You Should Know: Our Growing Awareness of Traumatic Brain Injury

The movie Concussion opens with the story of “Iron Mike” Webster. Fifteen years as a center in the NFL for the Pittsburgh Steelers had earned him stardom and four Super Bowl rings, but also a host of behavioral and memory problems in his later years. Pittsburgh’s hometown hero gave away or lost all of his money (he couldn't remember which), would often slip into a catatonic state, and eventually became homeless, living out the last years of his life in his truck.

After Webster died at the age of 50 from a heart attack, a young Nigerian forensic pathologist named Bennet Omalu (played by Will Smith) performed the autopsy for the county coroner’s office. Omalu had heard the stories about how Webster had essentially gone crazy in his later years and wanted to know why. After months of studying Webster’s brain, he discovered signs of a new disease marked by severe brain damage. He named it chronic traumatic encephalopathy (CTE) and published a paper that linked the new disease to the repeated concussions suffered by Webster while playing football.

While the NFL rejected Omalu’s report that Webster and other NFL players suffered CTE as a result of playing football, the genie was out of the bottle, so to speak. Several subsequent studies of NFL veterans and other athletes vindicated Omalu’s research and ignited a firestorm of concern and discussion about sports-related concussions. Eventually we would learn that even a single mild TBI can more than double the risk of early-onset dementia.

The Big Denial

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Anatomy of an Impact (click to expand)

For years, the NFL ignored extensive medical evidence until finally acknowledging in 2009 that repeated head injures can cause brain damage. Litigation has played an important role in forcing the NFL (and other organizations) to address this growing crisis and change head injury protocol, as documented in this extensive report from the American Association for Justice. Attorneys and Dr. Bennet Omalu joined forces with the family of Mike Webster and other past NFL players to sue the NFL for disregarding medical research and not doing more to prevent TBIs. During this lawsuit, it was revealed that the NFL ignored its own actuarial research showing an estimated one-third of its former players would suffer from brain damage caused by TBIs.

The NFL eventually settled for $765 million, causing a ripple effect throughout the sports world. Many professional, college and high school sports programs have changed concussion protocols and rules of play as a result, and insurance companies have followed suit by requiring stricter adherence to proper procedures for TBI care. The NFL even started its own brain bank to study the brains of former players with the hopes of creating new measures that will combat the possibility of brain damage or CTE. NFL data released ahead of Super Bowl 50 showed that concussions were down 25% this season, mostly due to changes in technique by the players.

The Story Closer to Home

Football is lead cause of head injuries for high schoolers.

In 2006, high schooler Zackery Lystedt went back out on the football field after suffering a concussion earlier in the game. After being struck in the head again, Zackery collapsed with what proved to be a debilitating brain injury. In 2009, his home state of Washington passed the Lystedt Law. This legislation requires annual mandatory training for athletes, parents and coaches. It also requires the immediate removal from sporting events and practices of any athlete suspected of having suffered a concussion until cleared for return by a medical professional. Since Washington took action, every state except Wyoming has enacted a “When in Doubt, Sit Them Out” law. Compliance to these guidelines has increased from 50% in 2007 to 80% in 2013.

That’s the good news. The bad news is that very few states have enforcement mechanisms to make sure these laws are being followed, and only six states require parental notification of a child’s TBI. So for parents, athletes and coaches, vigilance is still the first line of defense. Know the signs and protocol for dealing with TBI (review here) and don’t delay seeking medical attention. Note that many other contact sports cause head injuries, as outlined in the chart above, not just football. Automobile crashes and other blunt trauma to the head account for many times more.

 This article appeared in our February 2016 "You Should Know" e-newsletter. 

You Should Know: Unregulated E-Cigarettes Mask Hidden Dangers

E-cigarette use among teens tripled from 2013 to 2014, alarming health officials.

E-cigarette use has skyrocketed in the last few years. About 10 percent of U.S. adults now vape, as the practice is called, almost four times more than the 2.6 percent reported by the government in 2013. And that growth means big business: Sales are estimated at $3.5 billion for 2015 versus $2.5 billion in 2014 and are projected to grow 25 percent annually through 2018.

E-cigarettes use a heating element to vaporize liquid nicotine that is then inhaled by the smoker. Many smokers view e-cigarettes as a way to quit smoking traditional cigarettes, avoid some of the health hazards caused by regular cigarettes, or as an alternative to smoking in public places that ban the practice.

Click to enlarge infographic.

No Regulations or Warnings

So far e-cigarettes are entirely unregulated by the U.S. Food and Drug Administration, a fact that surprises many users. Both the vaporizing devices and the nicotine-based liquid itself are unregulated, so manufacturers create and disperse products with no oversight. There are already more than 500 different brands of e-cigarettes, with over 7,700 flavors of nicotine liquid. The amount of nicotine in the liquid, as well as other dangerous chemicals or carcinogens, are not monitored and are not required to be represented accurately on the packaging. Nevertheless, research cited by the American Lung Association highlights the significant health risks posed by the nicotine and other hazardous chemicals found in e-cigarettes.

Use Triples Among Teens

The fastest growing segment of e-cigarette users are teens and young adults. Between 2013 and 2014, e-cigarette use tripled from 4.5 percent to 13.4 percent for teens, followed by an increase among middle schoolers from 1.1 percent to 3.9 percent during the same period.

Officials with the Centers for Disease Control and Prevention expressed extreme alarm at the findings, pointing out the harm nicotine exposure can pose to brain development among young people along with the potential for long-term addiction. Public health advocates also fear that unregulated advertising in print and on television by e-cigarette companies is making the product look “cool” and is driving increased use among young users.

Not Working to Help Smokers Quit

For those hoping that e-cigarettes might help them stop smoking entirely, a new study suggests that the opposite may be true. Researchers in California found that e-cigarette users were less likely than those who never used e-cigarettes to quit or cut down on smoking cigarettes. “We hypothesize that maybe [users] are getting higher doses of nicotine, and so it becomes less likely they’re able to quit,” reported the researcher.

Many vapers also practice dual use, meaning they smoke traditional cigarettes but then use e-cigarettes where traditional smoking is banned. This makes it more likely that people addicted to nicotine can get a fix whenever they have the desire, thus actually increasing the amount of nicotine they are ingesting every day.

Exploding E-Cigarettes Cause Serious Injuries

Another serious problem with e-cigarettes can now be added to the list of hazards. A growing number of users have been injured by e-cigarettes that explode due to unstable lithium-ion batteries. Recently a 29-year-old California man suffered a broken neck, facial fractures, burns to his mouth and shattered teeth after an e-cigarette exploded while he was using it.

Although these incidents are rare, federal officials report 25 such incidents between 2009 and 2014. Because there are so many makers of e-cigarettes and none are regulated, shoddy manufacturing practices can go unchecked. Federal transportation officials have already banned e-cigarettes from packed luggage for fear of explosions inside the luggage hold. 

 This article appeared in our January 2016 "You Should Know" e-newsletter. 

You Should Know: America’s 2015 Top Safety and Justice Stories

It was a busy year for those who fight for the health, safety and legal rights of all Americans. While this short list is by no means exhaustive, here are some of the top stories we were watching in 2015:

1. Forced Arbitration Is Forced Injustice

Many Americans are signing away their right to a day in court.

There’s a legal land mine buried deep in thousands of consumer and employment contracts called a “forced arbitration” clause that threatens our right to hold major corporations accountable for wrongdoing. This loophole prohibits Americans from taking companies to court and instead forces them into secretive arbitrations, which are typically stacked in favor of the company. An investigation by The New York Times has focused renewed scrutiny on the harm caused by forced arbitrations in claims of medical malpractice, sexual harassment, hate crimes, discrimination, theft, fraud, elder abuse and wrongful death. You can join others in petitioning Congress to ban forced arbitration right here.

2. Food That Sickens Rather Than Nourishes

Major cases of food contamination at Chipotle Mexican Grill and Blue Bell Ice Cream this year illustrate the growing problem of foodborne illness. According to a new report from the American Association for Justice, 48 million people fall sick, 128,000 are hospitalized and at least 3,000 die each year from foodborne illnesses. Questionable production techniques and cost-saving measures, combined with weak state and federal oversight, threaten to make the situation worse. Litigation helps shed light on dangerous practices and hits companies back hard with large financial penalties and damaged reputations.

3. Cost Savings Creates Deadly Defect in Guardrails

Trinity Industries installed 220,000 guardrails throughout the country that may spear cars on impact.

Trinity Industries modified its highway guardrails to save money but instead created a deadly hazard, all of which didn’t come to light until it was sued by a whistleblower and those who suffered injuries as a result of the defect. Rather than slow down a vehicle when impacted, the Trinity guardrails spear through the passenger compartment. A federal judge recently ordered the company to pay $663 million in penalties for concealing the design modification from federal officials. At least 14 lawsuits blame the guardrails for causing injuries in crashes, including five deaths, according to The New York Times.

4. Exploding Airbags Seriously Injure Motorists

Airbags made by Takata and installed in vehicles from 12 different automakers can explode when deployed, injuring or even killing occupants. A report published in The New York Times alleges that Takata knew of the defects for years but failed to take action. Since then the National Highway Traffic Safety Administration (NHTSA) has recalled 19 million vehicles in the United States, fined Takata for failing to cooperate with its investigation and handed down a record civil penalty of $200 million.

5. New Regulations Protect Nursing Home Residents

Proposed regulations would improve nursing home safety.

The federal watchdog for nursing home safety has proposed sweeping new regulations designed to improve patient care and safety for more than 1.5 million Americans living in long-term care facilities. Such regulations are long overdue, according to patient safety advocates, family members and nursing home lawyers, who report numerous cases of abuse and neglect. If the regulations are finalized, “unnecessary hospital re-admissions and infections would be reduced, quality care increased and safety measures strengthened,” according to the Centers for Medicare & Medicaid Services.

6. VW Trumps GM as Most Untrustworthy Car Maker

The scandal at Volkswagen over rigged emissions in more than 11 million cars worldwide reminds Americans once again that car manufacturers are often willing to jeopardize the health and safety of consumers to protect their profits. News of the VW scam comes just over a year after GM admitted it had covered up a defect in an ignition switch that has been blamed for at least 124 crash deaths. Both companies might have gotten away with their misconduct if not for a wrongful death lawsuit (in the case of GM) or a chance discovery by a small research team at West Virginia University (in the case of VW). Meanwhile, some in Congress are considering a bill that would bail out VW: learn more and tell Congress to vote no here.

7. Defective Products Create “House of Horrors”

Toxic drywall, failing sprinklers, leaking windows and even bursting toilets ... these are just a few of the defective and dangerous products that are featured in the “House of Horrors,” an informative infographic from the American Association for Justice. Each case demonstrates how consumers have fought back against shoddy manufacturers through class-action lawsuits, a right that is threatened by forced arbitration clauses as discussed above.

8. Toys Still Injuring Kids

Nearly 260,000 kids visit emergency rooms each year for toy-related injuries, according to the Consumer Product Safety Commission. And sadly, 11 children under the age of 12 died while playing with toys in 2014. The most common injuries include poisoning, choking, ingesting magnets or falling from riding toys. While regulators, safety advocates and the parents of injured children have succeeded in ridding store shelves of many unsafe toys, too many still get through. Learn more.

 This article appeared in our December 2015 "You Should Know" e-newsletter. 

You Should Know: Your Responsibilities as a Party Host

Protect Yourself and Your Guests When Hosting a Holiday Party

Hosting a party this holiday season? Before stamping that last invitation, learn how you can protect yourself and your guests. The legal principles at work here are called premises and social host liability. Here are tips and suggestions for preventing injuries and protecting your interests before guests arrive:

Let’s Start with Alcohol

“Holiday cheer” is often synonymous with alcoholic beverages in many people’s minds. There is nothing wrong with that thinking, but homeowners should be aware that they may be held liable in some states if intoxicated guests leave the party and cause injury or property damage to others. So...

• Encourage guests to pick a designated driver.
• Stock plenty of non-alcoholic beverages and serve food.
• Don't pressure guests to drink too much and cut off anyone who has already had enough.
• Call a cab for intoxicated guests, give them a ride (if you are sober), or offer a place to sleep at your house.
• Never allow minors to drink.
• As the host, stay in control by not drinking too much yourself.

Click to view a Drinking & DUIs During the Holidays infographic

Now, Look Around Your House

As the property owner, you are responsible for protecting your guests from unsafe conditions on your property. So...

• Fix any tripping hazards like broken stairs or loose handrails, double-stick tape throw rugs and secure extension cords.
• Remove any dangerous items that might injure children like an old freezer, a broken swing or poison hazards.
• In colder climates, keep sidewalks and steps free of ice and snow.
• If you have a pool, keep gates locked or make sure kids are supervised by an adult if using the pool.
• Consider restraining pets as you may be liable if a guest is bitten or scratched.

Review Your Homeowner’s Insurance

The liability coverage in your homeowner’s insurance may be your final line of defense if someone is hurt during a party at your home. So...

• Make sure it is in force and that your policy limits are high enough to cover an injury. Standard minimums of $100,000 to $300,000 may not be enough to cover all the costs associated with a serious injury.
• If you have significant assets in addition to your home, consider an umbrella policy for added liability protection.
• Check for exclusions and contact your agent if you have any questions.

This article appeared in our November 2015 "You Should Know" e-newsletter.

You Should Know: Tips for Keeping Loved Ones Safe at Home

Most Homes Are Not Designed to Prevent Injury to Older Americans

Storage areas for medications should be well-lit

In 2013, there were 44.7 million Americans age 65 and older. As the baby boomer generation ages, that number will spike upwards to 56.4 million in 2020, 82.3 million in 2040 and 98.2 million in 2060. Most baby boomers will live longer on average than previous generations, remain independent and age gracefully, which makes “aging in place” (living at home as long as possible) an attractive option. But several studies suggest that most homes are not designed to minimize safety risks for people over age 65.

Five Tips for Keeping Loved Ones Safe at Home

Independent living and safety are not mutually exclusive. In fact, aging itself isn’t necessarily a hazard; rather it’s often the living space that needs to be updated. Here are five tips from the American Geriatrics Society’s Health in Aging Foundation to protect loved ones from home hazards:

1. Keep Emergency Numbers Handy.

Always keep a list of emergency numbers by each phone and write them big enough to read easily if in a hurry or frightened. Be sure to include numbers for the poison control center, fire and police departments, family members and the family doctor.

2. Prevent Falls.

The Centers for Disease Control and Prevention reports that falls are the leading cause of injury for older Americans. Every 13 seconds a fall-related injury is treated in an emergency room and every 20 minutes someone dies from a fall.

To prevent falls, make sure all hallways, stairs and paths are well-lit and clear of objects, use rails and banisters when taking the stairs, and tape all area rugs and cords to the floor so they don’t move. Also consider a wearable alert system that allows a senior who has fallen to summon emergency personnel. Download this step-by-step fall prevention checklist.

3. Protect Against Fire and Related Dangers.

Older adults are at greater risk of dying in a home fire. They may move more slowly or have trouble hearing a smoke alarm. Smoking is the leading cause of fire deaths, so try to smoke outside and never in bed. Make sure there is a LOUD, working smoke alarm on every level of the house, in bedrooms and outside of sleeping areas. Download this tip sheet from the U.S. Fire Administration for additional information.

4. Avoid Bathroom Hazards.

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Falls are the leading cause of injury for older Americans.

Bathrooms are especially hazardous for older adults, accounting for 80 percent of all falls according to the National Institute on Aging. They have slippery and unforgiving floor surfaces, and few sturdy handholds. Install grab bars in the shower and near the toilet. Put rubber mats in the bathtub. And consider setting the water heater thermostat no higher than 120 F to prevent scalding. Consumer Affairs has a number of additional tips for making bathrooms safe for seniors.

5. Prevent Poisoning.

The risk for a medication mistake increases as we age. According to 2014 Medicare records, there are more than half a million drug-related injuries that occur at home every year. Mistakes can include taking too much medication, taking the wrong medication or incorrectly mixing two or more medications.

To prevent accidental poisoning, keep all medications in original containers to avoid mix-ups, and store medications in a well-lit room so the labels are easier to read. Ask the pharmacy to put large-print labels on prescriptions. And bring all pill bottles to doctor appointments to ensure medications are being taken correctly.

 This article appeared in our October 2015 "You Should Know" e-newsletter. 

You Should Know: Common Household Products Can Put You, Others at Risk

As more chemicals are used in our homes and workplaces, it is important to know what substances are dangerous and how to avoid contamination. According a 2012 Poison Control Center report, pain medication, cosmetic and personal care items, and household cleaners were the substances most frequently involved in human exposures. The good news is that government regulators and private retail chains are helping to limit what gets used in the products we encounter daily.

Common cleaners are the number two cause of dangerous exposures in the United States.

In 2013, both Wal-Mart [download] and Target, two of the world’s largest retailers, announced ambitious sustainability plans. Both companies plan to bring increased transparency to the ingredients used in products and called for a reduction in especially harmful chemicals used in the products they sell. While the plans were aimed more generally at sustainability and reducing negative environmental impacts, both set strict guidelines for safer products.

The U.S. government has also joined the fight against hazardous chemicals and misleading ingredient labels. In early June, the U.S. House Committee on Energy & Commerce approved HR 2576, a bill that would expand the Toxic Substance Control Act of 1976 and allow the EPA to test for and regulate hazardous substances in consumer goods and products. The bill, if passed, would also allow the EPA to evaluate substances for unreasonably risky ingredients. It would also limit any state or local government's power in regulating a chemical substance that the EPA has determined safe under its intended uses.

You Should Know How to Avoid Contamination

While the government and private businesses work to make consumer goods safer, it is still important to always use caution when dealing with potentially dangerous chemicals. In 2013 the Center for Disease Control reported that there were 38,851 unintentional poisoning deaths that year alone. Never mix chemicals when cleaning, and always wear gloves and wash your hands thoroughly. Dangerous products are not limited just to cleaning supplies; others come in the form of carbon monoxide, lead paints, asbestos and other harmful building supplies, as well as cosmetics and lawn care products. To avoid these dangers, use carbon monoxide alarms, always have an inspector walk through and test any new building that you may be considering purchasing, and take extreme caution when using fertilizers and pesticides.

Storing Toxic Chemicals

Keeping chemicals locked away and out of the reach of youngsters and pets is paramount to preventing accidental contamination and poisonings. When storing hazardous chemicals and cleaning supplies, always:

    •    Keep chemicals in a well-ventilated area like a garage or shed;

    •    Read labels and follow directions accordingly;

    •    Store chemicals out of reach of children or pets;

    •    Store chemicals away from food storage;

    •    Be sure containers are sealed tightly before storing;

    •    Keep soaps and dental hygiene products out of the reach of young children;

    •    Lock medicines away if possible; and

    •    Always read and follow label instructions on proper storage.

If you are ever exposed to a dangerous chemical or have a question about a product or ingredient, call the Poison Control Center Hotline 24/7 at 1-800-222-1222

 This article appeared in our September 2015 "You Should Know" e-newsletter.