GLOBAL NEUROLOGY REPORT: THE PERILS OF FETAL MONITORING IN AFRICA

Dr. James C Johnston

Maclean’s news recently interviewed neurologist and attorney Dr. James C. Johnston, his Ethiopian colleague and neurology Professor Dr. Mehila Zebenigus and Rwandan neurologist Dr. Jules Nshimiyimana for an editorial discussing the perils of using electronic fetal monitoring (EFM) in Africa.

Western medical advances exported to developing nations are supposed to improve healthcare and save lives.  However, “The West sometimes exports not just its medical advances, but its medical mistakes.”  This is unquestionably the case with EFM, a procedure that causes more harm than good.

EFM has been a birth myth for fifty years.  It is the standard of care in the West despite overwhelming evidence that it is ineffectual, rife with interpretive errors, has a 99% false positive rate, and has completely failed to reduce the incidence of cerebral palsy or any other neonatal neurological disorder.  EFM has, however, dramatically increased the caesarean section rate.  And C-sections create needless dangers to mothers and babies, increase risks in future pregnancies, and may account for an increased risk of future chronic diseases and neuropsychiatric disorders in children.

Why is this sham procedure being used against all scientific evidence?  To protect physicians and hospitals from lawsuits, as well as generate significant revenue.  And doing the procedure is not only medically harmful, but it completely neglects patient autonomy and informed consent.

Drs. Zebenigus and Johnston, along with renown medical ethicist Professor Berna Arda and leading medical malpractice attorney Thomas P. Sartwelle have discussed these concerns in the peer reviewed literature with publications in the Journal of Child Neurology, British Medical Journal, Journal of Maternal Fetal and Neonatal Medicine, Journal of Childhood and Developmental Disorders, Surgery Journal, Medical Law International, Neurologic Clinics and several other publications including the Legal Medicine and Medical Ethics textbook of the American College of Legal Medicine.  Many of these articles are freely available at ResearchGate.net:  https://www.researchgate.net/profile/James_Johnston6.

The more serious problem is that EFM is now being pushed in Africa, where the potential damage from a useless procedure is compounded by the utter waste of very limited resources.  The global fetal monitoring market is a multi-billion dollar business, and most of the growth in the next decade is projected to be in developing regions such as sub-Saharan Africa.  Drs. Zebenigus and Johnston have already seen the use of EFM machines increasing in Ethiopia, and Dr. Jules and other physicians report the same in Kenya, Rwanda, Tanzania, Uganda and other countries.

The cost of the EFM machines, training staff to read a useless test, and the resulting unnecessary C-sections all drain valuable resources that would be better used to care for children who have cerebral palsy.

“EFM has made birth less safe in the United States – and now, through a kind of medical imperialism, it is poised to potentially make birth less safe throughout the world.”

Read the Maclean’s news article at:

https://www.macleans.ca/society/health/the-use-of-electronic-fetal-monitoring-is-expanding-into-africa-and-thats-a-problem/

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Global Neurology Report: WHO List of Essential Diagnostic Tests

On 15 May 2018, the World Health Organization (WHO) published the first Essential Diagnostics List, providing a catalogue of tests that are necessary to diagnose many common conditions as well as a number of global priority diseases.

This represents a crucial step to improving global healthcare since many people are unable to access diagnostic services, and others are incorrectly diagnosed due to poor quality or improper testing.  As a result, these people do not receive proper treatment and, in some cases, may actually be given the wrong treatment due to a misdiagnosis of their condition.

The list details 113 tests – 58 for common conditions such as diabetes, and the remaining 55 focus on priority diseases such as malaria, tuberculosis, HIV, hepatitis and syphilis.  Some of the tests are designed for primary health facilities in severely resource limited areas, and do not require electricity or trained laboratory technicians.  Other tests are more sophisticated and will necessarily be used in better equipped medical settings.

This Essential Diagnostics List will serve as a reference for countries to develop or update their own protocols within the context of local conditions, ensure appropriate supplies and equipment, and train personnel for the testing.

WHO intends to expand and update the list to incorporate additional non-communicable diseases, neglected tropical diseases, antimicrobial resistance and emerging conditions.

Drs. Mehila Zebenigus and James C. Johnston serve as Directors of Global NeuroCare®, an NGO accredited by WHO and in Special Consultative Status with the UN ECOSOC, and strongly support this initiative.

The full document may be accessed through the following link:

http://www.who.int/medical_devices/diagnostics/EDL_ExecutiveSummary_15may.pdf

American Academy of Neurology Meeting

Dr. James C Johnston

Dr. James C. Johnston recently attended the 70th American Academy of Neurology meeting in Los Angeles, California.

Over 13,000 neurologists and other medical professionals attended the annual meeting, coming from over 100 countries.  There were seven plenary sessions, 240 educational programs and over 3,000 scientific abstracts.

Dr. Johnston and one of his Ethiopian colleagues, neurologist Dr. Mehila Zebenigus, presented an abstract entitled The Spectrum of Neurological Disorders in Addis Ababa, Ethiopia.  (DOI:  10.13140/RG.2.2.15263.25769).

 This study was prompted by the fact that neurological disorders constitute a significant portion of the global burden of disease, and are rapidly increasing in sub-Saharan Africa, yet the paucity of data on neurological disease patterns in this region precludes effective allocation of the limited available resources.

The study incorporated all new patients referred to a neurology clinic in Addis Ababa, Ethiopia over a continuous twelve month period.  Board certified neurologists diagnosed and treated each patient after performing a history, examination and any necessary testing including laboratory, neurodiagnostic or neuroimaging studies.  A total of 4,195 patients were evaluated, with a mean age of 41.3 years and sex ratio of 106.9.

The most common conditions were musculoskeletal disorders (33.6%), predominantly degenerative spine disease (28.5%).  The most common neurological conditions were nerve, root and plexus disorders (15.4%), epilepsy (11.7%), headache (11.1%), cerebrovascular disease (8.4%), generalized neuropathies (6%), movement disorders (3.3%) and neurodegenerative diseases (2.7%).  Brain or spine tumors and psychiatric disorders were less common at 1.2 and 2.2% respectively.

This was the first report of disease patterns at a private outpatient neurology clinic in Ethiopia.  It demonstrated that degenerative spine disease with or without radiculopathy, entrapment neuropathies and episodic disorders (epilepsy, headache, cerebrovascular disease) comprise the vast majority of conditions.

More importantly, these common conditions are effectively treated within this resource limited setting, underscoring the importance of allocating resources to train more neurologists in developing nations.  Drs. Johnston and Zebenigus have emphasized this approach through the non-profit organization Global NeuroCare®.  (www.GlobalNeuroCare.org).

GLOBAL NEUROCARE IN SPECIAL CONSULTATIVE STATUS WITH THE UNITED NATIONS

Dr. James Christopher Johnston

In 2010, Dr. James C. Johnston established the non-profit Global NeuroCare® to advance healthcare in developing regions.  Global NeuroCare® was formally granted Special Consultative Status with the United Nations as a Non-Government Organization in 2013 and this status has been continually renewed.  It is the highest status granted by the United Nations to NGOs.

The UN ECOSOC Committee on NGOs, which is comprised of 54 Member States, recommended Global NeuroCare® after a lengthy and laborious application process including a review of its statutes, objectives, past and present affiliation, and achievements.  The UN ECOSOC grants Special Consultative Status to NGOs with programs of direct relevance to the aims and purpose of the United Nations.

This position allows Global NeuroCare to provide expert analysis on issues directly from its experience; help monitor and implement international agreements; take an active role in advancing United Nations goals and objectives; serve as an early warning agent; raise public awareness of relevant issues; provide essential information and analysis at organizational events; make written and oral statements at international conferences and events; and organize additional or side events.  Global NeuroCare® members can serve as UN delegates at the UN sessions in New York, Geneva and Vienna.

In accordance with Article 71 of the UN Charter, the Economic and Social Council (ECOSOC) of the United Nations has fully accepted Global NeuroCare in its circle of accredited non-governmental organisations.

This consultative relationship is governed by the UN ECOSOC resolution 1996/31, which outlines the eligibility requirements for consultative status, rights and obligations of NGOs in consultative status.

Based on his experience in Global Health, James C. Johnston, MD, JD has presented multiple statements to the UN with recommendations on improving healthcare in developing regions, and these have been accepted and published by the ECOSOC High Level Political Forum and the Commission for Social Development.

GLOBAL NEUROLOGY REPORT: A CRITIQUE OF ELECTRONIC FETAL MONITORING

 

The Surgery Journal recently published a peer reviewed critique of electronic fetal monitoring (EFM) by neurologist James C. Johnston, MD, JD and leading healthcare attorney Thomas P. Sartwelle.

These authors, Thomas P. Sartwelle and Dr. James C. Johnston, along with pre-eminent medical ethicist Professor Dr. Berna Arda, have repeatedly advised that continuous EFM should not be performed in routine labour due to a 99.8% false positive rate, and the fact it does not predict or prevent cerebral palsy or any other neonatal neurological injury.

EFM does increase the caesarean section rate, with an increase in maternal and newborn deaths and birth complications as well as devastating long term complications. In fact, these very concerns have led Australia, New Zealand and the UK to advise returning to intermittent auscultation (IA) instead of EFM, and in 2017 the American College of Obstetrics and Gynecology finally provided a long overdue recommendation that women be given an informed choice between IA and EFM.

Unfortunately, there are EFM apologists continuing to defend the procedure, and journal editors suppressing scientific debate on the topic. This most recent Surgery Journal article exposes one example of these harmful practices, and should raise serious questions about those EFM proponents recommending a procedure that causes more harm than good to mothers and babies alike. But perhaps the more disturbing aspect is a medical journal editor determined to stifle scholarly debate.

This open access article is available through the following link:

https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0038-1632404

The authors have also published their concerns in the Journal of Child Neurology, Maternal Fetal and Neonatal Medicine, British Medical Journal, Neurologic Clinics, Journal of Pediatric Care, Maternal Health Neonatology and Perinatology, Medical Law International, Surgery Journal and several other journals and books. These articles are available at James C. Johnston’s ResearchGate.net site:

https://www.researchgate.net/profile/James_Johnston6/contributions