As I’ve grown older I’ve learned to appreciate the difficulty of keeping my body (and mind) in great physical (and mental) shape. I hit the gym three days a week to lift weights with a trainer. On the odd-date days I really stretch myself by doing yoga or speed-walking to the Starbucks^® a couple of miles from my home. As my age has increased so has my strength and muscle-mass. I only wish I’d been as dedicated when I was in nursing school.

Before I became a nurse, my exercise consisted of scrambling for Mardi Gras beads and doubloons in the crowded parades of New Orleans (a true contact sport), playing intramural basketball for my high school, playing neighborhood touch football and baseball in the streets, and wrestling with my twin brother Vince (and sometimes his friends, wink-wink). Closest I ever came to an injury was burning my mouth on a bowl of my Grandma’s seafood gumbo.

In nursing school I got a whole different education in exercise that involved weightlifting – lifting patients, lifting more patients and when we were done, lifting even more patients. At 5′ 2 ½”, 110lbs I was hardly Arnold. No training could really prepare me to lift and/or turn patients twice my size. The result? Nursing school turned out to be more hazardous than a childhood of physical activity! It was in the hospital that I strained my back trying to lift and turn a patient. Being the good old days I was prescribed a period of bed rest and, of course, Darvon. I remember telling my nursing student peers, “what a worthless drug it was despite all the hype.” Obviously I’m not much of a drugstore cowgirl. All it did was make me feel fuzzy – it didn’t touch my back pain.

An FDA advisory committee recently recommended a ban on Darvon, Darvocet and their generics, notably after they have been in use for more than 50 years (check out the presentations from the meeting). According to the testimony, Darvon and Darvocet have been associated with over 10,000 confirmed deaths and 2,110 reported accidental deaths in the United States, and the risk of death, overdose, addiction and life-threatening side effects, outweighs the minimal benefits provided by these drugs over other available painkillers.

The committee’s recommendation is nonbinding on the FDA which has 90 days to act on it and either pull the drug from the market or let it go on killing people. Hard to believe but, yes, a drug that according to the AMA is less effective than two adult-strength aspirin, kills.

As of the date of this posting I haven’t seen any cases filed yet, but plaintiff attorneys are already advertising for potential clients. This is where you, the savvy Certified Legal Nurse Consultant, come in.

If you are interested in consulting on these potential products liability cases, research the plaintiff attorneys who are advertising for these cases and market yourself to them. Defense firms are a potential market too. There will be plenty of issues for both sides in these cases as the drug is often prescribed to elderly patients, it’s addictive, it doesn’t mix well with other drugs and a good portion of the deaths are suicides.

If you’re looking to get involved in pharmaceutical cases – Darvon will probably be a good starting place. Just do your research and watch your back.

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How do you start your day? Does your breakfast contain a line of pills (and I don’t mean vitamins) longer than your middle finger? If you open your medicine cabinet too quickly is there an “orange avalanche” of pill bottles? Have you succumbed to the slick marketing of pharmaceutical companies like many of my baby boomer friends who daily whip out an array of drugs for restless leg syndrome, elevated cholesterol, reduced bone density and sleep deprivation?

If you read any magazine and look at the ads, you’ll see that the pharmaceutical companies have medicalized just about every illness, condition and quirk. Not only are drugs shamelessly marketed directly to potential “patients” but to the physicians who would and do prescribe them. My 27 years of experience consulting on products liability and medical malpractice cases as a legal nurse consultant have caused me to be very suspicious of pharmaceutical companies and the diseases they create, and of course, very agitating to my personal doctors.

My Italian grandmother lived a long life and never took a single prescription drug. In Italy, food is the drug, and she proved to me first hand that what I shove into my mouth directly impacts my energy level and the state of my health. Relax, this isn’t a blog on diet. I don’t advocate any particular diet but I try and stick to a Mediterranean diet (mainly for the spaghetti), it’s what keeps me a healthy size 4 (I wish).

I’m a small woman at 5′ 2½”. When I was diagnosed with osteopenia my physician immediately recommended Fosamax^®. Considering all the side effects of Fosamax, which I’m intimately familiar with because of products liability litigation, I rejected it outright, but I know others who haven’t and others who won’t when their time comes (good luck chewing your steak).

Instead I increased my vitamin D, calcium and vitamin K intake; hit the weights in the gym a lot harder and added a little jump roping; all without the help of estrogen (natural, artificial or otherwise). It took some serious discipline but in one year I had gained significant bone mass – at a time and at an age at which the vast majority of women lose bone mass.

My physician couldn’t believe it and in fact, seemed almost upset that I did it without her help (or her meds). Surely I was an anomaly. No matter the evidence, there was no way she was a believer. She continues to practice medicine like the typical pill-pushing physician who’s been brainwashed by the pharmaceutical companies. Thank God I’m a nurse and can think for myself.

But most consumers can’t, so that’s why the book Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Petersen is one of my favorites on the pharmaceutical industry. Not a day goes by that I don’t read about a new drug’s serious side effects and the products liability cases generating from them. This book focuses on the institutional deception of pharmaceutical companies and is a must read for all Certified Legal Nurse Consultants who consult on pharmaceutical products liability cases, and even medical malpractice cases. The author discusses physicians’ less-than-appropriate relationships with the pharmaceutical industry and how it’s marketing, not science that drives these companies.

You won’t need this book to tell you what you probably already know, but it will help you think differently about your legal nurse consulting business and the CLNC^® services you provide to your attorney-clients in this drug-dependent age.

Add this book to your “must reads.” And be careful what you put in your mouth – remember doctors used to endorse cigarettes once upon a time.

Success Is Inside!

P.S. If you want a truly eye-opening book on food and diet, try this one: Good Calories, Bad Calories by Gary Taubes – it’s not a diet book and not a light read but will change your thinking (it got Tom off beer).

Lawyers USA, one of my favorite legal publications, reported that Fosamax^® lawsuits are set to take off in 2009. Fosamax^®, manufactured by Merck is used for treatment of osteoporosis.

700 plaintiffs are alleging that Merck failed to warn users of the potential risk of osteonecrosis of the jaw which causes the jaw to deteriorate. The plaintiffs also allege that the FDA upon approval in 1995 requested Merck to perform further testing and place a warning on the package.

Another reported alleged complication of Fosamax^® is atrial fibrillation.

Certified Legal Nurse Consultants interested in Fosamax^® litigation should research on the Internet both the plaintiff and defense attorneys representing these cases. Fosamax^® cases will undoubtedly increase in number, and will create a long-term legal nurse consulting opportunity.

The 30 CLNC^® services Certified Legal Nurse Consultants provide are relevant, and here are some examples of how you can apply these 30 CLNC^® services to Fosamax^® cases.

1. Assess all relevant prior medical records for causation and risk of osteonecrosis unrelated to Fosamax^®. (Example – history of receiving chemotherapy.)
2. Provide a detailed history regarding the plaintiff’s use of Fosamax^®.
3. Assess and provide a summary of medical records for evidence of osteonecrosis or atrial fibrillation and related injuries and damages.
4. Research, summarize and create a “library” of all relevant, peer-reviewed articles on Fosamax^® and its relationship to osteonecrosis and atrial fibrillation. Educate the attorney about the mechanism of Fosamax^®. Avoid nonauthoritative Internet services.
5. If working with an attorney who represents numerous plaintiffs, identify the percentage of plaintiffs who have osteonecrosis, atrial fibrillation or both osteonecrosis and atrial fibrillation.
6. Develop a plaintiff interview form focused on Fosamax^® to interview plaintiffs quickly and consistently.
7. Locating medical experts, i.e., pharmacologists and dental surgeons who are qualified to testify to alleged defect and causation issues. Communicate with experts on behalf of your attorney-client.
8. Analyze and summarize all medical expert testimony for accuracy, and both favorable and unfavorable opinions.

Fosamax^® cases will be a hot topic for years to come. This is the time to jump in and be part of this very interesting litigation. Incorporate these eight specific services when you market your legal nurse consulting business, and attorneys handling Fosamax^® cases will instantly see how you can save them time and money.

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