Pediatricians say Energy Drinks for Kids = Bad Idea?

Making the rounds early this week is news of a recent study that highlights the use, overuse and possible confusion among adolescents and energy as well as sports drinks. From the abstract of the study:
 
  Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.


From the report:
" Confusion about energy by young people can lead to unintentional ingestion of energy drinks when their goal

is simply to rehydrate and replenish carbohydrate, electrolytes, and water with sports drinks."


There is clearly a proliferation of sports drinks on the field of play for children as young as 8-10 years of age. As a coach of youth sports, it is not uncommon to see a child lugging a sports drink bottle to practice or a game. I try to counsel the parents that for activities like soccer, anyone under 15 should drink water.  Sports drinks are a different class of fluid than an energy drink. Unfortunately, some children don't know the difference. Now, we have a clinical report to back up what many have believed - their is rampant misuse of these drinks, and education on them has to start now. 




This report goes on to explain to pediatricians:   


Understand that energy drinks 

pose potential health risks primarily because of stimulant content; therefore, they are not appropriate for children and adolescents 

and should never be consumed

Rakofsky v. The Internet?

Image via Wikipedia
Make sure to read the disclaimer at the bottom of this post:

There  has been much reported on the handling of a criminal case by an attorney named Joseph Rakofsky. You can simply google his name to learn more, but the upshot is that after news and analysis of a case he handled made the rounds in the news -both in the papers and on the web - he found himself a lawyer. That lawyer then sued more than 65 people/lawyers/businesses for among other things, defamation. The Complaint may be found here. 


I won't be commenting on how it came to this point. I sat down to read the Complaint and how in the world this lawsuit would make it through the state court in New York. 

First - the parties. I remember the first semester of Civil Procedure class and the cases involving jurisdiction. Minimum contacts with NY? With more than 65 Defendants, many of whom are out of state, it's going to cost a lot of money to get proper service and secure jurisdiction. 

Without researching the substantive law in detail, mail service on a defendant out of state (not in NY) won't cut it unless the other state's  rules expressly authorize it. Since the case will not be at issue until all Defendants have been properly served, hurdle one is getting it right. Tack and mail which may be done in NY is not permitted in many states. Service by publication won't be cheap either, and any judgment obtained that way is quite literally not worth the paper it is printed on for execution.


Second- Jurisdiction.  If somehow some way all Defendants are served, there will be real jurisdictional concerns. How is a resident of Florida with an account on Twitter, who limits her practice to Florida,  somehow agreeing to NY jurisdiction? The Motions to Dismiss will - based upon my read of the papers - probably exceed fifty. Will they all be heard? One at a time or over the course of days? 
Will Special Answers (as they are called in GA) be filed?  Plaintiff may have to respond to each and every Motion. Just getting to the oral argument point for the cases probably takes 500 hours of more of research, drafting, finalizing, filing, and submission.   

Third - Substantive Dismissal Motions. If for the sake of discussion several Defendants are dismissed leaving only New York Defendants remaining, the next hurdle may be the filing of Motions to Dismiss on substantive grounds. At least in some states, just getting to this stage will take some time, and there is likely no discovery that goes forward until such motions are decided. Will any Defendants remain after this stage?

Fourth - The Merits. For sake of this discussion, what happens if after the initial rounds of motions are heard, the Court decides that some Defendants will remain in the case in the early part of the process. My law professors as well as the two USDCT Judges I clerked for always said "prove what you plead." That is why notice pleading is so common  - plead only what you must in order to proceed with any litigation. 


In the Complaint there are detailed allegations regarding statements made in hearings out of state, in court, and between persons who clearly do not live in New York. How will those statements make it to the courtroom? A transcript of a trial in another state - does that come in without authentication? If GA, a transcript is not necessarily an exception to any hearsay. Basic laws of evidence will almost assuredly keep many of the allegations out of the courtroom without a proper foundation and more importantly cooperation from a non party witness.



Reading the pleadings, documents will not save the day for the Plaintiff, IMHO. So what to do? Depositions? Will a Judge allow his deposition to be taken? Given what the Plaintiff quoted from a trial (in his Complaint), I'm not sure anyone would want that testimony preserved by deposition. If counsel for Plaintiff goes that route, the cost for travel, deposition transcripts and witness fees is going to run in the thousands. How about a videographer? 

From the perspective of those named, it seems like the commentary, analysis, and discussions of how the Plaintiff handled the underlying case are just that - fair comments as that term is defined in most state law jurisdictions.   Fair comment is defined as a "common law defense [that] guarantees the freedom of the press to express statements on matters of public interest, as long as the statements are not made with ill will, spite, or with the intent to harm the plaintiff" Source.  The issue may be does that defense apply in this case. 

Finally: I see many ways that the Judge  this case is assigned to will control the proceedings. I would expect Motions to Strike, Motions to Dismiss, Motions for Summary Judgment, and Motions in Limine to be filed and argued. This does not even get to the substance - proof as well as the pesky little thing called damages. Will Plaintiff be ready to undergo what will surely be a day or days long deposition? How about deposing up to 70 Defendants? Is this Plaintiff ready to spend in costs (not including attorney time) up to $250,000? I use that figure based on my 20 years of experience as a civil litigator. 

Where will this case go? My opinion  is  that it will be dismissed early in the proceedings. I have my own opinions, but my bet is the first Order written in this case by the assigned Judge will be quite candid. The Court is not going to be happy with this case. 

Now for some unsolicited comments: If someone like the Plaintiff came to my office to discuss a possible lawsuit like this, I'd ask him/her these questions: Are you prepared - as a recent law grad trying to build a practice - to spend the next 2-5 years emotionally involved in this litigation? Are you ready to have potential clients read about the lawsuit on the internet, and answer questions in detail? Are you ready to advance what may be as much as $75,000 in the first 24 months of this litigation for costs? Have you thought through the possible implications on your law license? Your malpractice insurance?Your office life? Are you ready to open up your earnings, your client lists, your finances and credit history as part of proving damages? Are you ready to have your law life go under the microscope? Do you really want all of that?


Disclaimer: I do not practice criminal law. I'm a consumer lawyer with more than 20 years of experience. I am a litigator and have tried three cases to verdict in 2011. I serve as lead counsel in mass tort cases and am currently on the Steering Committee for the In Re Hydroxycut Litigation MDL proceedings pending in San Diego, among other cases. I do not handle defamation cases, but I do read the law.  

No to Avastin for ROP?

There is news this week on a recent article titled: On the use of antiangiogenetic medications for retinopathy of prematurity. 


From the article: 

In contrast to the adult, the third trimester fetus experiences one of the most intense periods of growth and maturation of its lifetime. Early development is characterized by the existence of critical periods when environmental factors effectively produce long lasting changes.

Proliferative Retinopathy of Prematurity (ROP) is a potentially blinding disease characterized by uncontrolled retinal angiogenesis. This pathologic angiogenesis is the target for two new treatment modalities for retinopathy of prematurity (ROP) i.e. intravitreal anti VEGF (bevacizumab) and systemic propranolol, which are being evaluated in ongoing or planned studies. VEGF is essential for normal angiogenesis in a growing infant and the adrenergic system is important for many organ systems and, in addition, for plasticity of the visual and olfactory systems.

Conclusion:  This viewpoint raises concerns regarding the currently studied antiangiogenetic treatments for ROP and their possible general effects on the developing preterm infant.

Source. 

There may be some question that Avastin is a source of treatment instead of laser therapy to cure retinopathy of prematurity. It's important to discuss this medication to treat r.o.p.

HARO vs. SEBELIUS: UNITED STATES DISTRICT COURT DISTRICT OF ARIZONA

On May 9, 2011 in the United States District Court for the District of Arizona, some substantial guidance was obtained on two very important questions affecting the application of the Medicare Secondary Payer Act (“MSP”): 

 

1)      Whether or not the Center for Medicare and Medicaid Services (“CMS”) can require prepayment of an MSP reimbursement claim (often times referred to as “conditional payment”) before the correct amount is administratively determined when a beneficiary either appeals or seeks a waiver of that MSP Reimbursement amount; and

 

2)      Whether or not CMS can hold plaintiffs-attorneys financially responsible for MSP reimbursement if they do not hold or immediately turn over to Medicare their clients’ injury compensation awards. 

 

The following paragraphs set out the main findings of law by the Court on the issues set out above.

 

As to the first question, the Court found that the CMS’s application of the 60-day reimbursement requirement to support immediate collection activities against beneficiaries when the reimbursement claim is in dispute is neither rational nor consistent with the statutory scheme providing for waiver and appeal rights.   The Court went on to state that this collection practice  is not permissible because it unnecessarily chills a beneficiary’s right to seek a waiver or to dispute the reimbursement claim and reaches beyond the fiscal objectives and policies behind the 60-day reimbursement provision.

 

As to the second question, There is no statutory authority, express or implied, to support a direct action against attorneys, except to the extent they are end-point recipients of settlement proceeds.  Unlike any other claim against an end-point recipient of third-party insurance proceeds, a reimbursement claim against an attorney seeks to recover property from another “entity”.  The Court based its finding on the fact that an attorney’s fees and expenses are another entities property due to CMS recognition of procurement cost offsets under 42 CFR §411.37(c).  An attorney only retains as a right or entitlement an interest in that portion of settlement proceeds that pay for his or her services, and that the attorney maintains no right or entitlement to retain any other portion of the settlement awarded his client.

 

CONCLUSION: The Court found that CMS may not collect disputed reimbursement claims from beneficiaries or their attorneys, pending resolution of waiver requests and appeals, and it may not preclude plaintiffs’ attorneys from disbursing undisputed portions of settlement proceeds to their beneficiary clients. The Court ruled as a matter of statutory construction and did not consider Plaintiffs’ due process clause arguments.

FDA Warns Not to Feed SimplyThick to Premature Infants

Image via WikipediaDo not feed the thickening product called SimplyThick to infants born before 37 weeks because it may cause a life-threatening condition.

This advice to parents, caregivers, and health care providers from the Food and Drug Administration (FDA) is based on reports of infants with necrotizing enterocolitis (NEC) in which tissue in the intestines becomes inflamed and dies.

SimplyThick is a brand of thickening agent—available to consumers and medical centers—to help manage swallowing difficulties. It is sold in packets of individual servings and in 64-ounce dispenser bottles. The product can be purchased from distributors and local pharmacies throughout the United States.
Benson M. Silverman, M.D., director of FDA’s Infant Formula and Medical Foods Staff—himself a neonatologist—explains that the thickening agent is added to breast milk and infants’ formula to help the premature babies swallow their food and keep it down, without spitting up. The product is also used in older children and adults with swallowing problems caused by trauma to the throat, he notes.

 

The Problem

FDA first learned of bad side effects possibly linked to SimplyThick on May 13, 2011. Silverman says he was alerted by two reports in FDA’s MedWatch Adverse Event Reporting system. He followed up with the physicians who filed those reports and subsequently with a network of other neonatologists.
Karl Klontz, M.D., a medical officer in FDA’s Center for Food Safety and Applied Nutrition, says the severity and scope of the problem soon became apparent. To date, the agency is aware of 15 cases of NEC, including two deaths, involving premature infants who were fed SimplyThick mixed with mothers’ breast milk or infant formula products. The mixture was fed to infants for varying amounts of time.
At least four different medical centers around the U.S. have reported the illness in infants who became sick over the past six months.
This situation is unusual because NEC most often occurs in babies while they are in the hospital early in their premature course. But some of the ill babies that FDA is aware of got sick after they had been discharged from the hospital and sent home on a feeding regimen that included SimplyThick.
At this time it is not known what about SimplyThick is making babies sick. FDA is actively investigating the link between SimplyThick and these illnesses and deaths.

Symptoms to Watch for

• bloated stomach
• greenish-tinged vomiting
• bloody stools

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm256250.htm

Globe All Wellness, LLC Issues Recall of Dietary Supplement Slim Xtreme™ - Found to Contain an Undeclared Drug Ingredient

From the FDA.gov

May 24, 2011 - Globe All Wellness, LLC has been informed by the Food and Drug Administration (FDA) that one of the company’s weight loss dietary supplements that was sold by a seller that was not authorized by Globe All Wellness, LLC to sell the product contains an undeclared drug ingredient. FDA lab analyses of this dietary supplement was found to contain undeclared Sibutramine. The FDA has not approved Sibutramine; therefore the safety and effectiveness of this product is unknown.
All lots of the following dietary supplement products are being recalled:

Slim Xtreme™ Herbal Slimming Capsule 30 Capsules/Bottle

The products listed above were sold and distributed nationwide via the internet and at the company’s headquarters in Hollywood, Florida. The FDA advises that this product poses a threat to consumers because Sibutramine is known to substantially increase blood pressure and/or pulse rate in some patients and may present a significant risk for patients with a history of coronary artery disease, congestive heart failure, arrhythmias or stroke.

No illnesses or injuries have been reported to Globe All Wellness, LLC to date in connection with this product.

With abundance of caution, Globe All Wellness, LLC is voluntarily recalling all lots of SLIM XTREME™ from the market as a precautionary measure.

This recall does not affect the sales and distribution of Globe All Wellness, LLC’s other products such as SLIM XTREME GOLD™ or GELSLIM™.

Globe All Wellness, LLC has taken this voluntary action because it is committed to providing accurate information about its products and because of the concern for the health and safety of consumers. Globe All Wellness, LLC is working with the FDA in the recall process. It sincerely regrets any inconvenience to customers.

More signs that a diabetes drug is linked to bladder cancer?

 
Between 2004 and 2009, more than half a million adverse reactions among people taking anti-diabetic drugs were added to an official U.S. Food and Drug Administration database. Among those reports were 138 instances of bladder cancer in patients taking at least one of more than 15 different anti-diabetic drugs.
However, more than a fifth of those bladder cancers were in patients taking Actos (pioglitazone), suggesting a "disproportionate risk" in comparison with other anti-diabetics, said study author Dr. Elisabetta Poluzzi of the University of Bologna in Italy.

The article is: "Assessing the Association of Pioglitazone Use and Bladder Cancer Through Drug Adverse Event Reporting" and may be found here. 

Here is the abstract:

OBJECTIVE To analyze the association between pioglitazone use and bladder cancer through a spontaneous adverse event reporting system for medications.

RESEARCH DESIGN AND METHODS Case/noncase bladder cancer reports associated with antidiabetic drug use were retrieved from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) between 2004 and 2009 and analyzed by the reporting odds ratio (ROR).

RESULTS Ninety-three reports of bladder cancer were retrieved, corresponding to 138 drug-reaction pairs (pioglitazone, 31; insulin, 29; metformin, 25; glimepiride, 13; exenatide, 8; others, 22). ROR was indicative of a definite risk for pioglitazone (4.30 [95% CI 2.82–6.52]), and a much weaker risk for gliclazide and acarbose, with very few cases being treated with these two drugs (6 and 4, respectively).

CONCLUSIONS In agreement with preclinical and clinical studies, AERS analysis is consistent with an association between pioglitazone and bladder cancer. This issue needs constant epidemiologic surveillance and urgent definition by more specific studies. 

source

Georgia: Amoxilina Recalled by FDA (May 16, 2011)

Image via WikipediaMulti-Mex Distributor Inc., of Tucker, Ga., is recalling dietary supplements whose packaging appears to be an intentional marketing ploy to mimic antibiotics and may be directed at Hispanic buyers, according to the Food and Drug Administration.

The products were distributed to retail stores and distributors in Texas, Georgia, Tennessee, California, Illinois, North Carolina, South Carolina, Colorado and Indiana.

 
The FDA inspected the full range of products from Multi-Mex and recalled all of them, including Amoxilina.

Multi-Mex products are in U.S. stores with names that sounded very similar to names in México, including Bisolbom (Bosilvon), Vermex (Vermox), Neolubrina (Neomelubrina), Pentreximil (Pentrexil), Sinalar (Synalar), Terramocina (Terramicina) and Vitaderogil (Aderogil15).

http://www.brownsvilleherald.com/news/dietary-126527-supplements-company.html

Procrit: Does Drug Worsen Heart Attacks?

Image by gandhiji40 via Flickr People who have been administered via IV the drug erythropoietin alfa after suffering a heart attack could allegedly be at risk for new heart problems and possible greater cardiac damage from the attack if a new study is accurate.

The drug has been prescribed for people who had prior heart attacks patients because certain studies suggested it might reduce the extent of heart attack damage.



Find the report here:
http://jama.ama-assn.org/content/305/18/1863.short

Texas AG's Office: Companies Misleading Latinos with Amoxilina

From Latino Fox News: 

'Companies from Texas and Georgia were misleading mostly Latino consumers by selling a dietary supplement whose name is nearly identical to the Spanish translation of a widely popular antibiotic, Texas authorities said.

Now the Texas attorney general's office is suing the companies, claiming their marketing tactics is deceiving consumers. The suit, filed last week in state district court, says the companies further their marketing ploy by making the packaging similar to that of Amoxicillin.

The antibiotic, Amoxilina, was once available in Mexico without a prescription.'

Read more: http://latino.foxnews.com/latino/health/2011/05/09/texas-ags-office-sues-antibiotics-marketed-latinos/#ixzz1LtSkbon3

Multi-Mex Distributor Inc. Announces Recall of Dietary Supplements

Image via Wikipedia
From the FDA:


Multi-Mex Distributor, Inc., Tucker, GA is recalling dietary supplements that may be labeled as antibiotic drugs.

The products were distributed in the following states: Georgia, Tennessee, California, Illinois, Texas, North Carolina, South Carolina, Colorado, and Indianapolis, to the retail store and distributors.

The following products are being recalled:

ITEM	Usos	UPC #
AMOXILINA CAPSULS 500 mg (30 Caps)	Suplemento Dietetico	619114010081
AMOXILINA SUSPENSION (3.4 oz)	Suplemento Dietetico	619114010074
BISOLBOM JARABE ADULTO (4.06 oz)	Suplemento Dietetico	619114010104
BISOLBOM JARABE NIÑO (4.06 oz)	Suplemento Dietetico	619114010198
CALCIO + D LIQUIDO ADULTO (8 oz plastic bottle)	Suplemento Dietetico	619114010388
CALCIO + D LIQUIDO INFANTIL (8 oz plastic bottle)	Suplemento Dietetico	619114010371
M. VERMEX  (6 TABLETS)	Suplemento Dietetico	619114010302
M. VERMEX  (1 TABLET)	Suplemento Dietetico	619114010326
M. VERMEX  (1 oz)	Suplemento Dietetico	619114010319
NEOLUBRINA  JARABE (3.38 oz) Syrup	Suplemento Dietetico	619114010234
NEOLUBRINA TABLETAS 500 mg (10 tablets)	Suplemento Dietetico	619114010241
PENTREXIMIL PLUS 500 mg (30 CAPS)	Suplemento Dietetico	619114010012
PENTREXIMIL PLUS Syrup 3.4 oz	Suplemento Dietetico	619114010050
SINALAR GOTAS NARIZ (0.5oz) Drops	Suplemento Dietetico	619114010067
SINALAR GOTAS OIDOS (0.5oz) Drops	Suplemento Dietetico	619114010036
SINALAR GOTAS OJOS (0.5 oz) Drops	Suplemento Dietetico	619114010029
TERRAMOCINA CAPSULAS 500 mg (30 Caps)	Suplemento Dietetico	619114010296
VITADEROGIL GOTAS INFANTIL (0.5oz) Drops	Suplemento Dietetico	619114010142
VITADEROGIL JARABE ADULTO (5 vials inside)	Suplemento Dietetico	619114010159

Warnings of these dietary supplements made news in Texas on Thursday, April 28th, when four children were taken to a Medical Center due to worsening illnesses after being given dietary supplements the parents may have believed were antibiotics and which were packaged to resemble antibiotics that are readily available as over the counter drugs in Mexico. Giving the dietary supplement delayed legitimate medical treatment. Although the labels were printed in English and Spanish, the packaging appears to be an intentional marketing ploy to mimic antibiotics and directed at Hispanic buyers. It was determined the children had been given a dietary supplement, Amoxilina, which the parents may have believed was the antibiotic Amoxicillin.

Image via WikipediaThe makers of cold and fever medications that contain the painkiller acetaminophen said Wednesday night that they will discontinue infant-drops versions of the products to avoid confusion that might lead to overdoses, the Associated Press reported.


Once production ends, later this year, the companies will sell just one formula for all children under the age of 12. Companies such as Johnson & Johnson currently sell infant versions of the drugs (80 milligrams) that contain half the amount of acetaminophen found in regular children's formulas, the news service said.
Acetaminophen is a widely used drug found in a variety of products that helps to ease pain and reduce fever.


The manufacturers' announcement preceded a U.S. Food and Drug Administration meeting scheduled for later this month, at which time agency advisers will consider whether clearer instructions and safety labeling are needed for products containing acetaminophen that are marketed for children younger than 2 years of age, the news service said.

Source here. 

Four Loko Lawsuit News

Image by Getty Images via @daylifeA New Jersey man who says he suffered permanent heart damage after drinking the alcohol- and caffeine-laced Four Loko beverage is suing its manufacturer.


.
The lawsuit, first reported last week by The Press of Atlantic City, claims that during a visit to Atlantic City in October, Mustica drank 2 1/2 cans of Four Loko and suffered heart arrhythmia.
Each can of Four Loko contains 12 percent alcohol — the equivalent of three cans of beer.
Phusion spokesman Chris Hunter declined to comment Monday to The Star-Ledger of Newark but says the company still believes mixing alcohol and caffeine is safe. Phusion agreed to remove caffeine from the drink in November after complaints from the Food and Drug Administration.

Source here. 

Regenerect Recall News May 4, 2011

Image via WikipediaFrom the FDA

Ethos Environmental, Inc. announced today that it is conducting a voluntary nationwide recall of the company’s dietary supplement sold under the brand name Regenerect with the following Lot Numbers:

Regenerect Lot Numbers:
100521 - blue capsule sold individually in foil packets, expires 5/2012
112850 - clear capsule sold individually in foil packets, expires 11/2013

Ethos Environmental, Inc. is conducting a voluntary recall because FDA lab analysis has confirmed the presence of Sulfoaildenafil, an analogue of Sildenafil, making these products unapproved new drugs. Sildenafil is an FDA-approved drug used as treatment for male Erectile Dysfunction (ED). The active drug ingredient is not listed on the label for these products.

According to the FDA, use of these products may pose a threat to consumers because the analogue may interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous levels. FDA has advised that consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. FDA has advised that ED is a common problem in men with these conditions, and consumers may seek these types of products to enhance sexual performance.

Ethos Environmental, Inc. has distributed Regenerect via sales made over the internet to consumers in the United States of America and Puerto Rico.

Ethos Environmental, Inc. advises any customers in possession of the Regenerect product matching the lot numbers above to return any unused product for an exchange, or a full refund, to the company directly. Customers can call (866) 925-9553 (Monday through Friday from 6am to 6pm Pacific Time) for instructions on the return and exchange/refund process.
Ethos Environmental, Inc. is committed to improving its products and avoiding future recall issues by improving testing procedures. Ethos Environmental, in an effort to be abundantly cautious, is issuing a voluntary recall on the two lots, mentioned above, that did not comply with the newly adopted testing protocol of Ethos Environmental. The Company’s testing protocol and test results will be available on the Company’s website for all consumers. Any consumers requesting an exchange of product from the two lots in question will be receiving Regenerect product that has been subjected to the Company’s new testing procedures. Ethos Environmental promises its customers the highest possible quality and welcomes the recall process as further evidence of our commitment to our brands, products and consumers.

Synthroid, Levoxyl, Levothroid, Unithroid and a New Study Regarding Fracture Risk?

Some senior citizens could face an increased risk for fractures if they ingest excessive doses of drugs used to treat thyroid problems - so says a new study.


You can find the information here: BMJ online. The article's title is:Levothyroxine dose and risk of fractures in older adults: nested case-control study:

From the abstract:

Main outcome measure Primary outcome was fracture (wrist or forearm, shoulder or upper arm, thoracic spine, lumbar spine and pelvis, hip or femur, or lower leg or ankle) in relation to levothyroxine use (current, recent past, remote). Risk among current users was compared between those prescribed high, medium, and low cumulative levothyroxine doses in the year before fracture. 

Results Of 213 511 prevalent levothyroxine users identified, 22 236 (10.4%) experienced a fracture over a mean 3.8 years of follow-up, 18 108 (88%) of whom were women. Compared with remote levothyroxine use, current use was associated with a significantly higher risk of fracture (adjusted odds ratio 1.88, 95% confidence interval 1.71 to 2.05), despite adjustment for numerous risk factors. Among current users, high and medium cumulative doses (>0.093 mg/day and 0.044-0.093 mg/day) were associated with a significantly increased risk of fracture compared with low cumulative doses (<0.044 mg/day): 3.45 (3.27 to 3.65) and 2.62 (2.50 to 2.76), respectively.

The Myth that "Social Media" is a must for Attorneys (Solo, Small Firm, Big Law)

PT Barnum I rarely write about Social Media. We blog (obviously), have a Twitter account, and post on other blogs - mostly with posts that relate to Georgia law and/or pharmaceutical litigation news. Our office is made up of litigators. We try cases- I am in trial Tuesday of this week for the third time this year.

I regularly read about what marketers and other lawyers say about Social Media. The so called social media are for the most part nothing more than  carnival barkers. What I have just read has me irritated because the post's author is just plain wrong and uninformed.

I read an article titled: Small Firms, Big Lawyers: 7 reasons to Avoid Social Media

From the start the author (Jay Shepherd)  points to a recent report that "had a section about which marketing methods solos and small firms found most effective." Shepherd commented on this report:

"The leading methods were:

• online directories (17.7%);
• word of mouth — which isn’t really a method, but more of a thing that happens (15.5%);
• group-advertising ventures (whatever the hell that is) (13.3%); and
• Yellow Pages (8.9%).

"The takeaway for me from that list is that small-firm lawyers don’t know what they’re doing when it comes to marketing." (emphasis added)

“Word of mouth” means sit back and hope someone tells someone else to hire me, “group-advertising ventures” sounds like some sort of mail-order scam, and I didn’t know they still printed Yellow Pages. ... (Sorry, Yellow Pages advertisers. Oh, wait. You’re not reading this because you’re offline.)"

Jay, you're wrong. First -You obviously don't mind putting down practices  you know nothing about  - 'group-advertising ventures" have been around for years. The ventures may look like the Jim Sokolove model, or Staggerwalt and Associates, or others. Surely you have heard about the Texas group that advertises for IP clients on the web. You knew about those firms, right Jay? Or how www.findlaw.com touts its mass buying power on the web to garner better placement for little ol' small firms like mine.

For our office 'group advertising ventures' in the personal injury area of the law might look like a true 'joint venture' - Anywhere from two to seven  law firms form a group that advertises on the web, radio, tv, or newspapers for a particular type of case . (For example, Katrina levee related property damage claims, or those seeking Dupuy knee work).Our firm gets approached at least 3 times a week by ventures seeking our $$$.  OK, dead horse beaten, on to next mistake.  
   

I don't understand your disdain for word of mouth - maybe you stammer in public, or are too arrogant to mix with 'the common folks.' In the south, word of mouth is proactive.

Word of mouth is speaking at a CLE on any area of the law - like trucking. My good friend and litigator Joe Fried is known simply as The Trucking Lawyer. He will speak at more than 30 CLE seminars this year. Here's his site: http://www.thetruckingattorneys.com. Before you scoff, does your firm have more than $25 million in verdicts like his - in the past 10 months? Clients come to him thanks to word of mouth. Lawyers send him work thanks to word of mouth - where he engages people and talks about his results.
  

Word of mouth is the stock in trade for many smaller town attorneys. Rotary clubs, schools groups, alumni groups, lawyer groups, church groups, bible studies, business chambers - that is where word of mouth works.  In my trial last month - in a tech city that is Atlanta - of 34 potential jurors less than 20% had heard of Twitter, but more than 75% were members of a civic or church group.  

We both agree on the Yellow Pages. If you have received a call from 'the books' you'd know that there is a reason why only 8.9% admitted to paying for placement. In fact, I'd guess that 8.9% of any town's lawyers are on Twitter at all.  

To my amazement, there is still an area not yet at the forefront for lawyers on the web - blogging. It is by far the most successful project my firm has taken on in the past 5 years. Our firm has three separate blogs.

Where is an area with little competition? Specialty sites for niche areas of the law. If you are not familiar with this type of site, go ahead and crap on it, Jay.  For others reading this, take a look at  the lawyers at Water Colorado: http://www.watercolorado.com/water_rights2.shtml or attorneys who handle cattle cases:  http://cattlelawyers.com/default.aspx

Specialty sites should be part of a law firms' tech arsenal long before any Twitter account is set up by an attorney. Web sites now are easy to set up and maintain. If for example, someone needs an immigration attorney in the Vietnamese community, what makes a better first impression - a site focused on that ethnic group, or a site that has a law firm with a .jpg of a gavel, and a nav bar with 22 areas of the law?  Spend 20 hours looking at the competition for the type of work your firm wants - and then set up a site in that area alone.    




Now, on to Twitter: Lawyers who get hornswaggled or even brow beaten into thinking Twitter is a must have should be ashamed of themselves for being so damned gullible. But hey, Jay, lead them to Twitter and away from blogging - hours and hours of time will be wasted on Twitter.

You wrote: "But I can connect to 2,345 people at once on Twitter and tell them about something that’s on my mind or that I think they should read.It would take a lot more time to make all those phone calls or have random acts of lunch." Read this though Jay - 99% of those people don't  really care about your one tweet. It's just noise. 


Here's a thought for attorneys - spend more than an hour a month just updating the firm web page. Learn Google Ad Words. Buy a google ad just for your firm name. Buy a .com that is the same as your office telephone number. Learn the basics of the web - before you get seduced by the allure of Twitter.

Find a listserver somewhere - GTLA has one, the Florida Justice has one - and get active there - post on subjects. Comment, engage.  

Those basics - along with word of mouth - will bring results with hard work and discipline.