Mammon

Healthy participants volunteering to receive first-in-human safety trials of a drug are well compensated, and receive round the clock monitoring. But sick persons opting into an experimental program pay to exploit a legal loophole, and there’s no oversight. This truly exemplifies survival of the fittest.

Drugs are priced by preparedness to pay.

Drugs are priced by preparedness to pay.

A doctor, accused of administering banned substance Thymosin beta 4 (TB4) to footballers, was exonerated by the Medical Board in June of trying out etanercept on stroke patients. This genetically-engineered bioagent is the subject of an earlier blog , and is a last resort in arthritis. It trades improved Quality of Life, for reduced Quantity. This is a moral decision, but one informed by solid clinical evidence of the risks vs benefits of blocking autoimmune responses. The AHPRA letter declares that his “… decision to use etanercept was based on high-quality evidence. All patients were informed before attending and fully understood the position in Australia…”,  and ends with an apology for the stress of their investigation. The doctor wrote in his defence that “Griffith Uni was in the process of doing clinical trials with the drug“. Uhh, no. Dr Rick Williams has approval only for his trial protocol, but insufficient funding to begin. This footage from 60Minutes is the only ‘proof’ of efficacy:

Clinical notes show that patients were informed that this would cost $6k in Florida. So a vulnerable person was injected on the basis of pricepoint. Some had also signed off on a 29 point consent form, which includes unspecified “immune stimulating injections”. I have no idea how such conduct can be condoned, but it is indeed compliant with the Good Medical Practice Code-of-Conduct Sn2.2.6. Providing treatment options based on the best available information. With no definition of what constitutes an evidence base, misconduct is unfettered. Snake-oil salesman Dr Tobinick had been challenged to support a clinical trial, but sued detractors instead – a case thrown out by the US District Court 30 Sept 2015.

The doctor presented at a Florida conference in 2015: “Thymosin beta-4 affects immune responses and is integral to formation of growth of normal tissue when damage has occurred rather than the chaotic formation of scar tissue that normally happens.” and his Aust website states: “Peptides such as AOD 9604, Thymosin beta-4 and Follistatin are peptides … Agewell is a world leader in the use of these medications.” The TGA site is more enlightening: “These substances are currently used illicitly to enhance sporting performance and more broadly across the community often for body building and image enhancement purposes…

  • No form of Thymosin Beta 4 is yet approved for human therapeutic use anywhere in the world.
  • The medications are considered experimental in humans, with potential side effects including carcinogenicity and cardiovascular problems.”
Injecting room at HyperMed

Compounded concoction in the injecting room at HyperMed

But they’re still legal, with the doctor’s scrip. Which doesn’t even require a consultation, as an order from Peptide Clinics demonstrates. Fairfax’s sports journalist Jon Pierik and crime reporter Cam Houston were shown evidence of all this a month ago, but only wanted to know whether celebrity sports stars were implicated. Or had I seen any bikies? The consumer is left uninformed, and quite unprotected by regulatory authorities.

Stephen Dank administered peptides to rugby player Jon Mannah, who had been in remission from cancer but then died in 2013 after relapse. Dankenstein sued the Daily Telegraph for claiming that he had a case to answer for manslaughter, and the Supreme court agreed with the paper – dismissing the defamation complaint. No charges have yet been laid however, there’s uncertainty over the drug used. In April of this year, a peptides patient died suddenly, but there’s more chance of prosecution since TB4 is written in clinical records. Nonetheless, the Crown hasn’t yet taken action after 7 months – so perhaps it’ll suffice to blame the victims, rather than the perpetrators? That’s what the Essendon players discovered.

I recently lodged formal complaint to AHPRA over the disparaging statement by a guest Professor on radio “… holistic nature of alternative medicine albeit not evidence based … alter some of the biological behaviour in an adverse fashion, but that’s not out there in the public, so people who spruik these things may get away with it“. This was dismissed since the Private & Confidential letter states: “It cannot be concluded that these comments unreasonably reduce confidence in the therapy, as it is reasonable for Prof XXX to proffer this opinion“. That’s what I’d spent several months attempting to obtain directly, an admission that his ‘opinion’ had no supportive facts whatsoever, and indeed the therapy has a substantial gold-standard evidence base (used in cancer support at the Alfred Hospital). The man is a great oncologist (albeit one ignorant about complementary therapies), so I won’t further his embarrassment with naming. Doctors’ unfounded ideas are taken as advice from the Oracle, even justifying deadly human experimentation, but complaints are dealt with in secret and there’s no rights to appeal.

It’s a dog eat dog world. Some are rabid.

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HealThy Self

Both the happiness that I strive for, and the suffering that I wish to be free of, are results. Recognizing that, one seeks out the causes that lead to these results: to well-being, or to grief and suffering. HH the Dalai Lama ’97.

Three years ago this blog kicked off with a rationale to ‘Fight’. Exploitation of the vulnerable, chronically ill as stable generators of revenue by Pfarma led to further posts exposing many of the tricks played within medical research. The worst example being a university assignment to investigate SmART which highlighted thousands of lives were deliberately put at risk and dozens were killed. “Shouldn’t we tell an authority?” Replied Prof Rory Wolfe: “Happens all the time“. I’m loathe to shatter the hopes of those trusting in drugs and their peddlers, but our understanding of the molecular basis of autoimmunology is barely embryonic. Pills have approval based upon short-term feedback, so “results may vary” because our knowledge of the body’s adaption to this newly created chemical imbalance is mostly guesswork. That’s paraphrasing Prof Eric Morand, head of rheumatology translational (from lab to patient) research at Monash. Prof David Healy describes medical kidnapping at his site RxISK.org
by well-intentioned physicians, who’re unfortunately stuck with a corrupted evidence base. Offering addictive, longterm palliative relief whilst waiting on the big breakthrough … one that  would then impact upon research institution sponsor’s revenue stream. Sure, that’s going to happen  Cynical, yes. Honest? Judge for yourself. Even a notification that misconduct would be published openly to the scientific community wasn’t enough to warrant regulatory interest. Self-regulation within industry is a nonsense.

The fight within. External forces can be blamed for a situation, or salvation can be sought in a medication, a therapy, even prayerful belief in higher power. Paramedic turned documentary filmmaker Daniel McGuire interviewed several Balian, or shaman, supernatural doctors (including Ketut from ‘Eat, Pray, Love’). These healers are sought when Western medicine has failed them, providing what’s essentially psychotherapy.  “I am like a bridge.” says one, Mangku Pogog: “I span a region between sickness and health. But the patient has to walk across.”
This is a putting to use of the character strengths of self-regulation and bravery. Chronic sickness can be a comfort zone, writes Daniel, referencing Joseph Campbell on mythology as a means of tricking oneself onto the path to becoming well. Leave one identity as recipient of healthcare behind, to then courageously explore another, uncertain world. Believe more in yourself than that  faith placed in doctors or deity.

Balian doctor Ketut

Balian doctor Ketut

Negativity bias. You may know it as survival instinct. Defensively reacting out of self-protection. Competitive skills from the jungle don’t help in survival any more, not when the backstabbing of office politics is destroying your peace of mind. As well as your health. A new era in mind and body healing has begun, focused on positives. Not just optimistic, positive thinking. But starting from a realization that your weaknesses are less of a vulnerability in an evolved society, then means  it’s more fruitful to be dedicating focus onto strengths. Positive psychology develops the strength within – recognizing that ‘cover your arse’ is a sign of pathetic submission to a toxic culture. Reactive, fear-driven living stimulates the fight or flight adrenal axis and your body suffers. Forever. Self-defense, and even self-esteem (which relies on comparisons to others) are less helpful than self-worth, which values your positive attributes over perceived failings.

Nobody needs to know of further weaknesses in healthcare provision. There’s enough reasons already presented to start making changes in your thinking, so this blog will now quiesce in order to concentrate on solutions.

Taking the easy way out

If you torture the data long enough, it will confess…..Ronald Coase (economist)

Carole is backtracking from PostGrad qualifications in Coaching, to undertake an undergrad Psychology degree.  I’m overwhelmed by the depth of statistical expertise expected of her, and despite having a GradDip in Clinical Research I draw a blank on something called factor analysis. Psychologists doing investigations gather together factors which may be influential on the patient outcome, and search for interactions in the data. Medicine doesn’t do this. In fact post-hoc analyses are anathema. Data dredging – shame! The example often given is from 1988, in the Lancet, when studying the benefit of aspirin after a heart attack it was found that subgrouping by starsign significantly affected recovery. [Laughter 🙂 ]

Subgroups behaving badly

Subgroups behaving badly

Actually, this is worth thinking about. If you’ve been told since birth the behaviours expected from a Taurean, it’s quite possible you need additional counselling to subdue the inner beast. And not simply a different med dosage. But everyone except the doctors mines data nowadays. The social sciences statistical packages are being heavily adopted by business to glean profitability trends, most notably since IBM acquired SPSS.

All clinical trials have a single purpose, ie to test a hypothesis, even if multiple outcomes are considered and when multi-arm interventions (factors) are being tested (see Bonferroni). If the analysis isn’t declared upfront in the protocol, the ensuing report will be discredited by colleagues. Worthless even, since physicians’ distrust of their peer’s integrity leads to a presumption of bias – doing unethical selective analysis so as to claim ‘Eureka’ for something, anything! Earnest conferences churn out checklists for marking studies – GRADE, CONSORT, SPIRIT, PRACTIHC, STROBE, and even specialty specific guidelines such as PEDro (for Hispanic physiotherapists?). All seemingly ensuring transparency in the system, but somehow we’re forever growing the numbers of malcontents who claim that the regulatory oversight is broken.

Myself included. The problem arises from the cartel of institutional research, and I’ve written here often about our delusional confidence.  The investment in years to attain a medical qualification, followed by the personal sacrifice of a research-entitling doctorate  leaves medicos with little choice but to play the game. I don’t have evidence as to whether the psych’s datamining or the physician’s approach to test a hypothesis yields more fruit but am concerned that despite their claims to foster creativity, the universities stultify nonconformists as we make progress by degrees. Just getting funding is enough grounds to claim a breakthrough.

This month saw the publish of the ‘Handbook of Academic Integrity’, 72 chapters and starting price $USD400. To prove there’s no sanctimony on my part, here’s a sneaky free link to half a dozen chapters.

Shameless, actually

Shameless, actually

Everyone’s guilty of wrongdoing, sin is in our nature. Doing something even more wrong here:

I can’t breathe… oxygen makes me sick

Antioxidants are good, right? Wrong! According to Cochrane, a statistical trainsmash of the results from all relevant clinical trials found that beta-carotene, vitamin E, and higher doses of vitamin A increase mortality. Some countries aren’t govt funded to license that link, so in brief: a collate of 78 studies with 297,000 participants determined that antioxidants caused harm. One might think that this made marketing of such products a little awkward, but its publication in 2012 hardly sent shockwaves around the world – indeed the report is one of many similar findings. Free radicals in advertising? Sure they can stay, although Trump may want to lock them up.

Thanks Ron, now for the weather....

Thanks Ron, now for the weather….

A little science (sorry), oxygen oxidates – that’s what makes metals rust. Stable oxygen or O2 does the opposite, it ‘reduces’ one electron at a time, becoming more oxidative in reactive species (ROS) superoxide ->hydrogen peroxide->hydroxyl. These free radicals are biologically toxic – the immune system uses such ROS to kill invading microorganisms. Lipid peroxidation is the process of cell membrane destruction by radicals (and this can be a programmed termination), so the body relies on antioxidant enzymes to keep this in moderation. The danger of hydrogen peroxide’s potent reactivity is shown by its use as rocket fuel, and in torpedoes – where there’s no air to burn in any conventional engine. A leak was responsible for the explosion that sank the nuclear submarine Kursk. We’ve been designed to run on rocket fuel, and no supplements can stop this.

In 1956 Professor Denham Harman argued in the Journal of Gerontology that breathing oxygen caused free radicals to prosper, ultimately leading to death. You can’t read that without a subscription, sorry again. In interview he explained: “I was sitting there reading. All of a sudden the phrase ‘free radicals’ crossed my mind. You know just ‘out the blue’. I’m sure you’ve had the same experience…. And it was apocryphal, it just was born of thin air! No one … everyone accepts it and no one has a clue to the source!“. Aside from the decade spent getting the idea to take root, this theory became mantra but has recently come under challenge, such as the article ‘The free-radical damage theory: Accumulating evidence against a simple link of oxidative stress to ageing and lifespan‘. I’m really, very sorry again, but this important research on whether oxygen is a good thing is also copyright. It’s only relevant to the cave salamander (Proteus anguinus) and the naked mole rat (Heterocephalus glaber) anyway, since these clever critters live up to 8 times longer than is typical, thriving under high oxidative stress in the absence of protective antioxidants – levels about 70 times lower. Perhaps exposure to advertising is proving fatal to our species? On the other hand 28 scientists collaborate in speculating that Harman’s thought bubble was a blunder, questioning accepted dogma that the longer you breathe air the closer you come to death.

Novak undergoes HBOT

Novak undergoes HBOT (photo courtesy of HyperMed)

I published a report on the efficacy of hyperbaric oxygen (HBOT) for neuralgia – the pain arising from damaged nerves. Anyone clipping a pulse oximeter to their finger nailbed knows that their O2 saturation is ~98%, nearly perfect due to uptake by haemoglobin (making blood red). HBOT in a compression chamber also floods the plasma with dissolved oxygen, and ROS increases exponentially.  Explaining the seemingly contradictory harm from oxidative stress was avoided by citing arguments about preconditioning – HBOT kickstarts natural responses. Speit calls it adaptive protection, and Deneke describes a rebound effect, whereas Thom considers the brief exposure in HBOT as minimal harm risk from ROS (a natural process anyway). One HBOT benefit is after traumatic brain injury – the vasoconstrictive effect of oxygen reduces cerebral fluid hence intracranial pressure, without compromising perfusion. Hypoxic neurons die, whereas if you overdose on oxygen then temporary convulsions are the worst that can happen. Another Cochrane review   discusses the consequence of such therapy – the authors raise moral issues of how much improvement justifies keeping alive (potentially) severely brain-damaged peoples. HBOT for Multiple Sclerosis is commonplace in the UK, but poor quality of clinical trial evidence raises the question over exploitation of vulnerable people clutching at straws. It’s also an interesting therapy for connective tissue disorders, and although benefit for sporting injury has been disproven , world #1 Novak Djokovic relies upon the treatment. Most centres (6000) are in China and Russia, with 306 in Mexico as reported in the ‘Physiology and Medicine of Hyperbaric Oxygen Therapy’ chapter contributed by Gerbino & Hampson, 2006. Medicine discredits much of their available research as evidence, either due to perceived bias or translation difficulties.

Quod me nutrit, me destruit (what nourishes me destroys me)

Quod me nutrit, me destruit (what nourishes me destroys me)

Oxygen builds you up, knocks you down, and builds you up again. The recent publication ‘Dual effect of oxidative stress on leukemia cancer induction and treatment’ informs us that ROS induce cancer, but that’s also how the cytotoxic chemo drugs destroy malignancies “…. only a thin line separates the beneficial level and deleterious level of ROS“. The mitochondria engine powering your cells maintains this fine balance, enough antioxidants to create the ROS and then eventually break them down to water.
Six times nominated for a Nobel Prize, Harman also published a paper linking polyunsaturated fats to cancer risk. Perhaps best not to eat avocado, nuts, seeds, fish, or leafy greens, and find air with less oxygen – such as in a high density city? Nutritionists are now rethinking fats, as I wrote elsewhere, meantime take it easy on the antioxidants.

Author Geoff’s lifespan is still 40 years short of Harman’s achievement, and I do take a supplement: CoQ10. It’s complex.

Important: This article may arouse emotions including despair. If afflicted with intolerable, chronic pain then I suggest discussing these issues with your support network.

'No future', the anthem for fans of Johnny Rotten

‘No future’, the anthem for Johnny Rotten/John Lydon fans.

Fibromyalgia (FM) pioneer Prof Fred Wolfe looked up the endgame result for 8,000 fibromites and 10,000 osteoarthritis sufferers over a period of up to 35 years. Neither condition showed increased mortality overall, but for those 15 with FM who succumbed to suicide this risk was treble the national average.  His report is similar to one in Denmark reporting a six-fold increased risk, and not unlike the outcomes found from tracking registry CFIDS for Chronic Fatigue. Some insights can be found from a survey on symptoms of pain and Quality of Life which shows medical professionals failing to validate their illness to be the major determinant of poor subjective score.

Women’s Healthy Aging Project (WHAP) has tracked a cohort of 440 in Melbourne for 25 years to study disease impact on Quality Affected Life-Years. Although musculoskeletal has been included in scope (above the red line), requests for any available research rheumatologist to partake have been unfruitful.

Govt priorities

Aussie Govt priorities: cancer, heart, neuro, mental, lung, diabetes, injury, and lastly arthritic.

Leaving aside the prioritised ranking of #8 (a Dutch burden report puts it up at #1, and cancer as #8), this is remarkable since Monash homes the Cochrane evidence base for musculoskeletal. Their collation of clinical guidelines by 700 active health care professionals, researchers and consumer representatives is a task shared with Ottawa, however the Canadian Govt recently pulled funding to Tugwell’s team. Although this group claims to be inclusive of FM, there’s no reviews of treatment efficacy published. Those are instead posted on the Pain, Palliative, and Supportive Care (PaPaS) group site, where 16 interventions are evaluated. Repeat – there’s no consideration given to treating FM syndrome, but focus is wholly upon symptomatic pain relief. In perpetuity, which makes the FM meds market rather attractive and trial sponsorship good business sense.

A challenge was issued to PaPaS editorial manager Prof Andrew Moore re the inclusion of a Pfizer employee, Dawn Carroll, in a 2009 ‘independent’ review of Pfizer products Lyrica and Neurontin (considered as helpful: “For gabapentin and pregabalin only we found reasonably good second tier evidence for efficacy” in the latest version). His reply was thoughtful and extensive, particularly in regard to their recent policy decision to segregate FM from neuropathic pain. This decision isolating distinct conditions is at odds with our TGA & PBS approvals for Lyrica/pregabalin for neuralgia but not FM – despite being the most commonly prescribed treatment. Further insanity is shown in the single approved med for FM, the SNRI (anti-depressant) milnacipran not actually being distributed in Australia.

But I can’t help but be troubled by their letter to the BMJ dismissing Dr Des Spence’s criticism of Cymbalta – and he’s someone who’s also skeptical of Lyrica’s benefit. Prof Moore reveals that he’s paid as a consultant by Eli-Lilly, the manufacturer of Cymbalta.

Hope comes from bold rheumatologists who offer scrip for Disease Modifying Anti-Rheumatic Drugs in FM, and patient communities who share their experiences. 65,000 fibromite subscribers to one site donate their data in hopes of cure or remission. 1.6% are on a DMARD (including the aggressive biological agents). There’s no formal trials ever run on these drugs suitability, this is totally circumventing a broken system. For other solutions, see here.

Gagging

Endemic corruption within medical research is of no concern to government, since the issues previously raised have been put to Health Ministers and even to PM Turnbull. Without a response. Few have the integrity to whistleblow, due to lack of both regulatory authority and legal protection. After all, there’d be no shortage of backfill for your position upon dismissal from the increasing numbers of vulnerable foreign workers on tenure of a temporary visa. The blue bar charted shows post-docs, paid the same as a burger-flipper while Australia trains them in our wily ways. Employment Minister Eric Abetz denied existence of this scam in correspondence of 16th Sep ’15, despite a University advising “The Department of Immigration and Border Protection has limited the value of the living assistance which can be provided by the University to subclass 402 – research stream visa holders. The maximum contribution by the University to living expenses is approximately $34,000 per annum (at October 2012); this amount may alter on an annual basis.

402

Report BR0169

This matter has been raised with Immigration Minister Peter Dutton several times, but the office has never responded. Wouldn’t he be concerned about history judging him harshly, should the truth ever come out regarding misconduct? Uhh, no. Already looking at a pension of 1/6th of a million dollars annually, that means his CV needn’t be without a fault or three. Even if it’s already blemished by his  previous portfolio as Health Minister resulting in his poll ‘win’ from Australian Doctor magazine as being the worst performer in its 35 year history. No remorse at that failure either – last months confrontation with doctors of Lady Cilento childrens hospital showed his contempt for human rights also.
Your vote comes with no guarantee of governance, as there’s no accountability for policy made up on the fly. President of the amoral AMA turned politician, Dr Brendan Nelson, surprised both the Air Force and Defence Materiel by purchasing $7bn in Super Hornets from ex-parliamentary colleague Andrew Peacock, then a Boeing salesman. “It just flawed me … there was no independent analysis,” recalls AVM Peter Criss, a retired Air Commander of Australia. John Howard approved the suggestion in 2006 without seeking expert opinion, and far from showing remorse for events as they’ve unfolded is instead reveling in regularly being voted Australia’s best PM by Murdoch press conducted polls. That’s despite being outed as a liar regarding ‘children overboard’ by Admiral (rtd) Ritchie, onetime Chief of Navy.

The first planes were delivered in 2010, but six years later we’re still investing heavily in a future around the Joint Strike Fighters (JSF). That’s a project we’d supported by pre-purchasing 100, but both the budget and time were wasted during the cocaine-fuelled ‘nought-ies’ (the era which led to the GFC). Both aircraft are already outclassed by the Russian SU-30 & 35s purchased by five SE-Asian neighbours. “This thing [Super Hornet] will not survive in a fight now in our region,” says Criss. While the JSF struggles to achieve operational readiness, the SU ‘Flanker’ continues to evolve.

Photo courtesy LAC/W (RAAF) Kim Eager Sarah McLeod from the Ducati team with Dr Brendan Nelson. Minister for Defence Dr Brendan Nelson launched the Defence Motorcycle Awareness Campaign at the Sutton Road DriverTraining Centre, ACT near Queanbeyan on the 4th August, 2006.

Photo courtesy LAC/w (RAAF) Kim Eager
Sarah McLeod with ‘Top Gun’ Dr Brendan Nelson on the 4th August, 2006.

If Brendan ‘need for speed’ Nelson didn’t know what he was doing (he dropped out of his economics degree), nor do we know what they’re thinking. There’s a Senate inquiry into the JSF concluding in May 2016, but a previous report is pertinent “… the arguments are of a highly technical nature and much of the data necessary to form an understanding of the performance of the JSF is classified and not available for public scrutiny“.  The quid pro quo of political understandings with business here doesn’t work so well strategically however. Regardless of commitments to JSF, or however many M1A1 battle tanks Howard purchased, it’s been made crystal clear that our new “best friends” are Japan. Regional instability as a consequence of South China Sea conflict won’t be America’s problem, even if they are the trigger.

The secrecy that allows medical research to fester is the cause of the problem here, too. Any misconduct in national affairs remains secret, and public servants intending to whistleblow should pay heed to Sn 70(2) of the Crimes Act, 1914: A person who, having been a Commonwealth officer, publishes or communicates, without lawful authority or excuse (proof whereof shall lie upon him), any fact or document which came to his knowledge, or into his possession, by virtue of his office, and which, at the time when he ceased to be a Commonwealth officer, it was his duty not to disclose, shall be guilty of an offence.
 Penalty: Imprisonment for two years.

The USA, on the other hand, rewards with a payment up to 10% of the public monies recovered.

Changed thinking about the mind

In 1994 rheumatologist Elliot Pellman chaired the NFL’s council on Mild Traumatic Brain Injury (TBI – there is NO ‘Mild’ in this issue). “Concussions are part of the profession, an occupational risk,” … a football player is “like a steelworker who goes up 100 stories, or a soldier. Veterans clear more quickly than rookies…They can unscramble their brains a little faster, maybe because they’re not afraid after being dinged“.

“There’s going to be some controversy about you going back to play.”  Pellman personally sent a concussed Wayne Chrebet back onto the field soon after he had been knocked unconscious by a hit, reportedly telling him, “This is very important for your career.” Days later, Wayne is sluggish and his head aches. In 2005 Pellman et al published their seventh study in the official journal of the Congress of Neurosurgeons, concluding: “Return to play does not involve a significant risk of a second injury either in the same game or during the season.” And remember that the identities of the physician peers who reviewed and approved this nonsensical article are kept secret.

This may be perplexing to non-US residents. The opening of 2012 Southpark episode ‘Sarcastaball’ explains why taking a massive hit is a game tradition, using the naivete of kids.

0Forensic pathologist Dr Bennet Omalu’s investigations from 2002-’09 are documented in the book by Jeanne Marie Laskas, ‘Concussion’ (and now a Ridley Scott film). An outsider to medicine despite attaining eight degrees,  his strongly principled clash with the industry is a repeat of the tobacco deception. Right down to the NFL sharing the same law firm, Covington & Burling! US Congress questions were the turning point for transparency over subsequent years, and not the medicos. NFL boss Roger Goodell still thinks the concussion protocol just needs tweaking.

Self-regulation failed again.

It was only a month ago that the National Institutes of Neurological Disorders & Stroke, and of Biomedical Imaging & Bioengineering defined the ‘neuropathological criteria for the diagnosis of chronic traumatic encephalopathy‘ (CTE). Mostly unintelligible to layfolk, it’s nonetheless of sufficient importance to be published in a public journal. Like boxing, CTE is estimated in about a quarter of gridiron players, and is manifest in mental disturbances – but the tau tangles are invisible to imaging, until staining of brain slices post-mortem. Higher risk is posed to the spectrum of disease from Alzheimers to Parkinsons, and the month prior funds were allocated to research on diagnostic tests in the living. Although the NFL contributed nothing, the Players Union did. Professor Stern’s lab website is linked, and the urgency of guidelines for safer ages to start playing football fires discussion of their work, since the myelin sheath on neurons improves protection after the age of 14. Demyelination diseases include MS, so research implications go far beyond these elite professionals turning violent. Omalu also found CTE in a TBI war veteran who suicided, hence the penny has dropped regarding ‘Walking Wounded’.

I clashed with our Ski Patrol MO, then a Resident at Box Hill hospital, over management of a teenager who’d bounced off a tree. His mother’s concern was that the subdued manner was totally opposite to his usual bouncing off walls. A doctor trumps a paramedic, and I was chastised for trying to turn him into a victim. She sent them home, saying “Don’t worry about vomiting, he’s likely to be carsick“. Next day I rang the family – he slept for 21 hours.

How can this come to pass? I suspect the teaching in a medical degree that anything above the ears is the province of psych, must be addressed first. Holistic medicine is the only sensible way to treat.