The non-communicable diseases (NCDs) – heart and lung diseases, stroke, cancer, diabetes – are responsible for 7 out of 10 deaths in the world, 41 million people every year. The United Nations 2030 Sustainable Development Goal of reducing premature mortality from NCDs by one-third appears out of reach. Additionally, the overall situation is worse in the least developed nations that are facing a triple burden on ongoing infectious diseases, rapidly increasing NCDs and the diverse effects of globalization including increasing accidents and injuries.
 Dr. James C. Johnston, the founder and director of Global Neurocare, and partner in Global Neurology Consultants, has published extensively on neurology and global health topics. One area of neurology Dr. James C. Johnston has written on is cerebral palsy (CP), a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination. There may be associated intellectual disability, epilepsy, vision and hearing impairment, contractures and a number of orthopedic deformities.
The limited available data from Africa suggests the prevalence of CP is 3-fold higher than in the developed world. CP may be due to genetic mutations that impact brain development, or other damage to the brain as well as acquired causes including post-natal diseases such as meningitis or cerebral malaria. There is no cure for CP, but children should be treated with appropriate physical, occupational and speech therapy, as well as medications for management of seizures or spasticity, and appropriate specialist care. Assistive devices are also necessary to ensure children are able to lead productive lives if possible. More importantly, neurological specialist care is essential to treat the children as well as train therapists, coordinate research and teach the general practitioners how to address CP. This is an overwhelming hurdle in sub-Saharan Africa where there is a severe shortage of neurologists, and many patients are treated by traditional healers. Global NeuroCare works in partnership with the Addis Ababa University Department of Neurology which has trained almost 40 neurologists over the past decade, increasing the ratio in Ethiopia to one neurologist for every 2-3 million people. The program now trains physicians from other Africa nations but it will be many years, if ever, before this region meets the World Health Organization recommendation of one neurologist for every 100,000 people. Even then, if it ever reaches that ratio, the neurologists need adequate resources to treat these children with CP and related conditions, including trained therapists, adequate medications and a contingent of other specialists to manage the orthopedic issues, impaired vision, and hearing loss. And this is just one condition having a profound impact on this region of the world - it is imperative for the medical community to focus on advancing neurological care in Africa, which already has the greatest burden of disease and the least resources. James C. Johnston, MD, JD recently discussed the important of addressing this burden in Africa, and previously summarized the model training program in Ethiopia in letters to Neurology Today. https://journals.lww.com/neurotodayonline/pages/articleviewer.aspx?year=2018&issue=01250&article=00005&type=FullText https://journals.lww.com/neurotodayonline/Fulltext/2016/12220/Letters_to_the_Editor.4.aspx  An alumnus of the University of Texas Health Science Center in San Antonio, TX, Dr. James C. Johnston is a board certified neurologist and a licensed attorney and counselor at law. With close to three decades of professional experience, he serves as medical director of Legal Medicine Consultants. Dr. James C. Johnston shared his expertise in a letter he co-wrote to the editor of Neurology Today which was published on March 17, 2016.
Reacting to a published article on diagnostic errors in neurology, he noted that the report understated the problem and did not provide practical advice to neurologists on how to better deal with the issue. His letter states two fundamental principles to apply in order to manage the risks. The first is for the practitioner to come to a clear understanding about how evidenced-based medicine can be used to treat patients, and conversely, how this knowledge can be used against the practitioner in a clinic and in court. Once it is understood, stringent patient treatment documentation will become habitual, saving the physician from additional lawsuits as compared to other means of risk mitigation. The second principle is for the physician to become aware of the scenarios that will usually lead to litigation. When faced with one of these scenarios, the practitioner should escalate attention, increase followups, and promptly address patient complaints. Adhering to these principles will lead to better patient outcomes and lower the probability of a malpractice suit. Dr. James C. Johnston provides specific examples in a recent chapter published in Neurologic Clinics 2016 entitled "Neurological Fallacies Leading to Malpractice: A Case Series Approach." This article may be accessed on researchgate: https://www.researchgate.net/profile/James_Johnston6/contributions  Dr. James C. Johnston is a board certified neurologist with 26 years of medical experience, and is also an attorney who serves as the director for Legal Medicine Consultants. As a medical and legal professional, Dr James C. Johnston, who received his MD from the University of Texas Health Science Center in San Antonio, Texas, has published on a number of subjects regarding medical malpractice and litigation.
He has co-authored several articles on cerebral palsy and electronic fetal monitoring (EFM), which have been published in the Journal of Child Neurology, Journal of Maternal-Fetal and Neonatal Medicine, Journal of Childhood and Developmental Disorders, and The Surgery Journal. Electronic fetal monitoring is based on a virtually non-existent scientific foundation, has a false positive rate exceeding 99%, and has not affected the incidence of cerebral palsy or any other neonatal malady. It has, however, increased the cesarean section rate, with the expected increase in morbidity and mortality to mothers and babies. EFM is the cardinal driver of the worldwide malpractice litigation crisis centered around cerebral palsy. In addition, the daily use of this ineffective procedure creates a ethical dilemma of extraordinary proportions, as expectant mothers are not routinely provided with informed consent regarding EFM, which is performed to protect doctors and hospitals from lawsuits. Dr. Johnston and his co-author propose linking EFM to the Daubert exclusionary evidence doctrine to end cerebral palsy litigation, and following contemporary ethical guidelines to provide women with a choice by telling them the whole EFM story, including the emerging evidence that cesarean sections may expose babies to the risk of future chronic diseases and neuropsychiatric disorders.  A graduate of the University of Texas Health Science Center in San Antonio, TX, Dr. James C. Johnston has nearly three decades of experience as a neurologist. Throughout his professional career, Dr. James C. Johnston has remained an active member of various professional organizations like the American Academy of Neurology.
The American Academy of Neurology (AAN) is the world's largest professional association of neurologists, and the leading resource center for neurologists around the world. The organization was founded in 1948, and now represents more than 30,000 members. It is dedicated to promoting the highest quality patient-centered care. The 68th AAN Annual Meeting will take place April 15-21, 2016, in Vancouver, British Columbia, Canada, where leading neurologists will discuss the latest breakthroughs in the field. There will be more than 12,000 attendees including neurologists and neuroscience specialists. Lectures, meetings and discussions will focus on common neurological problems and controversies. Additionally, there will be presentations of contemporary issues such as global health concerns. These are particularly relevant for Dr. Johnston, a Partner in Global Neurology Consultants and Director of GlobalNeuroCare.org, a 501(c)(3) charity dedicated to improving neurological care in resource limited regions. Dedicated to evidence-based neurological care and expanding neurological services in developing countries, Dr. James C. Johnston serves as the director of Legal Medicine Consultants, and is the founder of the nonprofit Global NeuroCare. As a lawyer and board-certified neurologist, Dr. Johnston also authors various articles related to his fields of expertise, including a recent article in the Journal of Maternal-Fetal and Neonatal Medicine titled Neonatal Encephalopathy 2015: Opportunity Lost and Words Unspoken.
Dr. James C. Johnston co-authored the article with Thomas Sartwelle in response to what they deemed to be an oversight by the international Task Force Study on Neonatal Encephalopathy Second Edition 2014. According to the article, the Task Force failed to denounce the use of electronic fetal monitoring (EFM), a 40-year practice unsupported by science that trial lawyers exploit to blame physicians for infant cerebral palsy. The authors state that the task force acknowledged EFM’s inadequacies but still recommended that physicians use EFM for every woman in labor. In the article, the authors explore the Task Force’s omission of critical EFM information, trial lawyers’ interest in continuing the use of EFM, and EFM’s misguided support from professional organizations. The authors also assert that the Daubert doctrine could help exclude “EFM junk science” from courtrooms around the world. Dr. James C. Johnston is a neurologist serving as director of Global NeuroCare, an organization that strives to improve people’s health at home and around the world. Dr. James C. Johnston’s areas of focus include the neurological consequences of malnutrition.
In many areas of the globe, malnutrition is a common problem, and a well-known factor of infant and child mortality rates in regions with little food availability and limited medical resources. Not getting enough nutrients (causing malnutrition, retarded growth and related problems), or lacking the proper balance of nutrients (causing micronutrient deficiencies), has many negative effects on an individual’s body and long-term health outlook. It affects all aspects of the anatomy, with a profound impact on the nervous system. These neurological effects are long-term, and greatly impact a person’s ability to function. Early detection is crucial since proper nutrition may prevent many of the developmental abnormalities. For example, malnutrition can lead to problems in the cognitive development of children. Malnourished children may have difficulty remembering things, have poor reasoning skills, and experience trouble paying attention, all issues which can negatively affect school performance and long-term well-being. Additionally, the lack of energy associated with not getting enough food can make children less playful and interested in their surroundings, circumstances which can further stunt their mental and emotional growth. With these extraordinarily serious effects, the problem of malnutrition should be addressed as soon as possible. Dr. James C. Johnston has practiced neurology for more than 25 years and is the founder of Global NeuroCare, a nonprofit organization dedicated to providing medical and rehabilitative services with a particular focus in developing countries. In addition to his work in international health care, Dr. James C. Johnston belongs to the American Academy of Neurology.
The American Academy of Neurology estimates than one in six people in the U.S. suffer from a brain disease, and for more than 67 years, it has worked to raise awareness about the severity and prevalence of various neurological conditions through the American Brain Foundation. The Neuro Film Festival competition is one of the premiere fundraising and awareness events hosted by the American Brain Foundation, and on April 21, the winners of the 2015 Neuro Film Festival were announced. The grand prize went to “The Curse: The Bhutan Epilepsy Project,” which follows the life of a young boy with epilepsy in the Kingdom of Bhutan in the Himalayas. In addition to portraying the stigma of living with epilepsy, the short film shows the lack of infrastructure for training specialists. The runner-up prize was awarded to “Looks like Laury, Sounds like Laury,” a deeply personal vignette of Laury Sacks, an actress and mother who was diagnosed with frontotemporal dementia at age 46, and her subsequent decline in health. The audience choice award went to “Changing the Face of Parkinson’s,” which highlights the various community resources available to those with the condition. All short films from 2015 and previous years are available for viewing on the American Brain Foundation’s website at www.patients.aan.com/go/about/neurofilmfestival. Dr. James C. Johnston is a board-certified neurologist with additional certification in neurorehabilitation. Additionally, Dr. James C. Johnston is a partner with Global Neurology Consultants.
Neurologists are the specialists trained to evaluate and treat patients suffering from cerebrovascular disease and stroke. Strokes are a leading cause of death and disability worldwide, but they are often difficult to predict without costly medical tests. However, a recent study published by the American Heart Association suggests that the ability to balance on one leg is a simple test that doctors can use to screen for functional impairments in the brain. In a study conducted by a team of researchers from Kyoto University, a sample of nearly 1,400 men and women with an average age of 67 years were asked to balance on one leg for about 20 seconds. Of those who had trouble balancing for this length of time, more than 30 percent showed symptoms of small vessel disease or “microbleeds,” both of which are major risk factors for stroke. Shorter balance times were also associated with lower scores on memory and thinking tests. These findings suggest that the ability to balance on one leg may be an indicator of subclinical cognitive decline and, if correct, this simple assessment would contribute to improved preventive and neurorehabilitative care. Dr. James C. Johnston directs Global NeuroCare (GlobalNeuroCare.org) in providing medical and rehabilitative services, and commented that "these type of clinical tests are particularly important in developing countries where neurologists are scarce and testing facilities limited." As a neurologist and attorney, Dr. James C. Johnston provides advisory services to Legal Medicine Consultants, serves as a Partner with Global Neurology Consultants and is a Barrister of the High Court of New Zealand. Dr. James C. Johnston is the author of numerous peer reviewed publications focusing on legal medicine and medical ethics. He is a Fellow of both the American College of Legal Medicine and the Australasian College of Legal Medicine, and maintains membership in the World Association for Medical Law, Texas and Washington Bar Associations, and American Academy of Neurology.
Each year, the American Academy of Neurology hosts a conference in Washington, D.C., called Neurology on the Hill. This event gives neurologists and related professionals an opportunity to discuss critical national policy issues with lawmakers on Capitol Hill. It also serves the purpose of educating members of government about health care and needed reforms. In 2014, Neurology on the Hill addressed the importance of neurologists to the health care system, the preservation of Medicaid patient access to neurologists, and the permanent repeal of the Medicare sustainable growth rate (SGR) formula. In respect to the latter, the organization supports abolishing the Medicare SGR formula in order to deter future costly funding shortfalls and budgetary patches. As of 2014, $164 billion has been spent to make amends for short-term payment cuts triggered by the SGR formula. The Academy believes that a permanent solution will preserve the integrity of the Medicare program. |
AuthorA respected neurologist and attorney, Dr. James C. Johnston is the Founder and Director of Global NeuroCare, a 501(c)(3) non-profit dedicated to advancing neurology in developing regions. Archives
September 2018
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