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Trial lawyers, rejoice! Health overhaul leaves malpractice system intact: MedCity Morning Read, Jan. 20, 2010

It's a good time to be a major Democratic Party donor. Trial lawyers appear to have secured a major victory in the health-overhaul movement, largely preserving the status quo in the U.S. malpractice system over fierce objections from Republicans and doctors.

By Brandon Glenn on January 20, 2010
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Highlights of the important and the interesting from the world of health care:

Health overhaul does little to change malpractice system: It’s a good time to be a major Democratic Party donor. Trial lawyers appear to have secured a major victory in the health-overhaul movement, largely preserving the status quo in the U.S. malpractice system over fierce objections from Republicans and doctors, the L.A. Times reports. That puts trial lawyers in stark contrast to insurers and Big Pharma, for example, which have been essentially forced to make “costly concessions.” The House bill forbids the imposition of caps on attorney’s fees and damages, an idea popularly known as “tort reform.” (To be clear, it’s far from definite that tort reform would actually reduce U.S. health costs, which is the strongest argument in favor of it, so the status quo may not be such a bad thing. Conservatives and doctors no doubt would vehemently disagree with that statement, and conservative doctors would really disagree with it.)

Democrats “did not want to take on the trial lawyers in addition to everybody else they were taking on,” former Democratic National Committee Chairman Howard Dean says, according to the Times. The $3 million that the trial lawyers’ lobbying arm sent to candidates through the organization’s political action committee in the 2008 election cycle probably didn’t hurt either.

Entrepreneurs aren’t risk takers: Rather, they are “predators.” That’s the premise of an article by celebrity journalist Malcolm Gladwell from the New Yorker. “The truly successful businessman … is anything but a risk-taker,” Gladwell writes. “He is a predator, and predators seek to incur the least risk possible while hunting.” (Unfortunately, only an abstract is available on the New Yorker’s site, which requires a subscription to read the full piece.) Connie Loizos of peHub takes great umbrage to Gladwell’s assertion, in a well-conceived response. Loizos writes:

What [Gladwell] never acknowledges is that most entrepreneurs fail, whether they are zany or calculating, and whether or not they are prepared for the challenges of creating a new business. What never gets said is that that risk and smart decision-making are not, and never will be, mutually exclusive.

The cure for too many referrals? Though he finds much to dislike about federal health overhaul, Dr. Jeffrey Parks (aka Buckeye Surgeon) supports one measure that would penalize primary care physicians for over-referring patients to specialists.  Parks asks, “Does every type II diabetic need an endocrinologist? Does ever obese patient with rickety knees need referral to an orthopod for joint replacement?” Indeed, excessive referrals to costly specialists are one of many reasons U.S. health care costs continue to soar. As blogger KevinMD points out, more doctors don’t necessarily improve a patient’s care.

So why do so many patients find themselves referred to specialists by their primary care doctors? KevinMD lists the often-cited problem of “defensive medicine.” Afraid that they’ll be sued, many primary care physicians almost reflexively refer patients to specialists simply to cover themselves from potential liability (another argument against the current U.S. malpractice system). Also problematic is the lower rates at which insurers reimburse primary care docs compared with specialists. “In the outpatient setting, so long as time is not valued, some [primary care doctors] would rather send the patients off to a consultant, rather than spend the time necessary to diagnose a problem,” KevinMD says.


Boom in Indian biotech: India’s biotechnology industry could hit $5 billion by next year and then double by 2015, a top Indian biotech executive says. As clinical trials and manufacturing shift from the U.S. and Europe to India and China, the biotech industry in those countries has hit a “critical mass.”  Exponential growth could follow, says Biocon chief Kiran Mazumdar-Shaw, Fierce Biotech reports.

“India is today becoming the vaccine capital of the world,” explains Mazumdar-Shaw. “Bio-manufacturing offers a huge potential and already there are indications that many global contract manufacturers announced they will be shifting their base from Europe to Asia. I think India will be one of the beneficiaries of that particular strategy.”