Hawaii’s New Strick E-Bike Law to Prevent Brain Injury

Dr. Josh Green in white coat with stethoscope in office and Hawaiian flag

Governor Josh Green signed Act 259 (HB 2021) on July 15, 2026, giving Hawaii its first comprehensive statewide e-bike framework. The law requires helmets for all riders under 18, bars anyone under 15 from operating an e-bike, and prohibits riders under 16 from using Class 2 or Class 3 models without adult supervision.

The measure grew out of an alarming rise in head trauma. Hawaii Department of Health data reported that e-bike injuries more than doubled between 2022 and 2025, from 106 to 244. Honolulu EMS also found that 81 percent of the e-bike patients that were treated wore no head protection. Honolulu-based Kapi’olani Medical Center’s trauma team reported that e-bike crashes recently became the leading cause of injury among the children it treated.

Man riding a bicycle on the sandy beach during sunset

Green, previously an emergency physician, has been blunt about the stakes. “If they have a head trauma, they’re probably going to have long-standing disability from the traumatic head injury,” he said in a September 2025 interview.

The law also reclassifies machines exceeding 28 mph as e-motorcycles, subject to licensing, registration, and insurance. California imposes comparable rules, while New Jersey now goes further, requiring helmets for e-bike riders of every age.

See also: E-Bikes and Brain Injury: The Risks, the Recovery, and the Law

Widely Used Birth Control Comes With Brain-shaped Asterisk

Vial of Depo-Provera and syringe on medical tray

Per the CDC, roughly 1 in 4 sexually active American women have used the form of birth control Depo-Provera. Studies, though, found that the effects of this injectable go beyond contraception. The government paper trail also keeps growing, regarding the risks it may cause.  A JAMA Neurology study found a 2.43-fold higher risk for developing a brain tumor among users. Just this month, on July 2, 2026, another JAMA study flagged the injection as having the strongest risk of brain tumor development of any contraceptive. (This study also reported reassuring news: risk fades within roughly five years of stopping. Additionally, absolute risk stays low, as less than 5 in 10,000 women have this extremely negative effect.)

According to the Mayo Clinic, “Depo-Provera is a birth control shot that has the hormone progestin.” In actuality, it injects medroxyprogesterone acetate, a synthetic version of the natural hormone progesterone.  Long-term use of this injection can result in meningiomas, which are usually benign brain tumors. Meningiomas, though, can crowd the brain, triggering headaches, vision loss, and seizures. In December 2025, the U.S. Food and Drug Administration ordered a warning on the Depo-Provera label.

Meanwhile, Pfizer reached a June 2026 settlement covering over 5,500 federal lawsuits alleging it downplayed the danger. Though this number may seem large, the percent of Depo-Provera users it represents is small. So, users shouldn’t panic but should talk to their doctor about duration of use.

The Post-TBI Weight Gain No Diet Could Stop Until Now

For some survivors, uncontrollable gain weight can be a consequence of a brain injury. The condition, known as acquired hypothalamic obesity, strikes when there is damage to the hypothalamus, the brain region that regulates hunger and energy balance. Once that control center is disrupted, patients are left with relentless hunger and rapid weight gain that resists diet and exercise alone. (Most often, the condition follows treatment for brain tumors, but traumatic brain injuries and strokes can trigger it too.)

Pharmacist pointing at a medication bottle while a woman and a young man listen

Those with this condition previously have nowhere to turn for real help, but that changed on March 19, 2026: the U.S. Food and Drug Administration approved setmelanotide, sold as Imcivree, as the first therapy specifically designated for this rare disease. The drug works by restoring hormone signaling along the MC4R pathway, which is the same circuit the injury disrupts.

The approval followed the largest placebo-controlled study ever conducted for this condition, published in the New England Journal of Medicine on July 8, 2026. Patients on the drug saw a 16.5 percent average drop in BMI, compared with a 3.3 percent increase among those on the placebo. Trial co-author Dr. Reema Habiby confirms, “These results offer real hope to children and families who have had very few options.”

Group-home Debate in NH Focuses on Those With Brain Disorders

Elderly man with walker, young woman wearing helmet, and caregiver talking outside a blue assisted living home

New Hampshire’s group homes for people with brain injuries and developmental disabilities are getting new legislative scrutiny: Gov. Kelly Ayotte signed House Bill 1763 into law on June 19, 2026, creating a committee to study how these residences are sited, built and maintained statewide, and whether siting disputes push vulnerable residents from needed care.

The panel, which was formed after neighbors in towns like Bow objected to state-backed homes appearing without notice, must report findings by Nov. 1, 2026. Sponsor Rep. Mike Drago said “residents feel blindsided” when facilities open unannounced. Disability advocate Lisa Beaudoin countered that “it is perfectly safe to have people with developmental disabilities in one’s neighborhood.” More so, advocates state that it is needed, as New Hampshire’s estimated 2,000 residents with acquired brain disorders rely on such housing to stay near family and services.

New Hampshire isn’t first to grapple with this tension. California has guaranteed small group homes equal footing with single-family houses since 1978. Connecticut adopted similar zoning-parity protections around 1980, later adding density limits after litigation. New York took a study-first approach in 2025, forming a working group on group-home families – a path New Hampshire now follows, as well.

Update: Mercury on the Mind

Industrial refinery at sunset with a yellow danger sign warning of mercury area and hazardous chemicals

Mercury is a potent neurotoxin. It is particularly dangerous for pregnant women and young children. As a 2018 TBI on the Hill piece noted, mercury exposure “may delay developmental milestones” in fetuses and children, and acute poisoning can bring tremors, slurred speech, and hallucinations.

The EPA finalized the 2012 Mercury and Air Toxics Standards, targeting coal- and oil-fired power plants. In 2024, these standards were tightened by Congress. Supporters of this heightening of standards argued that the tighter limits reduced toxic exposures tied to neurological harm. Critics countered that by 2021 mercury emissions were already down 90% from pre-2012 levels, and the 2024 update’s compliance costs outweighed its measurable benefits.

In February 2026, the EPA repealed the 2024 update, reverting to 2012 standards. In turn, on April 27, 2026, Senator Whitehouse (RI) introduced S.J.188 to reinstate 2024 standards, which would nullify the presidential proclamation from earlier this year. When the Act went to the Senate floor on June 3, 2026, the resolution failed 46-53, with voting falling in party lines, as they considered (1) Did the 2024 rule cause unnecessary economic stress on the industry, costs that are then passed on to the consumer”, and/or (2) Are the brain-protective regulations too great for the government to ignore?

A Dangerous TBI Two-Way Street

A traumatic brain injury doesn’t just raise your risk of later neurological disorders; preexisting neurological disorders may raise the risk of brain injury, concludes a recent 2026 study from the San Francisco Veterans Affairs Health Care System.

Diagram showing circular relationship between brain injury and epilepsy with arrows indicating feedback loop and mutual exacerbation of seizures and brain damage

Published June 17, 2026. in the journal Neurology, the Department of Defense-supported study tracked more than 55,000 older veterans. Scientists found that traumatic brain injury was tied to higher rates of stroke, dementia, epilepsy, and Parkinson’s disease both before and after the injury. “Our findings raise the possibility that… [pre-existing brain diseases] are themselves risk factors for TBI in older people,” said study author Carrie Peltz, PhD, of the San Francisco Veterans Affairs Health Care System.

In the year before a TBI, older veterans were about three times more likely to have been diagnosed with stroke, dementia, or Parkinson’s and more than four times more likely to have epilepsy. After a TBI, they were roughly twice as likely to have a stroke or epilepsy. This results greatly build on an Oxford Academic, PubMed-accessible, 2025 study that found, “Among those with TBI, patients with pre-injury dementia had particularly high chronic mortality.” While causality has not firmly been medically defined, the study’s results are clear.

Women With Brain Injuries Less Likely to Reach Trauma Centers – But the Full Picture Matters

Male patient with head injury eating with visitor and female patient with head injury writing

A major new study published June 15, 2026, in the Canadian Medical Association Journal (CMAJ), and found in the PubMed database, reveals a striking inequity: women hospitalized with traumatic brain injury (TBI) in Ontario are significantly less likely than men to be admitted to specialized (Level I or II) trauma centers. After adjusting for age, injury severity, comorbidities, and income, women’s odds for prompt treatment remain 26% lower (OR 0.74) than that of men.

The finding echoes earlier work: a 2022 US study found that female trauma patients, including those with TBI, experienced longer delays to reach trauma care than men even after accounting for injury severity and type. An accompanying editorial was pointedly titled “Sex Disparities in Trauma Care -Why Are the Women Waiting?” Other U.S. research similarly documents women being undertriaged in emergency departments despite comparable injuries.

Yet context is essential. Per CDC data reported in 2018 and 2020, males were nearly two times more likely to be hospitalized for a TBI (79.9 age-adjusted rate versus 43.7) and three times more likely to die from one than females (28.3 versus 8.4). Even in the Ontario study, men had more severe head trauma (33% vs 25%). The disparity in care is real and demands attention, but men remain more likely to sustain, and die from, TBI overall.

President Jackson’s Badge of Freedom

Portrait of a 19th-century man in black suit holding a sword with U.S. Capitol visible through window

Long before he became the seventh president, 13-year-old Andrew Jackson was a prisoner of war. As America’s last president to have served in the Revolutionary War, he and his brother were captured during the British invasion of the Carolina backcountry in 1781. Jackson was then ordered to clean a British officer’s boots. When he refused, the officer answered with a saber, slashing Jackson’s hand and head.

Revolutionary War soldiers in Carolina backcountry 1781

The wound never fully left him. Reports from his friends later stated that they could lay a finger in the dent it left in his skull. In fact, he wore this scar as a badge of freedom rather than a mark of defeat. Historians have long debated what role that early head trauma may have played in the headaches and volatile temperament that shadowed him for life, though no clinical record can say for certain.

This July 4, The Museum of the Waxhaw, in Waxhaw, NC, steps from young Jackson’s refusal, and the resulting wound, honors this moment in American history with a reading of the Declaration of Independence.

FY27 Defense Bill Takes Aim at Military Brain Injuries

Stacks of defense budget documents laid out on a table with the U.S. Capitol building in the background at dusk

The Fiscal Year 2027 National Defense Appropriations Act advances several significant provisions for service members living with traumatic brain injury, moving through both chambers of Congress with bipartisan momentum this June.

The Senate Armed Services Committee approved S. 4784 on June 10 after a three-day markup. The bill includes a provision “requiring the Secretary of Defense to provide a briefing on the feasibility of regular cognitive testing and establishing blast overpressure and TBI logs, and encouraging DoD to approach brain health, blast overpressure exposure tracking, and suicide risk analysis as force health protection.” Additionally, it includes “the provision of training to the armed forces of partner nations in the Indo-Pacific and Arctic regions in the following areas: (A) Health effects and medical response related to chemical, biological, radiological, nuclear, and explosive weapons, (B) Trauma care, (C) Preventive medicine and infectious disease, (D) Post-traumatic stress disorder, (E) Suicide prevention, (F) Traumatic brain injury, (G) Medical and health intelligence, (H) Health policy and administration.”

The House version, H.R. 8800, passed committee 44-12 and includes a section that would create a working group to develop an AI-driven digital strategy for treating brain injuries, and $7.5 million for a Cognitive Performance Enhancement Program for Special Operations Forces. H.R. 8800 has not yet received a floor vote.

The Biggest Veterans Bill in Years Buries a Tinnitus Trap

U.S. flag waving with Capitol building and two military personnel silhouette, text about Veterans Act 2026

House Veterans’ Affairs Chairman Mike Bost (IL) and Senate Veterans’ Affairs Chairman Jerry Moran (KS) introduced the Take Care of America’s Veterans Act (H.R. 9237/S. 4744) on June 10, 2026. This new 554-page, 62-page bill includes many sections that affect the brain injured from multiple angles:

Led by Rep. Jack Bergman (MI), a retired Marine general, and Rep. Sarah Elfreth (MD), the BEACON Act provision authorizes roughly $60 million for VA grants targeting non-pharmacological treatments for mild-to-moderate TBI. The Precision Brain Health Research Act, championed by Sen. Jerry Moran and Sen. Angus King (ME), directs a 10-year VA research plan on repetitive low-level blast injuries. The bill’s TBI provision includes A Blast Overpressure Task Force and HBOT reporting requirement, from Rep. Gregory Murphy (NC). A catastrophic-disability supplement of $833/month would benefit many severe TBI cases.

Furthermore, the package includes the Major Richard Star Act, the Love Lives On Act, and the Veterans’ ACCESS Act, among others. Rep. Gus Bilirakis (FL), a Congressional Brain Injury Task Force member, is among 20 House cosponsors; Senate cosponsors are John Boozman (AR) and Kevin Cramer (ND).

While the bill may appear wholly beneficial, it’s controversial because it offsets costs by reclassifying tinnitus – often a TBI symptom – as a derivative condition. (A derivative condition refers to a medical, legal, or mathematical situation that results directly from a pre-existing or primary cause.) This new classification would eliminate its standalone VA rating and data shows that it could potentially cut $57 billion in benefits for 1.5 million veterans.