Monthly Archives: January 2013

Johnson & Johnson Failed to Warn Patients of Hip Replacement Risks

hippainMore than 90,000 patients received a DePuy hip implant, manufactured by Johnson & Johnson. The company reportedly knew that these all-metal hip implants would fail within the first five years in nearly 40% of patients. However, they neglected to share that information publicly, according to recently released court documents.

The company became aware of the high failure risk following an internal analysis of the product, completed in 2011 after the hip recall was initiated in 2010. Even as the analysis neared completion, Johnson & Johnson continued to publicly downplay similar results found by a British implant registry, reports The New York Times. This analysis is just one of the hundreds of documents that will soon become public in a series of lawsuits brought by patients who received the ASR device.

The hip implant at the center of the controversy consists of a metal cup and ball. Surgeons stopped using the device in 2010 after discovering that repeated grinding of the components within the patient’s body released metal debris, damaging tissues and bones. According to The New York Times, these particular metal-on-metal hip implants failed at three times the rate of other artificial hips. When first released, Johnson & Johnson and DePuy Orthopaedics insisted that the failure rate was 12-13%, even though their own data showed a failure rate of up to 40%.

More than 10,000 patients have filed lawsuits following the failure of their DePuy hip replacement, according to Attorney Lindsay Rakers, writing for The Legal Examiner. Although the ASR is no longer being used in the United States, these lawsuits remind us of the risks inherent with any joint replacement surgery. Last year, an Oxford University study found insufficient data on the long-term effectiveness and reliability of knee replacements. The same research team also found that many patients who underwent knee replacement surgery were young or had mild symptoms, and may not have actually needed the surgery.

Do Women Have a Higher Risk of TMJ Disorders?

jawpainPrevious research has shown that temporomandibular joint disorders (TMD) are associated with temporomandibular joint lesions and with increased estrogen levels. Contact sports are known to increase joint lesions, while adolescence increases estrogen levels in females. A recent study sought to determine whether female adolescent athletes have more signs of TMD than non-athletes, and to examine the association between different stages of adolescence and TMD.

Study participants included 89 female basketball and handball players between the ages of 10 and 18 years, and 72 female non-athletes between the ages of 10 and 19. A survey was used to assess TMD signs and symptoms. According to the survey answers, the adolescents were classified in two groups: no signs or symptoms present, or at least one sign or symptom present. Those who showed at least one sign or symptom of TMD underwent a standardized functional examination. Physicians then grouped the study participants into three subgroups based on pubertal status.

No significant difference in TMD signs of symptoms was found between the athletes and non-athletes and between different stages of adolescence. This lack of significant differences may indicate that although contact sports are known increase the risk of temporomandicular joint lesions, and estrogen levels are a risk factor for the onset of TMD, when considered alone they do not significantly impact the onset of this disorder.

This research can improve our understanding of temporomandibular joint disorders suffered by auto-injury patients.

Reference

Weiler RM, Santos FM. Prevalence of signs and symptoms of temporomandibular dysfunction in female adolescent athletes and non-athletes. International Journal of Pediatric Otorhinolaryngology 2013; [E-pub ahead of print].

Why Auto Injury Compensation Can Improve Recovery

recovery from autoinjuriesFeelings of injustice after an auto collision can actually worsen whiplash recovery, confirms the results of new research published in the Journal of Occupational Rehabilitation.

The study showed that patients who believe they have been treated unjustly after an auto injury suffer from worse symptoms a year after the crash compared to patients who do not feel the same sense of injustice.

Earlier research has suggested that a sense of injustice can detrimentally affect patients’ prognosis from auto-injuries. In 2008, researchers from McGill University in Canada developed a tool for assessing these perceptions called the Injustice Experience Questionnaire (IEQ).

Now, in this latest study, the same group of Canadian researchers have confirmed that the IEQ can be used as a predictive tool for evaluating the perceptions and prognosis of whiplash patients. They discovered that patients with more intense feelings of injustice, indicated by high IEQ scores, were more likely have greater pain intensity a year after the crash. They also had a heavier dependence on narcotic drugs.

This research highlights the important of identifying and targeting feelings of injustice in whiplash patients.

Although some have argued that the compensation process could harm the health of auto-injury claimants, recent research calls that argument into question. In another new study analyzing the research on recovery and compensation, researchers determined that there is no clear evidence to support the idea that compensation negatively impacts prognosis in auto-injury patients. Instead, this latest research on the IEQ suggests that compensation could support recovery by reestablishing a sense of justice in patients. These improved perceptions, in conjunction with reduced stress and anxiety and access to adequate medical care, makes fair compensation all the more important for recovery.

 

Reference

Scott W, Trost Z, Milioto M, Sullivan MJ. Further validation of a measure of injury-related injustice perceptions to identify risk for occupational disability: a prospective study of individuals with whiplash injury. Journal of Occupational Rehabilitation 2013. [E-published ahead of print]. doi 10.1007/s10926-013-9417-1.

Sullivan M, et al. The role of perceived injustice in teh experience for  chronic pain and disability: scale development and validation. Journal of Occupational Rehabilitation 2008; doi 10.1007/s10926-008-9140-5.

Cellphone Bans Don’t Decrease Accident Rates in Rural Areas

turnedheadMany states have flocked to pass laws banning the use of cellphones while driving. At first blush, these laws make sense since cellphones are involved in 23% of auto collisions. But a new study suggests that barring cellphones from cars doesn’t always lead to lower accident rates.

The study compared accident rates in rural and urban counties of New York and Pennsylvania where it’s illegal to use a cellphone while driving. Although there was clear evidence that cellphone bans correlated with a dip in accidents rates within urban counties, the bans did not produce the same effects in rural counties.

Douglas King, co-author of the study, explained, “Based on this research, it suggests that a blanket cellphone ban may not always lead to a greater benefit. Based on the seven-year time period that we were able to examine, the outcome in each group of counties after the ban was not uniformly beneficial.”

Still, the researchers said there is strong evidence to support cellphone bans in areas with denser populations.

Meanwhile, lawmakers in Maryland and Virginia are considering increasing penalties against drivers who text while driving.

NFL Faces New Brain Injury Lawsuit Filed By Junior Seau’s Family

juniorseau
NFL Linebacker Junior Seau, Photo by David Sizer via Creative Commons

The family of Junior Seau is suing the NFL for wrongful death, claming that his suicide resulted from a brain disease developed during his time in the league. Last week, autopsies of Seau’s brain confirmed that he had the degenerative brain disease known as chronic traumatic encephalopathy (CTE), which can develop as a result of repeated concussions.

Seau shot himself in the chest last year with the intention of preserving his brain so it could be examined for signs of CTE. At the time, CTE could only be diagnosed post-mortem, although symptoms of aggression, impulsivity, and problems with memory and cognition are often indicators of the disease while a person is living. Just this week scientists from UCLA published a study in which they discovered a way to diagnose CTE in living patients. One day, the new diagnostic techniques could help athletes like Seau prevent the progressive brain degeneration of the disease with early detection.

The plaintiffs in the wrongful death case accuse the NFL for “acts or omission” that obfuscated the real dangers of repetitive blows to the head. They also claim the NFL concealed evidence and deliberately ignored the risks associated with multiple mild traumatic brain injuries.

The outcome of Seau’s case could significantly impact the families of 34 former NFL players who were recently confirmed to have the disease.

Seau’s lawsuit is the latest litigation the NFL has faced in recent years. More than 3,800 players have sued the NFL in cases related to brain injuries, according to a review from The Associated Press.

Breakthrough Discovery for Brain Disease Research of CTE

brainxraysScientists have discovered a holy grail in brain-injury research: the ability to diagnose the degenerative brain disease chronic traumatic encephalopathy (CTE) in living patients.

Previously, CTE could only be diagnosed through autopsy. But scientists from UCLA say they’ve developed a new technique in brain imaging that allows them to detect the build up of protein tau in the brain, a key indicator of CTE.

CTE can develop in the brains of athletes, military personnel, or anyone exposed to repeated blows to the head. Recent autopsies revealed that 34 former NFL players had the disease, and several former NHL players have also been diagnosed with CTE.

This week the family of former NFL linebacker Junior Seau filed a lawsuit against the league, claiming he developed the disease as a result of the multiple concussions he obtained during his career. Seau showed signs of the disease while he was living, like mood changes, irritability, memory problems, and cognitive deficits, but the former limitations of CTE diagnosis meant Seau committed suicide without ever knowing whether he had the disease.

Now, doctors could one day diagnose CTE in  athletes like Seau and help them take steps to slow the progression of the disease.

The study included six former NFL players aged 45 and older who had a history of concussions and were experiencing problems with cognition and mood changes.

Researchers injected the athletes with a new dye containing a radioisotope called FDDNP which clings to deposits of tau “tangles” and amyloid beta “plaques” in the brain. The dye shows up on PET scan images, acting as a visual marker of the build up of plaque and tau tangles in the brain.

When compared to healthy men without a history of concussions, the NFL players had higher levels of FDDNP, particularly in parts of the brain responsible for learning, emotions, behavior, and memory. Their FDDNP levels were similar to patterns of tau deposits found in the brains of people with CTE.

This is the first and only imaging technique that can measure tau proteins in living subjects, the researchers pointed out.

Although larger follow-up studies are need to confirm the results, the findings represent a major step forward for brain-injury treatment.

 

State Lawmakers Consider New Texting While Driving Penalties

Photo by Jason Weaver via Creative Commons.
Photo by Jason Weaver via Creative Commons.

Lawmakers in Virginia and Maryland are considering new legislation that would strengthen existing penalties for texting while driving.

In both states, texting while driving is only a secondary offense, which means that drivers can only be punished for cellphone use if they’ve been pulled over for another reason.

The current penalty for texting while driving in Virginia is only a $20 fine. The new law would make texting behind the wheel a form of reckless driving, a Class 1 misdemeanor with a punishment of up to one year in prison and $2,500 fine.

The Maryland legislation is less stringent and would only charge texters with a $500 fine. But penalties could be waved for first-time offenders who appear in court and demonstrate they were using a hand-free device.

Cellphones are involved in 23% of auto collisions, according to a 2011 study from the National Safety Council. Another new study found that at least a third of smartphone owners admit to using their phones behind the wheel.

Psychosocial Factors Predict Whiplash Recovery

womeninpainLong-term pain and disability following whiplash injuries have become an increasingly significant problem, causing substantial individual and social costs. Some whiplash patients recover relatively quickly, while others experience chronic pain and long-term disability. However, risk factors influencing whiplash prognosis are not well-understood. In recent dissertation published in the Danish Medical Journal, researchers used questionnaire data to determine whether pre-collision health-related and socio-demographic factors affect whiplash recovery.

The study involved patients with whiplash injuries resulting from auto collisions in Denmark from 2001 to 2003. Thirty-six percent of these patients reported considerable neck pain one year after the collision. Certain self-reported characteristics were found to be important for recovery following whiplash trauma. The researchers found the following factors to predict future neck pain: pre-collision self-reported pain, high psychological distress, low educational level, and female gender.

This study suggests that data on pre-accident factors could provide valuable information about prognosis following acute whiplash trauma, and help to identify patients who may at risk of chronic pain following whiplash.

In another recent study, researchers tested new guidelines that could help doctors predict whiplash prognosis.

Reference

Carstensen TB. The influence of psychosocial factors on recovery following acute whiplash trauma. Danish Medical Journal 2012;59(12):B4560.

Gender Differences in Whiplash Recovery

whiplashpainIt’s well-known that more women than men experience whiplash following auto collisions. However, little is known about the reason for this disparity, or about the possible gender differences in coping with whiplash injuries. A new study adds to the knowledge surrounding gender and whiplash recovery by examining possible gender differences in coping with neck pain following whiplash trauma.

The study involved 740 patients who were injured in auto collisions in Denmark. Participants completed questionnaires on socio-demographics, collision characteristics, and psychological distress. Three months after the initial injury, they completed a coping strategies questionnaire and were asked about neck pain intensity 12 months after the injury.

The chance of long-term neck pain was more than twice as high for women than for men. However, the researchers found no gender differences in coping. The coping strategies examined – distraction, reinterpreting, catastrophizing, and praying and hoping – showed no differences by gender. Thus, different coping strategies did not explain the different neck pain prognosis observed in women and men.

Reference

Carstensen TB, Frostholm L, Oernboel E, Kongsted A, Kasch H, Jensen TS, Fink P. Are there gender differences in coping with neck pain following acute whiplash trauma? A 12-month follow-up study. European Journal of Pain 2012;16(1):49-60. doi: 10.1016/j.ejpain.2011.06.002.

Work Disability Common After Mild Auto Injuries

lowbackpainStudies examining disability following auto collisions are generally aimed at patients with serious injuries. Less is known about the disability caused by milder injuries not requiring hospitalization. A new study sought to fill this gap by examining the work disability of patients who were hospitalized compared to those whose injuries did not require hospitalization.

The study involved people injured in road traffic accidents in Victoria, Australia between 2005 and 2007 who had compensated time off work for their musculoskeletal or orthopedic injuries. Of those patients,  57%  required hospitalization and 15% were hospitalized for more than a week.

Long-term work disability was common; 32 percent of injuries resulted in work disability more than 6 months after the injury. Those whose injuries did not require hospitalization accounted for 27% of all work disability days, with the majority missing less than a week of work. Patients who were female, under the age of 35, or had an early prescription for painkillers had an increased risk of work disability six months after the injury.

This study confirms that many patients with mild injuries still miss work days because of their injury.

In another recent study, patients with more serious auto injuries said the crash still impacted their daily lives a full year after the accident.

Reference

Berecki-Gisolf J, Collie A, McClure R. Work disability after road traffic injury in a mixed population with and without hospitalisation. Accident Analysis & Prevention 2013; 51 (129-134).