Tort Reform, Defensive Medicine, and the Diffusion of Diagnostic Technologies

This study examines the effects of state-level, tort law reforms on the diffusion of medical technology in the United States. The central thesis focuses on the diffusion of medical technology as an indicator of defensive medicine. Specifically, if physicians reduce their level of defensive medicine in the wake of liability reforms, this will show up as a reduction in the demand for and, more importantly, in the quantity supplied of medical technology. I discover after analyzing panel-data reflecting the availability of hospital-based diagnostic technologies by states and for the years 1987, 1990, and 1993 that differences in the availability of the technology are partially the result of state-level liability reforms. Moreover, there are significant differences in the impact of reforms on established (diffused) technologies and newer (diffusing) technologies. The results provide further evidence of the existence of defensive medicine and of the impact of the legal environment on the diffusion of medical technology. Eastern Economic Journal (2008) 34, 141–157. doi:10.1057/palgrave.eej.9050024

Elimination of rabies—a missed opportunity

Rabies is one of the oldest known zoonoses. Recognized etiological agents consist of at least 15 proposed species of lyssaviruses with primary reservoirs residing in the Orders Carnivora and Chiroptera. A plethora of viral variants, maintained by a diverse set of abundant hosts, presents a formidable challenge to a strict concept of true disease eradication. Despite the availability of affordable and efficacious animal and human vaccines, today however dog rabies continues to escalate unabated across much of Asia and Africa, causing millions of suspect human exposures and tens of thousands of human rabies deaths annually. By identifying what hampers global human rabies elimination this chapter emphasizes that, given the global epidemiology of rabies, the “One Health” concept is key to solving the problem. Next to state of the art human rabies prevention, immunization and experimental therapy, it is obvious that human rabies can only be eliminated through rabies control at the animal source. This ‘paradigm shift’, however, needs new grassroot initiatives as well as political will and the closing of ranks of all stakeholders in the near future