The editor’s experience as an Associate Professor of neurosurgery at Temple University Health Sciences Center in Philadelphia Pennsylvania in the 1970s served as a personal “wake-up call” for some of these good intentions.

During this period Temple University made a valiant attempt to include in its medical school applicants those who were underprivileged or minorities. It soon became evident that such students would require extra help and this was than provided to them on a regular basis.

Unfortunately, the students involved, caught on that the institution intended to not let them fail by providing unique privileges and also allowing them to take tests over again. The result of this effort was a loss of motivation on the part of the affirmative action students because they developed an attitude that “they would not be allowed to fail”. The non-affirmative action students began to look down on their classmates and amongst themselves labeled them as “the dummies.”

Many of the affirmative action students actually made it to the clinical specialty rotations at which time they were subject to verbal examinations by faculty. The answer to the question as to how a specific clinical problem might be treated was often answered by the response “I just didn’t have enough time to study that area.” It was pointed out that a physician care-giver would not fare well giving this response to the family of a bereaved patient who had been inappropriately cared for.

Few of these affirmative action medical students made it to medical school graduation. Sadly, they had been deprived of their greatest asset, the motivation to succeed. This sad, but well-intentioned, program failed. The lesson learned was to select students based on their previous merits irrespective of their backgrounds or ethnicity.

The post An Example of Affirmative Action Failure appeared first on The Burton Report.

The modern fiber-optic surgical headlight has represented a quantum advance from the  screw-in light bulb headlight which was commonly in use throughout the surgical world at the beginning of the 20th century. The Editor and his fellow neurosurgical residents at Johns Hopkins Hospital during the 1960s were always identifiable by the characteristic red burn mark occupying the middle of their foreheads caused by frequent contact with the operating surgeon’s headlight whenever the surgeon turned their head. To add insult to injury the illumination produced by such headlights just wasn’t much better than that produced by a a poor flashlight.

When the Editor advanced from being the chief resident in neurosurgery at Johns Hopkins to being a Navy neurosurgeon in 1967, heading up a 40 bed surgical unit, he made a personal resolve to try to come up with something more effective in the way of practical illumination and magnification. He was fortunate in that one of his optometrist father‘s classmates at the Columbia University School of Optometry had a son, Richard Finebloom who was head of the firm Designs for Vision which specialized in manufacturing eyeglass mounted magnifying loupes and telescopes. With the advent of fiberoptic cables it was clear that the combination of magnification in conjunction with a highly concentrated beam of light would allow for microsurgical technique to be routinely employed without the need for expensive and cumbersome operating microscopes.

 Beginning with the first prototypes in 1967 a practical Burton Fiberoptic headlight then emerged. Shown on the right is the Editor performing spine surgery using the first Burton headlight in conjunction with 4.5 magnification eyeglass mounted on Designs for Vision operating telescopes.

On February 29, 1972, the unit shown to the left featuring a welder’s headpiece and a universal swivel joint, was awarded U.S. Patent 3,645,254.

In today’s world most surgeons use this technology for performing routine cases which they now take for granted.

The post 50 Year Anniversary of the Fiberoptic Surgical Headlight appeared first on The Burton Report.

Burton Report would like to suggest a new and different approach. That of creating Paladins. Classically Paladins have been legendary peers or knightly champions . This could continue to be the case in a modern world.

The certification of Paladins would require the development of a new and unique thought and credentialing process. It would involve enlisting those individuals who would be willing and able to meet and then follow the following requirements:

• Extensive background screening.
• Extensive firearms training.
• Continuing firearms recertification.
• Periodic behavioral peer review.
• Acceptance of the circumstances under which there Paladin certification could be revoked.

Much like “enhanced” drivers licenses and airline “pre-check” Paladin certification would be a new official recognition which would allow a unique and limited group of individuals to maintain concealed carry, at all times, in all environments.

  DEATH and GUNS: WHY PALADINS?

At the present time there are many state gun laws. There are also many federal statutes regulating the manufacture, trade, possession, transfer, record keeping, transport, and destruction of firearms, ammunition, and firearms accessories. None of these laws has yet prevented extremists from obtaining the weapons they seek to destroy innocents.

As of July, 2016 qver the past four decades, the United States has experienced an average of 19 mass shootings a year claiming an estimated 3,712 victims. Research has documented that those states which have passed “right-to-carry” laws have experienced a significant decrease in deaths and injuries from multiple-victim shootings of strangers while non-stranger homicides have dramatically increased at the same time. It is clear that these trends will only increase in the future unless some sort of reasonable action is taken.

Why is there so much death and violence which is unique to the United States? Well clearly there are many factors we need to stop and think about the steady diet of violence and death being fed to all of us, on a daily basis, in our newspapers, magazines, television, movies and other means of communication. Perhaps this is but only another example of the xylotyl phenomenon.

While it is fact that the second amendment of the Constitution is consistently a front page issue most American citizens are unaware that another fundamental principle of American law is that the government, and its agents, are under no general duty to provide public services, such as police protection to any individual citizen. Law enforcement in the United States is clearly not geared to the protection of individual citizens and is, in many environments, presently unable to effectively cope with endemic crime.

The post Gun Sanity With Palladins appeared first on The Burton Report.

The following is part of one of many letters which have been received by Burton Report from  World War  II veterans who experienced Pantopaque® myelography at that time:

It all started in the US Army where I was hurt during exercises and had to have a disc repaired. They did an oil-base mylogram and then I had 5 other surgeries in the service where the same dye was used each time the did a mylogram. I am now wheelchair bound. I had the Medtronic morphine pump for 5 years and it was a God send until it leaked at the cath site at T10 and T11 and it grew a cyst that paralysed my right leg completely and my left leg to the knee. I now have to cath. myself to unrinate as that function never returned. I wear a brace on my right leg for support when I stand. I belong to ASAMS (Arachnoiditis Sufferers Action and monitoring Society) and it is a great place to be.

Although neurosurgeon William  Van Wagenen published, in 1942, the information that Pantopaque® actually was responsible for causing a “chemical meningitis” in patients and that the subsequent medical literature further documented that Pantopaque® not infrequently led to death and disability due to the production of associated adhesive arachnoiditis, this information was, and continued to be,suppressed by the drug manufacturers and those who then marketed it. Remarkably, Pantopaque® was never banned from clinical use in the United States.

Despite the valiant efforts of arachnoiditis self-help organizations created around the world by victims of this disease to promote awareness governments who have looked into the issue and who have documented the existence of this remarkably extensive world-wide public health problem have endeavored mightily to suppress public awareness and enlightenment. Their reasons for doing so appears to relate directly to the economic  realization that to acknowledge this widespread health disaster and to provide appropriate care for the many sufferers still alive would involve a significant effort involving a high level of expenditure to legitimately identify and medically treat these adhesive arachnoiditis sufferers scattered throughout the globe.  So much for the issue of integrity.

Derek Morrison ([email protected]) has been one of the many individuals throughout the world who have been afflicted with adhesive arachnoiditis as a result of ill-advised Myodil oil myelography. Over the years he has endeavored to bring his research and commentary to the attention of fellow patients and the authorities and has now been in the process of publishing a book (from which this advanced segment has been provided) “The Day They Poisoned JFK Article” presenting evidence that “the true reason” JFK suffered from back pain was because of adhesive arachnoiditis due to pantopaque myelography. Mr. Morrison has overcome the denial of full access to JFK’s  medical records and has located and presented JFK’s 1944, 1947, and 1951 lumbar x-rays documenting the presence of residual pantopaque in his sub-arachnoid space. See the following for additional information: https://thedaytheypoisonedjfk242371146.wordpress.com

The post Adhesive Arachnoiditis: The Day They Poisoned JFK appeared first on The Burton Report.

As of November 24, 2012 the Center for Disease Control had identified 478 cases of fungal meningitis and 34 deaths due to this steroid contamination in the United States.

Remarkably, a much more serious widespread health care problem related to epidural steroid injections has received essentially no attention from the medical community or governmental agencies. This has been specifically related to inadvertently causing a severe chemical meningitis when some sterile steroid suspensions are unknowingly injected, not into the epidural space, but directly into the spinal fluid (the subarachnoid space)

The subarachnoid space which surrounds our nervous systems (brain, spinal cord, etc.) contains the cerebro-spinal fluid (CSF) and is the most fragile and pristine environment in the human body.  It does not well tolerate irritants or toxic materials.  It is the last place where toxic chemicals should be placed due to the intolerance of the surrounding tissues leading to an inflmmatory reaction referred to as “arachnoiditis” which, if progressive, can produce severe scarring, a condition referred to as “adhesive arachnoiditis”. This inflammatory condition is capable of producing permanent injury to the spinal nerves of the cauda equina which is typically reflected by associated intractable and constant pain which can be totally disabling. Unlike bacterial or fungal meningitis, which can lead to death, chemical meningitis rarely produces death but often results in totally disabling life-long chronic pain.

During the early 1940s oil based myelographic agents (pantopaque and myodil), which had not received drug approval were introduced for routine use in military hospitals by a Army officer who, along with his associates, had personally received a patent for Pantopaque. Even though neurosurgeon William Van Wagenen identified Pantopaque as the cause of “chemical meningitis on” in the spine it was marketed throughout the world, and at the height of its use is estimated that thousands of servicemen and approximately 450,000 patients a year received Pantopaque myelogramsa year in the U.S. . The fallout from this was hundreds of thousands of totally disabled individuals. Pantopaque was never banned from use in the US but fortunately was replaced by safer myelographic substances in the 1970 at which time it  “fell into disuse.”

The serious problems relating to chemical meningitis secondary to Pantopaque were never really effectively made known to the medical profession and, because of this, many practitioners have not become aware of this history. This can not, however, be considered a legitimate excuse by those whose ignorance is placing their patients at high potential risk.

Following the initial use of the steroid cortisone in medicine in 1949 epidural steroid injection became popular as a means of treating low back pain. Steroid solutions such as hydrocortisone, methylprednisolone, triamcinolone, and betamethazne along with suspensions containing other substances came into routine use. It is interesting to note that although double-blinded randomized and prospective studies generally failed to support the efficacy of epidural steroid injections even their detractors continued to use this procedure on a regular basis and there is no doubt, that when used safely, that epidural steroid injections have withstood the test of time as a valuable adjunct in the treatment of low back and leg pain.

Steroids by themselves are rarely associated with inflammatory reactions or chemical meningitis. In fact steroids tend to be a first line of defense in treating inflammatory conditions. The same, however, cannot be said to be true in regard to the associated substances often added to the steroid solutions intended to prolong shelf life and to decrease absorption. The most commonly used steroid for epidural injection has been methylprednisolone combined with stabilizers such as polyethylene glycol in suspensions such as Depo-Medrol. Research has shown that the prime offender in causing conditions such as chemical meningitis leading to adhesive arachnoiditis  has been the polyethylene glycol component in suspensions such as Depo-Medrol.  One solution is to simply inject solutions rather than suspensions.  It must be pointed out that not infrequently, in the past, safer solutions have not been available for practitioners to use.  Compounding pharmacies have provided an important service in making safer steroids more available with better and cost-saving packaging. This does not, however, excuse poor quality control allowing product contamination.

Due to the high risk level it is essential that steroid suspensions be reliably deposited into the epidural space and do not enter the subarachnoid space. Unless the procedurist performing the epidural steroid injection utilizes the safeguards of fluoroscopic monitoring and epidurography to safely guide the needle clinical studies document that in approximately 30% of cases the needle is not where the procedurist thinks it is. Typically, this problem occurs with “blind” epidural steroid injections performed by practitioners ignorant of the potential complications and thus unable to provide their patients with adequate informed consent. True informed consent is not possible when the physicians performing epidural steroid injections are themselves ignorant of the potential adverse consequences of their actions.  Shown below is a popular patient hand-out on “Lumbar Epidural Injections” originally published in 1998.which does not even mention chemical meningitis, or its sequela, as possible complications:

Even more remarkable is the following comprehensive review on Epidural Steroids published by the prestigious North American Spine Society in 2003, also failing to even mention chemical meningitis as a possible complication:

Checklist To Follow Before Ever Having A Epidural Steroid Injection

• Become a well-informed consumer and always seek informed consent.
• Request a specific diagnosis before ever agreeing to have any form of invasive therapy.
• Always inquire if alternative non-invasive therapies are available.

If an epidural steroid injection is being recommended inquire regarding the type of technique being used and the specific steroid being used.  Always avoid having a blind injection performed.

The post The Real Health Issue With Epidural Steroid Injections appeared first on The Burton Report.

In February 2013 the Federal Parliament of Australia appealed to Glaxo Smith Kline to “do the right thing” in assisting patients disabled by adhesive arachnoiditis from their products by setting up a charity for this purpose.  This request has not yet been initiated.

It remains most most disturbing that after over half a century no one has been actually held accountable for this blot on world health care. Also, because the issue has never been provided with the exposure it deserves, patients and physicians have not learned from history.  The continuing fall-out from this phenomenon has been the continued practice of ill-advised blind epidural steroid injections (using suspensions containing toxic materials) continuing to cause disabling chemical meningitis leading to the pathologic entity adhesive arachnoiditis.

The post Australia Once Again On Target: Chemical Meningitis and Adhesive Arachnoiditis appeared first on The Burton Report.

Directly due to some of the significant scientific limitations of present medical practice, the treatment of tick-borne disease has now become the single most controversial illness in modern medical history. Unfortunately, this controversy has now spilled over to invoke demeaning vitriol, ugly politics, and attempted character assassination. Treating physicians are being subject to treatment consistent with a modern resurgence of the Spanish inquisition while other physicians have, in the process, become ‘enemies of the people’ whose safety has, sometimes, been held at risk.

The editor of this web site is a neurosurgeon medical director of a multi-specialty clinic, which has included the treatment of patients disabled by the sequela of tick-borne disease.  I, and my colleagues, have observed, over the years, many disabled patients coming to our clinic from around the country who have been previously given hopeless diagnoses, such as multiple sclerosis, and have been told that there was no possible treatment.  We have observed  that many of these patients, following positive blood cultures and subsequent antibiotic treatment, have made remarkable recoveries.

As I have become more interested and involved in the issue of tick-borne disease, my eyes have been progressively opened to this ongoing and non-ending American medical tragedy.  As a long-term resident of Minnesota who remembers well the experience of emerging from Pogami swamp in Ely MN during an Outward Bound exercise covered with leeches (aka African Queen), I was relieved to have the knowledge that leeches only rarely transmitted any disease harmful to humans.

The question then is why ticks, on the other hand, have such filthy mouths with their saliva rife with spirochetes, ricketssia, gram negative bacteria, and parasites?  Does this situation reflect a normal process of evolution or does this reflect the creation of  “Frankensteinian” bio-warfare weapons as suggested in The Plum Island Expose involving scientists working in secret facilities creating “designer” arachnids?

Even though the DNA of the Borrelia burgdorfi (Bb) spirochete was found in the body of the 5,000 year old frozen alpine man Otzi, it remains an interesting historic fact how Bd came to be associated with the city of Lyme Connecticut and thus became the poster child for all tick-borne disease.

Bb’s reputation as “public enemy #1” is however well deserved.  This organism is the most genomically (genes, plasmids, etc.) complex bacterium known to science and it is this complexity which allows Bd to continuously morph both physically and physiologically into its environment allowing it to continue to survive despite the adversity of drugs and the body’s immune system.  Identifying Bb is difficult enough but this process is further confused by less than reliable laboratory testing and the existence of other Borrelias, including Borrelia miyamotoi which is also endemic in the U.S. and presents with symptoms similar to Bb in patients who have tested negative for Bb but who have had favorable responses to antibiotic treatment.

To add to the confusion, there are at least eight different species of Bartonella known to infect humans.  In addition to infecting body tissues such as joints and the nervous system as does Bb, Bartonella has a particular affinity for becoming intracellular making it even less susceptible to antibiotic treatment.

It is unfortunate that the routinely used tests to determine Lyme disease are essentially non-specific and unreliable. In the past clinic has been fortunate in having been able to identify a Bd culture test offered by Advanced Laboratory Services of Sharon Hill, Pennsylvania. A  positive organism culture being the “gold standard” for the diagnosis of infectious disease.  Unfortunately, because of unwarranted “bad press” Advanced Labs has ceased to perform this important service  which had previously been an important means of assisting us in making the determination as to who to treat with multiple antibiotics over significant periods of time.

Treating tick-borne disease with antibiotics is a  difficult challenge and certainly falls into the non-specific .   “shotgun treatment” liabilities shared by our present management of psychogenic disease, cancer, and a number of other infirmities. Continued antibiotic use does indeed promote more in the way of antibiotic resistant organism strains.

What is the conscientious physician’s alternative? I was taught as a medical student that my responsibility was to always try to make the best diagnosis for my patient.  If there was a 90% likelihood of an untreatable condition being present, it was my task to focus on the other 10% to come up with a treatable condition.  Many patients diagnosed with untreatable neurologic problems have subsequently turned out to have treatable conditions.  As a neurosurgeon, I have seen many MRI scans of the brain and spinal cord containing lesions which were considered to be “diagnostic” for demylinating disease such as multiple sclerosis.  I now know that similar lesions can result from tick-borne disease.

Because epidemiologists have not always found live Bb organisms in chronic tick-borne disease cases, some have represented to the medical community that there is no such thing as “chronic Lyme disease” and. accordingly, the treatment of chronic Lyme disease can “not be supported by the medical literature.”   The fall-out from this has led to the harassment and sometimes prosecution (with loss of medical license) of concerned physicians attempting to do what they believe to be in the best interest of their patients. This modern era example of the Spanish inquisition has, sadly, created a climate of fear in the medical community resulting in many physicians being unwilling to even treat cases of tick-borne disease.

The population of ticks and the incidence of tick-borne disease has dramatically increased in the U.S.  It has been estimated that 90% of patients who continue to have disability secondary to tick-borne disease have not yet been identified in our population.  In August 2013 the Centers for Disease Control (CDC) announced that they had revised their estimate regarding the prevalence of Lyme disease in the United States by 10 times. Clearly, the untreated cases become chronic and when they are finally diagnosed, they are typically often seriously impaired as well as costly to treat. Long-term antibiotic therapy is expensive and not without risk. The practice of medicine and surgery is always associated with some degree of risk.  Good medical practice should always balance this risk against the potential benefit of treatment.

Today’s health care “buzz word” has become “evidenced-based medicine”; not “good evidence-based medicine.”  This editor is aware of poor, flawed, and even faked scientific and clinical studies as well as good studies whose results have been misinterpreted. Although the present treatment of tick-borne disease has sadly pitted disabled patients against physicians, as well as physicians against physicians, there is good reason to believe that within a reasonable period of time (8+ years) that this controversy will finally be relegated to an episode that all will be pleased to forget.

Not only is our present testing for organisms non-specific it must be pointed out that our present treatment are also non-specific;  and certainly not innocuous. With the coming of the new discipline of nanoscience this is, however, likely to change for the better.

NANODIAGNOSTICS- includes the development of nanodevices utilizing materials such as graphene (as thin as one atom) which will finally offer the possibility of being able to accurately identify single proteins.

NANOANTIBIOTICS- nanoantibiotics and nanopolymers will offer the possibility of directly targeting and destroying specific bacteria as well as infected cells.  Nano technology will allow for small volumes of nanoantibionics to be much more highly effective thus avoiding the liability of creating resistant bacterial strains.

MICRO-DELIVERY SYSTEMS- the present means of delivering parenteral antibiotics requires central lines and ports.  With the advent of small fluid volumes subcutaneous reservoirs can be connected to small implanted devices in the intra-osseous space.  Few clinicians presently recognize that the intra-osseous space (bone marrow) is a direct connection to the body’s venous system.  Small intra-osseous implants placed in the pelvic ileum are presently under development and are capable of continuously delivering nanoantibiotics (or other drugs) into the body at a constant rate over a period of weeks or months .

In addition to the fast developing field of notnano science there is every reason to believe that with better definition of each individuals genomic makeup that even more selective therapies will become possible in the future.

There is no place in our world for medical “witch hunts.”  Those with opposing views need to re-establish not only a professional respect for their colleagues, but also for their patients.

Charles V. Burton, M.D., F.A.C.S.

The post Managing Tick-Borne Disease: A Sad Chapter in Health Care appeared first on The Burton Report.

In the 1947 movie “The Secret Life of Walter Mitty”, Danny Kaye daydreams that he is a world famous surgeon in the process of making an incision, when he suddenly announces to the collective operative team that “coreopsis” has set in and all involved then recoil in horror. The sound bit “coreopsis” could not be a better means of conveying the impression of an terrible affliction being discovered.  Coreopsis, is, however, actually the name of a flowering houseplant.

There was a time when medical diagnoses were characterized by a wealth of similarly nonsensical and non-specific diagnoses, of which such terms such as: “inanition”, “dropsy”, and “imbalance of the body humors” were not uncommonly used to state a definitive diagnosis.

Remarkably, it now appears that we are once again harkening back to the age of nonsensical medical diagnoses.  As a neurosurgical spine specialist the editor has observed, with a rising sense of alarm, imaging studies of the spine being read by radiologists as primarily demonstrating “spondylosis” (Spondylo- vertebrae; -osis condition of)  as the initial diagnosis.

When dictating radiologists have been queried about this issue their consistent answer has been that the diagnosis of “spondylosis” was being used by their organizations only because this had been found to be the magic key to unlocking reimbursement whereas other, more specific diagnoses, were not being reimbursed.

It is evident that economics is driving this nonsense.  Will the next step be describing lesions of the brain as being “neuralosis”?  Or, how about describing a cause of death as being due to “corpuslosis” (condition of the body)?

The computer techies talk about “garbage in, garbage out.”  It does not take very much imagination to see that some of the fallout from the likes of  coreopsis as a medical diagnosis will be the increased “garbaging” of future health care statistics and the decreasing reliability of healthcare related incidence and prevalence studies.

One of today’s other unfortunate realities is that treating physicians, in the attempt to place the best interests of their patients first, will sometimes list an incorrect diagnosis as part of a well-intentioned effort to have the treatment approved and equally as important, to have such paid for by the patient’s insurance.

All of this behavior demeans and undercuts the science and practice, as well as the ethics of patient care. While there may not be an easy answer to this dilemma the first productive step needs to be the identification of such nonsense.

The post A Return To Nonsense: Coreopsis As A Medical Diagnosis appeared first on The Burton Report.

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This encounter served as food for thought.  Who owns the wrist?
Is it the:

General Surgeon?
Neurosurgeon?
Orthopedic Surgeon?
Plastic Surgeon?
Hand Surgeon?
Someone Else?

No one owns the wrist.  Who is best prepared to treat the specific infirmity being addressed?  That all depends on the training, experience, skill and outcomes of the surgeon who steps up to the plate.  Who is the umpire?  The umpire is the patient.

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