The costs associated with medical liability—including legal costs and payouts associated with medical malpractice cases, malpractice insurance, and the practice of defensive medicine—total $55.6bn (£36.2bn; €43.6bn) a year or 2.4% of annual healthcare spending in the United States, concludes a study aimed at estimating the direct and indirect costs of protecting against medical negligence.
The study analysed the various components of the medical liability system, including payments made by malpractice plaintiffs, the costs associated with defensive medicine, administrative costs, such as lawyers’ fees, and the costs of working time lost by clinicians associated with malpractice suits.
The results showed that most of the cost, an estimated $45.6bn, was due to defensive medicine, including tests or treatments carried out largely to avoid potential lawsuits (Health Affairs, doi:10.1377/hlthaff.2009.0807).
Michelle Mello, a professor of law and public health at the Harvard School of Public Health, Boston, and the study’s lead author, said, “Based on data from New York we believe that only about 2% of patients injured by [medical] negligence file a claim. We would like to see that number higher. Countries that have an easier filing process have a rate of about 10%, which is still low.
“We don’t have any reason to believe that patient safety is a whole lot better in other systems than it is in the US or that the level of negligence is lower.”
However, how different countries deal with medical negligence varies tremendously, she pointed out. “The payouts in those countries [with lower administrative barriers to filing claims of harm] are much lower—often capped at around $1m.”
These countries tend to have more extensive health and social welfare programmes that cover the cost of remedial medical care and compensate for lost income, she said, suggesting that this raises a different set of challenges in accounting for the true cost of medical negligence.
More than $4bn, or about 55% of medical malpractice insurance premiums in the US, are spent on administrative costs and litigation. “If we could figure out ways to encourage more rapid resolution of incidents we could avoid a lot of those costs,” Professor Mello said. She noted that countries that compensate a larger proportion of patients who have experienced medical harm have administrative costs of 10-14% of insurance premiums.
She believes that insurance and tort reform that encourages early resolution of claims might “whittle down” administrative costs, resulting in more money going to injured patients and less to trial lawyers.
Reform of health care itself is “murkier,” Professor Mello said. One component might be “a ‘safe harbour’ for compliance with practice guidelines,” she said. “If we want doctors to practise less defensively, let’s agree on what represents good medicine; and if you comply with it you will have a defence in a malpractice lawsuit.”
She concluded: “Most traditional reform approaches don’t seem to be working and aren’t very promising.” However, she is more encouraged by a number of more innovative federal demonstration projects that are attempting to “give doctors greater certainty around standards of care, that provide mechanisms for resolving the incidence of medical injury without recourse to litigation, and that provide more streamlined processes of claiming.”
Notes Cite this as: BMJ 2010;341:c4905
**Published in BMJ
08 September 2010
Dolormecum
El dolor es un síntoma, el indicador principal de que se ha producido una disfunción, una alteración del correcto equilibrio de la cosas en el cuerpo del paciente. La valoración del dolor y de su desaparición, pareja a la mejoría y curación de la enfermedad, es una de las tareas más importantes del médico.
Por ello los Laboratorios ESTEVE han editado "Dolormecum", una guía con la descripción de los medicamentos actualmente comercializados para el tratamiento farmacológico del dolor. La información que se presenta en esta guía ha sido obtenida fundamentalmente de la AEMPS y está actualizada al mes de noviembre de 2009. Las especialidades que se incluyen están todas comercializadas de acuerdo con la página web de la AEMPS.
El coordinador ha sido Carlos Goicoechea García, del Departamento de Farmacología y Nutrición Facultad Ciencias de la Salud Universidad Rey Juan Carlos Alcorcón, Madrid
Ultimas semanas para presentar candidaturas a la IV ediicón Premios Esteve "Unidos por la atención al paciente"
Los galardones Esteve, cuyas candidaturas pueden presentarse hasta el próximo día 15 de octubre, reconocen aquellas iniciativas para mejorar la relación entre médicos, farmacéuticos y pacientes
Hasta el día 15 de octubre estás a tiempo de presentar tu candidatura para la IV Edición de los Premios Esteve “Unidos por la Atención al Paciente”. Los galardones, organizados por Esteve en colaboración con el Consejo General de Colegios Oficiales de Farmacéuticos (CGCOF) y la Organización Médica Colegial (OMC), premian aquellas iniciativas que tienen como objetivo mejorar la comunicación del profesional de la salud con el paciente.
Hasta el día 15 de octubre estás a tiempo de presentar tu candidatura para la IV Edición de los Premios Esteve “Unidos por la Atención al Paciente”. Los galardones, organizados por Esteve en colaboración con el Consejo General de Colegios Oficiales de Farmacéuticos (CGCOF) y la Organización Médica Colegial (OMC), premian aquellas iniciativas que tienen como objetivo mejorar la comunicación del profesional de la salud con el paciente.
Como en anteriores ocasiones, los galardones se dividen en dos tipos de candidaturas: una para el colectivo médico en la que pueden participar médicos que ejercen en España, así como asociaciones o entidades dedicadas a la salud; y otra para el colectivo farmacéutico, en la que pueden participar los farmacéuticos que ejerzan en nuestro país, así como asociaciones o entidades dedicadas a la salud. Los premios, de carácter bienal, se engloban dentro del programa "Esteve, más cerca: Programa de Atención al Paciente". Los proyectos serán valorados por cada uno de los Jurados en cada categoría, cuyas presidencias ostentan el CGCOF y la OMC. Cada uno de los premios está dotado con 15.000 euros y una escultura del artista Marcel Martí.
Las bases completas de los premios, así como el formulario de inscripción, se pueden consultar en la página web de los premios:
www.premiosesteve.com o en www.cgcom.org de la OMC, y en www.portalfarma.com del CGCOF.
Vicente del Bosque subasta un valioso reloj a favor de la Fundación Síndrome de Down de Madrid
El seleccionador de España de fútbol, Vicente del Bosque, subastará el reloj que llevó en la muñeca durante el pasado Mundial de Sudáfrica de 2010 para colaborar con la Fundación Síndrome de Down de Madrid.
La subasta tendrá lugar el día 4 de octubre, en la tienda especializada Ansorena de Madrid. Los interesados pujarán por un cronógrafo SPORTSTER 'Vicente del Bosque', una pieza única creada en exclusiva por la prestigiosa firma de alta relojería suiza 'Bovet', y cuyo precio de salida será de 12.200 euros.
Un buen relax en Thailandia: el Santhiya Resort & Spa
En la misma playa de Thong Nai Pan Beach, al norte de la isla de Ko Phan Ngan, descansa este resort bañado por las azules aguas del mar y abrazado por un entorno paisajístico de gran belleza. Thailandia en pura expresión porque el tiempo parece detenerse cuando se traspasan sus puertas. Todas sus habitaciones, suites y villas están decoradas en estilo tailandés y equipadas con todo lo necesario para una lujosa y confortable estancia con vistas panorámicas a la selva o al mar.
Las exclusivas Pool Villas cuentan con jacuzzi y piscina privada en la terraza. La habitación más lujosa es la Santhiya Supreme Deluxe, con detalles especiales y pequeñas rocas que forman parte de la decoración. El hotel dispone de diversos restaurantes y bares donde degustar todo tipo de comidas y refrescos. Mención especial merece el Chantara Restaurant, especializado en cocina Thai y con espectaculares vistas sobre el mar y la bahía. La piscina, junto a la playa cuenta con una gran cascada artificial.
**Para más información en: http://www.santhiya.com/
Bird flu jumps to pigs
The H5N1 bird flu virus may be evolving the ability to spread from mammal to mammal, says a team who have discovered that pigs in Indonesia have been infected with the disease since 2005. It's one step in the frightening chain of events that could lead to human transmission and a pandemic.
The H5N1 bird flu kills 60 per cent of the people it infects. However, most infections occur after direct contact with an infected bird and the disease does not appear to spread well between humans. As long as human to human transmission remains rare, the virus cannot cause a flu pandemic.
This could change. One way the virus could develop the ability to spread among humans is to first infect pigs, which have many biochemical similarities to humans. Flu viruses adapted to pigs have less trouble adapting to humans than do bird flu viruses – one pig-adapted virus caused the swine flu pandemic in 2009.
Chairul Nidom of Airlangga University in Surabaya, Indonesia, and colleagues in Japan, have been tracking H5N1 in pigs since 2005 in Indonesia, the country hardest hit by the avian flu virus. They now report that between 2005 to 2007 when the avian flu peaked, 7.4 per cent of 700 pigs they tested also carried H5N1. There have been sporadic reports of H5N1 in pigs, but this is the first time the extent of the problem has been measured.
The H5N1 bird flu kills 60 per cent of the people it infects. However, most infections occur after direct contact with an infected bird and the disease does not appear to spread well between humans. As long as human to human transmission remains rare, the virus cannot cause a flu pandemic.
This could change. One way the virus could develop the ability to spread among humans is to first infect pigs, which have many biochemical similarities to humans. Flu viruses adapted to pigs have less trouble adapting to humans than do bird flu viruses – one pig-adapted virus caused the swine flu pandemic in 2009.
Chairul Nidom of Airlangga University in Surabaya, Indonesia, and colleagues in Japan, have been tracking H5N1 in pigs since 2005 in Indonesia, the country hardest hit by the avian flu virus. They now report that between 2005 to 2007 when the avian flu peaked, 7.4 per cent of 700 pigs they tested also carried H5N1. There have been sporadic reports of H5N1 in pigs, but this is the first time the extent of the problem has been measured.
-Poultry to pig
In each case, the virus in pigs closely resembled H5N1 from nearby outbreaks in poultry, suggesting it has jumped from the bird to the pig population. That and the small proportion of pigs infected suggests the virus cannot yet spread between pigs. "If the virus was better adapted to pigs it would have spread like wildfire," says Ab Osterhaus of the University of Rotterdam in the Netherlands, a flu expert not involved in the research.
Since 2007, avian flu outbreaks have diminished in poultry and in people in Indonesia and the investigators found that the the rate of infection in pigs has similarly dropped. Although pigs are still carrying signs of recent infection.
This means the virus could still be spreading and evolving because the team discovered, to their surprise, that infected pigs show no symptoms. "H5N1 viruses could easily evade detection as they spread through Indonesia in asymptomatic pigs," warn Nidom and colleagues.
And there are worrying indications that H5N1 is already evolving. Nidom says that in one pig, the virus had developed the ability to bind to a molecule present in the noses of both pigs and humans. That's exactly the kind of change that could allow it to spread between people.
"This shows we should keep a close watch on pig flu, as it can change rapidly," warns Osterhaus. The European Union is heeding the call and is funding a scientific collaboration called FLUPIG, to study how bird flu adapts to pigs and how pig flu spreads to people. It will meet for the first time later this month.
Journal reference: Emerging Infectious Diseases , DOI:10.3201/eid1610.100508
In each case, the virus in pigs closely resembled H5N1 from nearby outbreaks in poultry, suggesting it has jumped from the bird to the pig population. That and the small proportion of pigs infected suggests the virus cannot yet spread between pigs. "If the virus was better adapted to pigs it would have spread like wildfire," says Ab Osterhaus of the University of Rotterdam in the Netherlands, a flu expert not involved in the research.
Since 2007, avian flu outbreaks have diminished in poultry and in people in Indonesia and the investigators found that the the rate of infection in pigs has similarly dropped. Although pigs are still carrying signs of recent infection.
This means the virus could still be spreading and evolving because the team discovered, to their surprise, that infected pigs show no symptoms. "H5N1 viruses could easily evade detection as they spread through Indonesia in asymptomatic pigs," warn Nidom and colleagues.
And there are worrying indications that H5N1 is already evolving. Nidom says that in one pig, the virus had developed the ability to bind to a molecule present in the noses of both pigs and humans. That's exactly the kind of change that could allow it to spread between people.
"This shows we should keep a close watch on pig flu, as it can change rapidly," warns Osterhaus. The European Union is heeding the call and is funding a scientific collaboration called FLUPIG, to study how bird flu adapts to pigs and how pig flu spreads to people. It will meet for the first time later this month.
Journal reference: Emerging Infectious Diseases , DOI:10.3201/eid1610.100508
**Published in "New Scientist Health"
Cost-cutting bacteria reap benefits of energy thrift
Bacteria are cheapskates. When producing proteins that end up outside the cell, they act like cut-rate builders by using the least costly materials they can.
Cells must expend energy to make the amino acids that are building blocks for proteins. Each of the 20 different amino acids has a different energy cost, with the most expensive, tryptophan, requiring more than six times as much energy as the cheapest, glycine. Matthew Chapman, a microbiologist at the University of Michigan in Ann Arbor, wondered whether bacteria would prefer to use cheaper amino acids in proteins that would be lost from the cell, because they have no way of recovering these proteins for later recycling.
To find out, Chapman and his student Daniel Smith looked at every protein in Escherichia coli bacteria and calculated the average energy cost of the amino acids used in each. Proteins exported from the cell cost about 12 per cent less than average, they found.
The researchers then compared the proteins of a diverse set of 25 bacterial species. In every case, they found, proteins that ended up outside the cell were cheaper than those that remained within – an economy that saves the cell about 8.7 per cent of the proteins' construction cost, and about 1.5 per cent of the cell's overall energy bill. Though that sounds like a small advantage, such cells should outnumber their less thrifty cousins 15 to 1 after 250 generations. "I think there's a lot of room for this sort of economical evolution," says Chapman.
The results accord well with earlier work showing that cells also use cheaper amino acids to build their most abundant proteins. "This really seems to be an important evolutionary force," says Dan Krane, a bioinformatician at Wright State University in Dayton, Ohio.
Journal reference: mBio, DOI: 10.1128/mBio.00131-10
**Published in "NewScientist Life"
Cells must expend energy to make the amino acids that are building blocks for proteins. Each of the 20 different amino acids has a different energy cost, with the most expensive, tryptophan, requiring more than six times as much energy as the cheapest, glycine. Matthew Chapman, a microbiologist at the University of Michigan in Ann Arbor, wondered whether bacteria would prefer to use cheaper amino acids in proteins that would be lost from the cell, because they have no way of recovering these proteins for later recycling.
To find out, Chapman and his student Daniel Smith looked at every protein in Escherichia coli bacteria and calculated the average energy cost of the amino acids used in each. Proteins exported from the cell cost about 12 per cent less than average, they found.
The researchers then compared the proteins of a diverse set of 25 bacterial species. In every case, they found, proteins that ended up outside the cell were cheaper than those that remained within – an economy that saves the cell about 8.7 per cent of the proteins' construction cost, and about 1.5 per cent of the cell's overall energy bill. Though that sounds like a small advantage, such cells should outnumber their less thrifty cousins 15 to 1 after 250 generations. "I think there's a lot of room for this sort of economical evolution," says Chapman.
The results accord well with earlier work showing that cells also use cheaper amino acids to build their most abundant proteins. "This really seems to be an important evolutionary force," says Dan Krane, a bioinformatician at Wright State University in Dayton, Ohio.
Journal reference: mBio, DOI: 10.1128/mBio.00131-10
**Published in "NewScientist Life"
Subscribe to:
Comments (Atom)