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Global NeuroCare Supports Neurology in Developing

A neurologist with three decades of experience, James C. Johnston, MD, JD, established Global NeuroCare® to improve neurological care and services in developing regions, especially in the least developed nations. Global NeuroCare® is a 501(c)(3) non-profit organization in Special Consultative Status with the United Nations ECOSOC, accredited by World Health Organization, and affiliated with the Office of the Special Adviser on Africa. Mehila Zebenigus, MD and Dr. Johnston serve as Directors of the NGO, with a mission of improving neurological care in developing regions to achieve the vision of global neurological equity. Global NeuroCare® received the highest status granted by the United Nations to NGOs, after recommendation of the ECOSOC Committee, comprised of 54 Member States, which performed a lengthy assessment including review of its statutes, objectives, past and present affiliations, and achievements. Drs. James C. Johnston and Mehila Zebenigus, on behalf of Global NeuroCare®, provide expert analysis to the UN, implement and monitor international agreements, actively advance UN goals, make written and oral statements, and serve as UN delegates at sessions in Geneva, New York, and Vienna. Global NeuroCare® works in partnership with Addis Ababa University, where Dr. Johnston serves as an Honorary Professor of Neurology and focuses on developing and advancing the neurology residency training program. This program has trained over 50 board-certified neurologists since inception in 2006, making a significant improvement in the Horn of Africa where there remains a dearth of neurologists. More importantly, in addition to seeing patients, these neurologists teach at the medical school to ensure general physicians and internists are trained to manage common diseases such as stroke, epilepsy, dementia, and headache. There remain significant hurdles – a continuing shortage of neurologists (according to the WHO, Ethiopia needs up to 4,500 neurologists, an impossible goal), narrow geographical distribution of the current staff, significant infrastructural barriers, and limited equipment and supplies, all superimposed on a fragile political system, widespread poverty, and limited educational opportunities. The most effective approach to improving medical care in these impoverished regions is to work in partnership with universities, hospitals, and clinics, ensuring a global standard of care, fostering independence, with realistic goals, and maintaining full accountability and transparency.

#Neurology

Neuroimaging in Headache discussed at AAN meeting

An accomplished neurologist with three decades of experience, Dr. James C. Johnston is the founding partner of GlobalNeurology® and works closely with neurologist Dr. Mehila Zebenigus, both serving as Directors of Global NeuroCare, a 501(c)(3) non-profit dedicated to advancing neurological services in developing regions. Mehila Zebenigus, MD and James C. Johnston, MD, JD recently attended the American Academy of Neurology (AAN) conference in Philadelphia and led a discussion on the proper use of neuroimaging in the diagnosis and treatment of headache disorders. One of the most common diagnostic errors in neurology is the misdiagnosis of headache, including the failure to diagnose brain tumors or other intracranial structural diseases. This is partially attributable to the United States Headache Consortium guidelines which state that neuroimaging is not warranted in patients with migraine and a normal examination. These guidelines, however, were based on a very small number of retrospective, flawed, outdated studies incorrectly reporting a 0.2% incidence of intracranial abnormalities in patients with headache and a normal exam, which the guideline authors considered too low to warrant an MRI. Dr. James C. Johnston summarized more recent data extrapolated from many thousands of MRIs demonstrating that the true incidence of intracranial abnormalities is over 3% and depending on age and other factors may range up to 5% or more. These abnormalities included brain tumors, aneurysms, cysts, vascular changes, congenital anomalies and a number of other conditions, some benign and others needing further investigation, monitoring or treatment. And yet, some neurologists and other specialists continue following the outdated guidelines, and even recommend further restrictions in the name of cost containment to prevent patients with headache from having an MRI. But those guideline proponents have failed to recognize the enormous cost of headache misdiagnosis. Drs. James C. Johnston and Mehila Zebenigus recommended deleting the outdated guidelines until imaging protocols are prudently refined through well-designed prospective studies focused on improving patient care. Drs. Zebenigus and James C. Johnston have presented their recommendations at the recent World Association for Medical Law conference, and published several chapters in the leading medical law textbooks such as Legal Medicine and Medical Ethics and Legal and Forensic Medicine, as well as a number of articles in peer-reviewed journals including Neurologic Clinics; Neurology; Headache; and Medical Law.

#Neuroimaging #headaches

GLOBAL NEUROLOGY REPORT: BURDEN OF DISEASE

James C. Johnston, MD, JD and his colleagues Drs. Seid Gugssa and Mehila Zebenigus at the Addis Ababa University Department of Neurology in Ethiopia recently published a letter to the editor in Neurology Today discussing the Global Burden of Disease Study, and the substance of that letter is summarized below.

The study revealed a significant increase in neurological disease burden. Dr. Johnston and his colleagues were not surprised by these findings. Some of the increased burden was attributable to the World Health Organization (WHO) reclassification of stroke as a neurological disorder, but there was an absolute increase due to rapid population growth and aging. The important point is that these findings illustrate the devastating impact of neurological disorders and should serve as a call for more appropriate resource allocation.

The most serious concern is in sub-Saharan Africa (SSA) which harbours the highest burden of disease, the least resources, and a population exceeding one billion that is expected to double over the next generation. Improving access to neurological care in this region is absolutely crucial, but significantly impeded by a host of diverse factors including a dearth of healthcare workers, limited diagnostic facilities, lack of medications, adherence to traditional beliefs, and seemingly insurmountable infrastructural challenges, all superimposed on abject poverty with food and water insecurity and frank undernutrition. This seemingly hopeless situation may deter outsiders from helping.

But it is precisely because of these diverse barriers that the international neurological community must unite to address these overwhelming healthcare disparities and “reach the furthest behind first.” This mandates collaborative partnerships with a goal of developing local programs to increase the recruitment, training and retention of medical staff, avoiding the common scenario of an academic university engaging in self-serving short term medical missions that cause more harm than good.

Global NeuroCare, a non-profit organization established by Dr. James C Johnston, working in consultation with the United Nations and other international organizations, focusing on the Addis Ababa University (AAU) Neurology Residency Training Program, strongly endorses this partnership approach. Moreover, this form of capacity building is aligned with the Sustainable Development Goals, supported by the WHO, and crucial for the continuing development of neurology in SSA, where there remains an abysmal ratio of 1 neurologist for every 3-5,000,000 people.

The AAU Program is a testament to the success of this approach, with 30 graduates over the past decade and more physicians entering the program every year. These outstanding neurologists are now training physicians from other African nations, engaging in triangular cooperation with South-South ties that will more effectively combat the burden of disease.

Partnerships like these engaging all stakeholders will ensure cooperative alliances to provide an integrated and sustainable approach for advancing neurological services. The end result will be a cross-cutting impact on the interrelated SDGs that not only improves neurological care but serves to promote poverty reduction, stimulate economic growth, eliminate harmful practices, encourage scientific research, and advance overall health security.

Dr. James C. Johnston has worked through Global NeuroCare and the United Nations promulgating guidelines for healthcare partnerships to ensure those partnerships' goals, and efforts to achieve those goals, are sustainable, ethically congruent, beneficial to the host, protect vulnerable populations and avoid destabilizing already fragile medical systems. In this manner, the international community can more effectively work towards neurological equity.

#neurology #disease #study #Dr. James C. Johnston

Global Neurology's Approach to Meeting Client Needs

A board certified neurologist and attorney who has published numerous peer-reviewed articles on various neurological topics affecting global health, Dr. James C. Johnston founded the nonprofit organization Global NeuroCare. This organization is accredited by the World Health Organization, and holds Special Consultative Status with the United Nations. Dr. James C. Johnston is also the founding partner in Global Neurology Consultants. Global Neurology seeks to improve or advance sustainable, evidence-based practices in neurosurgery and neurology while maintaining strict ethical standards. Through its team of independent consultants with offices in Australia, New Zealand, Norway, Switzerland, Turkey and the United States, Global Neurology tailors its services to meet the needs of individual clients. Global Neurology developed a unique multi-disciplinary model, combining neuroethics, neurosurgery, and neurology, to evaluate each situation in order to assist clients in enhancing their own neurological services. The company serves medical groups, faculties of universities, hospital staff, government representatives and non-government organizations. Its offerings include one-time or ongoing consulting, evaluation of active neuroscience programs, and legal and ethical opinions on the practice of neurology.

#Dr. James C Johnston #Global Neurology

James C Johnston of Independent Researcher is on ResearchGate. Read 70 publications, and contact James C Johnston on ResearchGate, the professional network for scientists.

Global Neurology Report: Malnutrition in Africa Remains an Ongoing Concern

Nutrition is a key determinant of health but may be overlooked while focusing on the double burden of ongoing communicable and rapidly increasing non-communicable diseases in the developing regions.

But undernutrition is still pervasive in the WHO African Region, and this has a significant impact on health, especially in the most vulnerable populations. In fact, the rates of stunting are continuing to rise – 25 of the Region’s 47 countries have high (>30%) or very high (>40%) rates of stunting. Thirty countries have wasting levels above 5%. Almost half of all deaths in children under 5 years of age are related to undernutrition.

Ethiopia is one of the many countries suffering marked undernutrition with >40% rates of stunting, and it may be impossible for this nation or any other sub-Saharan country to reach the 2030 Sustainable Development Goal of reducing stunting by 40%. The median wasting prevalence in this Region is 6.3%. Likewise, it may not be possible to meet the nutritional needs of adolescent girls, pregnant women and the elderly. For example, 22% of pregnant women in Ethiopia are anaemic, and the numbers are even higher in other countries.

This problem cannot be managed in isolation as it is inherently related to myriad factors including the dearth of healthcare workers, lack of nutritional education programs, poor water quality, agricultural issues, transportation needs, and various infrastructural challenges as well as a lack of appropriate medical facilities, and all of this may be compounded by drought, famine, civil unrest and related environmental and political concerns.

It is essential to focus on a proper nutritional surveillance program in order to ascertain the progress and lack of progress in facilitating improved nutrition. For example, the Accelerating Nutrition Improvement (ANI) in sub-Saharan Africa project (involving 11 African countries including Ethiopia) focuses on strengthening health information systems in order to make informed decisions on nutrition programs.

The most effective method of addressing nutritional concerns in this Region is through the healthcare sector, which will play an integral role in education, defining nutritional indicators, developing data collection tools, and building capacity to collect, analyze and use the data for improving care and expanding programs.

Global NeuroCare, a non-profit organization in Special Consultative Status with the United Nations ECOSOC, is actively involved in sub-Saharan Africa and particularly Ethiopia with a mission of advancing neurological care, and emphasizes that there must be inclusion of all stakeholders through cooperative alliances to address the cross-cutting nature of undernutrition.

Further information may be found in the recent publication: WHO 2017 Nutrition in the WHO African Region, or by contacting Global NeuroCare. ([email protected]).

#Global NeuroCare #malnutrition #nutrition #health #africa #ethiopia

NEUROLOGISTS CALL OUT INEFFECTIVE TESTING METHODS

As the Founder of Global NeuroCare.org and a Partner in Global Neurology Consultants, Dr. James C.Johnston focuses on international health concerns, including those impacting sub-Saharan Africa. Dr. James C. Johnston and co-authors Dr. Thomas P. Sartwelle and Professor Berna Arda have published several peer reviewed journal articles and book chapters on cerebral palsy and electronic fetal monitoring (EFM). Two more peer reviewed articles were recently released by Thieme Medical Publishers and a third in the journal Medical Law International. The Thieme articles published in the Surgery Journal by Dr. Johnston and his colleagues focus on the misguided use of EFM to prevent cerebral palsy. Cerebral palsy is a neurological condition typically affecting movement and posture, which is caused by a lesion to one or more specific brain regions during fetal development. According to the articles, EFM does not predict or prevent the occurrence of cerebral palsy, but causes more harm than good to mothers and babies alike. Dr. Johnston and his co-authors found that EFM type observation leads to significantly more cesarean section births than any other method of fetal monitoring. In 1970, approximately 6 percent of women had c-sections. By 2013, almost 40 percent of women in the United States gave birth by c-section due to the universal use of EFM. And the increased number of c-sections is not associated with a reduction of cerebral palsy, neonatal encephalopathy, stillbirth, neurological injury or any other conditions. One review in the Surgery Journal highlights the ethical concerns of EFM and recommends teaching physicians the whole story (https://www.thiemeconnect.com/products/ejournals/abstract/10.1055/s-0037-1599229), and the other Surgery Journal article discusses the ethical concerns related to EFM (https://www.thieme connect.com/products/ejournals/abstract/10.1055/s- 0035-1567880). Ethical concerns and informed consent are discussed in detail by Dr. Johnston and his colleagues in the Medical Law International article ‘Electronic Fetal Monitoring, Cerebral Palsy and Medical Ethics: Nonsense of a High Order’ published on 2 May 2017 in open access format after peer review (http://journals.sagepub.com/doi/abs/10.1177/0968533217704883). More disconcerting is the fact that resource limited countries in sub-Saharan Africa are now falling into the trap of requesting and receiving EFM equipment from Western countries, thinking this will help reduce the burden of cerebral palsy and related conditions. It is unfortunate that these individuals and organizations fail to recognize that EFM will simply add to the already high levels of morbidity and mortality without any benefit for routine births. Dr. Johnston and his colleagues are addressing this matter in the appropriate forums and recently lectured on the topic at the World Association for Medical Law conferences in Los Angeles and Baku, Azerbaijan.

#Dr. James C Johnston

GLOBAL NEUROLOGY REPORT: HEALTHCARE ACCESS IN AFRICA

The Economist Intelligence Unit recently published a report on access to healthcare in Africa and the Middle East. (www.accesstohealthcare.eiu.com). The report recognized the complex challenges of improving access to healthcare in sub-Saharan Africa, a region plagued by the ‘double burden’ of ongoing communicable diseases and rapidly increasing non-communicable disorders. These problems are compounded by a severe shortage of healthcare workers, poor infrastructure, limited transportation, and a dearth of supplies, equipment and medications.

The Economist Intelligence Unit Index ranked the countries on both (1) accessibility for most disease categories and access to medications, and (2) the healthcare system including coverage, infrastructure, efficiency and innovation. The Index evaluated progress considering current global policy agendas, such as the UN Sustainable Development Goals. It also adopted a forward-looking approach, asking whether each country is implementing the right mechanisms today for optimal access in the future.

Ethiopia ranked at the bottom in a cluster of other sub-Saharan countries. These least developed countries struggle with additional challenges such as underdeveloped supply chains for medications, a significant urban-rural gap in access and, most importantly, a continuing shortage of healthcare workers.

The increasing incidence of non-communicable diseases including neurological disorders is exacerbating poverty and significantly adding to the disease burden. The EIU reports that financial expenses of healthcare drive 11 million Africans into poverty every year. But, as Drs. James C. Johnston and Mehila Zebenigus discussed at the July 2017 United Nations High Level Political Forum, the situation is magnified by neurological disorders which afflict tens of millions of people, typically the young, causing cognitive impairment and physical disability, leading to loss of employment, marginalization, increased vulnerability and exclusion, contributing to a profound impact on the economy.

This EIU Report raises several suggestions for improvement including national health insurance, mobile technology applications, artificial intelligence platforms and focusing on specific disease threats. However, while these proposals may be beneficial if enacted, they do not address the key problem – a shortage of healthcare workers.

Drs. James C. Johnston and Mehila Zebenigus discussed these concerns at the 2017 World Association for Medical Law (WAML) conference and, while recognizing the many overwhelming challenges, recommended focusing on the root of the problem – the shortage of physicians and other healthcare workers. Africa has one-quarter of the global burden of disease but less than 3% of the world’s healthcare workers. The only way to ensure sustainable improvement if to ethically advance collaborative partnerships between developed countries and the least developed regions, with clearly defined goals, focusing on the needs of the South to establish self-sustaining programs that incorporate training, patient care and research, and provide triangular cooperation to improve South-South relations.

This focus on collaborative partnerships is the approach Global NeuroCare has adopted in working with the Addis Ababa University Department of Neurology, and that autonomous program has been extraordinarily successful, soon entering the 12th year, having graduated 32 board certified neurologists, with 21 more physicians in the three-year training program.

Drs. Johnston and Zebenigus serve as Directors of the non-profit organization GlobalNeuroCare.org and will discuss guidelines for developing sustainable collaborative partnerships at future meetings with the UN, WAML and other organizations.

American Academy of Neurology Prepares for 2017 Fall Conference

A consultant neurologist in private practice for nearly 30 years, Dr. James C. Johnston holds both a medical degree and a law degree, and is licensed in both professions. Dr. James C. Johnston adds to his skills through participation in a number of professional organizations and societies such as the American Academy of Neurology, American College of Legal Medicine, Australasian College of Legal Medicine, and World Association for Medical Law. In its efforts to help members stay abreast of the latest developments in the field, the American Academy of Neurology (AAN) holds several conferences and other events throughout the year including the 2017 Fall Conference, which will take place October 20-22 in Las Vegas. The three-day event will feature workshops and other sessions on multiple sclerosis, epilepsy, neuro-oncology, dementia, and a number of other clinical topics. Dr. Johnston recently returned from the 50th Anniversary of the World Association for Medical Law conference in Baku, Azerbaijan. Drs. James C. Johnston and Mehila Zebenigus presented a discussion on improving healthcare in Africa through advancing North-South collaborative partnerships. The key message emphasized avoiding short term medical missions which are harmful to the host nation, and focus on improving partnerships that address the needs of the South. Drs. Johnston and Zebenigus also presented a discussion of neuroimaging in patients presenting with headache, reviewed the current data, and recommended revising the AAN practice guidelines to improve patient care.

#Dr. James C Johnston #American Academy of Neurology #Fall Conference

TENET HEALTHCARE - ONGOING FRAUD

Neurologist and Attorney Dr. James C. Johnston is not surprised that Tenet Healthcare Corporation was indicted again in 2017 for insurance fraud in an ongoing investigation by the FBI Healthcare Fraud Unit, Department of Justice and Office of the Inspector General. Just a few months ago Tenet plead guilty to insurance fraud, sham contracts, bribes and kickbacks, paying the Department of Justice over $516 million to settle criminal and civil charges. For the past two decades Tenet has repeatedly entered settlements with the government over insurance fraud, illegal kickbacks and related crimes, paying several billion in fines, earning the label as “one of the most despicable healthcare companies in the United States.” A simple google search of ‘Tenet fraud’ leads to thousands of articles on this company’s appalling misbehaviour and abuse of patients.

In fact, 26 years ago, in 1991, Dr. Johnston was practicing in Texas at one of the Tenet Hospitals, at that time a chain of 116 hospitals that engaged in insurance fraud, bribes, kickbacks and performed unnecessary surgeries and procedures. Dr. Johnston refused to participate in the fraudulent schemes, referred his patients to other hospitals, and contacted the Department of Justice with a whistle-blower complaint against Tenet hospitals.

A hospital-based group of four physicians, one already repaying the government for Medicare insurance fraud, retaliated with an extortion attempt, bribing several workers’ compensation patients to make false allegations against Dr. Johnston. The physician involved in Medicare fraud was married to the district attorney, who filed specious charges against Dr. Johnston that culminated in a lengthy court battle. At the time, terrible things were said about Dr. Johnston. The New York Times printed a biased story before the conclusion of this ordeal.

In the end, Dr. Johnston prevailed – Judge Barbara Marquardt heard all the evidence at trial and dismissed the false allegations against him as “pure fiction,” declaring him innocent of any wrongdoing. The Texas Medical Board also reviewed all the evidence and cleared Dr. Johnston of any misconduct or illegal act, found him innocent, and concluded that he maintained the highest professional standards, exceeding the standard of care. So did every other medical board where Dr. Johnston held a license. The New York Times refused to print a follow up story on Judge Marquardt’s findings or the final medical board decision, leaving their misleading story languishing on the internet for the past quarter of a century.

Dr. Johnston’s complaints, along with those of several other physicians at various Tenet Hospitals between 1991-1994 led the Department of Justice, FBI and Office of the Inspector General to investigate, eventually forcing Tenet to sell off a number of hospitals and pay a $900 million fine for billing fraud and related illegal activities. (https://www.justice.gov/archive/opa/pr/2006/June/06_civ_406.html). Several of the doctors making false accusations against Dr. Johnston lost their medical licenses, had to repay the government for fraud, and one ended up in prison. The district attorney and his assistant were investigated by the FBI and resigned from office.

The medical community members that know the whole story hold the highest respect for Dr. Johnston – he made a huge personal sacrifice to do the right thing, and stand up for his patients.

Dr. James C. Johnston new york times james c johnston md

Jul 30, 2017

Global NeuroCare presents statement at UN High Level Political Forum

The 2017 United Nations ECOSOC High Level Political Forum meeting culminated on 17-20 July at which time the Council and the entire ECOSOC system addressed “Eradicating poverty in all its forms and dimensions through promoting sustainable development, expanding opportunities and addressing related challenges.” During the HLS, 43 countries presented reviews of their national implementation of the 2030 Agenda for Sustainable Development as part of the HLS convened under the auspices of ECOSOC. Members States and other stakeholders including Ministers, Cabinet Secretaries and high profile non-government organizations such as Global NeuroCare presented national, regional and international approaches to poverty eradication during the General Debate; addressed challenges and opportunities in global policies for the achievement of sustainable development via the High-level Policy Dialogue with various International Institutions; and focused on reducing multi-dimensional poverty in the SDG era during the Thematic Discussion.

Global NeuroCare was invited to participate because the NGO is in Special Consultative Status with the UN ECOSOC (since 2013), accredited by the World Health Organization and affiliated with the Office of the Special Adviser on Africa.

Drs. James C. Johnston and Mehila Zebenigus presented recommendations on behalf of Global NeuroCare, discussing the relationship between non-communicable diseases such as neurological conditions and poverty, and how improving access to neurological care will result in poverty reduction, thereby increasing economic, social and political stability in developing nations. They provided specific advice on how to advance capacity building in developing nations through guidelines to improve collaborative partnerships between the North and South, and suggested focusing on triangular cooperation to incorporate South-South relationships for the benefit of sub-Saharan Africa.

This was Global NeuroCare’s second presentation at the High Level Political Forum, in addition to statements at the Commission for Social Development and Integration Segments, and further discussion of this topic will be continued at the 2018 Forum.

Cerebral Palsy and Electronic Fetal Monitoring

Dr. James C Johnston is an accomplished neurologist with a private consulting practice and the founding director of the international nonprofit organization Global NeuroCare. In addition to his work as a clinical neurologist, Dr. Johnston has authored dozens of peer reviewed articles including a recent publication entitled “Cerebral Palsy and Electronic Fetal Monitoring - Rearranging The Titanic’s Deck Chairs.” Dr. James C Johnston coauthored the article with his colleague Thomas P. Sartwelle. Accepted in March of 2016 and published the following April, “Cerebral Palsy and Electronic Fetal Monitoring” appeared in volume 2 of the Journal of Childhood & Developmental Disorders. The article debunked several myths regarding the safety and effectiveness of electronic fetal monitoring (EFM) during the childbirth process. In particular, it challenges the unsupported but widely held belief that the use of EFM can prevent cerebral palsy and neurologic birth injuries. In addition to its lack of efficacy, EFM presents many problematic issues including a marked and contingent increase in the rate of cesarean sections. This article explains why cerebral palsy litigation is so successful, outlines the ethical dichotomy created by this scientifically flawed procedure, and proposes a solution to change the clinical standard of care, linking EFM to the Daubert exclusionary evidence doctrine recognized throughout the world’s courts, thereby ending cerebral palsy litigation. The article may be access on ResearchGate: https://www.researchgate.net/profile/James_Johnston6. Drs. Thomas P. Sartwelle, James C. Johnston and Berna Arda have published several related articles discussing cerebral palsy and electronic fetal monitoring, and these peer reviewed papers have been published in a wide selection of journals over the last three years including the Journal of Child Neurology; Surgery Journal; Journal of Maternal, Fetal and Neonatal Medicine; Medical Law International; Journal of Pediatric Healthcare; etc. Many of these articles are available on the ResearchGate website and through PubMed. Dr. Johnston and his co-authors have also contributed a chapter on this topic to the latest edition of Legal Medicine and Medical Ethics, the American College of Legal Medicine textbook that is recognized as one of the leading textbooks in the field.

#Cerebral Palsy #Fetal #Monitoring #Dr. James C Johnston

AAN Study Examines Telemedicine Effectiveness in Headache Treatment

An experienced professional in neurology and legal medicine, Dr. James C. Johnston has been in practice for 30 years. In addition, Dr. Johnston is the Founder and Director of GlobalNeuroCare.org, a non-profit organization holding Special Consultative Status with the United Nations and dedicated to advancing neurological care in developing regions such as sub-Saharan Africa. Apart from his daily work, Dr. James C. Johnston engages with other professionals through membership in a number of medical and legal organizations including the American Academy of Neurology. A recent study published on 14 June 2017 in Neurology, a peer-reviewed academic journal supported by the American Academy of Neurology, demonstrated that the benefits of telemedicine for patients suffering from headaches are comparable to seeing a physician in the office. Researchers gathered data from 402 participants suffering home headaches in drawing this conclusion. The study authors divided the participants into two research groups - those who saw a doctor in person for their headache issues and those who consulted with a doctor via video conference. In their findings, the researchers observed no discernible difference in outcome between the two groups. According to the authors, this study shows the potential effectiveness of telemedicine in treating non-acute conditions and could be the basis for further trials. In order to assess the safety, researchers evaluated the patients a year later to determine if the neurologists performing telemedicine were missing any underlying diseases causing the headaches. This is always the main concern in evaluating any patient with headache. Dr. Johnston has written a number of peer reviewed articles and book chapters on this very point, one recently published in the Neurologic Clinics 2016; 34:747-773 (Neurological Fallacies Leading to Malpractice). In the recent telemedicine study, researches estimated that a secondary headache would be missed in one of every 20,200 evaluations. Further investigation is needed, but it appears telemedicine may play a crucial role in headache management in the future, especially in remote regions, or areas with a shortage of neurologists.

#Dr. James C Johnston #Headache #Treatment #Telemedicine #American Academy of Neurology

“The Ethics of Teaching Physicians Electronic Fetal Monitoring”

An experienced neurologist, Dr. James C. Johnston completed general surgery at the University of Texas Health Science Center in San Antonio, TX, and neurology at the Texas Medical Center in Houston. In addition to his clinical practice, Dr. James C. Johnston has authored over 85 peer-reviewed journal articles, book chapters and related publications. Dr. Johnston recently co-authored an article published in the 2017 Surgery Journal entitled “The Ethics of Teaching Physicians Electronic Fetal Monitoring - And Now for the Rest of the Story” with his colleagues Thomas P. Sartwelle, BBA, LLB, and Berna Arda, MD, Med. Spec., PhD. (https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0037-1599229.pdf). The article begins by reiterating conclusive medical studies that have debunked the myth that electronic fetal monitoring (EFM) can predict or prevent cerebral palsy. It goes on to examine the various dangers of employing electronic fetal monitoring, citing evidence that this ineffectual modality increases the cesarean section rate and causes more harm than good to mothers and babies alike. EFM also raises significant ethical concerns since "every time a pregnant mother undergoes EFM, she is subjecting herself to the undisclosed risk that false EFM signals will prompt her physician to engage in a self-protection C-section, which, in turn, subjects her and her baby to substantial risks, possibly lifelong risks, associated with that major abdominal surgery." The myths and fallacies of EFM were discussed in related publications co-authored by Dr. James C. Johnston in the Surgery Journal 2015; 1(1):e28-e34; Journal of Child Neurology 2015; 30(7):828-834; and Journal of Maternal Fetal and Neonatal Medicine 2015; 29(9):1372-1375. The links are listed below: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0035-1567880.pdf http://journals.sagepub.com/doi/abs/10.1177/0883073814543306 http://www.tandfonline.com/doi/abs/10.3109/14767058.2015.1051526?src=recsys&journalCode=ijmf20 In this article, Drs. Thomas P. Sartwelle, James C. Johnston and Berna Arda recommend that resident physicians be taught both sides of the EFM story, instead of learning to simply adopt the current practice of performing EFM in every pregnancy.

#Dr. James C Johnston #Ethics #Fetal Monitoring

The Potential Dangers of Brief Medical Missions to Underserved Areas

A board certified neurologist and attorney, Dr. James C. Johnston also serves as a Partner with Global Neurology Consultants. Additionally, Dr. James C. Johnston is the founding director of Global NeuroCare, a non-profit organization dedicated to advancing medical care and training physicians in Ethiopia. There has been a rapid expansion of global health programs in the United States over the past decade, resulting in a number of brief medical missions to resource limited areas in the world. These missions are highly advantageous to the sending institutions, in particular academic medical centers that garner significant funding for global health activities, but they fail to provide any substantive benefit to the host country. In fact, these types of self-serving missions can and do cause actual harm. Visitors may fail to recognize local needs, are unaware of local customs, and frequently ill-suited to provide any meaningful teaching or medical care. The visiting physicians may be unfamiliar with local diseases and overwhelmed by the constraints and lack of resources in these areas, and fail to understand how their recommendations conflict with proper care. There are also serious ethical concerns about physicians practicing outside the scope of their training and failing to provide a continuum of care. Moreover, already overburdened local staff must take time out of their schedules to orient visiting physicians on clinical matters, resource limitations and personal issues while helping them cope with language, social and cultural barriers. Dr. James C. Johnston has made several presentations at the United Nations recommending guidelines to ensure that global health programs ethically promote capacity building with collaborative partnerships that focus on improving medical care, education and research in the host country. This is the most effective way to ensure sustainable growth of global health and prevent exploitation of the developing countries through brief medical missions that amount to doctor tourism and international medical paternalism. Dr. Johnston also discussed this topic at the World Association for Medical Law meeting in Los Angeles last year.

#Medical Missions #Dangers #Dr. James C Johnston #Underserved Areas

Global NeuroCare - Expanding Neurological Care in Ethiopia

With nearly 30 years of experience, Dr. James C. Johnston is a consultant neurologist in private practice and a Partner with Global Neurology Consultants. Concurrently, Dr. James C. Johnston serves as director of the nonprofit organization Global NeuroCare®. Dedicated to advancing neurological care in developing regions around the world, Global NeuroCare® holds Special Consultative Status with the United Nations Economic and Social Council. Global NeuroCare® works extensively in Ethiopia, an African country with fewer than 30 neurologists. The World Health Organization has stated the country needs an additional 900 to 4,500 neurologists to meet the medical needs of the country’s 100 million people. To address the shortage of neurologists in Ethiopia, Global NeuroCare® collaborates with the Addis Ababa University Department of Neurology which operates a residency program to train neurologists. This program has graduated 28 board certified neurologists who are seeing tens of thousands of patients and teaching the primary care physicians how to manage basic neurological conditions. Global NeuroCare® relies on the support of volunteers with the goal of expanding neurological care for the people of Ethiopia. To learn more about the organization or to contribute to its efforts, visit GlobalNeuroCare.org.

#Dr. James C Johnston #Global NeuroCare #ethiopia

World Association for Medical Law - 23rd World Congress

Experienced in the legal medicine field, Dr. James C. Johnston is a consultant neurologist and attorney in private practice. Active in his broader professional community, Dr. James C. Johnston maintains membership in numerous organizations, including the World Association for Medical Law (WAML), which will hold its 23rd World Congress beginning on July 10, 2017.

Coinciding with the WAML’s 50th anniversary, the 23rd WAML World Congress will take place in Baku, Azerbaijan. The event will bring together international experts in the medical and legal professions to discuss topics under the theme of Medical Law, Bioethics, and Multiculturalism. This year’s event will also feature several sub-themes including Challenges in Medical Law as well as a focus on Bioethics in Healthcare. Dr. James C. Johnston will be speaking on Global Health with recommendations on guidelines for advancing North-South collaborative partnerships. This is an extension of his presentation during the August 2016 meeting in Los Angeles where he lectured on Global Health: Medical, Ethical and Legal Concerns. Dr. Johnston will also discuss Neuroimaging in Headache and, along with Mr. Thomas Sartwelle, Professors Berna Arda and Mehila Zebenigus will present a poster on concerns regarding the use of electronic fetal monitoring in sub-Saharan Africa.

#Dr. James C Johnston #23rd World Congress #World Association for Medical Law

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