy to be alive.

"When I went to the neurologist two weeks after I woke up from the coma, the doctor said to me, 'It's nice to see you walking and talking, because you were supposed to be dead,' " Dineen said. "I had to go through death to realize how valuable life is."
 

 

Read more here.

Key speech on medical errors

I met Congressman Braley last season in Washington DC.  He strikes me as a man to watch.  Issues like health care reform, tort reform, patient safety, consumer safety, are so media drenched it is hard to understand them.  Well here is what  Bruce Braley has to say.  And you might consider that the people who hate trial lawyers only do so until they need one!

In Case You Missed It:

Times Union (Albany)

Key speech on medical errors
Advocates seeking action on issue heartened by congressman's talk


By CATHLEEN F. CROWLEY, Staff writer
Monday, November 23, 2009
http://www.timesunion.com/AspStories/story.asp?storyID=869285&category=REGION&TextPage=1

WASHINGTON – A short but fiery speech made on the floor of the House of Representatives has raised the hopes of patient safety advocates across the nation.

Rep. Bruce Braley, a second-term Democrat from Iowa, gave a speech about medical errors moments before the House voted on the health reform bill earlier this month.

Braley, 52, a trial lawyer who specializes in malpractice, said he had two minutes to prepare his speech. As he spoke, he was taunted by Republicans shouting "trial lawyer." But Braley impressed Helen Haskell, whose son died from a medical error.

"I was very pleased that somebody was standing up for patient safety. I thought the heckling was unbelievable," said Haskell, of South Carolina. Her son Lewis Blackman, 15, died in 2000 after a minor surgical procedure.

Haskell called Braley's office the next day to thank him.

Patient safety activists are cautiously optimistic that Braley may be the champion they need for their cause. "He's definitely an emerging leader and he seems to be very passionate about (patient safety)" said Lisa McGiffert, who heads Consumers Union's Safe Patient Project.

"Who will speak for the patients?" Braley said in his House speech. Referring to an Institute of Medicine report, Braley said "They told us the most significant way to reduce the cost of medical malpractice is to emphasize patient safety by reducing the number of preventable medical errors."

Consumers Union invited Braley to speak at its conference on patient safety in Washington, D.C., last week.

While some members of Congress have led efforts to increase the public reporting of hospital-acquired infections, few have embraced the larger issue of medical errors. Nearly 200,000 Americans die each year from errors made during their medical care and from infections acquired in the hospital. The lack of progress in reducing errors was the subject of a Hearst Newspapers series that can be read at www.deadbymistake.com.

"I am so grateful to Hearst publications for their Dead by Mistake series to put the human face on the problems that bring you all here today," Braley said to the audience at the Consumers Union conference. Braley said he has passed the series to other members of Congress to bolster support for patient safety initiatives in the health reform bill.

Braley grew up on a small farm in Iowa. His father was seriously injured in a fall from a grain elevator and his mother went back to work as a teacher to support the family. His father eventually went into the insurance business, while Braley began working in his teens to help the family.

He was a successful lawyer in Waterloo, Iowa, when he ran for an open seat in the House of Representatives in 2006.

In his short political career, Braley has rapidly climbed the ladder of leadership in the House.

Braley founded and chairs the Populist Caucus, which is a congressional group devoted to economic issues of the middle class. He was named vice chairman of the Democratic Congressional Campaign Committee, the campaign arm for House Democrats. Braley leads the committee's "Red to Blue" effort to capture Republican House seats.

During his second term, Braley was appointed to the powerful House Energy and Commerce Committee.

He also is past president of the Iowa Trial Lawyers Association.

"When my colleagues chose to attack me by screaming 'trial lawyer, trial lawyer' it wasn't affecting me in the least," Braley told advocates last week at the Consumers Union conference. "I was thinking of people that need someone to stand up for them when it comes to important issues of patient safety."

Braley said he fought for an initiative in the House health reform bill that will require Medicare to revamp its reimbursement system from a fee-for-service model to a pay-for-performance model. He believes it will reduce errors and improve quality, and he said he hopes to sponsor more legislation to improve patient safety.

"Unless medical consumers know that they have a system that is going to protect them, that is going to give them access to information to make them informed consumers," Braley said, "we will have missed a great opportunity to transform our system of health care delivery."

 

Misdiagnosed Coma for 23 years

I remember reading The Butterfly and the Diving Bell some years ago and then seeing the movie last year.  Similarly, an episode of House involved a patient with locked in syndrome.

Here is a real life story of a man, injured in a car accident, who was misdiagnosed in a persistent vegetative state for 23 years.  Doctors relied in part on a frequently over rated diagnostic technique called the Glasgow Coma Scale to conclude that the man was no longer viable.  Newer scanning tests revealed the man's mind was completely normal except for his inability to express himself.

A leading European neurologist has said many cases of brain injury around the world are wrongly diagnosed as 'coma' after discovering that a car-crash victim thought to have been in coma for the past 23 years was conscious all the time.

Steven Laureys, head of the Coma Science Group and Department of Neurology at Liege University Hospital, spoke after writing about the astounding case of Rom Houben, a Belgian who was thought to have slipped into a persistent vegetative state 23 years ago.

The paralysed Houben had no way of letting doctors know that he could hear every word they were saying.

'I dreamed myself away,' Houben, now 46 and able to tap out messages on a computer screen, told the Daily Telegraph. 'I screamed, but there was nothing to hear.'

Doctors in Zolder, Belgium, routinely used the internationally-accepted Glasgow Coma Scale to assess his eye, verbal and motor responses to conclude that his consciousness was 'extinct'.

But he was graded incorrectly each time - until three years ago a re-examination at the University of Liege using new hi-tech scans showed his brain was still functioning almost completely normally, the paper reported.

Houben, although physically paralysed, was fully aware of what was happening around him.

'Medical advances caught up with him,' said Laureys, whose recently account in a medical paper has brought the case to light.

Laureys plans to use the case to highlight what he considers may be similar examples around the world.

'In Germany alone each year some 100,000 people suffer from severe traumatic brain injury. About 20,000 are followed by a coma of three weeks or longer. Some of them die, others regain health.

'But an estimated 3,000 to 5,000 people a year remain trapped in an intermediate stage - they go on living without ever coming back again.'

Although Houben is never likely to leave hospital, he now has a special device above his bed which lets him read books while lying down.

Houben told the Daily Telegraph: 'I shall never forget the day when they discovered what was truly wrong with me - it was my second birth.

'I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead.

'All that time I just literally dreamed of a better life. Frustration is too small a word to describe what I felt.'

IANS 2009-11-23 18:30:00

BIAA Update November 20, 2009

Here is the latest from Sarah D'Orsie at the Brain Injury Association of America

Health Care Reform Update

This week, The Senate released and began debate on their Health Care Reform leadership measure. As many of you may know, originally, rehabilitation was not included in the Senate Finance bill as a minimum benefit. Due to the lobbying efforts of BIAA, largely supported and funded by our Business and Professional Council, we have been able to ensure that rehabilitation is a part of the minimum benefits package of the final product now being debated in the Senate.

Specifically, the Patient Protection and Affordable Care Act being considered would:
(Democratic leadership summary)

- Include immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices and provide Americans with better preventive coverage and the information they need to make informed decisions about their health insurance.

-Uninsured Americans with a pre-existing condition will have access to an immediate insurance program to help them avoid medical bankruptcy and retirees will have greater certainty due to reinsurance provisions to help maintain coverage.

-New health insurance Exchanges will make coverage affordable and accessible for individuals and small businesses.

-Insurance companies will be barred from discriminating based on pre-existing conditions, health status, and gender.

-Expand eligibility for Medicaid to include all non-elderly Americans with income below 133 percent of the Federal Poverty Level (FPL), with substantial assistance to States for the cost of covering these individuals.

- Make long-term supports and services more affordable for millions of Americans by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities.

- Eliminate lifetime insurance limits in all new individual and group plans for plan years beginning 6 months after enactment.

Today, as the Senate opened a two-day debate on the bill, Congressional Quarterly reported that Majority Leader, Harry Reid is closing in on the 60 votes needed to overcome an anticipated filibuster and bring the measure to the floor. Reid has filed cloture the bill and the vote on the motion to proceed to the bill is expected to occur on Saturday at 8:00 pm.

BIAA will continue to monitor the bill's progress closely as debate continues. Also, documents relating to the Senate leadership bill can be found on BIAA's website under the Health Care Reform Library section:

http://www.biausa.org/policyissues.htm#library
 

Veteran's Health Omnibus Bill

On Thursday, November 19, 2009, The Senate voted to pass a package of veteran's bills (S1963) that included both S. 801 and S. 252, both important Veteran's health care measures supported by BIAA.

The bill would expand services in rural areas and ensure that veterans who are catastrophically disabled or who need emergency care in the community are not charged for those services. It would also authorize VA hospitals to contract with non-VA providers to ensure that our returning service members have access to the care that they so desperately need and deserve.
 

PTSD and MTBI in Veterans Study

Pietrzak and colleagues published their study in the Journal of Nervous and Mental Disease (Posttraumatic Stress Disorder Mediates the Relationship Between Mild Traumatic Brain Injury and Health and Psychosocial Functioning in Veterans of Operations Enduring Freedom and Iraqi Freedom. Journal of Nervous and Mental Disease, 2009;197(10):748-753).

The study, from Yale University, evaluated whether posttraumatic stress disorder (PTSD) mediated the relationship between mild traumatic brain injury (MTBI) and general health ratings, psychosocial functioning, and perceived barriers to receiving mental healthcare 2 years following return from deployment in veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF).

"Compared with respondents who screened negative for MTBI, respondents who screened positive for MTBI were younger, more likely to have PTSD, more likely to report fair/poor overall health and unmet medical and psychological needs, and scored higher on measures of psychosocial difficulties and perceived barriers to mental healthcare. Injuries involving loss of consciousness were associated with greater work-related difficulties and unmet psychological needs. PTSD mediated the relationship between MTBI and all of these outcomes." 

The researchers concluded: "These results underscore the importance of assessing PTSD in OEF/OIF veterans who screen positive for MTBI."


For additional information, contact R.H. Pietrzak, Yale University, School Medical, National Center PTSD, VA Connecticut Healthcare Systems, 950 Campbell Avenue 151E, West Haven, CT 06516, USA.
 

Depression after Stroke

A new finding appears in Psychosomatics, the official journal of the Academy of Psychosomatic Medicine which publishes peer-reviewed research and clinical experiences in the practice of psychosomatic medicine/consultation-liaison psychiatry.

Poynter B, et al. Sex differences in the prevalence of post-stroke depression: a systematic review. Psychosomatics 50(6), 2009, find:

Depression occurs in as many as one-third of patients after a stroke, and women are at somewhat higher risk, according to a large new review of studies. Post-stroke depression is associated with greater disability, reduced quality of life and an increased risk of death.

The systematic review appears in the November-December issue of the journal Psychosomatics.
 

Understanding Depression

Americans do not believe they know much about depression , but are highly aware of the risks of not receiving care, according to a survey released today by the National Alliance on Mental Illness (NAMI).

See full survey results at http://www.nami.org/depression.

The survey provides a "three dimensional" measurement of responses from members of the general public who do not know anyone with depression, caregivers of adults diagnosed with depression and adults actually living with the illness.

- Seventy-one percent of the public sample said they are not familiar with depression, but 68 percent or more know specific consequences that can come from not receiving treatment-including suicide (84 percent).

- Sixty-two percent believe they know some symptoms of depression, but 39 percent said they do not know many or any at all.

- One major finding: almost 50 percent of caregivers who responded had been diagnosed with depression themselves, but only about 25 percent said they were engaged in treatment.

- Almost 60 percent of people living with depression reported that they rely on their primary care physicians rather than mental health professionals for treatment. Medication and "talk therapy" are primary treatments-if a person can get them-but other options are helpful.

- Fifteen percent of people living with depression use animal therapy with 54 percent finding it to be "extremely" or "quite a bit" helpful. Those using prayer and physical exercise also ranked them high in helpfulness (47 percent and 40 percent respectively).

- When people living with depression discontinue medication or talk therapy, cost is a common reason, but other significant factors include a desire "to make it on my own," whether they believe the treatment is actually working and in the case of medication, side effects.

"The survey reveals gaps and guideposts on roads to recovery," said NAMI Executive Director Michael J. Fitzpatrick. "It tells what has been found helpful in treating depression. It can help caregivers better anticipate stress that will confront them. It reflects issues that need to be part of ongoing health care reform."
 

Back Injury Second Leading Military Disability

Interestingly, back injury is reported second to psychiatric injury as a leading cause of military personnel non-return to duty.

Military personnel evacuated out of Iraq and Afghanistan because of back pain are unlikely to return to the line of duty regardless of the treatment they receive, according to research led by a Johns Hopkins pain management specialist.

In a study published in the  Archives of Internal Medicine, researchers found that just 13 percent of service members who left their units with back pain as their primary diagnosis eventually returned to duty in the field. Women, officers, those deployed in Afghanistan and those with previous back pain had better outcomes, but only marginally. Aside from combat injuries sustained during battle, the return-to-duty rate for spinal pain and other musculoskeletal disorders is lower than for any other disease or non-combat injury category except for psychiatric illness, the researchers said.
 

Read more here.

BIAA Health Care Reform Update

 The Brain Injury Association of America's Sarah D'Orsie reports:

Health Care Reform Update

On November 7, 2009, the House of Representatives approved their health care reform overhaul package by a vote of 220-215.  The bill includes the provisions below: (provided by Congressional Quarterly, CQ Today)

Coverage Requirements

Individual Mandate

* Requires nearly all individuals to obtain health care coverage beginning in 2013.
* Permits individuals to keep their current health plan as a "grandfathered" plan.
* Excludes from the mandate those exempt from filing income tax returns and others who receive a hardship waiver.
* Subjects those who do not obtain coverage to a penalty tax of 2.5 percent of adjusted gross income above a   threshold.

Employer Mandate
* Requires employers to offer their employees health care insurance, or make an insurance contribution on their behalf, starting in 2013.
* Exempts firms with payrolls of $500,000 or less.
* Subjects businesses that fail to provide coverage to penalties of up to 8 percent of their payroll.

Purchase of Coverage

Health Insurance Exchange
* Creates a federal exchange, to begin operation in 2013, that would allow individuals and small businesses to purchase health insurance from insurers participating in the exchange.
* Allows states to apply to operate their own state-based health insurance exchanges.

Public Option
* Requires the establishment of a public health insurance option within the insurance exchange by 2013.
* Directs the Health and Human Services Department to run the public option and negotiate with providers to determine rates.
* Requires those rates to be no lower than those under Medicare and no higher than the average for private plans.

Additional Options
* Authorizes loans to entities that want to create health insurance cooperatives.
* Permits states to enter into compacts that allow for the sale of insurance across state lines.

Affordability

Individual Subsidies
* Provides affordability credits to individuals and families with incomes of up to 400 percent of the federal poverty level.
* Requires that subsidies would be used to reduce premiums and out-of-pocket costs.
Small Businesses
* Provides tax credits for certain small businesses that offer health insurance to their employees.

Requirements for Insurance Companies

Pre-Existing Conditions
* Bars insurance companies from denying or reducing coverage based on pre-existing medical conditions, beginning in 2013.
* Restricts how long insurers can continue to limit coverage for pre-existing conditions until the full ban takes effect.
* Prohibits companies from considering domestic violence a pre-existing condition.

Coverage Caps
* Prohibits annual or lifetime coverage limits.

Premiums
* Limits variations on premiums based on the age of the beneficiary to a ratio of 2-to-1.
* Permits variations on premiums based on geography and family size.

Out-of-Pocket Expenses
* Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.
* Guarantees no out-of-pocket costs for preventive care.

Essential Benefits Package
* Requires all qualified health benefits plans to provide coverage that meets or exceeds the standards of an "essential benefits package."
* Requires an essential benefits package to, at a minimum, cover hospitalization, outpatient hospital and clinic services, professional services of physicians and other health professionals, prescription drugs, rehabilitative services; mental health and substance use disorder services; preventive services, maternity care, well-baby and well-child care, and medical equipment.
* Establishes a Health Benefits Advisory Committee, chaired by the surgeon general, to make recommendations to HHS regarding the details of covered health benefits included in the essential benefits plan.

Medicare and Medicaid

Medicaid Expansion
* Expands eligibility for Medicaid by allowing enrollment for those making up to 150 percent of the poverty level, beginning in 2013.
* Beginning in 2015, states would pay 9 percent of costs associated with the expanded coverage.
* Requires Medicaid to cover newborns during the first 60 days of life.

Medicare Advantage
* Reduces payments under the Medicare Advantage program over a three-year period beginning in 2011.
* Makes the rates for Medicare Advantage the same as those for traditional fee-for-service Medicare by 2014.
* Provides bonus payments to insurance plans in the program that offer high-quality insurance plans in low-cost areas.

As part of the debate, Congressman Bill Pascrell, Jr., Co-Chairman of the Congressional Brain Injury Task Force, offered a statement including BIAA's guiding principles for health care reform.  Also included in the statement, which can be viewed by clicking on the link below, was language regarding payment initiatives such as the bundling of services. 


http://www.biausa.org/elements/policy/2009/house_cr_statement_bp.pdf  

The statement detailed BIAA's position that "post-acute payment systems must facilitate, not impede, improvements in functional status of individuals with brain injury and their ability to return to their homes and communities. BIAA supports a deliberative planning process and rigorous pilot testing."

Congressman Pascrell has been a true champion in the fight for securing access to care for persons with brain injury during the health care reform debate.  Please take a minute to click on the link below and thank him for his dedication to this important issue:

http://pascrell.house.gov/contact/  

It is also important to note that BIAA's Business and Professional Council was integral in creating the content of BIAA's health care reform guiding principles.

Now that the House has passed its measure, BIAA is monitoring Senate activity closely.  Senate Majority Leader Harry Reid has alluded to Senate action on their leadership bill as soon as next week. 


Update from co-bloggers

Here are a number of brain injury blogs from other bloggers
Dallas Morning News

 

 

 

Mesquite ISD a pioneer on dealing with student concussions
Dallas Morning News
There has been a growing concern about mild traumatic brain injury, as concussions are formally called, as more and more professional football players show ...
See all stories on this topic

Program helps airmen deal with combat stress
AirForceTimes.com
So when Bryan — then an Air Force captain and now a civilian researcher — deployed to Balad Air Base, Iraq, as the head of the traumatic brain injury clinic ...
See all stories on this topic
Nanomedicine Promising For Treating Spinal Cord Injuries, Findings Show
Science Daily (press release)
The work has been funded by a Showalter Trust grant from Purdue and a grant from the Indiana Spinal Cord and Brain Injury Research Fund, and is partially ...
See all stories on this topic
Fort Hood tragedy rocks military as it grapples with mental health issues
Los Angeles Times
Besides PTSD, a high rate of traumatic brain injury has contributed to cognitive and psychiatric symptoms. The wars have been long and, without a national ...

Five Myths About Medical Negligence

American Association of Justice published "Five Myths about Medical Malpractice Negligence."  I reprint it below.

It is especially interesting since the Nevada Supreme Court is currently considering whether to make the "Keep Our Doctor's in Nevada" bill, passed in 2004, retroactive.  A woman is suing her lawyer for taking 40% of her over $5,000,000 award for a lawsuit she retained him for in 1999.  She is arguing that the attorney fee limits should apply retroactively and the attorney's fees be reduced.  Interestingly she is not arguing that her recovery be limited retroactively to the current ceiling on medical malpractice cases of $350,000.

Those opposed to real health care reform are flailing to come up with real, alternative solutions to our current crisis. With all the talk of death panels, government takeovers, and rationing of care, now tort reform has been thrown into the mix.

Yet it will do practically nothing to lower health care costs, and certainly will not fix our broken health care system. However, it will most definitely hurt patients injured through no fault of their own. Seemingly, the effects of legislation on real people have somehow evaporated from the discussion.

To break through all the hyperbole, lies, and distortions, the American Association for Justice today released a new report, "Five Myths About Medical Negligence." The next time a cable news pundit or opponent of health care reform starts talking about tort law changes, chances are this manual will rebut their claims.

As the health care debate moves forward, here are the key myths and facts:

Myth #1: There are too many "frivolous" malpractice lawsuits.
Fact: There's an epidemic of medical negligence, not lawsuits. Only one in eight people injured by medical negligence ever file suit. Civil filings have declined eight percent over the last decade, and are less than one percent of the whole civil docket. A 2006 Harvard study found that 97 percent of claims were meritorious, stating, "portraits of a malpractice system that is stricken with frivolous litigation are overblown."

Myth #2: Malpractice claims drive up health care costs.
Fact: According to the National Association of Insurance Commissioners, the total spent defending claims and compensating victims of medical negligence was just 0.3% of health care costs, and the Congressional Budget Office and Government Accountability Office have made similar findings.

Myth #3: Doctors are fleeing.
Fact: Then where are they going? According to the American Medical Association's own data, the number of practicing physicians in the United States has been growing steadily for decades. Not only are there more doctors, but the number of doctors is increasing faster than population growth. Despite the cries of physicians fleeing multiple states, the number of physicians increased in every state, and only four states saw growth slower than population growth; these four states all have medical malpractice caps.

Myth #4: Malpractice claims drive up doctors' premiums.
Fact: Empirical research has found that there is little correlation between malpractice payouts and malpractice premiums paid by doctors. A study of the leading medical malpractice insurance companies' financial statements by former Missouri Insurance Commissioner Jay Angoff found that these insurers artificially raised doctors' premiums and misled the public about the nature of medical negligence claims. A previous AAJ report on malpractice insurers found they had earnings higher than 99% of Fortune 500 companies.

Myth #5: Tort reform will lower insurance rates.
Fact: Tort reforms are passed under the guise that they will lower physicians' liability premiums. This does not happen. While insurers do pay out less money when damages awards are capped, they do not pass the savings along to doctors by lowering premiums. Even the most ardent tort reformers have been caught stating that tort reform will have no effect on insurance rates.

Over 98,000 people die every year from preventable medical errors. That's like two 737s crashing every day for a whole year. Instead of focusing on tort law changes that won't fix health care, let's make sure people aren't injured in the first place. Not only will that lower costs, but most importantly, will improve health care for everyone.



Read more at: http://www.huffingtonpost.com/anthony-tarricone/calls-for-tort-reform-des_b_345438.html&cp

You can view AAJ President Anthony Tarricone’s article on the Huffington Post and link to the article by clicking here.

Michelle Whitmore said these kind words...

Tim: I enjoy your updates. This "lawsuit by committee" idea is ridiculous. People just don't get it until they've been hurt. Very frustrating to see the insurance companies and corporate America pull the wool over everyone's eyes.

I've attached an article regarding the topic and will be looking for more current information as well.

Hope you and your family are doing well. Don't forget to call me if I can help out with any funding issues on your cases. I enjoy working with you:

Take care:

Michele Whitmore

Settlement Strategies, Inc.
19412A E. Mann Creek Drive
Parker CO 80134

phone: (303) 841-0420
fax: (888) 596-8273
 

Improving Cognitive Skills With Music

Here is a good one for all us musicians...

Regularly playing a musical instrument changes the anatomy and function of the brain and may be used in therapy to improve cognitive skills.

There is growing evidence that musicians have structurally and functionally different brains compared with non-musicians. In particular, the areas of the brain used to process music are larger or more active in musicians. Even just starting to learn a musical instrument can changes the neurophysiology of the brain.

Lutz Jäncke, a member of Faculty of 1000 Medicine, proposes using music in neuropsychological therapy, for example to improve language skills, memory, or mood. In a review for Faculty of 1000 Biology Reports, an online publication in which leading researchers highlight advances in their field, Jäncke summarizes recent studies of professional musicians

Read More.

Encephalitis - What is it?

I found this interesting article dealing with encephalitis:  Take a look:

Encephalitis is inflammation of the brain resulting from a viral infection. Encephalitis usually begins with flu-like symptoms, such as fever and headache. The symptoms rapidly worsen, and may cause seizures, changes in mental state, such as confusion, drowsiness and loss of consciousness, or a coma.

The severe and potentially life-threatening form of this disease is rare.

According to Medilexicon's medical dictionary, encephalitis means "inflammation of the brain."

Encephalitis occurs in two forms:

  • Primary form. Primary encephalitis involves direct viral infection of the brain and spinal cord.
     
  • Secondary form. In secondary encephalitis, a viral infection first occurs elsewhere in the body and then travels to the brain.

Seeking immediate medical assistance and receiving timely treatment is important because the course of the encephalitis is unpredictable. A person with encephalitis can suffer life-threatening damage to their brain. The damage caused to the brain can result in long-term complications, such as memory loss, epilepsy, and personality and behavioral changes.

Encephalitis can occur in people of any age, although children under seven and adults over 55 are more vulnerable to infection.
 

Read More Here.

More Diagnostics - Better Outcome - Less Cost

Hospitals that make greater use of inpatient diagnostic imaging exams achieve lower in-hospital mortality rates with little or no impact on costs, according to a peer-reviewed study of more than 1 million patient outcomes in more than 100 hospitals nationwide published in the November issue of the Journal of the American College of Radiology (JACR).

"The results of our in-depth study would indicate that greater use of imaging does, in fact, lead to better patient outcomes in terms of lower in-hospital death rates with no significant impact on overall cost," said David W. Lee, Ph.D., lead author of the article and Senior Director, Health Economics and Outcome Research at GE Healthcare. "This study dealt only with imaging provided in hospitals, but would seem to confirm what many have long suspected - that medical imaging exams save lives."

Read the full article here.

Good Diet - Less Depression

The British Journal of Psychiatry,  available online, published findings that good diet contributes to less depression.

A new study led by researchers in the UK found that an overall healthy "whole food" diet comprising a high proportion of fruits, vegetables and fish, protected middle aged people against depression compared to a processed food diet containing a high proportion of high fat dairy food, processed meat, fried food, refined grains and sugar-laden desserts.

 Read More Here.

New Treatment for Alzheimer's and Parkinson's

Researchers in the USA have discovered a potential new function for anti-epileptic drugs in treating neurodegenerative disorders such as Alzheimer's and Parkinson's disease. The study, published in BioMed Central's open access journal Molecular Neurodegeneration, found that neurons in the brain were protected after treatment with T-type calcium-channel blockers, which are commonly used to treat epilepsy.

Read more here.

Women Beat Men

Women come in first again!  This time it's officially scientific:

Women are better than men at distinguishing between emotions, especially fear and disgust, according to a new study published in the online version of the journal Neuropsychologia....

While women have long been thought to outperform men in neuropsychological tests, until now, these findings were inconsistent. To obtain more conclusive evidence, the Université de Montréal researchers did not use photographs to analyze the reaction of subjects. Instead, the scientists hired actors and actresses to simulate fear and disgust. "Facial movements have been shown to play an important role in the perception of an emotion's intensity as well as stimulate different parts of the brain used in the treatment of such information," says Collignon, who also works as a researcher at the Université catholique de Louvain's Institute of Neuroscience in Belgium.

Read More.

Malpractice Tort Reform Update

President Obama continues his quest to appease skeptics of his health care reform:

Since President Obama proposed using $25 million to test new ways to handle malpractice lawsuits, suitors have been lining up, the The Associated Press reports. One leading idea is to appoint expert panels to sort fact from fiction in malpractice claims. The "American Hospital Association has been shopping a new plan to lawmakers," and malpractice reform advocates are expected to propose another strategy for a pilot program at a Health and Human Services hearing next week. Doctors say they perform extra tests on patients because they fear lawsuits.

Read More Here.

It's Never Too Late!

Here is an interesting story about a 100 year old woman getting back surgery.  Just goes to show that health and age go hand in hand.

On World Osteoporosis Day, October 20, centenarian Helen Daniels of Poughkeepsie, NY, has a good reason to smile; she's able to comfortably walk again following minimally invasive spine surgery. After suffering two spinal fractures caused by osteoporosis, Mrs. Daniels had debilitating back pain.

Read more here.

Brain Imaging FAQs

The Brain Injury Association of America publishes this information regarding frequently asked questions about Brain Imaging.  I pass this along for my readers.

 Brain Imaging: Understanding the Basics

 Frequently Asked Questions

 1 – What is brain imaging?

 Brain imaging allows scientists and doctors to view and monitor the areas of the brain. Brain images can be produced using structural imaging techniques, commonly MRI (Magnetic Resonance Imaging) and CAT (Computed Axial Tomography), or functional imaging strategies like PET (Positron Emission Tomography) and functional MRI (fMRI). Structural imaging is designed to identify abnormalities such as strokes, bleeding, and tumors, while functional imaging procedures evaluate how the brain is working. Functional imaging techniques can be used to study the brain at rest, or during an activity such as when a person is hearing, seeing, feeling, moving, talking and thinking. These measurements are based on the flow of blood in the brain, and changing levels of oxygen in specific brain regions depending on that flow.

 2 – How is brain imaging used for understanding brain injury?

 In addition to studying the anatomy or structure of injury, studies during the past few years have shown that fMRI and PET scans may be able to capture an image of activity in the brain of an injured patient that is not possible to know or see otherwise. This is particularly important as some brain injuries result in loss of speech and movement.

During a scan, the patient may be asked to listen to familiar voices, or to imagine themselves in different scenes like being at home or playing tennis.

 Learning about the parts of the brain that are activated in such cases may help scientists and doctors have a better understanding of disorders of consciousness that can occur after brain injury, such as the vegetative and minimally conscious states. Repeated brain scans over time may help scientists and doctors better understand the process of recovery and the effectiveness of different rehabilitation techniques.

 3 – Can brain imaging be used to determine whether someone is conscious?

 At present, there are no diagnostic tests capable of detecting whether someone is conscious. Conversely, there are no imaging tests that can determine if someone is unconscious. Specialized rating scales and brain imaging techniques have been developed to investigate the likelihood that someone is consciously processing information, but neither of these approaches provides definitive evidence of consciousness or unconsciousness. Despite their limitations, doctors currently rely on bedside examination findings to diagnose disorders of consciousness.

 4 – What have we learned so far?

 In the few studies conducted to date, scientists have found that patterns of brain activation in patients in minimally conscious states can look similar to those of non-injured people when responding to language and other types of stimulation. In the future, the results of these studies may help improve diagnostic and prognostic accuracy.

 5 – Should I enroll my family member in a brain imaging study?

You should find out what is involved with a brain imaging study before acting as the decision-maker to enroll someone, such as your family member, by talking to your doctor and the scientist requesting your consent. Most studies pose minimal risk to the patient and the participation of your loved one can add important knowledge to the understanding of disorders of consciousness. It is critical to stress that, at the present time, these studies are entirely experimental. Therefore, you cannot expect to learn new information about the person’s condition, or to use the information in decision-making about next steps for his or her care.

 6 – What should I expect of future research?

 As new knowledge is gained every day about how the brain works, you can expect ever-improving diagnosis of and treatment for brain injury. The choice to participate in research is yours or another designate on behalf of another individual. Make the choice based by thinking about whether the person would have volunteered. Carefully assess the desire to contribute to science, the acceptability of participation to your family and others important to the person in question, and have a clear appreciation that whatever is learned from the study will have limited, if any benefit for you or your family member.

Written by:

Dr. Judy Illes and Patricia Lau, The University of British Columbia, Vancouver, British Columbia

Dr. Joseph T. Giacino, JFK Johnson Rehabilitation Institute, New Jersey

Acknowledgements:

The Greenwall Foundation, Dr. Joseph J. Fins (Weill Cornell Medical College), Dr. Emily Murphy (Stanford University), and members of the Ethics, Neuroimaging, and Limited States of Consciousness Workshop, Stanford University June 2007.

 

©2008 The University of British Columbia