Court ruling demonstrates ACA's power to reduce future medical expenses

Industry insiders who handle litigation involving catastrophic injury cases have eagerly awaited the first rulings to address the impact, if any, of the Affordable Care Act (ACA), often referred to as Obamacare, on claims for future damages. Before the ACA, it was uncertain whether injured individuals would have health insurance to cover ever‐growing health care costs in the future. Consequently, in most jurisdictions, the applicable rule of law has prevented the argument that future damages should be reduced because of the availability of health insurance. Because of this, damages have remained essentially unrebutted, and the law has permitted such unrebutted damage projections to be calculated into the future. These projections, primarily in the form of life care plans, are generally the single largest financial component of damage claims. Such plans often project massive expenses that can drive equally massive jury verdicts.     

Epidemiological evidence of a relationship between type‐1 diabetes mellitus and cancer: A review of the existing literature

This review explores the epidemiological evidence relating to type‐1 diabetes (T1DM) and cancer incidence and mortality. Mortality rates among those with T1DM are higher in every age group compared with the general population; the majority of this mortality is due to factors related to the consequences of diabetes, such as cardiovascular and renal disease. For over 100 years, researchers have explored the relationships between diabetes and cancer and although there is now a large body of work on the subject, consensus has not been reached. Such research has tended to focus upon type‐2 diabetes, with the result that very little is known about T1DM and cancer. As incidence of T1DM increases, by around 3% annually among children, the need for further research into its impact upon cancer incidence and mortality increases. Within this review, findings varied by study method utilised, T1DM definition used and study region and outcome measure explored. None of the case–control studies found a statistically significant link between the two diseases, whereas both of the meta‐analyses did. Cohort studies produced mixed results. There were also mixed findings among research that defined T1DM in the same way (e.g. defining individuals with the disease as those diagnosed with diabetes before 30 years of age). The review found a number of studies which explored cause‐specific cancer mortality among those with diabetes; such studies also had mixed findings. This inconsistency within results suggests the need for further research to understand better the potential relationships between T1DM and cancer.     

Regional risk factors for health inequalities in Scotland and England and the “Scottish effect”

This paper uses data from the Scottish Health Survey 2003 and the comparable Health Survey for England 2003 to look at whether Scotland's poor health image and mortality profile is reflected in regional inequalities in prevalence of four risk factors for cardiovascular disease: fruit and vegetable consumption, smoking, obesity and diabetes. It also looks at the “Scottish effect” – how much of any difference between and within Scotland and England remains once socio-demographic factors have been taken in to account. The paper then uses regional analyses to determine the extent to which areas within England and Scotland contribute to their national health advantage and disadvantage. All 2003 strategic health authorities in England and Scottish health boards were compared with Greater Glasgow health board as the reference category.The results showed that significant geographic variation in the risk factors remained once individual economic status was taken into account, but the relationship was complex and varied in strength and direction depending upon risk factor involved and gender of respondent. A small number of areas had significantly lower odds of fruit and vegetable consumption of five portions or more a day in men, compared with Greater Glasgow. In contrast some areas had significantly higher odds of fruit and vegetable consumption for women compared with Greater Glasgow.There was greater geographic variation in the odds of smoking in women than in men. Respondents in the south west and southeast of England (areas which usually show health advantage) did not show significantly lower odds of smoking compared with Greater Glasgow once socio-economic variation, age and urban residence was taken into account. It was respondents from central England that had lower odds of smoking than might be expected. Obesity stood out as the single risk factor that had demonstrated a “Scottish effect” in women only.