The Attorney-Client Privilege and the Work-Product Doctrine in Michigan

In Upjohn Co v. United States, the United States Supreme Court acknowledged that the attorney-client privilege - the oldest of the privileges for confidential communications known to the common law - has the crucial purpose of encourag[ing] full and frank communication between attorneys and their clients and thereby promote[s] broader public interests in the observance of law and administration of justice. Similarly, in Hickman v Taylor, the Court stressed the importance of the work-product doctrine, noting that [n]ot even the most liberal of discovery theories can justify unwarranted inquiries into the files and the mental impressions of an attorney. It is beyond question that, at a theoretical level, the attorney-client privilege and the work-product doctrine serve significant interests and that, at a practical level, attorneys constantly encounter issues involving these principles. Nevertheless, many attorneys do not acquire their familiarity with these crucial principles in any systematic way. Law school courses and casebooks often treat these principles superficially, and busy practicing lawyers tend to research specific issues only as they arise in the course of their work. As a result, many attorneys (and perhaps some judges) may not clearly understand the significance, scope, and limits of these doctrines. This publication is an attempt to solve this problem by offering a systematic and thorough examination of the attorney-client privilege and the work-product doctrine under Michigan law. Part II of this text addresses the attorney-client privilege; Part III addresses the work-product doctrine; and Part IV addresses ethics concepts of confidences and secrets. Wherever possible, Michigan authority has been cited and quoted. In some instances, federal cases are instructive in interpreting Michigan law or in filling an apparent gap in Michigan law; under those circumstances, the text freely cites and quotes from federal authority. The goal is to provide a comprehensive examination of these principles as interpreted by the Michigan courts.https://repository.law.umich.edu/books/1117/thumbnail.jp

Concurrent Intrathecal and Intravenous Nivolumab in Leptomeningeal Disease: Phase 1 Trial Interim Results

There is a critical need for effective treatments for leptomeningeal disease (LMD). Here, we report the interim analysis results of an ongoing single-arm, first-in-human phase 1/1b study of concurrent intrathecal (IT) and intravenous (IV) nivolumab in patients with melanoma and LMD. The primary endpoints are determination of safety and the recommended IT nivolumab dose. The secondary endpoint is overall survival (OS). Patients are treated with IT nivolumab alone in cycle 1 and IV nivolumab is included in subsequent cycles. We treated 25 patients with metastatic melanoma using 5, 10, 20 and 50 mg of IT nivolumab. There were no dose-limiting toxicities at any dose level. The recommended IT dose of nivolumab is 50 mg (with IV nivolumab 240 mg) every 2 weeks. Median OS was 4.9 months, with 44% and 26% OS rates at 26 and 52 weeks, respectively. These initial results suggest that concurrent IT and IV nivolumab is safe and feasible with potential efficacy in patients with melanoma LMD, including in patients who had previously received anti-PD1 therapy. Accrual to the study continues, including in patients with lung cancer. ClinicalTrials.gov registration: NCT03025256

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

The Attorney-Client Privilege and the Work-Product Doctrine in Michigan

In Upjohn Co v. United States, the United States Supreme Court acknowledged that the attorney-client privilege - the oldest of the privileges for confidential communications known to the common law - has the crucial purpose of encourag[ing] full and frank communication between attorneys and their clients and thereby promote[s] broader public interests in the observance of law and administration of justice. Similarly, in Hickman v Taylor, the Court stressed the importance of the work-product doctrine, noting that [n]ot even the most liberal of discovery theories can justify unwarranted inquiries into the files and the mental impressions of an attorney. It is beyond question that, at a theoretical level, the attorney-client privilege and the work-product doctrine serve significant interests and that, at a practical level, attorneys constantly encounter issues involving these principles. Nevertheless, many attorneys do not acquire their familiarity with these crucial principles in any systematic way. Law school courses and casebooks often treat these principles superficially, and busy practicing lawyers tend to research specific issues only as they arise in the course of their work. As a result, many attorneys (and perhaps some judges) may not clearly understand the significance, scope, and limits of these doctrines. This publication is an attempt to solve this problem by offering a systematic and thorough examination of the attorney-client privilege and the work-product doctrine under Michigan law. Part II of this text addresses the attorney-client privilege; Part III addresses the work-product doctrine; and Part IV addresses ethics concepts of confidences and secrets. Wherever possible, Michigan authority has been cited and quoted. In some instances, federal cases are instructive in interpreting Michigan law or in filling an apparent gap in Michigan law; under those circumstances, the text freely cites and quotes from federal authority. The goal is to provide a comprehensive examination of these principles as interpreted by the Michigan courts.https://repository.law.umich.edu/books/1117/thumbnail.jp