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Ethicon Media Monitoring 3/18/2019
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California Jury Awards $29m to Woman Who Said Johnson & Johnson Talc Caused Mesothelioma
Mar 18, 2019 | British Medical Journal
By Owen Dyer
...The company has also recently faced expensive litigation over vaginal mesh devices and metal hip implants. -
Pelvic Health Focus of ‘Integrative’ Physical Therapy Center
Mar 18, 2019 | WRAL MassLive
By Anne-Gerard Flynn
Physical therapist Patricia J. Young believes in health care that treats the whole person and that is the approach at Restore Physical Therapy and Wellness Center that she founded and owns in Hadley.
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California Jury Awards $29m to Woman Who Said Johnson & Johnson Talc Caused Mesothelioma
Mar 18, 2019 | British Medical Journal
By Owen Dyer
Johnson & Johnson must pay $29m (£22m; €26m) to a California woman who was given a diagnosis of mesothelioma after using the company’s talcum based products for years, a further blow to a company that still faces nearly 13 000 similar lawsuits across the United States.
Terry Leavitt told the court that she used Johnson’s Baby Powder and another company product called Shower to Shower through the 1960s and 1970s. Her mesothelioma was diagnosed in 2017.
The jury in Oakland’s superior court found that the products were defective and that consumers had not been warned of the risks, awarding Leavitt $29.4m in damages.
“We respect the legal process and reiterate that jury verdicts are not medical, scientific, or regulatory conclusions about a product,” Johnson & Johnson said in a statement. “We are disappointed with this verdict and will pursue an appeal because Johnson’s Baby Powder does not contain asbestos or cause cancer.”
The ruling was seen as ominous for the pharmaceutical giant, which began its talcum litigation fight with a series of victories but has now suffered several consecutive losses.
The verdict is the first since a report by Reuters and the New York Times in December claimed, on the basis of thousands of internal company documents, that the company knew from at least 1971 that its baby powder contained asbestos but kept the fact secret.1
Payouts in talcum litigation have been substantial. A New Jersey man who developed mesothelioma was awarded $117m last April. Last July in Missouri a jury awarded $4.7bn to 22 women with a diagnosis of ovarian cancer.2 Most of the nearly 13 000 talcum related lawsuits against Johnson & Johnson seek damages for ovarian cancer, but about 900 involve claims for mesothelioma.
Even these payouts were dwarfed by the roughly $40bn loss in the company’s market capitalisation as its shares tumbled by more than 10% in the hours after publication of the December report.
Further blows have followed. Last month Imerys Talc America, a key supplier of Johnson & Johnson’s mineral talcum and a co-defendant in litigation, filed for chapter 11 bankruptcy, seeking protection from over 10 000 pending lawsuits.
Also in February Johnson & Johnson disclosed in its annual report that it had received subpoenas from the Justice Department and the Securities and Exchange Commission. The federal inquiries “are related to news reports that included inaccurate statements,” the company said, a reference to the Reuters and New York Times allegations, which it has called false.
On 12 March the talcum issue came before the US Congress for the first time, in hearings before the House Subcommittee on Economic and Consumer Policy. The epidemiologist Anne McTiernan told members of Congress that she had reviewed 38 “high quality studies” done over the past 40 years.
She said, “Data consistently shows that women who had ever used talcum powder products in the genital area had a statistically significant 22% to 31% increased risk of developing ovarian cancer compared with women who had never used them.” Johnson & Johnson called the testimony biased, noting that she had been an expert witness in litigation against the it.
The company has also recently faced expensive litigation over vaginal mesh devices and metal hip implants.34
References
↵Dyer O. Johnson & Johnson knew for decades talcum powder contained asbestos, reports allege. BMJ2018;363:k5430.doi:10.1136/bmj.k5430 pmid:30593486FREE Full TextGoogle Scholar
↵Dyer O. Jury awards $4.7bn damages against Johnson & Johnson in talcum cancer case. BMJ2018;362:k3135.doi:10.1136/bmj.k3135 pmid:30012582FREE Full TextGoogle Scholar
↵Dyer O. Johnson and Johnson faces lawsuit over vaginal mesh devices. BMJ2016;353:i3045.doi:10.1136/bmj.i3045 pmid:27233292FREE Full TextGoogle Scholar
↵Dyer O. Johnson and Johnson pays $120m to settle hip implant claims from 46 US states. BMJ2019;364:l402.doi:10.1136/bmj.l402 pmid:30679188FREE Full TextGoogle Scholar
https://www.bmj.com/content/364/bmj.l1215
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Pelvic Health Focus of ‘Integrative’ Physical Therapy Center
Mar 18, 2019 | WRAL MassLive
By Anne-Gerard Flynn
Physical therapist Patricia J. Young believes in health care that treats the whole person and that is the approach at Restore Physical Therapy and Wellness Center that she founded and owns in Hadley.
The center’s staff helps patients dealing with a variety of musculoskeletal and orthopedic conditions, but Young’s specialty focuses on what is called the pelvic floor where muscles work to support organs related to sexual performance and childbirth as well as bodily functions related to waste elimination.
roblems such as incontinence of the bladder and bowel, organ prolapse and separation of the abdominal muscles are among common pelvic floor disorders.
Causes may include disease, hormonal changes, injury as well as aging, pregnancy and childbirth and participation in high impact sports.
It is estimated that one-quarter of women face pelvic floor disorders.
Physical therapists like Young specializing in pelvic floor disorders evaluate and treat patients through protocols that do not involve surgery or medication.
Young refers to her practice as an "integrative pelvic health center."
“It is integrative because we treat the whole body in terms of evaluation - not just a body part - and consider nutrition, mindfulness, acupuncture, pain management and lifestyle as part of the plan of care for everyone who comes for care,” Young said.
"We have an interdisciplinary referral source to support our work when needed such as psychotherapists, family practice primary care providers,naturopathic doctors, urogynecologists, obstetricians/gynecologists, midwives and doulas. We also have referrals with urologists and gastroenterologists."
The center offers ongoing wellness classes as well.
"The essence of pelvic health is to empower women and men through education and sound clinical rationale/treatment with the tools needed for good self-care so they can live a worry-free and pain-free life," Young said.
A graduate of the University of Massachusetts-Amherst, Young earned her master's degree at Springfield College and her doctorate of physical therapy at Philadelphia's Temple University.
She was asked in the following interview further about pelvic health and its treatment in women at her center.
Q. What do the pelvic floor muscles support and how might they become weakened after childbirth or as women age?
A. The pelvic floor muscles provide support for the uterus, bladder and bowel. These muscles are formed in a sling-like fashion from front to back and side to side. You can look at this muscle arrangement as scaffolding for the weight of the insides of your pelvis, a foundation if you will.
There are openings in these muscles: the vagina to the uterus, the urethra to the bladder and the anus to the bowels. However, in an even broader picture, the pelvic floor is a group of muscles that work in conjunction with the rest of your pelvic muscles, such as your gluteals (buttocks), low-back and abdominal muscles, and are also affected by your knees and ankles.
When you stand-up and walk you need all of these muscles to work together. So, you need to consider how the pelvic floor functions in relationship to your posture, weight, how you breathe, your hormones, how you walk, how you lift and carry, as well as your diet and stress levels.
If you address pregnancy and childbirth specifically, you have to note the many changes a woman's body goes through. There is a tremendous increase in pelvic floor stress with the growth of the baby. This causes pressure on bowel and bladder as the woman's center of gravity shifts. She may experience pain in low back, groin and in the pubic bone area.
During pregnancy she may also have increased urinary frequency and incontinence or constipation due to this pressure on bowel and bladder and of course the pelvic floor can become fatigued.
During vaginal childbirth, the hormone relaxin causes the joints and ligaments of the pelvis to slacken in order to accommodate the descension of baby. The pelvic floor muscles are also relaxed and stretched during this time. How much so really depends on the individual and her circumstances.
Women do heal well but have to remember it takes a few months to initiate the healing process and up to two years if the woman is breastfeeding or if there are other factors to consider.
The center offers ongoing wellness classes as well.
"The essence of pelvic health is to empower women and men through education and sound clinical rationale/treatment with the tools needed for good self-care so they can live a worry-free and pain-free life," Young said.
A graduate of the University of Massachusetts-Amherst, Young earned her master's degree at Springfield College and her doctorate of physical therapy at Philadelphia's Temple University.
She was asked in the following interview further about pelvic health and its treatment in women at her center.
Q. What do the pelvic floor muscles support and how might they become weakened after childbirth or as women age?
A. The pelvic floor muscles provide support for the uterus, bladder and bowel. These muscles are formed in a sling-like fashion from front to back and side to side. You can look at this muscle arrangement as scaffolding for the weight of the insides of your pelvis, a foundation if you will.
There are openings in these muscles: the vagina to the uterus, the urethra to the bladder and the anus to the bowels. However, in an even broader picture, the pelvic floor is a group of muscles that work in conjunction with the rest of your pelvic muscles, such as your gluteals (buttocks), low-back and abdominal muscles, and are also affected by your knees and ankles.
When you stand-up and walk you need all of these muscles to work together. So, you need to consider how the pelvic floor functions in relationship to your posture, weight, how you breathe, your hormones, how you walk, how you lift and carry, as well as your diet and stress levels.
If you address pregnancy and childbirth specifically, you have to note the many changes a woman's body goes through. There is a tremendous increase in pelvic floor stress with the growth of the baby. This causes pressure on bowel and bladder as the woman's center of gravity shifts. She may experience pain in low back, groin and in the pubic bone area.
During pregnancy she may also have increased urinary frequency and incontinence or constipation due to this pressure on bowel and bladder and of course the pelvic floor can become fatigued.
During vaginal childbirth, the hormone relaxin causes the joints and ligaments of the pelvis to slacken in order to accommodate the descension of baby. The pelvic floor muscles are also relaxed and stretched during this time. How much so really depends on the individual and her circumstances.
Women do heal well but have to remember it takes a few months to initiate the healing process and up to two years if the woman is breastfeeding or if there are other factors to consider.
With regard to the aging process, not only do women have changing hormones and loss of muscle mass but they also have established both supportive and not-so-supportive habits/behaviors.
It is important for women to have proper exercise and diet. Both are necessary for pelvic floor health because proper core strength and ease of bowel movements are essential in avoiding stressing the pelvic floor.
Q. Many women are said to have urinary incontinence as a result of weakened pelvic floor muscles and Kegel exercises are often recommended. How difficult is it to strengthen these muscles?
A. It is often believed that women leak because they have weak pelvic floor muscles. That is not always the case.
Yes, sometimes a woman is weak throughout her buttocks, hips, back and abdominals and the pelvic floor as well.
However, there are other times when the pelvic floor is actually in high tone or too tight. In this case, it is her other pelvic muscles that are not supporting the pelvic floor. Consequently, the pelvic floor has too many demands on it and leaking occurs.
These women may also have pelvic pain in addition to leaking.
This is why Kegels should not be go-to exercises for all women who leak. The whole picture has to be assessed. Just doing Kegels for a weak pelvic floor is not the answer which is why so many women get frustrated when they don't see results from doing just these exercises.
If the exam reveals that these contraction exercises of the pelvic floor are also needed, then patients are taught how to properly do the contraction. Often times people cannot connect with the pelvic floor muscles or only do so partially which is not effective.
Q. What are some of the treatment options you offer at the center for this condition?
A. When treating women for urinary incontinence we use a whole-body approach. A client will first have an orthopedic physical therapy exam where posture, walking, balance, reflexes, sensation and muscle strength are checked in standing, seated and lying down.
Then a pelvic floor exam is done and carefully explained. A patient always has the option of declining the internal part of the exam that is done to assess muscle volume as well as the muscles' ability to contract and relax, joint movement, pain points, sensation and skin integrity.
In gathering all this information, we then have the ability to decide how to approach a woman's problem. Is it stress? Is it weakness or a challenging walking pattern? Is she extremely weak in one area?
The approach to treatment always incorporates manual therapy, that is, bodywork, exercises/stretching, as well as discussion of diet and self-care. In other words, it is not usually one factor that contributes to this problem.
The pelvic floor physical therapist clarifies the factors contributing to the patient's concerns and empowers her to make positive changes.
Q. Once a woman has weakened pelvic floor muscles how long does it take to correct this problem and is there a need to continue to address their strengthening in an ongoing way?
A. There are many factors that play into correcting this problem but with consistent attention to the exercise program and lifestyle changes one can see improvement in several weeks and know what factors in her life exacerbate the problem.
Q. What advice do you give women to avoid the issue of weakened pelvic floor muscles, and is there something that pregnant women can do to lessen this issue?
A. Keeping an active lifestyle with attention to your pelvic floor is important. There are women who love to run and some have no problems with it but others I recommend walk uphill. Get your heart rate up for a good cardio workout without the pounding of running. Learn basic core stability exercises that do not put extra pressure on the pelvic floor.
Maintaining a healthy body weight is important as increased weight puts more pressure on the pelvic floor. Don't get constipated. Pushing and straining also puts adverse forces on your pelvic floor.
Pregnant women need to have access to pelvic floor physical therapy to help with low-back and pelvic pain or other concerns they may have. There are exercises and manual work a therapist can do to help a woman feel more comfortable during this time.
Having a good prenatal exercise program helps a woman be more in touch with her body and how to support the pelvic floor. All my pregnant clients come back for postpartum care to restore and replenish their bodies.
Q. What are some of the other most common issues that you help women address at your center?
A. I also treat people who have pain with sex, pelvic organ prolapse, diastasis recti, digestive issues, bladder pain, pubic and coccyx pain, low back and hip pain.
My colleague Paul Warner focuses on the athlete in the 40s- to 60s- age range who wants to stay in best shape without injury.
Carla Becker, a former dancer, loves to work with people who have movement challenges and uses Pilates as part of her physical therapy treatment.
We can co-treat with patients who would really benefit from another physical therapist's approach.
Q. When did you open your center and what inspired it? What need do you feel you were meeting in the community in terms of women's health care and why a trauma-based approach to some issues?
I opened my clinic a little over six years ago. I was inspired to do so based on some of the events I experienced during my child-bearing years and in talking to other women about the challenges they have had in health care.
Every person wants to be heard and have a choice about how to best resolve their impairment. I want to offer health care without the use of drugs, injections, or surgery for those who seek that avenue. Most importantly, I want to work collaboratively with the patient.
I also work with other disciplines I can refer out to if needed such as psychotherapy, nutrition and acupuncture.
A trauma-based approach is essential in working in pelvic floor physical therapy as often times a person's source of pain is from an earlier traumatic event or events in their lives. Trauma can also make physical therapy challenging or limited. If this is noted, we ask that if the patient is not currently working with a psychotherapist, that she connects with one.
Doing pelvic floor work can trigger people with a trauma history and we want a woman to have all the support she needs while participating in treatment so she can receive her best possible outcomes.
Q. How has the center grown and has it grown in any ways that you did not expect?
A. The center has grown organically in that we have made an amazing network of incredible people in the community. We have so many family members, friends and colleagues of patients who are an important part of Restore.
The doulas and midwives in the Valley have been invaluable resources for prenatal and postpartum clients. Our interdisciplinary colleagues are supportive and insightful, allowing us to provide the best care for our clients.
The next step is to train the new generation of pelvic floor physical therapists in our integrative approach to women's health. I am hoping to mentor a new physical therapist over the next several months to be able to offer more help to women who need this type of care.
We need to demystify what pelvic health is, provide support to women in a way they choose, and focus on wellness.
https://www.masslive.com/news/2019/03/man-killed-when-he-gets-out-of-his-truck-on-i-95-in-canton.html
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