who's the most science-friendly democratic candidate?

[Phobos]

[?]

[russ_watters]

Toughie - I'm not sure I'd ever describe any politician as "science-friendly." So I guess the most science-friendly would really be the one doing the least harm.

[Njorl]

It is hard to determine. A governer has little opportunity to promote science, except through education funding as a whole. In the senate, votes on science related topics are usually in omnibus bills. This means a senator may vote for a project he dislikes, or against one he likes because of the bill as a whole. Wesley Clark is clearly a "pro-tech" general, though. Whether this translates to a strong research inclination or not is not certain. All in all, it is entirely up in the air.

One thing is sure. None of them is as likely as Bush to stunt scientific research for religious purposes.

Njorl

[selfAdjoint]

Probanly the best you can get is a politician who is curious about things and fascinated by ideas. Reportedly Clinton was like this. I think the least closed-minded candidate on show in NH is Kerry. I remain to be convinced that Edwards is anything more than a bundle of enormous charisma in front of a crowd.

[wasteofo2]

Well Dean was, and his wife is (or was) a doctor, so almost certainly he'd support medicine research the most, he also has said that he thinks Bush saying the govt. won't fund stem cell research is wrong and hinted he would support it with government funding. He also strikes me as someone who's educated a bit in science and would have a more sympathetic ear to requests for funding.

Lieberman seems the most concerned with protecting the environment and utilizing sun/wind/geothermal/ocean power.

Edwards doesn't strike me as one who'd do much of anything for science, nor does Sharpton.

Kucinich would support alchemy and magic, the worst effect of pollution he could think of was that it would negatively affect New Hampshire's maple syrup.

Clark would likely do whatever is popular in regards to science, including ignore it.

I've no idea about Kerry.

[adrenaline]

I root for Howard Dean.

As for John Edwards, I despise him.

Despite the almost complete absence of scientific basis for these [medical malpractice] claims, cerebral palsy cases remain enormously attractive to lawyers,' Huber wrote.

The judgments or settlements related to medical malpractice lawsuits that focused on brain-damaged infants with cerebral palsy helped Edwards amass a personal fortune estimated at between $12.8 and $60 million. He and his wife own three homes, each worth more than $1 million, according to Edwards' Senate financial disclosure forms. Edwards' old law firm reportedly kept between 25 and 40 percent of the jury awards/settlements during the time he worked there.
According to the Center for Public Integrity, Edwards was able to win 'more than $152 million' based on his involvement in 63 lawsuits alone. The legal profession recognized Edwards' achievements by inducting him into the prestigious legal society called the Inner Circle of Advocates, which includes the nation's top 100 lawyers. Lawyers Weekly also cited Edwards as one of America's 'Lawyers of the Year' in 1996.

...Dr. Lorne Hall, one of the physicians with whom Edwards reached a confidential settlement in a malpractice case involving cerebral palsy, agreed, telling The Charlotte Observer in 2003 that "[Edwards] knows how to pick cases, and he knows the ones he can win."
Hall said Edwards was "very polished, very polite, dressed to the T's, smiling at the ladies." But the anonymous source for this story said Edwards displayed a "belligerent attitude" toward the medical profession.

"He sued nurses, doctors, hospitals. The reputation he had was -- he never wanted to hear that nobody did anything wrong. If you even walked by the door of an alleged malpractice incident, you were gong to cough up money too," the source said.
http://www.cnsnews.com//ViewPolitics.asp?Page=\Politics\archive\200401\POL 20040120a.html

He definately won't be advocating expenditures on cerebral palsey research.

[wasteofo2]

Your story said that it was rare for doctors to do anything leading to cerebral palsy, not that it never happened.

"At the end of the day, I verily believe we will find [the cause of cerebral palsy is] all genetic,"

I have doubts about that, I believe my mother, a practicing physical therpist, has had several cases of children who were born without cerebral palsy and went through some sort of trauma and developed it, but I'll have to check to be sure.

<edit> Ok, now my doubts have been confirmed. When I asked my mother she showed me several textbooks which had information on cerebral palsy and told me that most of the children she treats whom have cerebral palsy did not have it from genetics. She also told me about how early emergency c-sections can be preformed very early, and that she actually treats a child who had an emergency c-section at 20 weeks gestational age.

If the umbilical cord is positioned in such a way that it may strangle the baby during birth, it could deprive oxygen to the baby and lead to cerebral palsy. A doctor should be able to diagnose this and preform a c-section if necessary. Also, if the placenta forms irregularly, there could be bleeding and not enough blood getting to the fetus, again depriving it of oxygen and causing cerebral palsy, this could also be avoided by an early c-section.

If the fetus is positioned upside down, so that it's feet come out of the vagina first, then it could very easily have oxygen deprivation during birth, something else a doctor should be able to recognize and do a cesarian section for.

So those are things that can happen which are the doctors fault.

Here are some other things which aren't genetic but can still cause cerebral palsy:

When the fetus is inutero, if the mother smokes cigarettes, drinks alcohol, uses recreational drugs or certain perscription drugs, the fetus can get a direct poisoning from the substances in the mothers blood flow. Also, drugs in the mothers blood can lead to malformation of the brain and other systems which are needed to supply the brain with oxygen.

Also, head trauma can cause cerebral palsy, as well as anything else which can happen after the baby is born which deprives oxygen to the brain.


In conclusion, that article was purely malicious and provided false information. Also, no actual statistics were cited, no actual numbers given, just terms like "unlikely" and "unfounded". When someone just makes claims that something is unlikely without citing a source or explaining why something is unlikely, it's generally a good idea to not take what they say that seriously.

I'm sure if you posted a question about cerebral palsy in the biology board you'd get a total concensus that cerebral palsy can be caused by many things which aren't genetic.</edit>

[adrenaline]

In conclusion, that article was purely malicious and provided false information. Also, no actual statistics were cited, no actual numbers given, just terms like "unlikely" and "unfounded". When someone just makes claims that something is unlikely without citing a source or explaining why something is unlikely, it's generally a good idea to not take what they say that seriously.

I'm sure if you posted a question about cerebral palsy in the biology board you'd get a total concensus that cerebral palsy can be caused by many things which aren't genetic.</edit> [/B]


Actually, it was quite impartial. It stated facts. The whole crux of the article was summarized by the quote in the article Dr. John Freeman, a professor of neurology and pediatrics at Johns Hopkins Hospital in Baltimore, Md., also believes there is little obstetricians can do to prevent cerebral palsy during delivery. "Most cases of cerebral palsy are not due to asphyxia," Freeman told CNSNews.com. The writer just didn't pull it out of his *******.


Contrary to what you stated, the article did not attribute Cerebral palsey as a purely genetic problem. This was not what the article stated and your mother is right, most CP is not genetic, but most are prepartum, or peripartum related conditions.
Since 6% of all cerebral palsey may be due to the birth process, it is very rare for the delivering doctor to be soley responsible. So yes, the article was accurate.

My collegue was successfully sued for 6.5 mill because he did not do enough to help a patients obesity who died of a heart attack at 45 (he was also a heavy smoker). You can imagine how one can sway a jury on something as emotionally charged as CP. Jurys don't understand medicine and how things just happen.

CP is a very "jury sympathetic" issue. The delivery can go perfectly, and since 20% of cerebral palsey occurs after birth (virus, etc.) the gyn is still liable up to the child's 18 yrs of age (two years past that will be the statute of limitations so 20 yrs of age.) These are many of the cases...the idea is, well the obstetrican must have done something 5 years ago.



This acquired cerebral palsey results from brain damage in the first few months or years of life and can follow brain infections, such as bacterial meningitis or viral encephalitis, or results from head injury --(as you mentioned) and from a motor vehicle accident, a fall, or child abuse, yets obstetricians still get pinned with the blame.



There is relatively recent evidence that placental and perhaps other maternal infection can be associated with cerebral palsy.
Jaundice in the infant. Bile pigments, compounds that are normally found in small amounts in the bloodstream, are produced when blood cells are destroyed. When many blood cells are destroyed in a short time, as in the condition called Rh incompatibility, pigments can build up and cause jaundice. Severe, untreated jaundice can damage brain cells.


I reviewed some of John Edwards cases since my best freind is a malpractice lawyer for MAG and many of the cases the child had fetal jaundice but that evidence was excluded since a the law , not good science, deemed it as insignificant.

Note that severe oxygen shortage in the brain or trauma to the head does happen during labor and delivery. The newborn infant's blood is specially equipped to compensate for low levels of oxygen, and asphyxia (lack of oxygen caused by interruption in breathing or poor oxygen supply) is common in babies during the stresses of labor and delivery. But if asphyxia severely lowers the supply of oxygen to the infant's brain for lengthy periods, the child may develop brain damage called hypoxic-ischemic encephalopathy. A significant proportion of babies with this type of brain damage die, and others may develop cerebral palsy, which is then often accompanied by mental impairment and seizures.


In the past, physicians and scientists attributed most cases of cerebral palsy to asphyxia or other complications during birth if they could not identify another cause. However, extensive research by NINDS scientists and others has shown that very few babies who experience asphyxia during birth develop encephalopathy soon after birth. Research also shows that a large proportion of babies who experience asphyxia do not grow up to have cerebral palsy or other neurological disorders. These birth complications including asphyxia are now estimated to account for about 6 percent of congenital cerebral palsy cases.

Coagulation disorders in mothers or infants can produce stroke in the fetus or newborn baby. Especially those with factor V Leyden, antiphoshpholipid syndrome etc. Bleeding in the brain has several causes -- including broken blood vessels in the brain, clogged blood vessels, or abnormal blood cells -- and is one form of stroke. Although strokes are better known for their effects on older adults, they can also occur in the fetus during pregnancy or the newborn around the time of birth, damaging brain tissue and causing neurological problems. Ongoing research is testing potential treatments that may one day help prevent stroke in fetuses and newborns.
top

Now to address what you say docotors should be able to correct.

The pregnant woman is seen weekly by the obstetrician's office during the last 2 months of her pregnancy. The fetal heartsounds are auscultated and the position of the baby felt. Ultrasounds are only used if there is a suggestion the baby is in distress. Many times the ob has proof the baby had no umbilical cord around the baby on an ultrasound the week before delivery but was found to have it during labor. That is not the gyn's fault, it is a fact of nature, but they get blamed for it. C-sections are always carried out if there is bleeding suspected. However, if the blood counts are stable, the fetal heart rate is stable, no changes in vitals occur, then there is no need to do a C- section.


If the fetus is positioned upside down, so that it's feet come out of the vagina first, then it could very easily have oxygen deprivation during birth, something else a doctor should be able to recognize and do a cesarian section for

Not if the turn occurred a week out after the last peripartum exam which is the usual case. If this is found during the exam, you schedule a elective c section. Simple. However, since many breech births have been done safely without c-sections, HMOs will not let a doctor schedule an elective c section for the sake of it anymore. But since they can't be sued because of the Employee Benefit's act, a HMO can deny payment for a valid treatment (ie:) c section and not be liable. In fact, breech births are no longer an automatic c-section and you have to weigh the risks of c sections with that of natural vaginal deliviery.

My baby was breech 3 weeks before delivery but she turned around 4 days before delivery. Should my obstetrician scheduled a c-section 3 weeks before she was due and endanger me with the number one cause of complications due to elective surgery and subject me to anesthesia?

In fact, there is data that too many unneccessary c -sections are occurring and why do you think that is? It's called defensive medicine. By the way, the complication rates for the mother is much higher since you bring in the added factor of anesthesia and surgery and obs get sued for that.

You may like him, but have to pretensions that these lawyers do it for the sake of justice. I have beeen sued twice and the cases have been thrown out because it was obviously so frivolous (I treated a patient for asthma 5 weeks before she died of Disseminated coagulopathy from MRSA from her spinal surgery and I was pulled into the fray.) I spent $50,000 extricating myself from it in legal fees. The article was not one sided. The trial cases are public documents and many of the deliveries were done under the standard of care at the time, a good proportion of mothers were smokers, some were alchoholics but juries don't know how to sort that out. Doctors are probably the only people not judged by their peers. Any medical experience puts you out of a jury trial for a doctor, no matter how insignificant.


the article was right in that new data now in retrospect, exxonnerated many of the obstetricians that were sued successfully by Edwards: ie: the data on jaundice, placental infections, smoking, etc. Once again, you can look at the cases yourself since they are public documents.

[adrenaline]

If you want numbers and studies, here is a great review, http://www.medscape.com/viewarticle/457882


Field Notes in Obstetrics and Maternal-Fetal Medicine - Summary of the Publication, "Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology," by the ACOG Task Force on Neonatal Encephalopathy and Cerebral Palsy (Journal Article)

Jul 2003 - This report is the most extensive peer-reviewed document on this subject published to date. The crux of it is that most newborn brain injury does not occur during labor and delivery.

In it note the data on how even early C-sections did not affect the outcome overall of cerebral palsey This was done on twins which have the higher rates of cp and elective c-sections are scheduled all the time. This has not changed the rate of CP in this group. (By the way, some of the edwards case dealt with twins).

[wasteofo2]

For the record, I'm in support of Dean, I questioned that article's credibility only becuase I saw it seemed to contradict what I'd otherwise heard.

I agree that during the actual delivery there's little doctors can do and that things like mother using drugs or the placenta forming irregularly, the baby contracting any sort of infection etc. is not the fault of the doctor, but the fact remains that the article tries to lure the reader into thinking that there's largely nothing a doctor can do. You said that 6% of cases of cerebral palsy are caused during birth, there are likely many more caused by incompetance of the doctor somewhere along the line. I don't know anything about Edwards specific case, so I don't know if it's one that could have been caused by a doctor or not. The article didn't specifically say anything about the case in question, only that it was unlikely or uncommon for things to happen which edwards won his case on. Also, a doctor whom many of the quotes in the article came from did say he believed cerebral palsy was purely genetic, as I quoted in my previous post.