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New SD tourist stop shows ‘Declaration’ signing

first_imgRAPID CITY, S.D. | Rapid City’s newest tourism attraction opens Sunday.Founding Fathers Black Hills says it houses the world’s only life-size sculpture of the painting “Declaration of Independence” inside a reproduction of the historic Philadelphia hall.Visitors can see 47 original sculptures and listen to a presentation about the American Revolution leading up to the signing of the Declaration of Independence. A replica of the Liberty Bell that was cast at the same French foundry as the original bell is scheduled to arrive soon.The attraction is 6 miles south of Rapid City on the road to Mount Rushmore National Memorial.Online:https://www.foundingfathersblackhills.comlast_img


Mesa Verde National Park considers fee increase

first_imgMESA VERDE NATIONAL PARK, Colo. | Managers at Mesa Verde National Park are considering raising entrance fees next year.The Cortez Journal reports (https://bit.ly/2bem4kl ) that the proposal would raise fees from $15 to $20 per vehicle and $8 to $10 per person during the summer season, which lasts from May to October.For the spring, fall and winter seasons, vehicle fees would increase from $10 to $15 and individual fees would rise from $5 to $8.An annual pass would rise from $30 to $40.Park Superintendent Cliff Spencer said in a news release that he is committed to keeping the park affordable but hopes to use the extra money to offset increased construction and rehabilitation costs in the park.Park officials will hold a public meeting on the proposal in September in Cortez.___Information from: Cortez Journal, https://www.cortezjournal.com/last_img read more


Travel’s become a prime inspiration for home decor

first_img This undated photo provided by Melissa Smuzynski shows a capital A decoupaged in a US map on the wall in a travel-themed nursery. (Melissa Smuzynski/parenthoodandpassports.com via AP) When Melissa Smuzynski learned that she was expecting, she wanted a nursery that reflected her family’s love of travel. But when she and her husband, Damon Lane, went shopping for appropriate decor a few years ago, they didn’t find much.So they improvised, using luggage tags and airmail envelopes to create wall hangings. They found a fun suitcase to display in the room, and decoupaged a table with maps and travel-oriented scrapbook paper. The look came together pretty easily and inexpensively, said Smuzynski, who gave birth to daughter Avery in February 2015. This undated photo provided by Wayfair shows a room decorated with Global wallpaper available from Wayfair. (Wayfiar via AP) This undated photo provided by Melissa Smuzynski shows a framed poster paper of vintage luggage tags hanging in a travel-themed nursery. (Melissa Smuzynski/parenthoodandpassports.com via AP)center_img “It was more budget-friendly than if we had gone with a pre-assembled theme. This reflected who we are,” said Smuzynski, who wrote a blogpost about the effort on her website, parenthoodandpassports.com. “Travel has always been a significant part of our lives.”In just a few years, the trend seems to have taken off. “When I go into Hobby Lobby, there’s an entire section that looks exactly like her room,” said Smuzynski, of Oklahoma City.Many interior decorators, home goods manufacturers and trend spotters have embraced the travel theme. Some people decorate with pieces they bought on vacation or that remind them of past trips. Others simply go to the store for furniture, lighting and other elements that evoke the look and feel of places they’ve visited.It’s all part of a trend toward making decor personal and customized, said Donna Garlough, style director for Wayfair, an online home goods store.“These days, people crave homes that speak to them and their interests rather than one that was decorated in one fell swoop. And travel is one of those things that can really shape you, so it’s no wonder people want to reflect their favorite memories and destinations in their home’s décor,” said Garlough, whose book, “Your Home, Your Style” (Rizzoli USA), will be published this spring.Laura Casey of Laura Casey Interiors in Charlotte, North Carolina, designed a dining room inspired by a zebra photograph that clients had purchased during a trip to Africa. She incorporated complementary colors, textures and patterns, using Moroccan-inspired tiles to help the room feel travel-inspired and eclectic.Wall hangings are an easy way to add travel elements to a room, Casey said. Consider framing one of your photos or buying a print or art piece while traveling, she said.“One of my clients has family photographs from many countries they have visited. In their kitchen and den we made small gallery groupings to represent each trip,” she said. “It keeps the room casual and family-friendly, while also allowing the family to be reminded of their adventures.”Souvenirs are an obvious way to reference your travel, said Danielle Whitburn, a freelance writer for Home-Designing.com. But there are other options, as well.“I love pieces that make a subtle nod to another place or memory — a bicycle bookend that reminds you of riding by the shore, for example, or a pillow that reminds you of the color of a certain lake or sea,” said Whitburn, who lives in Auckland, New Zealand.Garlough agrees. “Rather than collecting souvenir spoons and refrigerator magnets like their parents and grandparents, today’s shoppers are incorporating their travel memories in bigger ways, such as an abstract landscape that reminds them of a hiking trip, or whimsical pillows with a beach motif,” she said. “It’s a subtle, constant reminder that they can appreciate every day.”Of course, it’s also possible to achieve this look without ever leaving home. Moroccan leather ottomans, Persian rugs and Mexican artwork are distinctive elements that evoke a sense of place and can be bought online or at a store, Whitburn said.As for souvenirs, today’s travelers often have a more global approach than in the past.“As travelling increases (in) popularity, we are seeing more pieces outside the traditional tourist haunts in Europe and North America,” she says. This undated photo provided by Melissa Smuzynski shows a travel-themed nursery. (Melissa Smuzynski/parenthoodandpassports.com via AP)last_img read more


Roseanne Barr will appear on TV for first time since firing

first_imgLOS ANGELES | Roseanne Barr will appear on television for the first time since she was fired from ABC and her namesake show was canceled.Barr will be a guest on the Fox News show “Hannity” on Thursday at 9 p.m. EDT.FILE – In this Monday, Jan. 8, 2018, file photo, Roseanne Barr participates in the “Roseanne” panel during the Disney/ABC Television Critics Association Winter Press Tour in Pasadena, Calif. Barr will appear on television for the first time since she was fired from ABC and her namesake show was canceled. Barr will be a guest on the Fox News show “Hannity” on Thursday, July 26, 2018, at 9 p.m. EDT. (Photo by Richard Shotwell/Invision/AP, File)ABC canceled its successful reboot of “Roseanne” in May following the star’s racist tweet likening former Obama adviser Valerie Jarrett to a cross between the Muslim Brotherhood and a “Planet of the Apes” actor.Barr recorded a podcast interview last month in which she said she feels remorse about the tweet.During the live interview Thursday, she’s expected to discuss the tweet as well as President Donald Trump.ABC said it ordered 10 episodes of a spinoff called “The Conners” after Barr relinquished any creative or financial participation in it.last_img read more


Medical device that treats pain shocks, burns patients

first_img In this Friday, Nov. 16, 2018 photo, Jim Taft watches The History Channel from the confines of his bed at his home in West Columbia, S.C. Taft has experienced debilitating health issues after a neurosurgeon implanted Boston Scientific’s Precision spinal cord stimulator in his back in 2014. (AP Photo/Sean Rayford) In this Oct. 4, 2018 photo, Dr. Steven Falowski stands for a portrait in Bethlehem, Pa. If spinal cord stimulators are used early enough for pain, they can prevent people from going on opium-based pain killers, said Falowski who speaks at conferences and teaches other doctors how to implant stimulators. (AP Photo/Peter Banda) In this Saturday, Aug. 25, 2018 photo, sales representatives for Medtronic and Boston Scientific work their booths at the NYC Neuromodulation Conference in New York. For years, medical device companies and doctors have touted spinal cord stimulators as a panacea for millions of patients suffering from a wide range of intractable pain disorders. But the devices, surgically placed inside the back, that use electrical currents to block pain signals before they reach the brain _ are more dangerous than many patients understand, according to an Associated Press investigation. (AP Photo/Mary Altaffer) COLUMBIA, South Carolina  |  Desperate for relief after years of agony, Jim Taft listened intently as his pain management doctor described a medical device that could change his life.It wouldn’t fix the nerve damage in his mangled right arm, Taft and his wife recalled the doctor saying, but a spinal-cord stimulator would cloak his pain, making him “good as new.”Taft’s stimulator failed soon after it was surgically implanted. After an operation to repair it, he said, the device shocked him so many times that he couldn’t sleep and even fell down a flight of stairs. Today, the 45-year-old Taft is virtually paralyzed, a prisoner in his own bed, barely able to get to the bathroom by himself.“I thought I would have a wonderful life,” Taft said. “But look at me.”For years, medical device companies and doctors have touted spinal-cord stimulators as a panacea for millions of patients suffering from a wide range of pain disorders, making them one of the fastest-growing products in the $400 billion medical device industry. Companies and doctors aggressively push them as a safe antidote to the deadly opioid crisis in the U.S. and as a treatment for an aging population in need of chronic pain relief.But the stimulators — devices that use electrical currents to block pain signals before they reach the brain — are more dangerous than many patients know, an Associated Press investigation found. They account for the third-highest number of medical device injury reports to the U.S. Food and Drug Administration, with more than 80,000 incidents flagged since 2008.Patients report that they have been shocked or burned or have suffered spinal-cord nerve damage ranging from muscle weakness to paraplegia, FDA data shows. Among the 4,000 types of devices tracked by the FDA, only metal hip replacements and insulin pumps have logged more injury reports.The FDA data contains more than 500 reports of people with spinal-cord stimulators who died, but details are scant, making it difficult to determine if the deaths were related to the stimulator or implant surgery.Medical device manufacturers insist spinal-cord stimulators are safe — some 60,000 are implanted annually — and doctors who specialize in these surgeries say they have helped reduce pain for many of their patients.Most of these devices have been approved by the FDA with little clinical testing, however, and the agency’s data shows that spinal-cord stimulators have a disproportionately higher number of injuries compared to hip implants, which are far more plentiful.The AP reported on spinal stimulators as part of a nearly yearlong joint investigation of the global medical devices industry that included NBC, the International Consortium of Investigative Journalists and more than 50 other media partners around the world. Reporters collected and analyzed millions of medical records, recall notices and other product safety warnings, in addition to interviewing doctors, patients, researchers and company whistleblowers.The media partners found that, across all types of medical devices, more than 1.7 million injuries and nearly 83,000 deaths were reported to the FDA over the last decade.The investigation also found that the FDA — considered by other countries to be the gold standard in medical device oversight — puts people at risk by pushing devices through an abbreviated approval process, then responds slowly when it comes to forcing companies to correct sometimes life-threatening products.Devices are rarely pulled from the market, even when major problems emerge. And the FDA does not disclose how many devices are implanted in the U.S. each year — critical information that could be used to calculate success and failure rates.The FDA acknowledges its data has limitations, including mistakes, omissions and under-reporting that can make it difficult to determine whether a device directly caused an injury or death. But it rejects any suggestion of failed oversight.“There are over 190,000 different devices on the U.S. market. We approve or clear about a dozen new or modified devices every single business day,” Dr. Jeffrey Shuren, the FDA’s medical device director said at an industry conference in May. “The few devices that get attention at any time in the press is fewer than the devices we may put on the market in a single business day. That to me doesn’t say that the system is failing. It’s remarkable that the system is working as it does.”In response to reporters’ questions, the FDA said last week that it was taking new action to create “a more robust medical device safety net for patients through better data.” ”Unfortunately, the FDA cannot always know the full extent of the benefits and risks of a device before it reaches the market,” the agency said. In the last 50 years, the medical device industry has revolutionized treatment for some of the deadliest scourges of modern medicine, introducing devices to treat or diagnose heart disease, cancer and diabetes.Pete Corby, who injured his back working as a movie stuntman, said a spinal-cord stimulator helped him deal with his constant pain and stop using the opioids he’d become dependent on.“This is the greatest thing that saved my life, literally saved my life,” said Corby, estimating that up to three-quarters of his original pain was alleviated by the stimulator.Medical device companies have “invested countless resources — both capital and human — in developing leading-edge compliance programs,” said Janet Trunzo, head of technology and regulatory affairs for AdvaMed, the industry’s main trade association.At the same time, medical device makers also have spent billions to try to influence regulators, hospitals and doctors.In the U.S., where drug and device manufacturers are required to disclose payments to physicians, the 10 largest medical device companies paid nearly $600 million to doctors or their hospitals last year to cover consulting fees, research and travel and entertainment expenses, according to an AP and ICIJ analysis of data from the Centers for Medicare & Medicaid Services. This figure doesn’t include payments from device manufacturers like Johnson & Johnson and Allergan, which also sell other products.On top of that, lobbying records show that the top four spinal-cord stimulator manufacturers have spent more than $22 million combined since 2017 to try to influence legislation benefiting their overall business, which includes other devices.Some companies have been fined for bribing physicians, illegally promoting products for unapproved uses and paying for studies that proclaim the safety and effectiveness of their products, according to the joint investigation.In a 2016 case, Olympus Corp. of the Americas, the largest U.S. distributor of endoscopes and related medical equipment, agreed to pay $623.2 million “to resolve criminal charges and civil claims relating to a scheme to pay kickbacks to doctors and hospitals,” according to the U.S. Justice Department. Olympus said that it “agreed to make various improvements to its compliance program.”In a case the previous year involving spinal-cord stimulators, Medtronic Inc. agreed to pay $2.8 million to settle Justice Department claims that the company had harmed patients and defrauded federal health care programs by providing physicians “powerful” financial inducements that turned them into “salesmen” for costly procedures. Medtronic denied wrongdoing. “As a matter of policy, Medtronic does not comment on specific litigation,” the company said in a statement. “We do stand behind the safety and efficacy of our Spinal Cord Stimulators and the strong benefits this technology provides to patients, many of whom have tried all other therapy options to no benefit.”Some doctors enthusiastically promote spinal-cord stimulators without disclosing to patients they’ve received money from medical device manufacturers. Some experts say doctors are not legally required to disclose such payments, but they have an ethical obligation to do so. Sometimes the money goes to the doctors’ hospitals, and not directly to them.As for Taft, he said he just wanted to get better, but he has lost hope.“This is my death sentence,” Taft said, stretched out beneath his bed’s wooden headboard on which he’s carved the words “death row.”“I’ll die here,” he said.___A generation ago, tens of thousands of women were injured by the Dalkon Shield, an intrauterine device that caused life-threatening infections. Consumer advocates demanded testing and pre-market approval of medical devices to prevent deaths and injuries associated with defective products.So in 1976, Congress passed the Medical Device Amendments, a law meant to assure Americans that devices recommended by their doctors would do good and not harm.“Until today, the American consumer could not be sure that a medical device used by his physician, his hospital or himself was as safe and effective as it could or should be,” President Gerald Ford said when he signed the bill into law.Charged with carrying out the law, the FDA created three classes of medical devices. High-risk products like spinal-cord stimulators are designated to be held to the most rigorous clinical testing standards. But the vast majority of devices go through a less stringent review process that provides an easy path to market for devices deemed “substantially equivalent” to products already approved for use.As designed by Congress, that process should have been phased out. Instead, it became the standard path to market for thousands of devices, including hip replacements implanted in tens of thousands of patients that would later be recalled because metal shavings from the devices made some people sick.The AP found that the FDA has allowed some spinal-cord stimulators to reach the market without new clinical studies, approving them largely based on results from studies of earlier spinal stimulators.Spinal stimulators are complex devices that send electrical currents through wires placed along the spine, using a battery implanted under the skin. An external remote controls the device.The four biggest makers of spinal-cord stimulators are Boston Scientific Corp., based in Marlborough, Massachusetts; Medtronic, with headquarters in Ireland and the U.S.; Nevro, in Redwood City, California; and Illinois-based Abbott, which entered the market after its $23.6 billion purchase of St Jude Medical Inc.St. Jude’s application to go to market with its first spinal stimulator contained no original patient data and was based on clinical results from other studies, while Boston Scientific’s application for its Precision spinal-cord stimulator was based largely on older data, though it did include a small, original study of 26 patients who were tracked for as little as two weeks.Once approved, medical device companies can use countless supplementary requests to alter their products, even when the changes are substantial.For example, there have been only six new spinal-cord stimulator devices approved since 1984, with 835 supplemental changes to those devices given the go-ahead through the middle of this year, the AP found. Medtronic alone has been granted 394 supplemental changes to its stimulator since 1984, covering everything from altering the sterilization process to updating the design.“It’s kind of the story of FDA’s regulation of devices, where they’re just putting stuff on the market,” said Diana Zuckerman, president of the National Center for Health Research, who has studied medical devices for nearly 30 years.Medical device manufacturers have cited multiple industry-funded studies showing the effectiveness of spinal-cord stimulation in the treatment of chronic pain. Experts say treatment is considered successful if pain is reduced by at least half, but not every patient experiences that much pain reduction.A 2016 study looking at different stimulation systems found “significant evidence” that they were “a safe, clinical and cost-effective treatment for many chronic pain conditions.”But Zuckerman noted that the more extensive studies came after the devices were being widely used on people.“These patients are guinea pigs,” she said.FDA said in a statement that it approves, clears or grants marketing authorization to an average of 12 devices per business day and its decisions are “based on valid scientific evidence” that the devices are safe and effective.Dr. Walter J. Koroshetz, director at the neurological disorders and stroke division at the National Institutes of Health, said trials for medical devices like spinal-cord stimulators are generally small and industry-sponsored, with a “substantial” placebo effect.“I don’t know of anyone who is happy with spinal-cord technology as it stands,” Koroshetz said. “I think everybody thinks it can be better.”___Every time Jim Taft walked into his pain management doctor’s office, he would glance at the brochures touting spinal-cord stimulators — the ones with pictures of people swimming, biking and fishing.Inside the exam room, Taft said, his doctor told him the device had been successful for his other patients and would improve his quality of life.On lifetime worker’s compensation after his right arm was crushed as he was hauling materials for an architectural engineering company, Taft had been seeing the doctor for five years before he decided to get a stimulator in 2014. What finally swayed him, he said, was the doctor’s plan to wean him off painkillers.“I felt backed into a corner,” said, Taft, who lives in West Columbia, South Carolina.Taft said his pain management doctor praised the technology, saying stimulators had improved the quality of life for his patients. But four years later, Taft is unable to walk more than a few steps.Taft is one of 40 patients interviewed by the AP who said they had problems with spinal-cord stimulators. The AP found them through online forums for people with medical devices. Twenty-eight of them said their spinal-cord stimulators not only failed to alleviate pain but left them worse off than before their surgeries.Zuckerman, who has worked at the U.S. Department of Health and Human Services and as a senior policy adviser to then-first lady Hillary Rodham Clinton, said no doctor wants to think they’re harming patients.“But there’s a tremendous financial incentive to downplay, ignore or forget bad patient experiences and just focus on how happy patients are,” she said.More than half the patients interviewed by the AP said they felt pressured to get stimulators because they feared their doctors would cut off their pain medications — the only thing helping them.Stimulators are considered a treatment of “last resort” by insurance companies, as well as Medicare and Medicaid. That means doctors must follow a protocol before insurance will pay for the device and implantation.Physicians must show that conservative treatments failed to help, and patients also undergo psychological assessments to evaluate the likelihood of success. They then typically undergo a trial period lasting three days to a week with thin electrodes inserted under the skin. If patients say they got relief from the external transmitter sending electrical pulses to the contacts near their spines, they have surgery to implant a permanent stimulator.Taft said his three-day trial helped reduce his pain so, a few days before his surgery, he began preparing for a new life. He ordered lumber to refurbish a patio and deck for his wife, Renee, as thanks for her years of support.In April 2014, Boston Scientific’s Precision stimulator was implanted in Taft by Jason Highsmith, a Charleston, South Carolina, neurosurgeon who has received $181,000 from the company over the past five years in the form of consulting fees and payments for travel and entertainment. A Boston Scientific sales representative was in the operating room — a common practice, the AP found.Highsmith would not comment on the payments. Other doctors have defended the practice, saying they do important work that helps the companies — and ultimately patients — and deserve to be compensated for their time.From the time Taft was cut open and the device placed inside his body, he had nothing but problems, according to hundreds of pages of medical records reviewed by the AP. The device began randomly shocking him, and the battery burned his skin.Taft and his wife complained repeatedly, but said his doctors and a Boston Scientific representative told them that spinal-cord stimulators don’t cause the kind of problems he had.That runs counter to Boston Scientific’s own literature, which acknowledges that spinal stimulators and the procedures to implant them carry risks, such as the leads moving, overstimulation, paralysis and infections.That also is not reflected in the AP’s analysis of FDA injury reports, which found shocking and burning had been reported for all major models of spinal-cord stimulators. For Boston Scientific devices, infection was the most common complaint over the past decade, mentioned in more than 4,000 injury reports.In response to questions, the company called infection “unfortunately a risk in any surgical procedure” that the company works hard to avoid. It added that the FDA’s data “shouldn’t be interpreted as a causal sign of a challenge with our device. In fact, many examples of reportable infections include those that were caused by the surgical procedure or post-operative care.”“In our internal quality assessments, over 95 percent of the injury reports were temporary or reversible in nature,” the company added.Taft said had he known the devices hurt so many people, he would have reconsidered getting one. A Boston Scientific sales representative tried reprogramming the device, he said, but nothing worked.“I told them that it feels like the lead is moving up and down my spine,” Taft said. “They said, ‘It can’t move.’” But in July 2014, X-rays revealed the lead indeed had moved — two inches on one side.Highsmith told the AP the electrode broke from “vigorous activity,” though Taft said that would not have been possible due to his condition. Taft said he was in such bad shape after his surgery that he was never able to redo the patio and deck for his wife or do anything else vigorous.That October, Highsmith said, he operated on Taft to install a new lead, tested the battery and reinserted it.Still, Taft’s medical records show that he continued to report numbness, tingling and pain. During a January 2015 appointment, a physician assistant wrote that the device “seemed to make his pain worse.”The stimulator was surgically removed in August 2015. The following June, Taft got a second opinion from a clinic that specializes in spinal injuries, which said he had “significant axial and low back pain due to implantation and explantation” of the stimulator.Highsmith said other doctors have documented severe arthritis in Taft and that, while he has not examined Taft in more than three years, it’s “likely his current condition is the result of disease progression and other factors.”He did not answer questions about whether he informed Taft of the risks associated with stimulators.The doctor said the overwhelming majority of his spinal-cord stimulator patients gain significant pain relief.“Unfortunately, in spite of the major medical breakthroughs with devices like these, some patients still suffer from intractable pain,” he said.Renee Taft, a paralegal, reached out to Boston Scientific in 2017, but said the company refused to help because her husband’s stimulator had been removed and blamed Taft for his problems, also saying he had engaged in “rigorous physical activity” after surgery.In the letter from the company’s legal department, Boston Scientific also noted that federal law shielded manufacturers from personal liability claims involving medical devices approved by the FDA.In response to questions from the AP, Boston Scientific again blamed Taft’s “activity level” but didn’t elaborate. The company also said other factors could contribute to his problems such as “hyperalgesia, a phenomenon associated with long-term opioid use which results in patients becoming increasingly sensitive to some stimuli.”Brenda Simpson-Davis of Milton, Florida, said Boston Scientific also disregarded her complaints after her husband suffered a life-threatening infection following implant surgery.George Davis, 57, had three Medtronic spinal-cord implants between 2003 and 2007 after a car accident mangled his back. They temporarily reduced some of his pain, but he said the non-rechargeable batteries that were supposed to last for years never did and he tired of multiple surgical removals.In 2015, his pain management doctor urged him to try Boston Scientific’s Precision Spectra, which he called the best on the market. Unlike Davis’s old models, it had a rechargeable battery.Within weeks of his surgery, Davis said, he started feeling pain shooting down his back and legs and a burning sensation at the implant site. After his skin started turning black, the doctor performed emergency surgery to remove the device.Months later, Davis reluctantly agreed when his doctor urged him to try another Boston Scientific model but found that device even worse.Over the next year, he spent more than 100 days in and out of hospitals battling a life-threatening infection. Today, Davis says he has trouble getting out of bed.Boston Scientific said it never received the stimulators that were implanted in Taft and Davis so could not “conclusively identify” the causes of their problems. “Numerous factors can contribute to a patient’s ongoing symptoms, from increased physical activity to the onset of pain in other areas,” the company said.Simpson-Davis said she spoke with attorneys around the country, who warned her about the high bar set for a lawsuit . Finally, she found a Texas lawyer who said he will consider taking the case if she can find another two dozen potential plaintiffs.“To me, it’s not about the money, It’s about the people. It’s about them knowing what they’re getting themselves into,” she said.___For years, Valerie McJunkin had been seeking relief from a rare neurological disorder that made her legs and feet feel like they were on fire. So when a medical device company sales representative and her West Virginia pain management doctor recommended what sounded to her like a “miracle device,” she was all in.They said a new kind of stimulator — one that targeted a bundle of sensory nerve cells in the lower back — was better than a spinal-cord device. She just needed to undergo a weeklong trial.When McJunkin showed up at the pain clinic this January for the trial, the Abbott sales representative was there, along with her doctor and his staff. They explained every detail. This device wasn’t for everyone, but she was the perfect candidate, she recalled them saying.Over the next week, they called or texted her nearly every day to see if the stimulator was easing her torment. And since the trial did seem to help, she went ahead with the implant.Within days, though, the device began randomly shocking her — a sharp pain that felt like a lightning bolt.When McJunkin called her doctor and the Abbott representative, she said they suggested that she was at fault because “stimulators don’t do that.” It wasn’t until she received a certified letter from Abbott in March that she learned it wasn’t all in her head: The company said her device was being recalled due to a glitch that could cause patients some “discomfort.”Since 2005, there have been 50 recalls involving spinal stimulators, averaging about four per year in the last five years. Roughly half the recalls involved stimulators made by Medtronic, the world’s largest device manufacturer, though none warned of a risk of serious injury or death.In early September, McJunkin invited an AP reporter to accompany her when she met with her doctor and the company sales representative to request the device be removed.The Abbott salesman and her doctor both suggested she get another stimulator, saying she had run out of options, especially since her doctor couldn’t write prescriptions for opioids because of a government crackdown. If she didn’t get another stimulator, he said, she faced a lifetime of pain. He did not suggest other options, such as steroid shots or continued physical therapy.“I’m not trying to force your mind,” the doctor said. “But for me, would I want to live my life like this?… If I get that new battery and it totally helps, that changes my life 180 degrees, right? But if I don’t I already know what’s going to happen to me: I’ll be suffering for the rest of my life.”On the drive home to Martinsburg, West Virginia, McJunkin gripped the steering wheel of her car, her tattoo reading “persevere” visible on her forearm.“You trust your doctor. You think he’s going to do the right thing,” she said. She paused, fighting back tears. “I just wanted to live without pain. But now that hope is gone.”In late October, her doctor removed the device.The experience of nearly all the 40 patients interviewed by the AP mirrored McJunkin’s: Their pain was reduced during the trial but returned once their stimulators were implanted.Experts say the answer may be a placebo effect created when expectations are built up during the trial that only the stimulator can offer relief from pain, exacerbated by patients not wanting to disappoint family members, who often have been serving as their caregivers.“If patients know this is a last resort, a last hope, of course they will respond well,” said Dr. Michael Gofeld, a Toronto-based anesthesiologist and pain management specialist who has studied and implanted spinal-cord stimulators in both the U.S. and Canada.By the time the trial ends, the patient is “flying high, the endorphin levels are high,” Gofeld said.Manufacturer representatives are heavily involved during the entire process. Along with often being in the operating room during surgery in case the physician has questions, they meet with patients to program the devices in the weeks following surgery.Most of the patients interviewed by the AP said the adjustments to their devices were performed by sales representatives, often with no doctor or nurse present. That includes one patient who was billed for programming as if the doctor was in the room, though he was not.“People who are selling the device should not be in charge of maintenance,” Gofeld said. “It’s totally unethical.”In a 2015 Texas case, a former Medtronic sales representative filed suit contending she was fired after complaining that the company trained employees to program neurostimulators without physicians present. She also claimed that a Medtronic supervisor snatched surgical gloves away from her when she refused to bandage a patient during a procedure, pushed her aside and then cleaned and dressed the patient’s wound. Medtronic denied the allegations, and the case was settled on undisclosed terms.In the Justice Department case involving Medtronic, a salesman who said he earned as much as $600,000 a year selling spinal-cord stimulators claimed sales representatives encouraged physicians to perform unnecessary procedures that drove up the costs for Medicare and other federal health programs.“While there have been a few instances where individuals or affiliates did not comply with Medtronic’s policies, we acted to remedy the situation in each case once discovered and to correct any misconduct,” the company said.Gofeld said he believes stimulators do work, but that many of the problems usually arise when doctors don’t choose appropriate candidates. And he thinks the stimulators are used too often in the U.S.Nevro, one of the four big manufacturers, has cited estimates that there are as many as 4,400 facilities in the U.S where spinal-stimulation devices are implanted by a variety of physicians, including neurosurgeons, psychiatrists and pain specialists.It’s a lucrative business . Analysts say stimulators and the surgery to implant them costs between $32,000 and $50,000, with the device itself constituting $20,000 to $25,000 of that amount. If surgery is performed in a hospital, the patient usually stays overnight, and the hospital charges a facility fee for obtaining the device. Costs are typically covered by insurance.The AP found that doctors can make more money if they perform the surgery at physician-owned outpatient surgery centers, since the doctor buys the device, marks it up and adds on the facility fee.In Canada, where Gofeld now works, he said the surgeries are done only by those who specialize in the procedures. He said spinal-cord stimulators should be used when pain starts and not after failed back surgeries.“By then,” he said, “it’s too late.”___While manufacturers and top FDA officials tout stimulators as a weapon in the battle against opioids, neurosurgeons like Steven Falowski are the front-line evangelists.“Chronic pain is one of the largest health-care burdens we have in the U.S. It’s more than heart disease, cancer and diabetes combined,” Falowski said in an interview.He referred AP to Corby, as one of his surgical patients who was helped by a spinal-cord stimulator.Corby got the device more than two years ago and says that, after some initial adjustments, he hasn’t had any further problems. He says he wouldn’t trade the stimulator for opioids.“I was actually buying them on the street … a little like a druggie because I couldn’t get them anymore” from his pain doctor, Corby said.Falowski said opioids are good for acute pain, but were never meant to treat long-term chronic pain. For him, that’s where spinal-cord stimulators come in.If they’re used early enough for pain, they can prevent people from going on opium-based pain killers, said Falowski, who speaks at neuromodulation conferences and teaches other doctors how to implant stimulators.Since 2013, device manufacturers have paid Falowski — or St. Luke’s University Health Network in Fountain Hill, Pennsylvania, where he works — nearly $863,000, including $611,000 from St. Jude or its new parent company, Abbott, according to the Centers for Medicare and Medicaid Services database. The payments range from consulting fees to travel and entertainment expenses.Falowski said he has conducted research and done other work for manufacturers, adding, “The contracts with industry are with my hospital and not with me.”St. Luke’s told the AP that it keeps the majority of the payments from device makers, but that Falowski “may receive a portion of these payments through his annual compensation.”Another of Falowski’s patients was Lisa Snyder of Kempton, Pennsylvania, who was searching for relief from a painful nerve disorder. By the time she came to Falowski, she had cycled through three spinal-cord stimulators, which were removed for reasons ranging from infection to rejection.“Not everybody could do it, but he was confident he could,” she said.After her fourth implant this March, “I complained about this battery right away. I knew it was positioned funny. It burned,” Snyder said.AP’s analysis showed Abbott products were more likely than other major models to include reports of a hot or burning sensation near the site of the battery, with about 5,600 injury reports since 2008 referring to the words “heat” or “burn.”Abbott said that many of the “adverse events” reports in the FDA’s data stemmed from a device that was voluntarily recalled in 2011. The company added that feeling a temperature increase at the implant site “is often a reality for rechargeable spinal-cord stimulation systems,” which is why the company is now concentrating on devices that do not need to be recharged.Snyder said she felt like Falowski’s nurse and physician assistant downplayed the problems and that the reprogramming of her device was conducted by the Abbott sales representative, with no medical staff present. On at least one occasion, she was charged as if the medical staff was there, when she said they weren’t, according to insurance bills reviewed by the AP.Despite insisting nothing was wrong with the unit, Snyder said, Falowski called her one day out of the blue. “He said ‘Under no circumstances are you to turn it on.’ I asked him why and he wouldn’t say,” Snyder recalled.Falowski then scheduled immediate surgery to remove the stimulator, she said.Falowski called Snyder a difficult patient and said she was receiving “100 percent pain relief” when she had the stimulator removed, adding that she “remained very appreciative of her care.” He added that programming is “performed under the direction of a physician.”“The physician is not present during the entire programming session, but provides oversight and direction….The only time programming sessions are billed is when the physician is actively seeing the patient during a visit which was the case with this patient,” he said.Snyder disputed the doctor’s characterization of her and became angry after being told Falowski and his hospital received money from manufacturers.“They need to be a little bit upfront,” she said.Falowski said doctors do important work for medical device companies, and he has been involved in device development, education, clinical trials and research.“You’re trying to help patients and you realize as a physician by yourself you’re not going to generate $200 million to make the next best implant for a patient and it’s going to take a company to do that,” he said. “So I think the important part in that relationship is transparency and disclosures.”Experts interviewed by the AP said doctors are not legally required to tell their patients about financial relationships with medical device manufacturers, but that it would be the right thing to do.“The patient should be fully informed before consenting to a procedure,” said Genevieve P. Kanter, an assistant professor at the University of Pennsylvania who specializes in internal medicine, medical ethics and health policy.All Snyder ever wanted was to feel better. Today, she often is immobilized by pain.Before the latest stimulator, she could walk, stand and cook meals. Now, she finds it hard to get out of bed and rarely leaves her house. She says the device has ruined her life.“My fear is I’ll be like this forever,” she said.___Washington D.C.-based Associated Press reporters Meghan Hoyer and Matthew Perrone contributed to this report, as did Denver-based video journalist P. Solomon Banda.___Contact AP’s investigative team at Investigative@ap.org This combination of Saturday, Aug. 25, 2018 photos shows demonstration models of implantable neurostimulators, top row from left, the Medtronic Intellis and the Boston Scientific Spectra WaveWriter SCS. Bottom row from left are the Abbott/St. Jude’s Proclaim 7 Implantable Pulse Generator and Proclaim DRG Implantable Pulse Generator. For years, medical device companies and doctors have touted spinal cord stimulators as a panacea for millions of patients suffering from a wide range of intractable pain disorders. But the devices, surgically placed inside the back, that use electrical currents to block pain signals before they reach the brain _ are more dangerous than many patients understand, according to an Associated Press investigation. (AP Photo/Mary Altaffer) NY713: In this Oct. 4, 2018 photo, Dr. Steven Falowski holds an electrode for a spinal cord stimulator in Bethlehem, Pa. The AP found that a number of high-profile doctors, including Falowski, who promote stimulators, co-authored manufacturer-funded studies and have implanted spinal cord stimulators, have received money for themselves or their hospitals from the industry or belong to trade associations that promote them. (AP Photo/Peter Banda) In this Oct. 4, 2018 photo, Lisa Snyder, of Kempton, Pa., shows where a malfunctioning spinal cord stimulator was removed. After a March 29 implant by Dr. Steven Falowski, she had problems, similar to others interviewed by AP. “I complained about this battery right away. I knew it was positioned funny. It burned,” she said. (AP Photo/Peter Banda)center_img In this Oct. 31 2018 photo, George and Brenda Davis look at his nerve stimulator and medical documents at their home in Milton, Fla. George Davis had three Medtronic spinal-cord implants between 2003 and 2007 after a car accident mangled his back. They temporarily reduced some of his pain, but he said the non-rechargeable batteries that were supposed to last for years never did and he tired of multiple surgical removals. In 2015, he decided to try a Boston Scientific device. But he said he soon started feeling pain shooting down his back and legs and a burning sensation at the implant site. Brenda Davis said Boston Scientific disregarded her complaints after her husband suffered a life-threatening infection following implant surgery. (AP Photo/Holbrook Mohr) Although there are roughly 4,000 types of medical devices in the FDA’s data, just six of them accounted for a quarter of device injury reports since 2008. In this Friday, Nov. 16, 20158 photo, Jim Taft watches The History Channel from the confines of his bed at his home in West Columbia, S.C. Taft has experienced debilitating health issues after a neurosurgeon implanted Boston Scientific’s Precision spinal cord stimulator in his back in 2014. (AP Photo/Sean Rayford) In this Oct. 4, 2018 photo, Dr. Steven Falowski holds a display of spinal cord stimulation equipment in Bethlehem, Pa. The neurosurgeon and his hospital have received $863,000 from medical device companies since 2013, including $611,000 from St. Jude or its new parent company, Abbott. The payments range from consulting fees to travel reimbursements and food and beverage costs. (AP Photo/Peter Banda) 1 of 10last_img read more


Carell, ‘Office’ producers reteam for ‘Space Force’ comedy

first_imgFILE – In this Oct. 8, 2018 file photo, Steve Carell arrives at the premiere of “Beautiful Boy” in Beverly Hills, Calif. Carell will reunite with his creative team from “The Office,” Greg Daniels and Howard Klein, for the new Netflix comedy series “Space Force.” (Photo by Richard Shotwell/Invision/AP, File)LOS ANGELES | Steve Carell is starring in a new workplace comedy that could be out of this world.Netflix said Wednesday that Carell is re-teaming with “The Office” producers Greg Daniels and Howard Klein on the series “Space Force.”It’s about the people assigned to create a sixth branch of the armed services focused on space, the streaming service said.The premise is grounded in reality: Last year, the Trump administration directed the Pentagon to form a Space Command aimed at the creation of a Space Force branch.Carell and Daniels are the sitcom’s co-creators and will serve as executive producers along with Klein.Daniels co-created NBC’s  “The Office,” based on the original Ricky Gervais-Stephen Merchant U.K. mockumentary series.last_img read more


Elementary for Watson

first_imgPSC Golf from Colin’s BarSunday, Dec. 27, Silky Oak – StablefordFirst day back after the Christmas parties with heads a little sore but still a reasonable turnout and enough for 4 groups.With a good breeze across the valley it promised to be a bit of a test today, but for some it was a walk in the park.  Bob Watson was back to his brilliant best just in time for the PSC Club Championship.  His 66 off the stick included 8 birdies, 8 pars and just 2 bogies to give his a remarkable 45 points and 7 clear of Christen Boysen in second place, who beat Mike Jeffrys on count back.Bob Watson. Jim Oakley left his glasses in a bar the previous night and not being able to see seemed to help him as he only dropped 2 shots on the first 7 holes and finished with 35 points overall.In B flight there was another runaway winner, Iain Jones with 39 points who stood six clear of second placed Marcus Earp.  Everyone else seemed to find it a struggle after the recent festivities.A Flight1st Bob Watson (3) 45pts2nd Christen Boysen (10) 38ptsB Flight1st Iain Jones (26) 39pts2nd Marcus Earp (29) 33pts2’s: Bob Watson (2), Jim Oakley, Christen Boysen, Mick Folan.Wednesday, Dec. 30, Burapha C & D – MedalAnother joint venue with the Phantom Bar saw a good turnout 34 players in 3 flights with three places in each plus near pins and long putts to shoot for.The weather was fine and the golf course in perfect condition as always, and with the 1,100 baht special green fee, maybe this is the reason so many want to play this course.  Colin’s Bar plays here every two weeks in high and low season.A good wind was blowing across the valley so the scores were not expected to be anything special today and so it turned out to be.  In A flight we had the only man to beat his handicap, Paul Smith who shot a net 71 for first place followed by the other 3 handicapper, Jack Grindvold, in second with a net 72.  Oliver Orth returned from his sick bed to shoot a net 76 for third place.In B flight the scores got even worse, with Peter Hynard taking top spot with a net 72, Mick Folan bagging second on net 74 and Tina Orth placing third with a net 75.C flight told the same old story as Mogen’s Melander secured first with a net 74, Toni Buerki was second on net 76 and Frazer was third with a net 81.The near pins were shared by Serge Streaten & Oliver Orth and the long putts by Colin Davis & Walter Baechli, who as always donated his prize to the Ban Jing Jai Orphanage fund.We would like to remind our golfers that from Jan. 12-14 we will be holding a 3-day Rayong Links Championship at Silky Oak, Green Valley and St Andrews.  The presentation & free buffet will be held at Colin’s Bar on Friday, Jan. 15.last_img read more


Gunnarson strikes at Eastern Star

first_imgJomtien Golf with the IPGCWednesday, Nov. 9, Crystal Bay – StablefordAfter Monday’s complete washout after nine holes at Parichat the forecast today was not promising either as we started just ahead of schedule, playing the C and B nines.  The clouds started bubbling up after nine holes and with four holes to play the showers started, but it was intermittent for the next 30 minutes so no problems.Magne Gunnarson (right) with son Gerry.The cut today in the two divisions was 8-19 and 20+ and two 35’s won both flights.  Dennis Scougall topped division 1 after beating Pete Sumner on a 18/17 count back and with 31 points Jerry Sweetnam was third, edging Tim Hake on another count back. The ferry owner Peter Davies won division 2 while John Walsh took second, beating Magne Gunnarson 20/15 on the back-nine after they both returned scores of 33 points.Near pins went to (Div 1) Tim Hake and Pete Sumner, and (Div 2) Peter Davies, Paul Hobson, Gil Phillips and Johnny Walsh.No ‘2’s in either division so rollovers to Pattavia on Monday.Friday, Nov. 11, Eastern Star – StablefordThere were 33 players in the comp today with the equal cut of 11 players in each division and the cut set at 8-15.2, 15.3-20 and 20.1 plus.  It was a very dry course here today with buggies allowed on the fairways so no ‘pick, clean and place’ despite all the rain earlier in the week.Steve Harris returned the best score of the day, winning division 2 with 39 points.  Dennis Scougall was second on 36 and Colin Aspinall took third place after beating Gerry Cooke 19/13 on a count back, both locked on 34 points.Brian Green topped division 1 standings with 37 points, with Tim Hake second on 35 and Per Forsberg third with 34.Magne Gunnarson won division 3 with 37 points, John Walsh was second on 34 and Juergen Heinzius took the final podium place in third with 32.Near Pins went to (Div 1) Bill Bertram, Arthur Hancock (2) and Jerry Sweetnam, and (Div 2) Gerry Cooke, Steve Harris, Edvin Jonassen and Max Wilson.Jerry Sweetnam birdied the 3rd to record the only ‘2’ of the day and scoop the pot in division 1.last_img read more


Jets on verge of playoffs _ with Rex Ryan standing in way

first_img)AP Photo/File)NEW YORK (AP) _ All that stands between the New York Jets and the playoffs is Rex Ryan.Well, how’s that for an absolutely juicy story line?The Jets, in their first season under coach Todd Bowles, are facing a win-and-in scenario against the Buffalo Bills and their former coach, who was fired after failing to lead New York to the postseason in each of the last four of his six seasons.“In the words of the great Steve Smith,” linebacker Calvin Pace said, referring to Baltimore’s loquacious wide receiver, “man, it’s going to be a bloodbath.”The Jets (10-5) went from being outside the playoff picture to controlling their chances with a 26-20 overtime victory Sunday over the New England Patriots _ helped in large part by Bill Belichick choosing to kick off rather than start the extra period on offense.Ryan Fitzpatrick coolly marched the Jets downfield and won it with a 6-yard pass to Eric Decker.Pittsburgh, which held a tiebreaker edge over New York, surprisingly lost to Baltimore and slipped behind the Jets in the playoff race.“I want it,” defensive lineman Sheldon Richardson said of reaching the postseason. “I want it bad.”He and the Jets get to prove how much next Sunday at Buffalo (7-8). The Bills had high hopes in Ryan’s first season, especially when he declared their playoff drought would end. Instead, they’ll miss out for the 16th straight year.So, after spending six years doing everything he could to get the Jets into the postseason, Ryan will be out to keep them from getting in.“It’s just the next game on the schedule,” cornerback Darrelle Revis said, downplaying the matchup.Ryan is already 1-0 against his former team after a 22-17 victory over the Jets in a Thursday night game. While Ryan was clearly excited by the win, he also predicted the teams’ next meeting would probably help decide who goes to the playoffs.He was half-right.On Monday, Ryan praised the Jets, not adding any extra fuel _ but, it’s early in the week, of course.“I think, first off, it’s about getting the win and we know we are facing a team that is red hot,” Ryan said in Buffalo. “This team is a complete football team.”After their loss to the Bills, the Jets fell to Houston 24-17 to drop to 5-5. A 4-1 start was washed away by inconsistency, lost opportunities and a search for answers.“We had to come together,” Pace said, “or the ship was gonna sink.”They haven’t lost since.“The past couple weeks have been playoff games,” Bowles said. “There really is no pressure. They just play together and we have fun and we try to get better as a team. There’s no pressure on us. We know have to win. We’ve been having to win the past five weeks. “Fitzpatrick’s steady play during the winning streak has been MVP-like. He has thrown for 1,525 yards and 13 touchdowns with one interception. In three of the last four games, Fitzpatrick has driven the Jets to a win in the final two minutes of regulation or overtime.“Fitz has been amazing for us,” Pace said.So has Brandon Marshall, who set the franchise’s single-season mark with 101 catches _ and counting. Decker has, too, with 75 catches, including 11 TD grabs.The defense has been terrific the past month, led by a front line that made things miserable for Tom Brady and the Patriots.These are the things the Jets players expected back in September.“There was still a ton of belief and I just think you know being in the league and having experience that a lot of us do have, you can recognize when you have a good team,” Fitzpatrick said. “So, I think the belief’s always been there just because we see the way that everybody works week in and week out and we see the talent level on this team.“I think that the belief has been there from Day 1 and it hasn’t wavered.”Left tackle D’Brickashaw Ferguson echoed that sentiment: “I think we knew we had a special team even at the beginning of the season.”Bowles let his team know what’s at stake in his postgame speech Sunday, telling the players: “Win and we’re in.”That’s about as far as the coach will go in terms of motivational tactics. Bowles feels none of that stuff is needed at this point with so much on the line.“We’re going to treat it the same,” Bowles said of the approach for Sunday’s game. “We understand what we’re going up against. We’ve got to continue to do the things we’ve been doing. We try to do anything else, then we won’t have a chance to win.”___AP NFL website: www.pro32.ap.org and www.twitter.com/AP_NFLlast_img read more


Steelers sign offensive tackle Ryan Harris to 2-year deal

first_imgThis Sunday, Dec. 9, 2012 file photo shows Pittsburgh Steelers tackle Kelvin Beachum (68) blocking San Diego Chargers defensive end Kendall Reyes (91) in the first half of their NFL football game in Pittsburgh. (AP Photo/Don Wright/File)PITTSBURGH (AP) _ The Pittsburgh Steelers signed veteran left tackle Ryan Harris to a two-year contract Tuesday, likely ending any chance the Steelers had of bringing back free agent Kelvin Beachum.The 31-year-old Harris started all 16 games at last season for the Denver Broncos, protecting for Peyton Manning and Brock Osweiler as the Broncos won the franchise’s third Super Bowl. Harris has started 70 of 110 career games while splitting his time with Denver, Houston and Kansas City.Pittsburgh entered free agency looking for depth along the line. The Steelers re-signed guard Ramon Foster last week before free agency began, but didn’t reach an agreement with Beachum, a former seventh-round pick who eventually became a starter. Beachum’s 2015 season was cut short by a knee injury in October.____Online: AP NFL website: www.pro32.ap.org and www.twitter.com/AP_NFLlast_img read more