Medical Malpractice and Compensation in Global Perspective: How Does the U.S. Do It?

This article describes the problem of health care error in the United States of America and the various regulatory, liability, and compensation systems that deal with medical mistakes. In terms of frequency, direct costs, and aggregate social costs, the problem of medical errors is staggering. Millions of patients are killed or injured every year. A large percentage of adverse events could be avoided by the use of reasonable care. Regulators have not dealt with these problems effectively. Regulators specifically appointed to police the medical profession are often lax, whether because of capture, or from a sense of there but for the grace of God go I. When it comes to health care, the primary focus of federal and state authorities has been how to pay for it, rather than how best to elevate its quality or protect patients from harm. Against this backdrop, the liability system does better than most people believe. It sorts claims with reasonable accuracy and doles out compensation in proportion to the severity of patients\u27 injuries. But the liability system deals with the tip of the iceberg, because only a minority of injured patients sue. The liability system is also stingy: Injured patients with valid claims often receive little or no compensation. This article also summarizes the findings of empirical studies our research group has done of Texas medical malpractice litigation, using an enormous database of closed claims

Medical Malpractice and Compensation in Global Perspective: How Does the U.S. Do It?

This article describes the problem of health care error in the United States of America and the various regulatory, liability, and compensation systems that deal with medical mistakes. In terms of frequency, direct costs, and aggregate social costs, the problem of medical errors is staggering. Millions of patients are killed or injured every year. A large percentage of adverse events could be avoided by the use of reasonable care. Regulators have not dealt with these problems effectively. Regulators specifically appointed to police the medical profession are often lax, whether because of capture, or from a sense of there but for the grace of God go I. When it comes to health care, the primary focus of federal and state authorities has been how to pay for it, rather than how best to elevate its quality or protect patients from harm. Against this backdrop, the liability system does better than most people believe. It sorts claims with reasonable accuracy and doles out compensation in proportion to the severity of patients\u27 injuries. But the liability system deals with the tip of the iceberg, because only a minority of injured patients sue. The liability system is also stingy: Injured patients with valid claims often receive little or no compensation. This article also summarizes the findings of empirical studies our research group has done of Texas medical malpractice litigation, using an enormous database of closed claims

Pharmaceutical Pricing When Success Has Many Parents

Pharmaceutical companies claim that high prices for drugs are needed to offset the costs and risks associated with research and development. In most instances, though, the initial (basic) research that leads to new discoveries is conducted at public institutions and paid for with public funds. Drugmakers tend to take over the process of bringing new drugs to market when the prospects for gaining regulatory approval seem good. Because the public helps cover the cost of research, many people believe that it pays twice for drugs—once when tax dollars support research and a second time when patients buy drugs for personal use. This Article takes a hard look at this “paying-twice” critique. We present case studies of two expensive drugs, Sovaldi and PrEP, that were developed with a combination of public and private support. We then survey the broader literature that attempts to quantify and assess the relative importance of both contributions. We then discuss the general problem of evaluating the importance of multiple contributions to productive activities in the absence of market-based allocations of the resulting revenue streams. Finally, we discuss the possibility of protecting consumers from high drug prices and deadweight losses by using prizes instead of patents to incentivize drug development. A prize regime would take the sting out of the paying-twice critique as well

Medical Malpractice Litigation and Tort Reform: It\u27s the Incentives, Stupid

Health care providers and tort reformers invariably claim that the medical malpractice litigation system is rife with behaviors that are irrational, unpredictable, and counter-productive. They attack civil juries, asserting that verdicts are skyrocketing without reason, are highly variable, and bear little or no relation to the merits of plaintiffs\u27 claims. They complain about patients, arguing that the few with valid claims sue rarely, while the many who receive non- negligent treatment sue all the time. They attack greedy lawyers, alleging that they rake in obscene profits by routinely filing frivolous complaints. They complain that compensation flows almost randomly, winding up in the hands of patients who were treated non-negligently as often as (or even more often than) it reaches patients with valid complaints. They argue that the tort system does a poor job of distinguishing real victims from phony ones, claiming that it no more discourages malpractice than a police officer would discourage speeding by ticketing drivers randomly. Instead of motivating providers to do better, the system supposedly paralyzes them with fear and causes them to hide their mistakes. Many of the preceding claims are facially implausible. The medical malpractice liability system is an enormous market whose principal trading partners-trial lawyers and liability insurers-are sophisticated, economically-oriented repeat players. They run the system, and they have the knowledge and incentives to select efficient means to accomplish their respective ends. Given this backdrop, their behavior and the behavior of the system they administer should not be random, or even particularly hard to explain. Nor, given the absence of market power and barriers to entry, should attorneys earn more than market-driven returns on the services they provide. Most of the preceding claims are also inconsistent with empirical studies of the medical malpractice liability system. These studies, which now constitute a substantial body of research, depict a system that is stable and predictable, that sorts valid from invalid claims reasonably well, and that responds mainly to changes in the frequency of errors and the cost of dealing with them. The system does have a number of pathologies, however, including its loading costs, the snail\u27s pace at which it processes claims, and its failure to compensate patients injured by medical negligence as fully and as often as it should

Chondroitin Sulfate Proteoglycans Are Associated with the Lesions of Alzheimer\u27s Disease

Chondroitin sulfate proteoglycans (CSPG) are extracellular matrix proteins inhibitory to neurite outgrowth in vitro and correlated with decreased neurite outgrowth after CNS injury. Previously, heparan sulfate proteoglycan and dermatan sulfate proteoglycan have been shown to be associated with senile plaques (SPs) and neurofibrillary tangles (NFTs) but CSPG was not. In an immunocytochemical study, three monoclonal antibodies to different sulfation states of the chondroitin glycosaminoglycan were used to localize CSPG in cases of Alzheimer\u27s disease. Chondroitin 4-sulfate was found in both SPs and NFTs. An antibody to unsulfated chondroitin strongly immunostained intracellular NFTs and the dystrophic neurites of SPs. Chondroitin 6-sulfate was found in NFTs and the area around SPs. These results suggest that CSPG, in addition or as an alternative to B-amyloid protein, could be responsible for the regression of neurites around senile plaques in Alzheimer\u27s disease

Motion as a phenotype: the use of live-cell imaging and machine visual screening to characterize transcription-dependent chromosome dynamics

BACKGROUND: Gene transcriptional activity is well correlated with intra-nuclear position, especially relative to the nuclear periphery, which is a region classically associated with gene silencing. Recently however, actively transcribed genes have also been found localized to the nuclear periphery in the yeast Saccharomyces cerevisiae. When genes are activated, they become associated with the nuclear pore complex (NPC) at the nuclear envelope. Furthermore, chromosomes are not static structures, but exhibit constrained diffusion in real-time, live-cell studies of particular loci. The relationship of chromosome motion with transcriptional activation and active-gene recruitment to the nuclear periphery has not yet been investigated. RESULTS: We have generated a yeast strain that enables us to observe the motion of the galactose-inducible GAL gene locus relative to the nuclear periphery in real-time under transcriptionally active and repressed conditions. Using segmented geometric particle tracking, we show that the repressed GAL locus undergoes constrained diffusive movement, and that transcriptional induction with galactose is associated with an enrichment in cells with GAL loci that are both associated with the nuclear periphery and much more constrained in their movement. Furthermore, we report that the mRNA export factor Sac3 is involved in this galactose-induced enrichment of GAL loci at the nuclear periphery. In parallel, using a novel machine visual screening technique, we find that the motion of constrained GAL loci correlates with the motion of the cognate nuclei in galactose-induced cells. CONCLUSION: Transcriptional activation of the GAL genes is associated with their tethering and motion constraint at the nuclear periphery. We describe a model of gene recruitment to the nuclear periphery involving gene diffusion and the mRNA export factor Sac3 that can be used as a framework for further experimentation. In addition, we applied to the analysis of chromosome motion a machine visual screening approach that used unbiased visual data rather than segmented geometric data. This novel analytical approach will allow for high-throughput study of processes that can be monitored via alterations in chromosome motion and connectivity with the nuclear periphery