James C Johnston

Global Neurology Consultants

The SARS-CoV-2 pandemic unleashed from Wuhan, China in 2019 rapidly seeded the entire world, leading to millions of deaths, unprecedented suffering, and wreaking global economic and social devastation. The pandemic overwhelmed medical systems, diverted healthcare, and destroyed years of progress in developing nations by derailing global health prog...

This paper provides an overview of using hypothermia in the treatment of neonatal encephalopathy.

The current guidelines for neuroimaging the patient with headache and a normal exam provide misguided recommendations which are a contributing factor in the misdiagnosis of headache and failure to diagnose intracranial structural disease. The authors recommend rescinding these guidelines until imaging protocols are prudently refined to ensure quali...

Review of the courtroom expert in addressing brachial plexus injuries.

Review and analysis of the New Zealand response to the pandemic.

Global NeuroCare respectfully calls upon this Forum to (i) undertake an independent, scientific, and transparent investigation into the origin of this pandemic, and (ii) coordinate aid to support relevant global health programs providing an integrated, multi-lateral, multi-faceted, cross-sector approach to improving healthcare access, in parallel w...

Observations and recommendations on the development of Africa in coordination with advancing the UN Sustainable Development Goals.

Global NeuroCare® cautions that a strategy limited to producing, distributing, and delivering the current vaccines is untenable, raising ethical concerns related to the limited efficacy for omicron and the likelihood future variants may escape present immunity, thereby depleting resources for marginal potential but unsustainable gains. The optimal...

Developing nations in sub-Saharan Africa are increasingly seeking electronic fetal monitoring (EFM) as a means of reducing the high perinatal mortality and morbidity. This call for EFM is predicated on the outdated causal concept that cerebral palsy (CP) is synonymous with birth asphyxia or neonatal encephalopathy. The truth, published in worldwide...

Global NeuroCare respectfully calls upon this Forum to (1) endorse our recommendations to properly investigate the origin of SARS-CoV-2 as a matter of high priority, noting with deep regret that the continuing failure to do so impedes scientific advancement and further jeopardizes health security; and (2) support an integrated, multi-lateral, multi...

Quadrennial Report (2017-2021) providing review of Global NeuroCare including assessment of UN activities and other services advancing the mission of this NGO.

The Alice Books, full of illogical thoughts, words, and contradictions, were unrivaled entertainment until the publication of the medical literature promoting electronic fetal monitoring (EFM) for every pregnancy. The modern-day EFM advocates acknowledge EFM's decades long failure but simultaneously recommend EFM use for lawsuit protection and beca...

The worldwide cerebral palsy (CP) litigation crisis is predicated on the hoax that electronic fetal monitoring (EFM) predicts and prevents CP. There are decades of research disproving this hoax, yet EFM continues to be performed in the vast majority of labors in developed countries with resultant harm to mothers and babies alike through unnecessary...

Fully aware that the world is faced with the unprecedented situation of a coronavirus disease (COVID-19) that started in Wuhan, China in 2019 and very rapidly evolved to a pandemic; * * * * * Global NeuroCare strongly reaffirms the critical necessity of ensuring well-directed financing focused on establishing self-sufficient local training progr...

A half century ago electronic fetal monitoring was rushed into clinical use with the promise that the secrets of fetal heart rate decelerations had been discovered and that the newly discovered knowledge would prevent cerebral palsy with just in time cesarean sections (C-sections) preventing babies from experiencing asphyxia, which was thought to b...

Objective: To evaluate the use of electronic fetal monitoring (EFM) as a means of reducing cerebral palsy (CP) in sub-Saharan Africa (SSA). Background: CP is a significant problem in SSA where it is characteristically albeit erroneously considered synonymous with birth asphyxia, leading to the increasing use of EFM in a misguided effort to reduce...

The use of electronic fetal monitoring in Africa for routine pregnancies does not reduce the incidence of cerebral palsy, is a waste of extremely scarce resources and adds significant morbidity and mortality to a desperately critical situation.

We categorically agree with Shevell’s article suggesting it is time to change the term "cerebral palsy" (CP) to "cerebral palsy spectrum disorder" or a similar rubric.1 Such a change would better describe the markedly heterogeneous nature of the many facets of CP, particularly its etiological basis. This would ensure the terminology comports with c...

The article by Do et al.1 on secondary headaches is particularly relevant since headache misdiagnosis consistently remains among the most common diagnostic errors in neurology.2 However, the literature must be carefully scrutinized to avoid distorting the use of red flags and, thereby, perpetuating headache mismanagement. For example, Do et al. cit...

This statement provides specific recommendations to improve healthcare access in resource limited areas as a strategy for promoting healthy lives, reducing poverty, and addressing inequalities and challenges to social inclusion, thereby improving all forms of social protection.

Electronic fetal monitoring (EFM) has no proven efficacy in routine childbirth yet is increasingly employed throughout sub-Saharan Africa (SSA) in a misguided approach to reduce the high perinatal mortality and morbidity. EFM has a 99.8% false positive rate, and does not predict or prevent cerebral palsy (CP) or any other neonatal neurological inju...

Objective: To ascertain the spectrum of neurological disorders among patients referred to a private outpatient neurology clinic in Addis Ababa, Ethiopia. Background: Neurological disorders constitute a significant portion of the global burden of disease, and represent a serious threat to public health. This is particularly true in sub-Saharan Af...

A half century after continuous electronic fetal monitoring (EFM) became the omnipresent standard of care for the vastmajority of labors in the developed countries, and the cornerstone for cerebral palsy litigation, EFM advocates still do not have any scientific evidence justifying EFM use in most labors or courtrooms. Yet, these EFM proponents con...

This presentation to the United Nations 56th Commission for Social Development cautions that any successful poverty reduction strategy necessitates improving access to healthcare for people with neurological disorders by increasing the recruitment, training and retention of physicians while protecting inherently vulnerable populations through ethic...

Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal mo...

Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal mo...

Discussion of the misguided use of EFM in sub-Saharan Africa.

Developing nations in sub-Saharan Africa are increasingly seeking electronic fetal monitoring (EFM) as a means of reducing the high perinatal mortality and morbidity. However, EFM is an ineffective modality with a virtually nonexistent scientific foundation, has a 99.8% false positive rate, and does not predict cerebral palsy, acidemia, stillbirths...

0069 World Association for Medical Law GLOBAL HEALTH: ADVANCING NORTH-SOUTH PARTNERSHIPS James C. Johnston, MD, JD | Mehila Zebenigus, MD | Guta Zenebe, MD Neurological diseases and disorders represent the one of the greatest threats to global public health. If not properly addressed, the resultant morbidity and mortality will have profound effe...

Global NeuroCare, holding Special Consultative Status with the United Nations ECOSOC, fully supports the 2017 High Level Segment theme ("eradicating poverty in all its forms and dimensions through promoting sustainable development") by focusing on strategies to achieve the Sustainable Development Goals, particularly Goal 3 seeking to "ensure health...

Electronic fetal monitoring (EFM) was predicted by its inventors to be the long-sought cerebral palsy (CP) nemesis. Rather than prevent CP or any other birth problems, 40 years of EFM use has done substantial harm to mothers and babies and created a worldwide CP-EFM litigation industry that enriches only trial lawyers. Physicians, frightened by the...

Permissions and Reprints Abstract Electronic fetal monitoring (EFM) does not predict or prevent cerebral palsy (CP), but this myth remains entrenched in medical training and practice. The continued use of this ineffectual diagnostic modality increases the cesarean section rate with concomitant harms to mothers and babies alike. EFM, as it is used...

We strongly encourage Drs. Burke and Callaghan to reread our comment, since it has nothing to do with the number of lawsuits filed, but the number of patients harmed (and claims made and settled before a suit is filed) due to substandard care by the intransigent adherence to outdated guidelines. The recommendation by Burke et al.¹ to limit neuroima...

In their article, Burke et al.¹ stated, “neuroimaging overuse appears to be high in both…populations.” This statement, as related to headache, is based on a retrospective analysis with the definition of overuse predicated on the United States Headache Consortium Guidelines, which recommended that neuroimaging is not warranted for patients with migr...

This Report provides a synopsis of the Ninth Board Examinations administered to the Addis Ababa University Department of Neurology Residency Training Program graduates for Gregorian year 2016 (Ethiopian year 2008). The comprehensive Eighth Board Examination Report issued on 2 October 2015 provided an in-depth review of the Department including (1...

E/CN.5/2017/NGO/19

Pandora opened the box releasing death and all other evils into the world. She hastened to close the lid but the whole content had escaped except for one thing at the bottom of the box - HOPE. Paraphrase of the Greek Myth in Hesiod’s Works and Days. Edward Hon opened the Electronic Fetal Monitoring (EFM) Pandora’s Box in the 1950s. Although perhap...

Electronic fetal monitoring (EFM) was designed to prevent cerebral palsy(CP). But EFM is based on nineteenth century unproven theories. The rate of CP is the same today as when EFM was introduced. Unnecessary C-sections are the result of EFM use and have resulted in EFM doing more harm than good to mothers and babies. At the same time EFM is used b...

The past decade has seen unprecedented growth of global health programs in United States academic medical centers. These programs often focus on brief medical missions to resource limited areas, predicated on ill defined goals that fail to address the ethical, medical and legal goals of the developing nation. The result for Africa has been an uncoo...

Letter to Editor

A young woman presents with an intracranial arachnoid cyst. Another is diagnosed with migraine headache. An elderly man awakens with a stroke. And a baby delivered vaginally after 2 hours of questionable electronic fetal monitoring patterns grows up to have cerebral palsy. These seemingly disparate cases share a common underlying theme: medical myt...

Global NeuroCare, formerly NeuroCare Ethiopia, holding Special Consultative Status with the ECOSOC, applauds the United Nations Transforming Our World: The 2030 Agenda For Sustainable Development. We fully concur with Declaration 26 regarding the importance of preventing and treating non-communicable diseases, including neurological disorders. Th...

Electronic fetal monitoring (EFM) has repeatedly proven clinically ineffectual, caused more harm than good to mothers and babies alike, and trapped obstetricians into daily violations of fundamental medical ethics. EFM is also the foundation for the continuing worldwide cerebral palsy (CP) birth injury litigation crisis which routinely results in l...

Letter to Editor

Electronic fetal monitoring (EFM) has repeatedly proven clinically ineffectual, caused more harm than good to mothers and babies alike, and trapped obstetricians into daily violations of fundamental medical ethics. EFM is also the foundation for the continuing worldwide cerebral palsy (CP) birth injury litigation crisis which routinely results in l...

Electronic fetal monitoring (EFM) entered clinical medical practice at the same time bioethics became reality. Bioethics changed the medical ethics landscape by replacing the traditional Hippocratic benign paternalism with patient autonomy, informed consent, beneficence, and nonmaleficence. But EFM use represents the polar opposite of bioethics' re...

This Report provides a synopsis of the Eighth Board Examinations administered to the Addis Ababa University Department of Neurology Residency Training Program graduates for Gregorian year 2015 (Ethiopian year 2007). It focuses on salient examination features including format, administration, methodology, content and scoring, and highlights recommen...

The Task Force Study on Neonatal Encephalopathy Second Edition 2014 failed to address Electronic Fetal Monitoring (EFM) and its forty years of clinical futility, failed to condemn EFM’s continued use against physicians in the world’s courtrooms and ignored the ethical breaches EFM’s use compels physicians to commit daily. This article considers why...

The cardinal driver of cerebral palsy litigation is electronic fetal monitoring, which has continued unabated for 40 years. Electronic fetal monitoring, however, is based on 19th-century childbirth myths, a virtually nonexistent scientific foundation, and has a false positive rate exceeding 99%. It has not affected the incidence of cerebral palsy....

Cerebral palsy litigation

Letter to Editor

Letter to the Editor

This report - prepared in association with Global NeuroCare and the United Nations ECOSOC - outlines the burden of neurological disease in sub-Saharan Africa and provides a focused discussion on improving neurological services in this region. The Addis Ababa University Department of Neurology serves as a prototype for advancing patient care, physic...

Epilepsy is arguably the most common neurological condition encountered by neurologists in Africa. Neuroimaging (CT and MRI) represents the most important recent contribution to the diagnosis, classification and management of the patient with epilepsy. To describe the role of neuroimaging in the evaluation of Ethiopian patients with epilepsy, by id...

This Seventh Report provides a synopsis of the Board Examinations with a detailed assessment of the actual exams and recommendations for improvement to advance the overall quality of training, and provides a broad assessment regarding the state of neurology in Ethiopia, followed by general and specific recommendations to improve medical care, physi...

Neurologists have professional, ethical, and social obligations to ensure that expert witness testimony is reliable, objective, and truthful. In the past, an absence of professional regulatory oversight combined with immunity from civil litigation allowed the partisan expert to flourish. This is no longer the case. The expert witness unquestionably...

Neurologists have professional, ethical, and social obligations to ensure that expert witness testimony is reliable, objective, and truthful. In the past, an absence of professional regulatory oversight combined with immunity from civil litigation allowed the partisan expert to flourish. This is no longer the case. The expert witness unquestionably...

This chapter provides an overview of the common legal issues affecting neurologists in the United States of America (USA). It focuses on tort law, with particular attention to the current malpractice trends. Illustrative management strategies are provided for several recurring claims involving selected neurological conditions. Non-malpractice liabi...

Syphilitic aortic aneurismal erosion into the vertebral column with associated neurological dysfunction is extraordinarily rare, and the very few reported cases typically involve the descending aorta. We describe the novel presentation of a 55year old man with a syphilitic aneurysm of the ascending aorta and arch causing spinal erosion with spastic...

The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding trea...

Background: Epilepsy is a common problem throughout sub-Saharan Africa, including Ethiopia. Electroencephalography (EEG) is useful for the diagnosis and proper treatment of this condition. However, the literature is scanty of reports describing EEG patterns in Ethiopian patients with epilepsy. This study attempts to bridge that gap and provide a ba...

Outcome measures of patient satisfaction are increasingly accepted as an integral component of the overall healthcare quality assessment. A survey of the outpatient neurology services in Addis Ababa, Ethiopia was performed to determine the overall patient satisfaction, provide an assessment of current services and form the foundation for improved e...

This article provides an overview of the current neurological malpractice trends, and outlines management strategies for several common recurring claims involving headache, stroke, and epilepsy. Selected nonmalpractice liability issues are reviewed, focusing on the unique risks engendered by the forensic expert.

Cervical spondylotic amyotrophy (CSA) is considered a syndrome of (1) unilateral upper extremity weakness and atrophy, (2) affecting either the proximal or distal musculature, (3) without sensory impairment or lower extremity dysfunction. The authors report a novel case of bilaterally symmetric CSA with blurring of the proximal-distal distinction,...

A 45 year old female with no stroke risk factors suffered a massive intracerebral hemorrhage (ICH) after ingesting Midrin--a combination of isometheptene mucate, dichlorophenazine and acetaminophen. Neuroimaging revealed no evidence of structural disease or underlying vasculopathy. This is the first reported case of isometheptene induced ICH in the...

The partisan expert will face a continuing trend of increased accountability.

§ 11.01 Introduction [1] Preface Neurology is arguably the most difficult and exacting medical specialty, requiring a thorough understanding of fiendishly complex topics such as neuroanatomy, neurophysiology, neuropathology and neuropharmacology. There are ghastly diseases presenting with baffling symptoms. It is extraordinarily challenging for a...

This chapter provides an overview of the liability issues affecting neurologists.

It may yet come to pass that the most effective remedy for the ills of our tort reparation system will be disclosed by demonstration, in an attractive, usually tranquil, and very civilized little country half-a-world away.… The developments “down under” thus merit our most careful and continuing observation.1 The New Zealand accident compensation...