NON-COMMUNICABLE DISEASES: A GLOBAL HEALTH THREAT

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World Association for Medical Law Congress in Tokyo on 6-8 August 2019.     

Non-communicable diseases (such as heart disease, stroke, cancer, diabetes) are collectively responsible for 7 out of 10 deaths in the world, 41 million people every year.  Many of these people die prematurely and the vast majority of these deaths are in the low income countries.  The World Health Organization considers non-communicable diseases to be one of the top ten global health threats.

The situation is even worse in the least developed nations that are facing a triple burden on ongoing infectious diseases, rapidly increasing non-communicable disease and the effects of globalization including accidents and injuries, compounded by a dearth of healthcare workers.

Neurologist and Attorney James C. Johnston, MD, JD and Neurologist Mehila Zebenigus, MD discussed these concerns at the 2018 United Nations (UN) High Level Political Forum in New York and provided specific recommendations for improving healthcare access in the least developed nations, particularly sub-Saharan Africa.

On behalf of Global NeuroCare® Drs. Johnston and Zebenigus published a written statement on improving healthcare as a strategy for poverty reduction at the UN 56th Commission for Social Development with specific recommendations for Member States to improve healthcare access.  Global NeuroCare® is a non-profit organization holding Special Consultative Status with the United Nations ECOSOC.  This allows Drs. Johnston and Zebenigus, as Directors of the NGO, to provide expert analysis on issues related to global health, make written and oral recommendation statements, and serve as UN Delegates at the United Nations sessions in New York, Geneva and Vienna.

Drs. James C. Johnston and Mehila Zebenigus reviewed their recommendations for improving healthcare in developing regions with leading international experts from over 40 countries at the 24th World Association for Medical Law Congress in Tel Aviv, Israel.  The WAML, in conjunction with the Israeli Ministry of Health and Tel Aviv University honored Dr. Johnston with the Inaugural Davies Award in Public Health.  Dr. Johnston dedicated the award to the Addis Ababa University Department of Neurology and donated the funds to Global NeuroCare.®

Drs. Johnston and Zebenigus have published another statement for the 57th Session of the UN Commission for Social Development addressing inequalities and challenges to social inclusion through advancing healthcare strategies.

They will also present these recommendations to the 25th  World Association for Medical Law Congress in Tokyo on 6-8 August 2019.

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GLOBAL NEUROLOGY REPORT: WORLD ASSOCIATION FOR MEDICAL LAW MEETING 2018

Topic:  Electronic Fetal Monitoring in Developing Nations – A Public Health Threat

The 24th World Association for Medical Law (WAML) Congress was held in Tel Aviv, Israel on 2-6 September 2018.  Leading international experts discussed topics related to Global Health, Medical Law and Bioethics, with a focus on Public Health concerns.

James C. Johnston, MD, JD, reviewed the use of electronic fetal monitoring (EFM) in Africa, and presented a paper co-authored with pre-eminent medical malpractice attorney Thomas P. Sartwelle, renowned medical ethicist Professor Dr. Berna Arda, and leading neurologist Dr. Mehila Zebenigus from Ethiopia.

Dr. James C. Johnston raised the concern that EFM has no proven efficacy in childbirth yet it is being increasingly employed in sub-Saharan Africa in a misguided approach to reduce perinatal morbidity and mortality.  In fact, EFM has a 99.8% false positive rate, and does not prevent or predict cerebral palsy or any other neonatal neurological disorder.  It does cause significant harm by dramatically increasing the cesarean section rate with all of the attendant risks and complications of that procedure, as well as increasing the risk that babies born in this manner may have a higher incidence of developing chronic diseases such as juvenile arthritis, asthma, inflammatory bowel disease, and neurodevelopmental problems.

After reviewing the overwhelming evidence against EFM, Dr. Johnston discussed the recent trend of developed countries to stop this procedure through specific guidelines published by birth-related professional organizations in the United States, United Kingdom, Canada, Australia and New Zealand.  For example, the United Kingdom National Institute for Health and Care Excellence states “Do not offer electronic fetal monitoring to women at low risk.”

Dr. James Christopher Johnston

The 24th World Association for Medical Law (WAML) Congress was held in Tel Aviv, Israel on 2-6 September 2018. Leading international experts discussed topics related to Global Health, Medical Law and Bioethics, with a focus on Public Health concerns.

And yet, EFM is rapidly increasing throughout sub-Saharan Africa due to a combination of intense marketing from the EFM manufacturing companies, and the failure of the medical community to understand that the procedure causes more harm than good to mothers and babies.  Dr. James C. Johnston provided specific examples of the marketing, including the Allied Market Research ‘Global Fetal Monitoring Report’ which concluded that the fetal monitoring market is expected “to reach USD 3.6 Billion by 2022,” that the market in “developing countries is lucrative,” and there is a “perpetual need” for these EFM machines.

Dr. Johnston and his colleagues concluded that the WHO should establish guidelines stating that EFM is an experimental procedure that is not scientifically reliable, the standard of care does not warrant EFM in low risk pregnancies, and it should not be performed.  This will allow local health boards in each country to adopt the guidelines, and ensure the medical community stops harming mothers and babies through this procedure.  Then, the resources wasted on EFM can be properly allocated to provide additional training of midwives and healthcare workers, and provide care for children with cerebral palsy and related conditions.

GLOBAL NEUROLOGY REPORT: WORLD ASSOCIATION FOR MEDICAL LAW MEETING 2018

Dr. James Christopher Johnston

The 24th World Association for Medical Law (WAML) Congress held on 2-6 September 2018 in Tel Aviv, Israel.

The 24th World Association for Medical Law (WAML) Congress was held on 2-6 September 2018 in Tel Aviv, Israel.  Leading international experts discussed topics related to Global Health, Medical Law and Bioethics, with a particular emphasis on Humanitarian Medicine, Law and Ethics.

Drs. James C. Johnston and Mehila Zebenigus discussed the urgent need for guidelines to improve relations between the North and South, and thereby advance healthcare access in the least developed regions.

Dr. Johnston was the only member and representative from New Zealand, and Dr. Zebenigus represented Ethiopia.  They explained that the most effective way to improve healthcare access is to establish local training programs in developing regions.  However, this requires international support which has been hampered by the unprecedented growth of global health programs, especially at United States academic medical centers.  This growth is attributable to a number of factors unrelated to improving patient care – factors such as establishing a reputation or ‘brand,’ increasing publications, and generating revenue through government, private and charitable sources.

Dr. James Christopher Johnston discussed how these academic global health programs have created a scramble for Africa characterized by self-serving short term medical missions that are highly beneficial to the sending institution but fail to provide any substantive benefit to the host country.  In fact, he described how these types of medical missions can and do cause actual harm, thereby impeding medical care in the very regions where it is most needed.

Dr. James C. Johnston discussed the urgent need for guidelines that focus on ethically advancing collaborative partnerships between the North and South to improve health care. This topic followed Dr. Johnston’s lectures last year at the WAML meeting in Baku, Azerbaijan and the prior year in Los Angeles, USA, where he and Dr. Zebenigus highlighted the medical, ethical and legal problems created by Western countries engaging in short term medical missions to resource limited nations.

This year, Drs. James Christopher Johnston and Zebenigus focused on the specific guidelines and policy recommendations which they presented to the United Nations High Level Political Forum last year and earlier this year.  James C. Johnston, MD, JD is dually qualified and licensed as a board-certified neurologist and barrister, and uniquely qualified to deal with this very specialized area of international medical law.  Mehila Zebenigus, MD is a board-certified internist and neurologist well-versed in the intricacies of global health.

Dr. James Christopher Johnston was honored for his paper on this subject with the Davies Award for Public Health.  He dedicated this inaugural award to Dr. Zebenigus and the Ethiopian team.

In terms of disclosure, Drs. Zebenigus and Johnston are Directors of the non-profit organization Global NeuroCare® which focuses on advancing neurological services in sub-Saharan Africa and particularly Ethiopia.  Dr. Johnston serves as an Honorary Professor of Neurology at Addis Ababa University in Ethiopia.

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

GLOBAL NEUROLOGY REPORT: WORLD ASSOCIATION FOR MEDICAL LAW CONFERENCE

World Association for Medical Law (WAML) Congress

World Association for Medical Law (WAML) Congress

The 50th Anniversary Meeting and 23rd World Association for Medical Law (WAML) Congress was held on 9-14 July 2017 in Baku, Azerbaijan.  Leading international experts from around the globe discussed topics related to GlobalHealth, Medical Law and Bioethics.

Drs. James C. Johnston, Mehila Zebenigus and Guta Zenebe presented recommendations for improving relations between developed and developing countries through guidelines that focus on ethically advancing collaborative partnerships to improve health care. This topic followed Dr. Johnston’s lecture last year at the WAML meeting in Los Angeles, USA discussing the medical, ethical and legal problems that arise when Western countries engage in short term medical missions to resource limited nations, resulting in medical paternalism, doctor tourism and actual harm to the very patients that are most desperate for help.  Specific examples of these problems were presented at both meetings, along with clear guidelines on how to avoid the harmful effects of these self-serving missions.

Drs. James C. Johnston and Mehila Zebenigus also discussed concerns related to neuroimaging for the patient presenting with headache. They recommended deleting the currently used guidelines because those guidelines are outdated, and have been a contributing factor in the continuing misdiagnosis of headache disorders.  Dr. Zebenigus discussed the management of the patient with headache in Ethiopia.

Drs. Thomas P. Sartwelle, James C. Johnston, Berna Arda and Mehila Zebenigus highlighted the concerns related to using electronic fetal monitoring in sub-Saharan Africa, how that procedure causes more harm than good, and wastes scarce resources that would be better used helping children with cerebral palsy.

In terms of disclosure, Drs. Zebenigus and Johnston are Directors of the non-profit organization Global NeuroCare® which focuses on advancing neurological services in sub-Saharan Africa and particularly Ethiopia, and is actively involved in all of these areas.