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How Corporate Health Care Leaders Maintain Their Impunity: The Case of Purdue Pharma's Funding of the Washington Legal Foundation to Attempt to Weaken the Responsible Corporate Officer Doctrine

The ongoing epidemic of narcotic (opioid) abuse, and the resulting rise in the deaths due to overdoses, has focused attention on pharmaceutical companies' aggressive promotion of these drugs which minimized their substantial risk. A recent article in the Intercept showed how the leadership of one such company tried to insulate itself from responsibility for such actions even while such promotions were continuing. Background: Impunity of Top Leaders of Big Health Care Organizations For years, we have railed against the impunity of top leaders of health care organizations.  We have noted that despite numerous legal settlements made by health care organizations of alllegations like fraud , bribery , and kickbacks , almost never do top leaders who presided over these actions face any negative consequences.  Lack of deterrence caused by such impunity appears to be a major cause of  the epidemic of continuing unethical behavior, crime and corruption on the part of large health car

Health Care and Head Trauma

From a simple bump to a concussion to death, getting a quick diagnosis for head trauma is critical. Brain dysfunction can be caused by an outside force, usually a violent blow to the head, and can result in many serious side effects. Brain injury or trauma often occurs as a result of a severe sports injury or car accident.

According to the Merck Manuals,
in the United States, about 13 in 10,000 people sustain minor head injury, and about 3 in 10,000 sustain severe head injury each year. In the United States, from 2002 to 2006, about 1.7 million civilians had traumatic brain injury (TBI) each year. About 1.4 million were treated and released from emergency departments. About 275,000 were hospitalized and discharged alive, and 52,000 died.

TBI (traumatic brain injury) is responsible for about 33% of all deaths caused by injuries of any kind. About 5.3 million people have permanent disabilities due to head injury. About 25% to 33% of people in the United States who have a severe head injury die. More information is located at this site: http://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/overview-of-head-injuries.

About half of head injuries result from motor vehicle crashes, and head injuries occur in more than 70% of severe motor vehicle crashes. Other common causes are falls (especially in older adults and young children), assaults, and mishaps during sports or recreational activities. Mishaps in the workplace (for example, while operating machinery) and firearms also cause head injuries.

Often, injury is caused by direct impact. However, the brain can be damaged even if the head has not been hit. For example, violent shaking or sudden deceleration can damage the soft brain as it collides with the rigid skull. In such cases there may be no visible injuries to the head.

According to the Mayo Clinic, Most head trauma involves injuries that are minor and don't require specialized attention or hospitalization. However, even minor injuries may cause persistent chronic symptoms, such as headache or difficulty concentrating, and you may need to take some time away from many normal activities to get enough rest to ensure complete recovery. Call 911 or your local emergency number if any of the following signs or symptoms are apparent, because they may indicate a more serious head injury.

Adults:
·         Severe head or facial bleeding
·         Bleeding or fluid leakage from the nose or ears
·         Severe headache
·         Change in level of consciousness for more than a few seconds
·         Black-and-blue discoloration below the eyes or behind the ears
·         Cessation of breathing
·         Confusion
·         Loss of balance
·         Weakness or an inability to use an arm or leg
·         Unequal pupil size
·         Slurred speech
·         Seizures

Children:
·         Any of the signs or symptoms for adults
·         Persistent crying
·         Refusal to eat
·         Bulging in the soft spot on the front of the head (infants)
·         Repeated vomiting

Keep in mind that even a minor head bump can cause a large swelling. And the speed, momentum and size of the people (full-grown adolescents versus young children), and the forces involved (such as impact with a concrete floor or other hard surface) may increase the possibility of serious injury. More information about head trauma is found at this website: http://www.mayoclinic.org/first-aid/first-aid-head-trauma/basics/art-20056626.

There are several types of brain trauma, according to Family Doctor. The following categories should be treated immediately by medical professionals:

A concussion is a jarring injury to the brain. Most of the time it doesn't involve a loss of consciousness. A person who has a concussion may feel dazed and may lose vision or balance for a while after the injury.

      A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling.

      A skull fracture is when the skull cracks. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury.

      A hematoma is bleeding in the brain that collects and clots, forming a bump. A hematoma may not be apparent for a day or even as long as several weeks. So it's important to tell your doctor if someone with a head injury feels or acts oddly. Watch out for headaches, listlessness, balance problems or throwing up.

It's normal to have a headache and nausea, and feel dizzy right after a head injury. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired. The person who has had a head injury may also have problems concentrating, remembering things, putting thoughts together or doing more than one thing at a time. These symptoms usually go away in a few weeks, but may go on for more than a year if the injury was severe. More details are available at this site: http://familydoctor.org/familydoctor/en/diseases-conditions/head-injuries.html.

Sport’s professional participants sustain severe brain injuries at far higher rates than the general population, according to the New York Times. They also appear to confirm what scientists have said for years: that playing football increases the risk of developing neurological conditions like chronic traumatic encephalopathy, a degenerative brain disease that can be identified only in an autopsy. An article reporting the link between concussions and long term health problems is found at this site: http://www.nytimes.com/2014/09/13/sports/football/actuarial-reports-in-nfl-concussion-deal-are-released.html?_r=0.

Head trauma, or traumatic brain injuries (TBI), result in permanent neurobiological damage that can produce lifelong deficits to varying degrees. The impact on a person and his or her family can be devastating.   More info is available at this website: http://www.traumaticbraininjury.com/.

Head trauma should be treated without delay. Always check with your doctor or a health care professional if you or a loved one suffers an injury or accident to the head. Although many blows to the head may not cause any difficulties, it’s always best to take an extra measure of preventive medical care to rule out the possibilities of any long term problems.


Until next time.

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