Effects of Alcoholic Beverage Server Liability on Traffic Crash Injuries

We examined effects on the frequency of injuries due to motor vehicle crashes of a sudden change in exposure to legal liability of servers of alcoholic beverages in Texas. A multiple time-series quasi-experimental research design was used, including the Auto-Regressive Integrated Moving Average and intervention-analysis statistical models on injury data from 1978 through 1988. We controlled for the effects of several other policy changes expected to influence injury rates in Texas, and for broader nationwide changes in injury rates in the 1980s. Results revealed 6.5% and 5.3% declines in injurious traffic crashes following the filing of two major liability suits in 1983 and 1984, respectively. Sever liability is one of several important public policy tools in efforts to achieve health objectives regarding reduced injury morbidity, and mortality.     

Legal consequences of standard setting for competitive athletes with cardiovascular abnormalities

This paper addresses the issue of whether establishing consensus standards for the treatment of particular medical conditions increases a physician's exposure to legal liability. The conclusion reached is that the legal effects of standard setting, rather than representing a significant threat of liability, should be seen as beneficial to the medical profession. A fundamental point is that the legal test for liability is entirely dependent on the medical profession's definition of what constitutes adequate care. The law incorporates the standard of care defined by the medical profession and does not impose an external norm. In the absence of formally stated standards, the process of defining relevant medical criteria will involve a great deal of uncertainty. Outcomes of legal contests will be affected by such extraneous factors as the relative experience of the lawyers involved, their access to knowledgeable expert witnesses, and their strategic decisions made with respect to tactics and procedures. Establishment of formal standards has the salutory effect of limiting the influence of these factors and thus reducing the randomness of the results reached. Formal standards also have the advantage of being easily replicated in unrelated proceedings and thereby contribute to the development of a consistent, evenly applied rule of liability. Finally, even if formal standards are either more, or less, progressive than the actual state of medical practice, there is relatively little risk that they will produce untoward results.     

Assessment of medical school institutional review board policies regarding compensation of subjects for research-related injury

PURPOSE: Although the Institute of Medicine (IOM) calls for research organizations to compensate subjects for research-related injury, administrators may fear that candid presentation of such policies would create financial risk. We hypothesized that informed consent language at U.S. medical schools would be particularly complex and fall short of IOM goals, especially for projects without industry sponsorship. METHODS: Medical school websites (N = 123) were surveyed for informed consent language for research-related injury. Text was extracted from 113 sites (92%) and evaluated for details regarding financial liability for research-related injury. When sufficient template text was available (n = 106), the readability of liability policies was compared with the readability of other standardized passages using Flesch-Kincaid analysis. RESULTS: Coverage for medical bills is offered at 61% (23/38) of schools when there is an industry sponsor as compared with 22% (22/102) when there is none (P <0.001). When coverage is offered in studies with no industry sponsor, it is limited to emergency bills in half (11/22) of these policies. Seventy-two percent (81/113) of medical school consent forms specifically rule out the possibility of monetary compensation. The mean (+/- SD) reading grade level of liability text in consent forms is higher than that in other template paragraphs (11.5 +/- 1.4 vs. 10.6 +/- 1.4; P = 0.0001). CONCLUSION: Federally funded research at most U.S. medical schools is conducted with consent form language that is particularly complex and that fails to protect subjects from the financial burden of research-related injury. Few schools meet IOM standards.     

Expert witness malfeasance: how should specialty societies respond?

There is little doubt that severe distortions are present in the legal adjudication of professional medical liability. The medical expert witness plays an important, often crucial, role in the medical liability cases. The expert assesses medical information, interprets and explains medical uncertainty, medical research, and customary practice for a nonscientific jury, and offers an expert level opinion as to whether the standard of medical care was met. When expert witnesses not merely disagree, but misrepresent data, misrepresent their background credentials and expertise, and offer egregiously false testimony, the legal process is violated and verdicts may be distorted. Many medical and surgical professional organizations, including the American Medical Association, have adopted programs that provide guidelines for members who serve as medical expert witnesses in professional liability cases. The American Association of Neurological Surgeons (AANS) was the first to develop a program to deal with irresponsible expert witness testimony. That program involves a published code of conduct, which outlines the expectations of society regarding expert witness testimony, and potential consequences for noncompliance. To date, the AANS program has withstood court challenge, in fact, has received judicial praise. Other medical societies, including the American College of Gastroenterology (ACG), have reviewed efforts by others and are considering developing their own programs.     

Emerging credentialing practices, malpractice liability policies, and guidelines governing complementary and alternative medical practices and dietary supplement recommendations: a descriptive study of 19 integrative health care centers in the United States

BACKGROUND: Little is known about policies governing the integration of complementary and alternative medical (CAM) therapies and providers. METHODS: To document emerging approaches in 19 US hospitals regarding credentialing, malpractice liability, and pharmacy policies governing integration of CAM therapies and providers into conventional medical settings, we surveyed 21 academic medical centers and 13 non-academically affiliated hospitals that are nationally visible and are integrating CAM therapies into conventional medical settings. Of the 19 respondents, 11 were tertiary care hospitals, 6 were community hospitals, 1 was a freestanding center associated with a community-based hospital, and 1 was a university-based rehabilitation hospital. RESULTS: Institutions had no consistent approach to provider mix and authority within the integrative care team, and minimum requirements for professional liability insurance, informed consent disclosure, and hiring status. Less than a third had a formal (stated) policy concerning dietary supplements; those selling supplements in their pharmacy lacked consistent, evidence-based rationales regarding which products and brands to include or exclude. Although many hospitals confiscated patient supplements on admission, institutions had inconsistent criteria regarding allowance of home supply. CONCLUSIONS: Hospitals are using heterogeneous approaches to address licensure, credentialing, scope of practice, malpractice liability, and dietary supplement use in developing models of integrative care. The environment creates significant impediments to the delivery of consistent clinical care and multisite evaluations of the safety, efficacy, and cost-effectiveness (or lack thereof) of CAM therapies (or integrative models) as applied to management of common medical conditions. Consensus policies need to be developed.     

Impact of Electronic Health Records on Malpractice Claims in a Sample of Physician Offices in Colorado: A Retrospective Cohort Study

BACKGROUND

Electronic health records (EHRs) might reduce medical liability claims and potentially justify premium credits from liability insurers, but the evidence is limited.

OBJECTIVES

To evaluate the association between EHR use and medical liability claims in a population of office-based physicians, including claims that could potentially be directly prevented by features available in EHRs (“EHR-sensitive” claims).

DESIGN

Retrospective cohort study of medical liability claims and analysis of claim abstracts.

PARTICIPANTS

The 26 % of Colorado office-based physicians insured through COPIC Insurance Company who responded to a survey on EHR use (894 respondents out of 3,502 invitees).

MAIN MEASURES

Claims incidence rate ratio (IRR); prevalence of “EHR-sensitive” claims.

KEY RESULTS

473 physicians (53 % of respondents) used an office-based EHR. After adjustment for sex, birth cohort, specialty, practice setting and use of an EHR in settings other than an office, IRR for all claims was not significantly different between EHR users and non-users (0.88, 95 % CI 0.52–1.46; p?=?0.61), or for users after EHR implementation as compared to before (0.73, 95 % CI 0.41–1.29; p?=?0.28). Of 1,569 claim abstracts reviewed, 3 % were judged “Plausibly EHR-sensitive,” 82 % “Unlikely EHR-sensitive,” and 15 % “Unable to determine.” EHR-sensitive claims occurred in six out of 633 non-users and two out of 251 EHR users. Incidence rate ratios were 0.01 for both groups.

CONCLUSIONS

Colorado physicians using office-based EHRs did not have significantly different rates of liability claims than non-EHR users; nor were rates different for EHR users before and after EHR implementation. The lack of significant effect may be due to a low prevalence of EHR-sensitive claims. Further research on EHR use and medical liability across a larger population of physicians is warranted.     

Methods for the assessment of abuse liability of psychomotor stimulants and anorectic agents in humans

Although stimulant drugs have been available and abused for centuries, it is only recently that procedures for evaluating their liability for abuse have been developed. This methodological development relies on several converging assessment procedures, combining to reveal the resultant profile of effects. The first of these, drug self-administration, is based on the principle that those drugs which can serve as reinforcers, maintaining behavior leading to their delivery, have a high liability for abuse. In addition, the more traditional approach to measuring abuse liability has been through assessing self-reported effects in which standardized questionnaires are used. A variant of this, a drug liking' scale has also been used. A third focus of measurement has been the accuracy with which subjects can identify the drug they have been administered, with some laboratories developing procedures for training subjects to discriminate specific substances. The profile of effects obtained with a specific compound can then be compared to the profile obtained with prototypic stimulants such as amphetamine or cocaine. The extent to which these profiles are similar would predict relative liability for abuse. This paper describes the data collected for amphetamine and concludes that the most accurate assessment of abuse liability is obtained when an unknown drug is compared to a drug with abuse liability using as many of these measures as possible.     

Cardiac evaluation of collegiate student athletes: a medical and legal perspective

Physicians participate in the screening, routine medical supervision, and disqualification process of collegiate student athletes today. Physicians and universities evaluating collegiate student athletes for athletic participation should understand the meticulous medical process necessary to make eligibility/disqualification decisions and the associated liability issues. It is the responsibility of a team physician to take the lead role in the college sports medical evaluation process. The first duty of a team physician and institution is to protect the health and well-being of their collegiate student athletes. The potential liability associated with the evaluation process requires institutions of higher education and physicians to develop sound and reasonable administrative strategies regarding college athletes and their participation in intercollegiate athletics. Reducing this liability risk requires an understanding of the evolving judicial framework and compliance with standard case law and available guidelines. As medical professional standards evolve, so will responsibilities under legal standards.     

Potential physician malpractice liability associated with complementary and integrative medical therapies

Physicians are increasingly grappling with medical liability issues as complementary and integrative health care practices are made available in conventional medical settings. This article proposes a framework in which physicians can assess potential malpractice liability issues in counseling patients about complementary and integrative therapies. The framework classifies complementary and integrative therapies according to whether the evidence reported in the medical and scientific literature supports both safety and efficacy; supports safety, but evidence regarding efficacy is inconclusive; supports efficacy, but evidence regarding safety is inconclusive; or indicates either serious risk or inefficacy. Clinical examples in each category help guide the clinician on how to counsel patients regarding use of complementary and alternative medical therapies in a given clinical situation. Specific strategies to reduce the risk for potential malpractice liability include the following: 1) determine the clinical risk level; 2) document the literature supporting the therapeutic choice; 3) provide adequate informed consent; 4) continue to monitor the patient conventionally; and 5) for referrals, inquire about the competence of the complementary and alternative medicine provider. This framework provides a basis for clinical decisions involving complementary and integrative care.     

Alcohol, psychological dysregulation, and adolescent brain development

While adolescent alcohol consumption has been asserted to adversely alter brain development, research in human adolescents has not yet provided us with sufficient evidence to support or refute this position. Brain constituents actively developing during adolescence include the prefrontal cortex, limbic system areas, and white matter myelin. These areas serving cognitive, behavioral, and emotional regulation may be particularly vulnerable to adverse alcohol effects. Alternatively, deficits or developmental delays in these structures and their functions may underlie liability to accelerated alcohol use trajectories in adolescence. This review will describe a conceptual framework for considering these relationships and summarize the available studies on the relationships among risk characteristics, alcohol involvement and brain development during this period. The cross-sectional designs and small samples characterizing available studies hamper definitive conclusions. This article will describe some of the opportunities contemporary neuroimaging techniques offer for advancing understanding of adolescent neurodevelopment and alcohol involvement.     

Availability of physician services in Florida, revisited: the effect of the professional liability insurance market on access to health care

BACKGROUND: Access to care remains a key part of improving health care outcomes in the United States. Recent reports have suggested that the number of physicians able to meet the demands for access to care may be decreasing. METHODS: We surveyed physicians practicing in rural and urban/suburban areas of Florida in 2004 to determine whether changes were occurring in health care service delivery. Secondary outcomes assessed included changes in professional liability insurance and their possible effects on changes in service delivery. RESULTS: Overall, 727 (54.4%) of responding physicians stated that the delivery of services had been decreased or eliminated in the previous year. The most commonly eliminated services were nursing home coverage (42.1%), vaginal deliveries (29.1%), cesarean deliveries (26.0%), emergency department coverage (22.8%), and mental health services (21.2%). Surgical specialists (70.2%) and general surgeons (68.5%) were the groups with the highest number of decreased or eliminated services, but this trend was broad, with 63.6% of obstetrician/gynecologists and 60.2% of family medicine physicians also decreasing or eliminating services. Decreases in services seem to be related to changes in professional liability insurance premiums when assessed by both percentage of change and total premium increases for physicians. Rural and urban/suburban physicians did not differ significantly in these assessments. CONCLUSION: The findings suggest that physicians across Florida have continued to decrease or eliminate important health services and that these decreases seem to be related to the difficulty of finding or paying for professional liability insurance.     

Drug discrimination methods in human drug abuse liability evaluation

The drug discrimination paradigm, which is sometimes considered to provide an animal model of human subjective effects, has been adapted for use with human subjects. This procedure provides a direct measure of stimulus similarity between the test drug and a known standard drug, information that may be of value in predicting abuse liability of novel compounds. The present paper reviews the general methods used in human drug discrimination studies, some of the drugs that have been tested, factors to consider in designing drug discrimination studies in humans, and evidence concerning the utility of the procedure in abuse liability assessment. Further research is needed to validate this procedure and to determine the conditions under which it has the greatest value in abuse liability assessment.     

Direct‐to‐consumer genetic testing for addiction susceptibility: a premature commercialisation of doubtful validity and value

Genetic research on addiction liability and pharmacogenetic research on treatments for addiction have identified some genetic variants associated with disease risk and treatment. Genetic testing for addiction liability and treatment response has not been used widely in clinical practice because most of the genes identified only modestly predict addiction risk or treatment response. However, many of these genetic tests have been commercialized prematurely and are available direct to the consumer (DTC). The easy availability of DTC tests for addiction liability and lack of regulation over their use raises a number of ethical concerns. Of paramount concern is the limited predictive power and clinical utility of these tests. Many DTC testing companies do not provide the consumer with the necessary genetic counselling to assist them in interpreting and acting on their test results. They may also engage in misleading marketing to entice consumers to purchase their products. Consumers' genetic information may be vulnerable to misuse by third parties, as there are limited standards to protect the privacy of the genetic information. Non‐consensual testing and inappropriate testing of minors may also occur. The United States Food and Drug Administration plans to regulate DTC genetic tests. Based on the ethical concerns we discuss below, we believe there is a strong case for regulation of DTC genetic tests for addiction liability and treatment response. We argue that until this occurs, these tests have more potential to cause harm than to contribute to improved prevention and treatment of addiction.     

Seven decades of Ramadan intermittent fasting research: Bibliometrics analysis,global trends,and future directions

Background and aimsThere is a large body of research focused on various aspects related to Ramadan intermittent fasting (RIF) and human health and disease. This study aimed to quantify the bibliometric data of RIF medical research over the past seven decades and explore these variables qualitatively via text mining analysis.MethodsWe used the Scopus search engine to identify published articles related to RIF from inception to December 31, 2021. All types of research articles were included. Scientometric and bibliometric measures were determined using Excel, Biblioshiny, and VOSviewer. This study proposed a bibliometric and text mining method to qualitatively and quantitatively recognize the RIF research trend.ResultsThe Scopus search returned 1915 relevant articles. Most citations pertained to publications from the last two decades, and most publications were original research articles. These publications had received around 27,000 citations, and the 20 most prolific publishing journals had an average h-index of 112.25. More than one-third of all medical publications were in open-access journals. There was a 13-fold increase in medical research on RIF over the past few decades. We identified the 10 most prolific publishing countries, institutes, journals, and authors. We also identified five scientific hotspots of RIF scientific literature, which were: diabetes, metabolic health, public health, physiology, and maternity.ConclusionThis is the first comprehensive bibliometric analysis of medical research related to RIF. The research gaps identified will shape future research directions and foster collaborative research activities toward enhanced medical nutrition research revolving around RIF.     

Medical liability disputes involving thoracic and cardiovascular surgeons

BACKGROUND: Medical malpractice claims against surgeons are increasing. In Germany, as in most other European countries, there is no central registry of medical malpractice claims. It is not known at which rate medical liability claims are decided in favor of the physician or the patient. METHODS: All cases of reproaches of medical malpractice in which our clinic was involved within the 10-year period between 1989 to 1999 were reviewed. To compare our results with the general experience in the field of thoracic and cardiovascular surgery, we reviewed the data of the regional medical society in the same time period. RESULTS: From 1989 to 1999, our Clinic was involved in 74 medical liability disputes. There were 28 reproaches of medical malpractice against our department (0.1% of cases performed). Malpractice was detected in only 7 of 74 claims (9.5%). Most reproaches were made for incorrectly performed operations (80%), but only 4 (6.8%) of 59 claims were regarded as medical malpractice. CONCLUSIONS: Reliable data on reproaches of medical malpractice are virtually absent. Only 10% of all reproaches in our study were finally regarded as medical malpractice. A central registry of medical malpractice cases would allow analysis of the areas in which we have to improve performance, and how unjustified reproaches of medical malpractice can be avoided.     

Performance and physiological measures in abuse liability evaluation

Abuse liability testing involves an evaluation of the likelihood of drug self-use and also an evaluation of the harmful effects of drug use. This paper reviews the rationale and utility of examining performance and physiological measures in clinical abuse liability evaluation. It is concluded that there are three important reasons to employ such measures in abuse liability studies: (1) to serve as a reference point to allow for between drug and across measure comparisons; (2) to directly quantify dose-response functions on multiple dimensions of drug effect and thus evaluate the overall profile of effects; and (3) to provide information on the likelihood that drug use will produce harmful effects. The review illustrates each of these purposes and briefly summarises conclusions from previous studies employing performance and physiological measures in the abuse liability evaluation of sedatives, stimulants, and opioids.     

Old age, life extension, and the character of medical choice

OBJECTIVES: This qualitative, ethnographic study explores the character and extent of medical choice for life-extending procedures on older adults. It examines the sociomedical features of treatment that shape health care provider understandings of the nature of choice, and it illustrates the effects of treatment patterns on patients' perspectives of their options for life extension. METHODS: By using participant observation in outpatient clinics and face-to-face interviews, we spoke with a convenience sample of 38 health professionals and 132 patients aged 70 or older who had undergone life-extending medical procedures. We asked providers and patients open-ended questions about their understandings of medical choice for cardiac procedures, dialysis, and kidney transplant. RESULTS: Neither patients nor health professionals made choices about the start or continuation of life-extending interventions that were uninformed by the routine pathways of treatment; the pressures of the technological imperative; or the growing normalization, ease, and safety of treating ever older patients. We found a difference among cardiac, dialysis, and transplant procedures regarding the locus of responsibility for maintaining and extending life. DISCUSSION: Provider and patient practices together reveal how the standard use of medical procedures at ever older ages trumps patient-initiated decision making.     

The role of the student-teacher relationship in the formation of physicians

Relationship-Centered Care acknowledges the central importance of relationships in medical care. In a similar fashion, relationships hold a central position in medical education, and are critical for achieving favorable learning outcomes. However, there is little empirical work in the medical literature that explores the development and meaning of relationships in medical education. In this essay, we explore the growing body of work on the culture of medical school, often termed the “hidden curriculum.” We suggest that relationships are a critical mediating factor in the hidden curriculum. We explore evidence from the educational literature with respect to the student-teacher relationship, and the relevance that these studies hold for medical education. We conclude with suggestions for future research on student-teacher relationships in medical education settings.     

Perspectives and future on testing for abuse liability in humans

Testing of drugs for abuse liability can benefit public health. By encouraging proper therapeutic use, appropriate regulation, and development of safer and more effective drugs, such testing can benefit both consumers and pharmaceutical manufacturers. Many factors influence actual abuse; animal and human drug abuse liability testing procedures are useful, though imperfect, predictors of abuse. Three suggestions are made concerning human drug abuse liability testing: (1) that more research is needed on differences between individuals and between different subpopulations tested with these procedures (2) that actual epidemiological experience concerning abuse should be the ‘gold standard’ for assessing the validity and utility of drug abuse liability testing methods; and (3) that methods for drug abuse liability testing in humans should be introduced and used systematically to guide appropriate development, regulation, and marketing of drugs.     

Comparative study of the abuse liability of alprazolam, lorazepam, diazepam, methaqualone, and placebo

Subjective effects of two benzodiazepines--alprazolam and lorazepam--were compared with two drugs of known abuse potential--diazepam and methaqualone--and placebo. This double-blind, crossover trial tested 30 casual recreational sedative users in a seminaturalistic setting. Methaqualone was more euphoriant and less sedative than the benzodiazepines. Diazepam and lorazepam were more euphoriant than placebo; alprazolam's euphoriant effect did not differ from these treatments. On other measures of abuse liability the benzodiazepines rated similarly, diazepam rating highest.