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The CMG Voice

Why Do People Get Cancer?

Posted Friday, December 1, 2017 by Gene Moen

We all know someone who has cancer or had it, and ask “why?” Is it genetic, environmental, or just random? It may a combination of these factors, but researchers are learning that a significant cause of many cancers is potentially modifiable risk factors.

The conclusion of recent studies is that more than 40% of new cancers and cancer death each year are caused by lifestyle factors. Some of them are obvious: smoking, alcohol, and exposure to other carcinogenic substances. Consistent with this, cigarette smoking was the most significant cause found in the studies, accounting for 19% of all cancers, with obesity and alcohol intake ranking as second and third.

These numbers likely underestimate the true magnitude of lifestyle factors’ impact on cancer risk, according to Farhad Isrami, MD, PhD, in an article published in CA: A Cancer Journal for Clinicians. Despite this new research, it is difficult to quantify the impact of all established risk factors, and many cannot yet be firmly established as causative.

For example, although tobacco use is considered the leading contributor to cancer death, it is necessary to consider all of the other factors that may correlate with smoking, including obesity, poor health habits, nutrition, physical inactivity, and alcohol consumption.

The study did not break new scientific ground, but reinforced the knowledge that prevention can play a major role in reducing the national cancer burden. One difficulty in further refining the statistics is that the sources of information about a particular cancer that is attributable to risk factors may be different for each type of cancer. According to Dr. Islami, “[we] didn’t have a comprehensive analysis of all the contemporary data, using the same methodology to make all the results comparable.” With advancing research techniques, it is hoped that more informed decisions can be made about establishing priorities for cancer prevention and control.

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Why Is It Sometimes Difficult To Find A Local Attorney To Take On A Medical Products Case?

Posted Monday, November 27, 2017 by Gene Moen

With recent news stories about major products cases involving talcum powder, hip replacement, and hernia mesh among others, one would think that local lawyers would be eager to take on such cases. Unfortunately, that is often not the case. Lawsuits involving medical products or drugs are often national cases that are undertaken only by large firms that handle such cases throughout the country. We often received calls about such cases, and I try to explain to the potential client why this is the case.

Most medical products cases are very hard-fought. The outcome for the manufacturers can be measured in many millions of dollars. Each time a claimant wins a lawsuit, this increases the settlement value of the cases yet to be tried. And each time an early lawsuit results in a defense verdict, the opposite occurs. The early lawsuits filed in these cases are a thus a little like the “canary in the mine,” since what happens in those early cases can mean million-dollar swings to both plaintiffs and defendants.

The business model for firms handling these cases is very different than that of a firm representing individuals in “one on one” medical negligence cases. Any firm taking on Johnson & Johnson or Medtronics in a products case needs a large number of clients, in part to be able to pick the best cases to initially take to trial. And as the firms go forward with the cases, they also need to be able to spread the huge costs of the cases among many clients. Handling a single such case, or even several of them, is difficult if not impossible. Years ago, my firm handled a dozen Fen-Phen diet drug cases, but I knew of a New York firm that had hundreds of clients. I have heard of early claims that had a reasonable verdict range of $1-2 million, but which motivated the law firm to spend several times that amount in preparing and trying that case. The reason is noted in the second paragraph of this blog. A win or a loss means much more that the verdict in that particular case.

How the cases are handled also affects the ability of a local attorney to take on such a case. Because of the many claimants throughout the country, such cases are usually in federal court and a single judge is assigned all of the cases. This is termed “multi-district litigation.” So a judge in St. Louis, Missouri, may be assigned to handle all the lawsuits filed in federal courts throughout the county, for that particular product. The judge then has hearings at which many attorneys appear, in order to issue orders about how the litigation will be handled. I attended one such hearing in San Francisco years ago, and I think there were over fifty plaintiff’s attorneys in attendance.

Among other things, the judge has to issue orders about how discovery will be handled. Obviously, fifty or more attorneys can’t each take the deposition of key company officials. So the judge appoints a plaintiff’s committee of nationally-known attorneys on the plaintiff side, which then is charged with conducting the discovery, including depositions. The judge may also order that, if an individual attorney wants to share in the benefits of such discovery, he or she has to pay a percentage of the fee received in his or her case, to help fund the huge costs of the discovery. I know of cases where the plaintiffs’ committee had a small army of attorneys spend months going over extensive records at the defendant company’s headquarters or research facilities.

A potential claimant can find national firms handling such cases by simply doing a computer search by typing in, for example, “hip prosthesis attorney” or “hernia mesh attorney.” The result will be websites of many firms that advertise on the Internet for such cases. If you watch late-night or daytime TV, you will also see ads by national firms wanting to represent you.

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Online doctor reviews – some health care institutions actually think more is better

Posted Monday, November 20, 2017 by Tyler Goldberg-Hoss

Technology marches on. The ways in which we get health care changes. Hopefully, marketplaces are created that allow health care consumers to pick and choose which providers they want to see.

In these scenarios, it is no wonder that patients take their impressions of the providers they see to the Internet. Websites, including Yelp, Healthgrades, Ratemds, and others have for some time published the reviews of doctors posted by patients. Most of these reviews are either favorable, or at least respectful in their criticism. Rarely, the review is of a kind that prompts the reviewed doctor to contemplate legal action, including hiring an attorney to sue the reviewer for defamation.

While legal action may be the right avenue for some doctors, other health care institutions are thinking about it a little differently, actually calling for more reviews, and posting them all (for the most part) on their websites. University of Utah was the first hospital to begin posting such comments on their website in 2012, and since then a number of other hospitals have followed suit.

Supporters of this transparency say that it forces some providers who get negative reviews to think about changing behavior and improving the relationship they have with their patients. Further, posting unedited comments (and not just cleaned up favorable reviews) allows for consumers to feel like they are getting better information from which to make decisions about which doctor to see.

Certainly there are bad apples in every bunch, and comments may be unfair. Hospitals often allow doctors to review the comments and appeal to an internal committee if the doctor can show that a particular review is unfair or untrue. And there will still be places like Yelp where patients can and will post negative reviews, and if the post is particularly unfair, untrue, and damaging to a doctor’s business, the reviewer may be subject to legal action. But it is the hope of many hospitals that greater transparency will be a net benefit.

You can read more about this here:

Some solicit, others sue: Doctors take various tacks to respond to online reviews

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New legal battle in fight over the opioid epidemic: suing the Joint Commission

Posted Thursday, November 16, 2017 by Tyler Goldberg-Hoss

Municipalities all over the country have begun filing lawsuits against the manufacturers and distributors of opioid medications, including here in Washington State.

However, in what appears to be a first of its kind, Cities in West Virginia have banded together to sue The Joint Commission, a non-profit accreditation entity, for spreading misinformation about the risks of opioid prescriptions and addiction, in part due to the cozy financial relationship it shared and shares with the manufacturers of the medication.

The Joint Commission is a nonprofit that accredits more than 20,000 health care organizations, including hospitals, across the US. Most every governmental entity in the US recognizes that the Joint Commission accreditation is a condition of licensure and receipt of Medicaid and Medicare reimbursements. The Joint Commission, then, is an authority in the US regarding safe practices in medicine.

The lawsuit claims that, starting with the first Pain Management Standards in 2001, the Joint Commission has downplayed the seriousness of opioid addiction, the result of collaborating on the standards with the makers of the drugs. This includes relying on research for these standards from groups who were accepting drug company money.

It is unclear whether the lawsuit will be successful, and even what “success” means in such a case. Certainly The Joint Commission does not have the deep pockets of some of the defendant manufacturers like Purdue Pharma. However, considering how accreditation from The Joint Commission is necessary for hospitals, it may put pressure on The Commission to relax pain management standards at West Virginia hospitals, so that the hospitals don’t have to choose between keeping their accreditation and prescribing fewer such drugs.

You can read an article on this here:

‘This is just the beginning’: Scope of opioid lawsuits widens to include hospital accreditor

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Does the time of day affect your outcome from open-heart surgery?

Posted Monday, November 13, 2017 by Tyler Goldberg-Hoss

Who would have thunk it?

Researchers in France have recently published the results of a study that looked at the rates of complications in patients who underwent heart valve replacement surgery in the morning versus the afternoon.

The study involved observing about 600 patients who had such surgery for six years. The study found that patients who had surgery in the afternoon had half the risk of a major cardiac event (like a heart attack) as those who had surgery in the morning.

One of the authors of the study suggested that a person’s circadian clock is at least part of the reason. And this isn’t the first time that medical researchers have considered the time of day and how medical treatments work. Other studies have shown that the efficacy of certain cancer treatments and vaccines may be affected by the time of day when the therapy or medicine is given.

These findings may be useful in treating patients in the future. First, scientists are testing whether they can “trick” heart muscle into healing in the way afternoon patients heal regardless of day. Further, it may mean that higher risk patients should be operated on in the afternoon.

You can read an article on these findings here:

Why having surgery later in the day might be better for your health

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