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News Briefs

The Surgical Innovation That Got Tua Tagovailoa Back on the Field for Alabama's Title Push
Sports Illustrated/By Ross Dellenger/January 6, 2019

SAN JOSE, California — The man who could be called the savior of Alabama’s season as much
as any player or coach has spent this weekend buried in snow. Thomas Clanton does not
describe himself that way, of course, but depending on your perspective, he has contributed to the
Crimson Tide’s national title push as significantly as Nick Saban or Tua Tagovailoa or Quinnen
Williams or Jerry Jeudy. Clanton is a foot and ankle surgeon living 1,300 miles from Tuscaloosa in
Vail, Colo., where on Saturday evening he had two feet of powder in his yard. “We’ve had a good
snow year this year,” Clanton says. “I’ve been skiing 12 times.”

Clanton politely scoffs at the notion that he deserves credit for where Alabama is this weekend. “I
don’t need any publicity,” he says softly. “I’m 68 years old. I’ve done all the things I wanted to do in
my career.” You probably don’t know much about Clanton, or Alabama team surgeons Norman
Waldrop and Lyle Cain, and you probably don’t know about a company called Arthrex and a product
named the Knotless Syndesmosis TightRope (hereafter referred to simply as the tightrope). But
the contributions of all of the above will come to a head in Santa Clara on Monday night, when the
Crimson Tide meet the Tigers in a title bout where so much hangs on an ankle held together by a
surgical procedure now getting national attention. “It’s amazing,” says Alabama quarterbacks
coach Dan Enos. “I don’t understand anything about it. I know this, though, it’s amazing.”

The tightrope is a relatively new innovation in the treatment of high ankle sprains, in which
ligaments and tissues around the leg bones, the tibia and fibula, are loosened and become
unstable. The tightrope offers an alternative to the traditional methods of treatment: rest and
rehabilitation or the insertion of screws into the tibia and fibula, bonding them like one would a pair
of two-by-fours with a nail. In tightrope fixation, surgeons slip a high-strength suture through small
holes in the bone, fasten it with small metal buttons and then tighten it as you would a zip tie. The
procedure takes about 25 minutes.

The speed of Tagovailoa’s return sent a wave of astonishment through college football, shining a
light on a procedure that the team has actually used for several years. Waldrop, an orthopedic
surgeon at the Birmingham-based Andrews Sports Medicine Center who serves as an Alabama
football team physician, introduced the tightrope to the team in 2014, three years after he learned
about the mechanism from Clanton in Colorado. “I know all about Jalen and Tua. I was watching
the [Orange Bowl] last week,” Clanton says. “I texted Norm and said, ‘You’re going to be in the
spotlight over this.’”

For Full Article with Illustration, see Sports Illustrated College Football. January 6, 2019

Emergency doctors: Hospitals aren't 'fully prepared' for natural disasters, mass casualty
By Paige Minemyer, May 22, 2018, FierceHealthcare

Emergency doctors are warning that hospitals aren't ready for disasters or mass casualty
incidents, especially because of ongoing shortages of crucial drugs and supplies.

The American College of Emergency Physicians surveyed 1,328 emergency doctors and found
that 93% do not believe their emergency rooms are "fully prepared" for the surge of patients that
follows a disaster or mass casualty incident. Fewer than half (49%) said they their ERs were
"somewhat prepared."

Among the top issues identified: A lack of critical medicines, with 90% of those surveyed saying
they faced either a shortage or the total absence of such supplies in their ERs.

For full article see FierceHealthcare 5/22/18.

WHO: Ebola Outbreak Not a PHEIC ... Yet
--WHO credits immediate response, warns against international travel restrictions
By Molly Walker, Staff Writer, MedPage Today, May 18, 2018

The recent outbreak of Ebola in the Democratic Republic of the Congo (DRC) has not yet met the
standards for a Public Health Emergency of International Concern, according to an International
Health Regulations (IHR) emergency committee convened at the World Health Organization

In a statement released following a press briefing, the committee said that given that the outbreak
only began 10 days ago, and that there was an immediate response by the DRC government,
including enhanced surveillance, deploying mobile labs and engaging community leaders, they
believe the outbreak "can be brought under control."

WHO director-general Tedros Adhanom Ghebreyesus, MD, spoke of the "evolving situation" in the
Congo, and they said they were encouraged by the "vigorous response" of the government,
healthcare personnel and partner organizations, such as Médicins Sans Frontières and UNICEF

Disrupted Circadian Clock Tied to Mood Disorders
--Increased risk for major depression, bipolar disorder
By Kristen Monaco, Staff Writer, MedPage Today, May 15, 2018

Several mood disorders were tied to poor sleep and disruptions in circadian rhythms, researchers

Using data collected from a large cohort of people wearing wrist accelerometers, Laura Lyall, PhD,
of the Institute of Health and Wellbeing at the University of Glasgow, U.K., and colleagues reported
that a one-quintile reduction in circadian relative amplitude was associated with a higher risk for
both lifetime bipolar disorder.

Published in The Lancet Psychiatry, the study also found that this degree of circadian rhythm
disruption was also linked to a higher risk for several other adverse mental health outcomes:
--Greater mood instability
--More loneliness
--Lower happiness
--Lower health satisfaction
--Higher neuroticism.

This relationship also extended to slower reaction times in individuals with circadian disruption.

"These associations were independent of various demographic, lifestyle, activity, and childhood
trauma variables, and associations with all well-being, personality, and cognitive variables, apart
from mood instability, remained after the exclusion of participants with a lifetime history of mood
disorders," Lyall et al said.

More Evidence Links Gum Disease to Stroke Risk
Sue Hughes/January 19, 2018/ Medscape Nurses

A new study has strengthened the link between gum disease and increased risk for future stroke,
showing a graded relationship with the extent of gum disease and stroke risk, and in addition
finding that regular dental care was associated with a lower stroke risk.

"This effort is one of the largest, US-based community studies of periodontal disease, dental care
utilization, and ischemic stroke," lead author, Souvik Sen, MD, University of South Carolina School
of Medicine, told Medscape Medical News.

"Our results show that individuals who regularly attend the dentist had half the stroke risk of those
who do not receive regular dental care," he said. "And our study of periodontal disease showed the
more severe this is, the higher the risk of future stroke."

In particular, periodontal disease characterized by increased inflammation had the strongest
association with stroke risk. "The risk conferred by gum disease is similar to that of high blood
pressure —  it is in the range of two to three times increased risk," he added.

In particular, periodontal disease characterized by increased inflammation had the strongest
association with stroke risk. "The risk conferred by gum disease is similar to that of high blood
pressure —  it is in the range of two to three times increased risk," he added.   

The relationship between gum disease and myocardial infarction is already well established, and
previous studies have shown an association between gum disease and stroke, he said. "Our
current results strengthen that link. If causal, these associations would be of great importance
because of the potential that periodontal disease treatment could reduce the stroke risk.

"It appears that good dental hygiene can do more than just keep your teeth and gums healthy — it
may also lower your risk of heart disease and stroke," Dr Sen said. "Our results emphasize the
need for good regular dental care, including a thorough home cleaning routine with brushing and
flossing and then regular dentist and hygienist visits."

The study was published online in Stroke on January 15.

With Healthcare, U.S. Is Unlike Other Countries
Suneel Dhand, MD, explains why
by Suneel Dhand, MD/September 28, 2017/Medpage Today

The debate about the future of healthcare rages stronger than ever. As someone who grew up and
trained in a country with probably the most centrally controlled medical system in the world -- the
United Kingdom with her NHS -- my views have admittedly done a 180 over the last decade. I am
no longer as strong a believer in socialized healthcare as I once was, and actually believe the
future for America lies somewhere between the extremes, with a potential hybrid-type system, as I

Unthinkable as it was only a decade ago, the current mainstream political discourse appears to
include serious consideration of a single-payer system. The momentum may eventually become
unstoppable, whether one agrees with this in principle or not (and there are many forms such a
universal access system could take). In the passionate and often heated debate, those who are
more gung-ho about a European-style government controlled healthcare system, frequently use
the line: "But every other developed country in the world has socialized medicine, why can't

here may indeed be a lot of merit in that argument, but there are also a lot of problems.
Let's start off with the counter-argument: But America is different from every other developed
country in the world. Put quite simply, and speaking as someone who has traveled the globe (and
it must be immediately obvious to anyone else who has done so), Americans and their collective
psyche are quite unlike any other society. Much of this likely goes back to the founding of the
republic itself, and the unique character of the nation. Founded on anti-authority and
rebelliousness, Americans rightly or wrongly have a centuries-old deep-rooted suspicion of
government and centralized control. A unique focus on individualism and self-reliance is also
inherently ingrained in the culture, that doesn't quite gel with the concept of socialized anything.

Many of the healthcare systems that exist in European countries sprung up from the ruins of World
War 2 -- a situation that fortunately did not apply to the American homeland. Today, America is
probably the most consumer-oriented society in the world, with the typical societal expectations of
choice and freedom that come with a free market economy. From what I've experienced during my
time in the States, many Americans simply wouldn't put up with the restrictions and paternalism
that are inherent in a socialized healthcare system. I remember one of the things that first struck
me when I started working in the United States, aside from the patient-centered nature of the
healthcare, was the uniquely American mentality of wanting to do everything possible and basically
"throwing the kitchen sink" at any clinical scenario, never wanting to give up. I'd never seen that
before. Of course, one could argue the outrageous unsustainable costs and futility of having this
attitude, but on a human level, there's something to be admired about this too.

It's been said before that America, being a nation of immigrants, is blessed with a peculiar gene
pool, the majority having descended from ancestors who had the "ambitious adventure gene."
People who upped and left, often at great risk, in search of a better future.

Despite the setbacks along the way and the transient daily politics, America still holds a special
place in the global consciousness. Everyone knows what's happening in America, and the
country's tumultuous ongoing story captivates billions around the world.

Americans today may not fully appreciate this, but go to any country in the world -- and the embassy
with the most people lining up outside trying to get a visa is invariably the embassy of the United

So yes, American healthcare has its fair share of problems and challenges to overcome. We need
to do better to expand access and reduce costs. There's enormous work to do. But in answer to
that question about why every other Western developed country can do universal healthcare, but
America can't. My answer is always: No other country is like America, and Americans are unlike any
other group of people the world has ever seen.

Suneel Dhand, MD, is an internal medicine physician and author of three books, including Thomas
Jefferson: Lessons from a Secret Buddha. He is the founder and director of HealthITImprove, and
blogs at his self-titled site, Suneel Dhand. This post appeared on KevinMD.com.

Generic for Liquid Tamiflu Approved
by John Gever, Managing Editor, MedPage Today/September 15, 2017

WASHINGTON -- The first generic version of the influenza drug oseltamivir phosphate (Tamiflu) is
now approved, the FDA said Friday.

The generic product -- made by Nesher Pharmeuticals -- comes as a 6-mg/mL oral suspension,
making it appropriate for very young as well as older patients.

"[This] is of particular importance in patients that are not able to ingest capsules," the FDA said in
announcing the approval, noting that the product is okayed for patients as young as 2 weeks.

As with the branded version, the generic is indicated for acute treatment within 48 hours of flu-like
symptom onset. It can also be used for prevention in patients 1 year and older.

The FDA stressed that the drug should not be used as a substitute for flu vaccination. Also,
oseltamivir does not prevent other illnesses, including bacterial infections, that may co-exist with

An ‘old wives’ tale’ drives calls for tetanus shots amid Houston flooding
By Helen BraswellL/AUGUST 29, 2017/STAT

People caught up in the tragedy of Hurricane Harvey face uncertainty and stress. But one thing
most of them don’t have to worry about right now is whether they need a tetanus shot.

Scattered social media posts from Texas have invoked the importance of tetanus shots for those
who have been wading through floodwaters; a U.S. congressman urged residents to start
considering whether they needed to get booster shots.

Those suggestions are based on the widespread belief that contact with floodwaters increases a
person’s risk of contracting tetanus, a potentially fatal infection.

That, health experts say, is simply untrue.

“It’s this old wives’ tale. It’s a myth,” Michael Osterholm, director of the University of Minnesota’s
Center for Infectious Disease Research and Policy, told STAT.

Osterholm expressed concern that public health authorities in the affected parts of Texas and
Louisiana — and in places taking evacuees from the flood zone — would try to mount mass
tetanus vaccination efforts.

Doing so would divert resources that are needed elsewhere and unnecessarily alarm people who
are already engulfed in a highly stressful situation, Osterholm said.

The Centers for Disease Control and Prevention does not recommend tetanus shots for people
who have been in floodwaters. “Exposure to flood waters does not increase the risk of tetanus, and
tetanus immunization campaigns are not needed,” the CDC website states.

The widespread belief may stem from the fact that being in floodwaters — which can be full of
debris and too murky to see through — does increase a person’s risk of experiencing a puncture

Taking part in the cleanup operations that follow these disasters also carries increased risk of
puncture wounds.

Both the CDC and the Occupational Health and Safety Administration recommend that workers
involved in flood cleanups ensure that their tetanus vaccination status is up to date.

For full article, see STAT.

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Liz Buddenhagen