Posts Tagged ‘cancer’

DC Hospitals Step It Up During Prostate Cancer Awareness Month – FREE Resources You Need to Know About

Wednesday, September 7th, 2011

September is Prostate Cancer Awareness Month. To raise awareness about prostate cancer, hospitals in Washington, D.C. are stepping-up this September for a good cause indeed.  Did you know that an estimated 240,890 new cases of prostate cancer will be reported this year? About 33,720 men will die this year alone from prostate cancer. About 1 in 6 men will be diagnosed with prostate cancer during their lifetime.

Although prostate cancer is the most common cancer in American men, the good news is that the survival rate is quite high for patients who are diagnosed and treated early.  If you are a man, a key to your survival is to be familiar with the signs and symptoms of prostate cancer and to seek regular screening.

This year, Georgetown University Hospital will recognize Prostate Cancer Awareness Month by offering men free prostate cancer screening.

Who should get screened?

-          Men over the age of 35 – particularly African-American or Hispanic men over the age of 35

-          Men with a family history of prostate cancer

If you meet the above criteria, don’t miss out on this opportunity. Free screening will be offered on Saturday, September 17, 2011 from 8:00a.m. to 12:00p.m. in the Lombardi Comprehensive Cancer Center. Free parking will be available in the Leavey Center garage.  The Georgetown University Hospital is located at 3800 Reservoir Rd. NW, Washington, D.C., 20007. “The screening will consist of blood testing to determine PSA (prostate specific antigen) level, total cholesterol, and a digital rectal exam (DRE) to be performed by physicians.”

If you or someone you know has been diagnosed with prostate cancer, you might want to contact the Providence Hospital prostate cancer support group.  This group is specifically dedicated to helping patients live and cope with prostate cancer. Brothers Prostate Cancer Support Group meets every 4th Tuesday between 6:30p.m. and 8:30 p.m. at Providence Hospital’s Wellness Institute (1150 Varnum St. NE, 3rd Floor, Washington, D.C 20017).  For more information, please call 202-269-7795.

Please share this information with your friends, fans, and readers. For more information about cancer support groups in the D.C. area, please visit DC Cancer Consortium.

Skin Cancer Prevention: The Dangers of Tanning Beds

Friday, July 1st, 2011

 

Image from hometanningbed.com

In my last two posts, I have examined the various types of skin cancer, their prevalence and survivability rates, and some prevention methods. Today, I will focus on another major risk factor for skin cancer. The use of tanning beds or “indoor tanning” greatly increases a person’s risk of developing skin cancer. It is a completely voluntary exposure to UV radiation, and yet many people choose to expose themselves despite all of the risks.

Known Dangers of Tanning Beds

Here are just a few statistics about indoor tanning from the Skin Cancer Foundation:

  • “Ultraviolet radiation (UVR) is a proven human carcinogen. Currently tanning beds are regulated by the FDA as Class I medical devices, the same designation given elastic bandages and tongue depressors.
  • The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet (UV) tanning devices in its Group 1, a list of the most dangerous cancer-causing substances. Group 1 also includes agents such as plutonium, cigarettes, and solar UV radiation.
  • Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.
  • Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.
  • Nearly 30 million people tan indoors in the U.S. every year; 2.3 million of them are teens.
  • On an average day, more than one million Americans use tanning salons.
  • Seventy-one percent of tanning salon patrons are girls and women aged 16-29.
  • Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.
  • People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.
  • The indoor tanning industry has an annual estimated revenue of $5 billion.”

Internal references omitted

 

Horrifically, it is mainly young people choosing to use these devices despite the greatly increased risk of melanoma and other skin cancers. Given the enormous financial incentive to service young people – the industry cannot be expected to regulate itself. If they can make $5 billion dollars a year in revenue with a largely young female population, why would they stop? (Aside from morality of course…)

How to Protect the Skin – Even if You Don’t Want To

From a social perspective, there need to be some changes to the value our society places on certain skin color and beauty. This is outside of the realm of this post – but what a shame that in this century, men and woman would still rather expose themselves to harmful radiation than live life with their natural coloring (or lack thereof).

From an education perspective, I think that public awareness and an increased focus on education must continue to be one prong to battle this problem. However, clearly warnings alone are not enough. This is exemplified by a recent news story about a now 23-year-old woman who visited tanning salons three to five times a week starting when she was 16 years old.  This young woman, who despite knowing the risks of tanning continued to use tanning beds until 2009, had to endure surgeries, drug therapies and over a year of painful treatment at the age of twenty-one for the advanced melanoma that had spread to her lymph nodes. Luckily, she is now cancer-free, but living with a greatly increased risk of developing another cancer. This is a cautionary tale, but it is also an example of the invincibility thinking of many young people that makes the risks seem lower than they really are to using tanning beds.

Legal Options – Regulation

So what remains? The tanning salon industry has a financial disincentive towards preventing skin cancers, the young patrons of these establishments may not understand the risks and consequences, yet the individuals and society are going to pay the price of devastating illness, high cost medical treatments and people’s lives if the current use of tanning beds continues. That is where the legal side of this post enters. There are a number of states that have started to regulate the use of these tanning beds – at least for minors. Most states do not regulate these very heavily. The National Conference of State Legislatures has compiled regulations from many states on their website. There are a combination of approaches which generally include either banning the use of tanning beds by very young children and teens (typically under 14 or 16 – but few states have an outright ban) and/or requiring parental consent for the use by children below a certain age (typically 18, occasionally 16). Some of these consent statutes require the parent to be present (in person) to provide consent. Others allow written consent or require the parent to be present only one time in the year. Do you think that these statutes are sufficient? Should the requirements involve vivid pictural warnings like the new requirements for cigarrettes?

In Maryland, Howard County is a leader in regulating this industry. In Howard County, minors under 18 years of age are not permitted to use tanning devices without a doctor’s note stating a medical reason and allowed frequency.  These rules are not subject to a parent’s consent. Many states legislators have proposed tougher legislation in the past few years to increase the regulations on this industry across the country, but few have been successful.

Your Thoughts?

What do you think should happen with the tanning industry? Do you think that there should be an outright ban for any minors using these devises? What about adults? There are still lots of tanning customers who are young adults who are over 18. What can be done to protect them from the increased risks of skin cancer? Is public education sufficient? Could it be done better?

Related Posts:

Skin Cancer: Types, Causes and How to Protect Yourself

Skin Cancer Prevention: Will New FDA Rules Help?

Skin Cancer Videos

 

Skin Cancer: Types, Causes and How to Protect Yourself

Tuesday, June 28th, 2011

Image from psvresort.com

From the (guest) editor:  Although today’s weather forecast is for thunderstorms, we should keep in mind that the summer season is upon us.  It is time to protect one of our largest organs — our skin!

–Jason

The news last week about the new FDA regulations on sunscreen had me prepared to write a blog article this week about the changes. I wanted to clarify what the new rules will mean for consumers – how to choose the correct product, what the various claims actually mean about protection, whether safety has been considered. However, as I delved deeper into the topic, I realized that the first concern has to be sun exposure and cancer in general. There is too much information – medical and legal – out there for one post. So, I am going to write a brief series. The first topic – today – will be about the startling statistics about various skin cancers. I will discuss various types of skin cancers, their prevalence and the survival and death rates from these cancers. In future posts, I plan to examine the original issue – whether the new regulations will help consumers choose a product that will help protect from some of these risks and how these legal steps may fall short of the final goal. Finally, I will look at the issue of tanning beds. Should children or teens be allows to use them? What about parental consent? There are medical and legal ramifications surrounding the use of tanning beds – I will look at a few of those. Along the way, please comment and let me know your thoughts. Or, if you are just daydreaming about enjoying summer…you can let us know that too (for my own personal idea of a great summer vacation see today’s photo).

Not All Skin Cancer is Created Equal

Personally, I tend to lump all skin cancer together in my mind. Unfortunately, whether you are putting yourself at risk for or are diagnosed with squamous cell, basilar cell or malignant melanoma makes a big difference. The rates of these diseases and the survival statistics are dramatically different.

So, first, what are these diseases?

Image from www.cancer.org

 

The National Cancer Institute at NIH explains the different types of skin cancers:

Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin.

How Common are these Cancers?

According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States. Of the various types of skin cancer, basal cell carcinoma is the most common (2.8 million/year the US), followed by squamous cell carcinoma (700,000/year), and finally melanoma (115,000). However, the death rates caused by melanoma are much higher than the other types of cancer. The statistics on the Skin Cancer Foundation website are shocking (just a sampling):

  • One person dies of melanoma every hour (every 62 minutes).
  • One in 55 people will be diagnosed with melanoma during their lifetime.
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
  • The incidence of many common cancers is falling, but the incidence of melanoma continues to rise at a rate faster than that of any of the seven most common cancers. Between 1992 and 2004, melanoma incidence increased 45 percent, or 3.1 percent annually.
  • An estimated 114,900 new cases of melanoma were diagnosed in the US in 2010 – 46,770 noninvasive (in situ) and 68,l30 invasive, with nearly 8,700 resulting in death.
  • Melanoma accounts for less than five percent of skin cancer cases, but it causes more than 75 percent of skin cancer deaths.

I was particularly taken by this last fact – while accounting for “less than five percent of skin cancer cases, [melanoma] causes more than 75 percent of skin cancer deaths.” This is startling because “[t]he survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent.” However, ‘”[t]he survival rate falls to 15 percent for those with advanced disease.” So the key here is clearly prevention and early detection.

Unfortunately, the melanoma incidence rate is rising annually. Melanoma is responsible for approximately 8,700 deaths a year in the US, as compared to rare deaths from basal cell carcinoma and approximately 2,500 deaths a year from squamous cell carcinoma.  And this is not just a problem for those with light skin – the Skin Cancer Foundation explains that “[w]hile melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.”

Given the high incidence rate and the high survival rate for early-diagnosed melanomas, it seems key that people should know the risks factors and causes for melanoma. The better the prevention, the less likely that you should develop this type of cancer. Secondly, if you are in a high-risk category, you should be seeing a dermatologist regularly since the key to survival is early detection.

Causes of Melanoma

The CDC provides confirmation that “[s]kin cancer is the most common form of cancer in the United States” and that the incidence of melanoma of the skin has “increased significantly by 3.1% per year from 1986 to 2006 among men” and 3% among woman from 1993 to 2006.Yet, we know many of the risk factors for melanoma.

The CDC reports that “[a]bout 65%-90% of melanomas are caused by exposure to ultraviolet (UV) light.” This is the kind of radiation that come from the sun – and tanning beds (more on that in a later post). There are three different types of ultraviolet light and two of them have a role to play in changing and damaging skin cells.

The three types of UV rays are ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC)-

  • UVA is the most common kind of sunlight at the earth’s surface, and reaches beyond the top layer of human skin. Scientists believe that UVA rays can damage connective tissue and increase a person’s risk of skin cancer.
  • Most UVB rays are absorbed by the ozone layer, so they are less common at the earth’s surface than UVA rays. UVB rays don’t reach as far into the skin as UVA rays, but they can still be damaging.
  • UVC rays are very dangerous, but they are absorbed by the ozone layer and do not reach the ground.

Too much exposure to UV rays can change skin texture, cause the skin to age prematurely, and can lead to skin cancer. UV rays also have been linked to eye conditions such as cataracts.

From the CDC website

In addition to sun exposure, there also additional risk factors to consider:

  • A lighter natural skin color.
  • Family history of skin cancer.
  • A personal history of skin cancer.
  • Exposure to the sun through work and play.
  • A history of sunburns early in life.
  • A history of indoor tanning.
  • Skin that burns, freckles, reddens easily, or becomes painful in the sun.
  • Blue or green eyes.
  • Blond or red hair.
  • Certain types and a large number of moles.

From the CDC website

Children and Adults are Not Doing Enough to Protect Themselves

Certainly, some of these risk factors are immutable, but others, like sun exposure and tanning are risks that can be avoided or at least minimized. The CDC says they have supported surveys that show that “U.S. youth and adults are being exposed to ultraviolet radiation and can do more to protect themselves. More than one-third of the U.S. population reported a sunburn in the previous year, with rates higher among men and the non-Hispanic white population.”

I found the CDC statistics troubling given how long it has been known that sun exposure and damage lead to skin cancer:

In 2005, only 56% of adults said they usually practice at least one of the three sun-protective behaviors (use sunscreen, wear sun-protective clothing, or seek shade).

  • 30% reported usually applying sunscreen (27% applied sunscreen with an SPF of 15 or higher).
  • 18% reported usually wearing some type of fully sun-protective clothing.
  • 33% usually sought shade.
  • Only 43% of young adults aged 18-24 used one or more sun protective methods, whereas 58% of those 25 years of age and older reported using one or more methods. Among men 18 and older, only 47% reported usually using one or more methods of sun protection, in contrast to 65% of women 18 and older.

Among high school students, when they were outside for more than an hour on a sunny day-

  • 11.7% of girls and 6.3% of boys reported they routinely used a sunscreen with an SPF of 15 or higher.
  • 15.9% of girls and 20.5% of boys reported they routinely stayed in the shade, wore long pants, wore a long-sleeved shirt, or wore a hat that shaded their face, ears, and neck.

Nearly 9% of teens aged 14-17 years used indoor tanning devices. Girls aged 14-17 years were seven times more likely than boys in the same age group to use these devices.

From the CDC – internal resources omitted.

The recommendations are clearly not being followed. To best protect yourself from sun damage, there are 3 simple steps:

  • Use Sunscreen
  • Wear Protective Clothing (including hats and sunglasses)
  • Find Shade

Do not forget that these tips are important whether you are at the beach or just around town and on both cloudy and sunny days. It is especially important to be careful during the peak times of 10 am to 4 pm.

Of course, “use sunscreen” is oversimplifying how to protect oneself. It is within this context that I will look into the various legal and marketing changes coming soon to sunscreens in my next post.

Did you know all of these facts about skin cancer? Did you know that melanoma was so common and so deadly, despite being very survivable when detected early?

Cancer: HIV/AIDS Patients At Increased Risk

Monday, June 27th, 2011

It is estimated that there are more than a million people in the U.S. infected with HIV.  In 2009 alone, there were roughly 50 thousand new HIV cases. There are approximately 16-18 thousand AIDS-related deaths in the U.S. each year. Although medical advancements have enabled many HIV/AIDS patients to live a relatively normal life, the truth is that the HIV/AIDS epidemic has been and continues to be a public health disaster of astronomic proportions.

As if life with HIV/AIDS is not difficult enough, researchers have also found that HIV/AIDS patients are also more prone to developing various malignancies when compared with the non-infected population. In fact, cancer is one of the leading causes of mortality in the HIV/AIDS  population. It is estimated that 30%-40% of HIV patients will develop some type of cancer during their life time.

The types of cancer that affect HIV patients can be generally divided into two groups: AIDS defining cancers and opportunistic cancers. An HIV positive patient who develops a cancer defined by the Center for Disease Control and Prevention as AIDS defining is considered to have AIDS.  These AIDS defining cancers include: Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and invasive cervical cancer. Other cancers are generally categorized as opportunistic.

Researchers have found that HIV/AIDS patients have a 2-to-3 fold increase in the overall risk of developing opportunistic cancers. Not only are HIV/AIDS patients more likely to develop cancer but the cancer prognosis is worse when compared with that of non-infected patients. HIV/AIDS patients also present with more advanced cancers at the time of diagnosis and, on average, they develop cancers at a younger age.

So, why is the risk for developing cancer higher in the HIV/AIDS population? It remains unclear whether the actual virus has a direct impact on the development of malignancies. It is believed, however, that the increased incidence of cancer is due to the fact that HIV/AIDS patients have a compromised immune system, which can lead to an impaired ability to produce antibodies or inflammatory responses.

Needless to say, if you are an HIV/AIDS patient or you know someone who is, please be aware of the increased risk for developing cancer. Be proactive and pursue proper and timely cancer screening. If you are experiencing unusual symptoms, don’t automatically attribute them to having HIV/AIDS (e.g., unusual fatigue). Unfortunately, they might just be symptoms of cancer.

 

Related posts:

H.I.V. treatment advances, but what are the implications of terminating research early?

 

 

Living With Cancer: What to Expect After the Diagnosis

Wednesday, May 25th, 2011

Alicia Staley - Cancer Survivor - Visual (Image from her site - awesomecancersurvivor.com

About a million and a half people will be diagnosed with cancer in the U.S. this year. The devastating truth about cancer is that about one-third of these people will die from cancer at some point. For most, the diagnosis is unexpected and completely overwhelming.The cancer does not just affect how one feels, it undermines all sense of security and stability. It changes lifestyles and redefines relationships. So often the emotional trauma is equally shared among family members and loved ones.

Needless to say, the original cancer diagnosis marks the beginning of a difficult, frightening and frustrating experience. For this reason, it is critical not to despair. One must always remain hopeful, adjust, and prepare for the way to recovery. A fundamental step in this process is gaining an understanding and familiarity with the impending medical treatment and associated lifestyle changes. A good deal of stress can be avoided by simply understanding what to expect. While cancer treatment varies depending on the type of cancer and the individual characteristics of the patient, the patient should generally be aware of the following:

Chemotherapy

The vast majority of cancer patients will receive some degree of chemotherapy. This may consist of one or more chemotherapy cycles.  Each cycle can be as long as 3-6 months. Chemotherapy involves the administration of various chemical agents called antineoplastic drugs in order to stop cancerous cells from dividing. Antineoplastic drugs are designed to attack and kill cells that divide in an uncontrolled or rapid matter. Antineoplastic drugs, however, are not able to discriminate between cancerous cells and normal cells. Therefore, cells that divide rapidly as part of their normal life cycle are also attacked. Chemotherapy may cure the cancer entirely or control its growth. Many times, chemotherapy is used in conjunction with other treatments. Some associated complications of chemotherapy include:

  • Anemia
  • Hair Loss
  • Lethargy
  • Nausea and loss of appetite
  • Kidney damage
  • Liver damage
  • Heart damage
  • Deterioration of pre-existing medical conditions such as osteoarthritis, among other things.

Radiation Therapy

In addition to chemotherapy, a patient may also receive radiation therapy. Radiation therapy involves exposing cancerous tissue to ionizing radiation (electromagnetic waves), which tends to destabilize the molecular structure of cancerous cells. In essence, the electromagnetic waves will ionize the atoms of the cancerous cells, by displacing electrons within the inherent structure of the atom. In turn, this process destabilizes the molecules of the cancerous cells, causing them to die.

Surgery

In a number of instances, cancer patients will also require surgery to treat their cancer. Often times, the malignant tumor is identifiable and localized (as opposed to metastasized). In such instances, timely surgery is preferred. Chemotherapy of radiation therapy may follow the surgery. The type of surgery  will vary depending on the type of cancer and how advanced it is. For example, a woman with ovarian cancer will likely undergo a total hysterectomy, including the removal of the ovaries. A patient with intestinal cancer may undergo a laparotomy with dissection of the cancerous tissue. Generally speaking, the sooner the cancer is identified, the less extensive the surgery.

Monitoring

After surgery and chemotherapy/radiation therapy, each cancer patient/cancer survivor should establish a systematic and well developed course of monitoring and supportive care with his/her physician. This will often involve a number of other health care providers such as physicians, nurses, and physical therapists. For example, a patient who has undergone treatment for ovarian cancer may require monitoring by an oncologist, a surgical oncologist, an internist (primary care physician), a gynecologist, and even a urologist. One must then factor in the extent to which the cancer treatment resulted in additional complications or the extent to which pre-existing medical conditions deteriorated as a result of the cancer treatment. As such, the patient may require the involvement of additional specialists to address and monitor the side effects of the cancer treatment. It is very important that the patient maintain a healthy nutrition and exercise regimen, if and as prescribed by the physician.

The bottom line is that cancer patients will invariably have a long and difficult road to recovery, which may take months or even years. Drastic lifestyle changes may be necessary, and patience as well as perseverance are essential. A cancer patient must know what to expect and be proactive to create support structures involving health care providers and family members/loved ones.

Helping Others in Need

If you or someone you know is a cancer patient/survivor, I encourage you to share your story with our readers. What helped you most to cope and persevere on your way to recovery?

Related Posts:

Ovarian Cancer: Five Tips to Get the Medical Care You Need

Ovarian Cancer: Early Intervention is Key – What You Must Know…

Breast Cancer: What You Need to Know About Digital vs. Film Mammograms

Warning to Women of Menopausal Age: HRT Linked to Increase in Death From Breast Cancer

Why early settlement is a win-win for all

Friday, May 20th, 2011

There is an old adage in the law that cases settle on the courthouse steps. There is a reason for that. When the parties are actually walking into court to try their case, they seem to suddenly recognize that there are significant risks to going to trial, and that there is serious money at stake. When you go to trial, only one side can win. The other side goes home a loser. Faced with such a stark outcome, both sides tend to become more reasonable in their assessment of their case and more willing to talk settlement. After all, despite all the years of experience that trial attorneys amass, no one can ever predict what a jury is going to do in any specific case. As one mediator I know likes to tell the litigants, going to court is like going to Vegas:  you roll the dice and you take your chances. So often times, the closer a case gets to the trial date the more motivated the two sides are to talk settlement. But is there a better way?

A couple of recent cases made me start to think about settlements and how they come about. (If you missed it, Brian Nash wrote an excellent piece on the frustrations of mediation and trying to settle cases). I’ve recently handled two cases that illustrate how settlements work and how two cases can go down dramatically different routes to ultimately get to the same place. Both of these cases are subject to confidentiality agreements so I can’t divulge the names of the parties or the settlement amounts, but they were both seven-figure cases with significant injury.

In the first case, the patient alleged that her doctor failed to timely diagnose stomach cancer over a period of several years. By the time the patient was properly evaluated by another physician, the cancer had progressed to the point that there was virtually no chance of a cure, and the young woman was likely going to die in the next few years. In the second case, the patient alleged that he suffered serious neurological complications (motor and nerve dysfunction in his arms and legs) as a result of post-operative complications that were not treated quickly enough. In both cases, a lawsuit was filed in court.  At that point, the two cases diverged.

Case Example #1 – Getting it done early

In the cancer case, before any depositions had taken place, the defense attorney called and asked if we might be able to talk about resolving the case. That’s always a great call to get as a plaintiff’s lawyer because it means there is a good chance that you will be able to get a nice result for your client, which is always the ultimate goal. Within a matter of weeks, we had reached an agreeable number and the case was over.

Case Example #2 – Grinding it out to the courthouse steps

In the second case, there was no early talk of resolution. The case proceeded through the normal course of litigation, which in the District of Columbia usually means about eighteen months of discovery, depositions, expert meetings, etc. Twenty-five experts were hired to review records and testify. Twenty-seven depositions ended up being taken. The case got all the way up to the Thursday before trial was scheduled to start on the following Monday morning. At that point, the parties finally reached agreement on a number and the case was settled.

Why the difference in approach?

So we have two cases, both with significant injury and both with questionable care. One case settled right away, and one dragged on for almost two years before settling. Is there a simple reason why? Not that I’ve been able to figure out. After years of doing this, I, like every other attorney, get a gut feeling as to what cases are worth, which ones will likely settle, which ones will go to trial. But it’s still a gut feeling; there’s no science involved.

It’s usually a combination of factors – the quality of the medical care, the severity of the injury, the likeability of the plaintiff and the defendant (more important than most people realize), the specific jurisdiction you’re in, etc. On top of these factors you have a myriad of psychological reactions that pop-up in lawsuits and there is no predicting those. Sometimes people get entrenched in fighting for no other reason than to fight. Some people get a number in their head for what a case is worth and don’t want to budge. So even though I can’t sit here and explain why certain cases settle early and some settle late, I do want to talk about the value of early settlements to all sides.

Common Sense and good economics say “get it done early”

It is easy to see why early resolution of cases benefits everyone, and it comes down to the costs of litigation. In today’s world, it can easily cost $75,000 to $100,000 (if not more in many instances) just in expenses to take a case to trial; it can easily be much higher in complex cases. (I know of one attorney who spent $300,000 on a case that he took to trial; he lost the case). These expenses consist primarily of expert fees paid to doctors to review records and testify. Expert doctors routinely charge at least $400 per hour and oftentimes more for their time. For trial testimony, doctors usually charge around $5,000 per day (some substantially more). If it runs into two days, that’s $10,000 just for one witness. It’s not unusual to spend tens of thousands of dollars for expert fees alone.

On top of that there is the cost of court reporters for each deposition, copying charges, obtaining medical records, long-distance calls, travel expenses, etc. Going through litigation is an expensive undertaking, and the longer the case goes on the more expensive it is. On the plaintiff side, all of those expenses are usually advanced by the attorney (in jurisdictions where this is permitted), but they all get paid back by the client at the end of the case (assuming the plaintiff wins; if there is no recovery, the plaintiff’s attorney “eats” those costs). So every dollar spent on litigation comes straight out of the client’s portion of the recovery.

On the defense side, insurers and self-insured institutions (like hospitals) have those same expenses, but on top of that, they also have to pay legal fees to their attorneys. Defense attorneys charge by the hour for everything they do on a file from reviewing records to meeting with clients to talking to experts to taking depositions. The complexity of medical negligence cases means long hours of work on each file, generating substantial legal fees. Those fees get paid to the defense lawyer whether the case is won, lost or settled at the last minute. The longer the litigation lasts, the higher the legal fees.

Of course it always costs money to investigate a case. There is no avoiding that.  Records need to be obtained and reviewed. Experts need to be retained for an initial opinion. But instead of spending $75,000 or $100,000 (or more) on a case, it may cost only several thousand dollars to work-up a case to get it ready to file – that is, to be in a position where early resolution can be discussed with the defendant. If a case can be settled early on, all of those thousands of dollars that would have gone to litigation costs go straight to the client. That is a huge benefit to the client.

The defendant benefits too. No hospital or insurance company wants to spend money needlessly. Early resolution means that the defendant doesn’t have to spend tens of thousands of dollars in expenses and tens of thousands more in legal fees. The only way it makes sense to spend that money is if, at the end of the day, the “defendant” (read insurer/hospital) believes it can either win the case or settle it for less down the road. But here’s the thing – a case can usually settle early on for less than the case would be worth had the case gotten closer to trial. This isn’t always true, of course, but as a general rule, a good case does not become less valuable over time.

Plaintiffs’ attorneys don’t undersell their cases to get an early settlement, but in practical terms, attorneys and clients are usually willing to consider some discount because they know that an early settlement is to their mutual benefit.The plaintiff gets a guaranteed financial payment now rather than waiting eighteen months for a trial and then a possible appeal that may drag the case out another two years. In that circumstance, the plaintiff is usually willing to take a little less money now because it is certain. It’s the age-old question: would you rather have X amount of money now, or wait eighteen months for the chance of getting more? For most plaintiffs, it’s an easy answer. Also the defense can pay less on a case than it would have ended up paying anyway and save thousands in expenses and legal fees by doing so. It’s a win-win for all parties.

Just do the math!

The big secret with early settlements (and which can sometimes be difficult to explain to a client) is that even though an early settlement might be for less than what a jury might award, the client can actually put more money in his or her pocket with a lower settlement amount. Again, we’re back to the issue of litigation costs. If a firm spends $10,000 to investigate a case and get it ready to file rather than $100,000 to take a case to trial, that is an extra $90,000 that goes straight to the client. Also, some law firms will have a contingent fee agreement in which the fee is higher (usually from 1/3 to 40%) when the case goes to trial, which serves to compensate for the additional time,  risk and expense of going to trial. When you consider the higher legal fees and the increased costs of litigation that have to be paid back, it can actually take a substantially larger jury verdict to put the same amount of money in the client’s pocket as he or she would get with a smaller early resolution.

Some cases may just need to be tried

I don’t mean to imply that every case that gets filed should be settled early. Far from it. Some lawyers undoubtedly file cases that are simply without merit and should be defended vigorously. Other cases – while they may be defensible – fall into a middle category where the care may not be the best but the plaintiff has problems with his/her case too. Some cases can be difficult to evaluate without further investigation and discovery to gauge the strength of the case. In those cases, it is entirely appropriate to proceed with litigation – even on a somewhat limited scale through discovery. No doubt there are instances where insurance companies do need to protect the interest of their doctors, and sometimes that means vigorously defending a case all the way through trial.

Some cases, however, – the cases where the medical care is truly egregious and the damages are clear – need to be looked at early on to see if the two sides can be reasonable and find some middle ground. If a case is going to ultimately settle (and believe me, experienced attorneys and claims adjusters can usually identify those cases early on), it makes sense to talk sooner rather than later. It requires compromise on everyone’s part, but the value to both sides is so great that it makes sense to talk early and get it done.

What has been your experience?

I’d be curious to know the experience of our readers. Has anyone been involved in a lawsuit that settled? Did it resolve early on or did it stretch out for years? Do you think the time involved had any impact on the amount of the settlement? Any tips or tricks you might suggest? Let’s hear from you – maybe we can all learn how to get these cases resolved earlier and stop wasting time, resources and money.

You may also want to read these related posts:

Frequently Asked Questions (FAQ’s)

A View from the Shady Side – The Defense Perspective

Every bad outcome does NOT a malpractice case make! Some practical advice

 

CT Scans – Are You Being Properly Protected Against Radiation?

Thursday, December 2nd, 2010

According to new research presented at the annual meeting of the Radiological Society of North America, breast shields should be used for men and women undergoing CT scans of the chest/lungs. According to Terry Healey, M.D., Director of thoracic radiation at Alpert Medical School of Brown University, the breast shield is capable of reducing the level of radiation by about 30%.  This is significant considering that radiation can cause or contribute to the development of various malignancies (e.g. breast cancer, lung cancer, esophageal cancer).

Although some physicians argue that the use of breast shields may impact the quality of the CT scan (i.e., by producing artifacts such as streaks or lines making the interpretation of the study more difficult), this new research suggests that the use of breast shields does not impact the diagnostic quality of the CT scan. A breast shield is nothing more than a thin piece of heavy metal placed in front of the chest during the CT scan procedure.

Researchers studied 50 patients, who needed CT scans of the chest. Most of the patients were undergoing the study to rule-out lung cancer.  For some patient the shield was placed directly on the chest. For other patients, the shield was slightly elevated from the chest surface. Overall, some artifact was present in about 2/3 of the cases. However, in the opinion of the researchers, there were no instances where the artifact interfered with the diagnostic quality of the radiographic study.

According to Judy Yee, M.D., vice chair of radiology at the University of California: ”[T]here’s no good reason not to use breast shields. The cost is relatively low and the benefit large.”

Perhaps a larger patient population is needed for the results of this research to be more widely accepted by the radiology community. We’d appreciate anyone who has experience in this field to share their thoughts on this topic. Do such shields cause artifact that makes the study less accurate and potentially dangerous to a patient? Does the accuracy of the scan, when a shield is used, depend on which type of scanner is used or which generation of scanner is being used? Are there other techniques that can be used to protect a patient yet not run the risk of artifact “mis-read”? We’re not physicians or radiology technicians, so we welcome any insights those who are might have on this topic.

If you are concerned about excessive radiation and need to undergo a chest CT, ask your radiologist if a protective shield can be used during your CT scan. Discuss the issue and – as we always stress – take charge of your own medical care. Be an informed patient and be responsible for your own health and safety. Know what the issues, risks and benefits are and discuss it with your doctor. Then – and only then – make an informed decision.

Image from emedicine.medscape.com

Should You Be Concerned About Cancer If You Have Lupus?

Tuesday, November 16th, 2010

Did you know that people with lupus are more likely to develop cancer?  According to a recent study presented at the American College of Rheumatology Annual Scientific Meeting, patients with lupus are 15 % more likely to develop cancer when compared with the general population.

The study also revealed that patients with lupus are three times more likely to develop lymphoma (cancer of the white blood cells) and that woman are less likely to develop estrogen-sensitive cancers if they have Lupus (breast cancer – 30% decreased risk, endometrium – 51% decreased risk,  ovary – 44% decreased risk).

With respect to other carcenomas, the following correlations were established:

  • 3.4 times more likely to develop non-Hodgkin’s lymphoma
  • 3.2 times more likely to develop any lymphoma
  • 2.8 times more likely to develop vulvo-vaginal cancers
  • 2. 2 times more likely to develop liver cancer
  • 1.7 times more likely to develop leukemia
  • 1.7 times more likely to develop cervical cancer
  • 1.2 times more likely to develop lung cancer

Systemic lupus (systemic lupus erythematosus or SLE) is an autoimmune disease, whereby the body’s immune system is unable to distinguish between harmful or foreign substances/tissue and normal/healthy tissue. As a result, the immune system ends up fighting healthy tissue as if it were diseased. Some of the symptoms associated with lupus include:

  • Arthritis
  • Fatigue
  • Fever
  • General discomfort, uneasiness or ill feeling (malaise)
  • Joint pain and swelling
  • Muscle aches
  • Nausea and vomiting
  • Pleural effusions
  • Pleurisy (causes chest pain)
  • Psychosis
  • Seizures
  • Sensitivity to sunlight
  • Skin rash — a “butterfly” rash over the cheeks and bridge of the nose affects about half of those with SLE. The rash gets worse when in sunlight. The rash may also be widespread.
  • Swollen glands

If you have lupus, you must appreciate your risk for developing cancer. The key to successful cancer treatment is early detection and treatment. Make sure that your doctor is aware of your lupus condition and that your risk for developing cancer is properly and systematically assessed.

Photo: from http://articles.elitefts.com

Update:New Painless Test for Colon Cancer Details – Still Experimental but Hope Abounds.

Monday, November 1st, 2010

Two weeks ago, this blog highlighted the issue of doctors not following recommended colon cancer screening guidelines. While the standard tests for colon cancer (primarily colonoscopy and flexible sigmoidoscopy) will likely remain in place for now, new information is coming out on a new test that may one day be used to detect colon cancer – a DNA stool test.  As reported by MedicalNewsToday.com and others, the test uses a stool sample and detects alterations in DNA that are linked to the presence of tumors.  Therefore, actual imaging of the colon is not necessary.

The test has been developed by a Wisconsin company called Exact Sciences.  What is key about this new test is that it is non-invasive, meaning that it does not involve any bodily penetration.  This would be a boon for those patients who put off getting tested because they don’t want to undergo more invasive procedures, or who don’t want to take time away from their busy lives to do it.  This new test can even be done at home.

Researchers at the Mayo Clinic have already tried out this new test on humans with surprisingly good results.  On a test involving 1,100 participants, the DNA test detected 85% of cancers and 65% of pre-cancerous adenomas larger than 1 cm.  87% of Stage I to Stage III cancers were caught by the new test, which is excellent news because the earlier cancer is detected, the better chance there is of a cure.

We must emphasize that this new test is experimental only at this stage.  Additional human trials are expected to get underway in 2011.  There is no word on when this test may become available for wide-spread use.  We will continue to post updates on this exciting new front.

New study links gene to ovarian cancer and may assist in early detection

Tuesday, August 10th, 2010

A new study by Yale University Cancer Center identifies new genetic markers that may be used to assess a woman’s risk for ovariancancer. Specifically, researchers concluded that women with variations or mutations of the KRAS gene were more likely to develop ovarian cancer. The KRAS gene is a stretch of DNA, which is specifically designed to code the KRAS protein. The KRAS protein serves an important function in tissue signaling. In many ways, the protein is a catalyst. When it is activated, it  promulgates various growth factors and stimulates a number of receptors. It has been known for some time that KRAS gene variations or mutations are linked to various types of cancer. This study suggests that the KRAS gene variation is specifically linked to ovarian cancer.

About a quarter of all patients with ovarian cancer were found to have a KRAS gene mutation. About 61% of the patients with ovarian cancer that also had a family history of ovarian or breast cancer were found the have the KRAS gene mutation as well.

To date, scientists have identified a number of genetic markers for ovarian cancer. Among the better known markers are the BRCA1 and the BRCA2 genes. The new KRAS marker appears to have a stronger correlation to ovarian cancer. While about 50% of women with ovarian cancer had the BRCA1 and BRCA2 genes, 60% of women in the same patient population had the KRAS gene mutation. It is also important to note that women with the BRCA genes were more likely to develop ovarian cancer at a younger age. In contrast, the incidence of ovarian cancer in the population of women with the KRAS mutation was more prevalent after menopause.

The Yale study appears to be great news for all women. Ovarian cancer is a particularly difficult and lethal cancer because of its apparently latent and suttle  development. The sings and symptoms are not easy to recognize, and for many women, it is often too late by the time the cancer is diagnosed. This study suggests that testing for KRAS gene mutations is a significant step forward to better screen and assess women for ovarian cancer. For more information on ovarian cancer, please read our prior posting entitled Ovarian Cancer – The Smear Test Won’t Tell You Much.