The litigation was complicated since there was a lack of clarity in jurisdiction between state laws, where product liability is determined, and federal law, which determines how drugs are labelled, as well as between generics companies, which had no control over labelling, and the originator company, which did. The litigation yielded at least two important cases. In Conte v. Wyeth in the California state courts, the claims of the plaintiff against the generic companies Pliva, Teva, and Purepac that had sold the drugs that the plaintiff actually took, and the claims against Wyeth, whose product the plaintiff never took, were all dismissed by the trial court, but the case was appealed, and in 2008 the appellate court upheld the dismissal of the cases against the generic companies, but reversed on Wyeth, allowing the case against Wyeth to proceed. This established an "innovator liability" or "pioneer liability" for pharmaceutical companies. The precedent was not widely followed in California nor in other states. Litigation over the same issues related to metoclopramide also reached the US Supreme Court in PLIVA, Inc. v. Mensing, in which the court held in 2011 that generic companies cannot be held liable for information, or the lack of information, on the originators label.
In cardiology, ventricular dyssynchrony is a difference in the timing, or lack of synchrony, of contractions in different ventricles in the heart. Large differences in timing of contractions can reduce cardiac efficiency and is correlated with heart failure. Types of dyssynchrony
Three chief presentations of dyssynchrony can occur:
Atrioventricular (AV) dyssynchrony occurs when there is an unfavorable difference in timing between atrial and ventricular contractions. Interventricular dyssynchrony occurs when there is a difference in timing between right ventricular (RV) and left ventricular (LV) Systole. Intraventricular dyssynchrony occurs when the timing in a sequence of activations and contractions of segments of the LV wall becomes abnormal. In all three types, changes in timing lead to changes in the dynamic behavior of the myocardial tissues, leading to mechanical dyssynchrony. All three presentations allow distinct and easily reproducible electrical signatures as illustrated by left and right bundle branch blocks, hemiblocks, etc. The concise measurement of the time and morphology of the QRS interval allows the interventional ability to manipulate this interval with biventricular pacemakers. It is important to distinguish ventricular dyssynchrony from ventricular dyssynergy. Dyssynergy refers to changes in relative strength of contractions, whereas dyssynchrony is a change in relative timing of contractions. Once again the terms inotropy and chronotropy apply to the pathology under examination. Biventricular pacing strongly favors chronotropy over inotropy. Diagnosis
Echocardiography and tissue Doppler echocardiography are both needed to fully diagnose the different types of ventricular dyssynchrony. Treatment
Recent studies suggest that cardiac resynchronization therapy can reduce the incidence of ventricular dyssynchrony and thus increase cardiac efficiency.