Medical Malpractice Myths
Sources: David A. Hyman, MD, JD ; and Charles Silver, JD; CHEST 2013; 143(1):222–227
Take it with a grain of salt as it comes from a physician-lawyer and a lawyer, but strongly consider a well-researched article published in a peer reviewed medical journal which seeks to dispel the 5 Major myths that are consistently brought up by advocates for tort reform.
Myth 1: Malpractice Crises Are Caused by Spikes in Malpractice Litigation (ie, Sudden Rises in Payouts or Claim Frequency)
So-called “runaway” jury verdicts are rare and payment on them rarer still. Using data from State and Federal databases, including the National Practioner Databank, the authors determined that the frequency of medical malpractice claims and medical malpractice payments on malpractice claims were either stable or declining in the years preceding the “medical malpractice crisis” 1999 to 2000. The vast majority of patients who have bad medical outcomes do not retain a lawyer and do not ever file a medical malpractice lawsuit.
Myth 2: The Tort System Delivers Jackpot Justice
Again, most medical malpractice cases are settled with less than 5% of medical malpractice cases going to trial. And the doctors tend to win, at least 75% of the time. The big verdicts get publicity because, well they are big verdicts. But the fact is that big verdicts aren’t typically paid verdicts. Appeals almost always follow and such cases, if not retried, are settled for substantially less money than the original reported verdict. Settlements are almost always on the condition of non-disclosure agreements and therefore these do not get published with the detail and names that the original sensational news item will.
Myth 3: Physicians Are One Malpractice Verdict Away From Bankruptcy
Any verdict, blockbuster or otherwise, that exceeds the limits of a provider’s insurance coverage (typically $500,000 to $1 million) is very unlikely to be paid. It certainly would be difficult if not impossible in some circumstances to collect a verdict directly from a doctor. Out-of-pocket payments by physicians are extraordinarily rare. In sum, physicians have effectively no personal exposure on malpractice claims (other than the obvious and unavoidable side effects of litigation, eg, the emotional and time-related costs of being deposed and the surcharges from their insurance company).
Myth 4: Physicians Move in Large Numbers to States That Adopt Damages Caps
The “we’re losing our doctors” cry has fallen on deaf ears. Your doctors are still here, for the most part. It is true that doctors are electing not to go into higher risk professions (obstetrics, surgery) and that this may be a response to medical malpractice claims but babies continue to be delivered at hospitals both with and without incident. According to the authors’ extensive research, those patients who suffered grave and permanent injuries (including death) received a mean payout of only $1.25 million and a median payout of about $1 million. Not the kind of thing that causes doctors to leave en mas
Myth 5: Tort Reform Will Lower Health-care Spending Dramatically
The direct costs of medical malpractice claims (including the cost of malpractice awards and settlements and all costs associated with defending against such claims, including the administrative costs of medical malpractice insurers is relatively modest. There is broad agreement that the direct costs of the malpractice system are on the order of 2% of health-care spending. Studies, commissioned by the Federal Government suggest that a cap on non-economic damages would reduce Medicare spending by a statistically insignificant 1.6%.
Damages caps do little to improve the malpractice system. Although they can dramatically reduce claims frequency, payouts per claim, and insurance premiums, they do not make health-care safer, reduce health-care spending, compensate those who are negligently injured, or make the liability system work better. The best reforms are patient safety initiatives that reduce the frequency and severity of medical mistakes. Those tend to come from medical malpractice lawsuits.
The Lewis Law Firm handles cases of medical malpractice in Philadelphia and New Jersey. Call for FREE consultation today. Have you or a loved one been the victim of medical maplractice? Contact the Lewis Law Firm for a free consultation.
Cancer Misdiagnosis Common
Sources: Best Doctors and the National Coalition on Health Care Joint Study; American Journal of Medicine; BMJ Quality and Saftey
Cancer is diagnosed more commonly than most physicians, themselves are aware. A series of recently published studies indicate a misdiagnosis rate from 15% to 28% of the time. There are a number of reasons cited by medical professionals for this seemingly high rate of misdiagnosis for cancer: Among these are: fragmented medical records; time-strapped doctors simply not having enough time with patients; errors in pathology interpretation; patients not knowing or sharing important pieces of their family medical history; and an inflexible adherence to protocols. In addition to the number of lost and damaged lives, there are considerable financial costs associated with a high misdiagnosis rate. $700 Billion dollars are estimated to be wasted by the US Medical System each year– countless billions of which are from diagnostic error.
Over 1.6 million new cancer cases in the U.S. are projected to occur in 2013, according to the American Cancer Society. Some 400 pathologists, medical oncologists and surgical oncologists were polled to determine their awareness of the relative rate of cancer misdiagnosis. When participating doctors were asked how often they would estimate misdiagnoses rates in oncology, the majority (60.5%) estimated 0 to 10% of the time. Only 4.8% believed misdiagnoses occur 20-30% of the time. These numbers counter published studies which show misdiagnosis rates in general reaching up to 28%, and up to 44% for some types of cancer, according to the Journal of Clinical Oncology. This lack of physician awareness is also concerning.
When asked what types of cancer conditions physicians believe are most often misdiagnosed or mischaracterized, 21 conditions were named. Leading the top five misdiagnosed cancer conditions by a considerable margin was Lymphoma, followed by Breast Cancer, Sarcomas and Melanoma.
Does this mean that all cancer misdiagnosis is the result of medical malpractice by a physician? No. However the number is too large to attribute the rate of misdiagnosis to exemplary medical care in all circumstances. So what does this mean for you, the patient? Be your own health care advocate. Insist on follow up testing if you feel that something is being treated lightly or may be overlooked. If physicians who specialize in the recognition and treatment of cancer are unaware of how frequently it is misdiagnosed, they might not be so quick to find it.
The Lewis Law Firm has a history of representing women who are diagnosed late with breast cancer. If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.
Advanced Breast Cancer Increase in Women under 40
Sources: JAMA (Journal of the American Medical Association) 2013;309(8):800-805; National Cancer Institute, SEER Cancer Statistics Review
ADVANCED breast cancer, or metastatic breast cancer (spread through the body) effectively tripled among women younger than 40 between 1976 and 2009. These are women whose cancer had already spread by the time it was diagnosed. In this small, but statistically significant trent, 800 women between age 25 and 39 are now being diagnosed with advanced cancer as compared with 250 a year in the mid-1970s.
Researchers analyzing trends in cancer rates have published their findings in a recent issue of JAMA. Among the more troubling things they found were: that the rate of cancer incidence has gone up fastest in younger women — ages 25 to 34; and, that the trend affects women of all ethnic backgrounds, in rural areas as well as cities, and it has been accelerating in recent years. Because young age itself is an independent adverse prognostic factor for breast cancer, and the lowest 5-year breast cancer survival rates as a function of age have been reported for 20- to 34-year-old women. The most recent national 5-year survival for distant disease for 25- to 39-year-old women is only 31% according to SEER data, compared with a 5-year survival rate of 87% for women with locoregional (non-metastatic) breast cancer.
Breast cancer is the most common malignant tumor in US adolescent and young adult women 15 to 39 years of age, accounting for 14 percent of all cancer in the age group. The individual average risk of a woman developing breast cancer in the United States was 1 in 173 by the age of 40 years when assessed in 2008. Young women with breast cancer tend to experience more aggressive disease than older women and have lower survival rates.
Rebecca H. Johnson, M.D., of Seattle Children’s Hospital and University of Washington, Seattle, and colleagues conducted a study in which breast cancer incidence, incidence trends, and survival rates as a function of age and extent of disease at diagnosis were obtained from 3 U.S. National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registries. These registries provide data spanning 1973-2009, 1992-2009, and 2000-2009. SEER defines localized as disease confined to the breast, regional to contiguous and adjacent organ spread (e.g., lymph nodes, chest wall), and distant disease to remote metastases (bone, brain, lung, etc).
Since 1976, there has been a steady increase in the incidence of distant disease breast cancer in 25- to 39-year-old women, from 1.53 per 100,000 in 1976 to 2.90 per 100,000 in 2009. The researchers note that this is an absolute difference of 1.37 per 100,000, representing an average compounded increase of 2.07 percent per year over the 34-year interval. And the trend shows no signs of stopping.
The researchers also found that the rate of increasing incidence of distant disease was inversely proportional to age at diagnosis. The greatest increase occurred in 25- to 34-year-old women. Progressively smaller increases occurred in older women by 5-year age intervals and no statistically significant incidence increase occurred in any group 55 years or older. Incidence for women with estrogen receptor-positive subtypes increased more than for women with estrogen receptor-negative sub-types.
The Lewis Law Firm has a history of representing women who are diagnosed with advanced breast cancer. If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.
Early Detection Critical for Breast Cancer!
Sources: American Cancer Society; and 30+ years of medical malpractice experience
EARLY detection of breast cancer, before it causes symptoms, is the key to cure and long-term survival of this disease. The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms. Breast cancers that are found because they are causing symptoms tend to be larger and are more likely to have already spread (metastasized) beyond the breast.
Although not all will admit this when they are Defendants in a medical malpractice case, most doctors believe that early detection tests for breast cancer save thousands of lives each year and that the size of a breast cancer when it is found and how far it has spread, and genetics, are the most important factors in predicting the prognosis (outlook) of a woman with this disease.
What are the risk factors for breast cancer? Many women with breast cancer have no apparent risk factors. There are breast cancer risk factors you cannot change. Among these are: Gender, men can develop breast cancer, but this disease is about 100x more common in women; Aging, your risk of developing breast cancer increases as you get older; Genetics, 5% to 10% of breast cancer cases are caused directly from genes BRCA1 and BRCA2; Family history of breast cancer, having a first-degree relative (mother, sister, or daughter) with breast cancer almost doubles a woman’s risk. 85% women who get breast cancer do not have a family history for it; Personal history of breast cancer, a woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast (contralateral) or in another part of the same breast; Race and Ethnicity, white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer; Dense breast tissue, women with dense breasts have a higher risk of breast cancer; Menstrual periods, women who started menstruating early (before age 12) and/or went through menopause later (after age 55) have a slightly higher risk of breast cancer; Previous chest radiation, treatment for hodgkin’s disease or lymphoma increases the risk of breast cancer as does chemotherapy.
What are the Signs and symptoms of breast cancer? The most common symptom of breast cancer is a new lump (mass). A mass that is painless, hard, and has irregular edges is more likely to be cancerous, but breast cancerscan be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new mass, lump, or breast change checked by your doctor and possibly by a breast surgeon. Other signs are: Swelling of the breast; Skin irritation or dimpling of the breast; Nipple pain or retraction (turning inward); Redness or scaliness of the breast; and, discharge. The American Cancer Society recommends that women age 40 and older should have a mammogram every year.
The Lewis Law Firm has a history of representing women who are diagnosed late with breast cancer. If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.
Women who Smoke have Twice the Risk of Cancer than Men.
Sources: Cancer Epidemiology, Biomarkers & Prevention, online edition, May 1, 2013; American Association for Cancer Research
RESEARCHERS at the University of Tromsø in Norway have concluded that women who smoke have a higher risk of cancer than men, Norwegian investigators found. Looking at the medical records of more than 600,000 patients between ages 16 and 67, they discovered the bowel cancer risk linked to smoking was twice as high in women than men. Female smokers had a 19% increased risk of bowel cancer while male smokers had a 9% increased risk, reports.
In the study, nearly 4,000 of the participants developed bowel cancer. Women who started smoking when they were 16 or younger and those who had smoked for decades were at substantially increased risk of bowel cancer. The findings clearly suggest that women may be biologically more vulnerable to the toxic effects of tobacco smoke.
Previous studies have shown that women who smoke are at an increases risk for heart attack as compared to men who smoke, althouth it is not clear why. According to research in more than one million women, those who give up smoking by the age of 30 will almost completely avoid the risks of dying early from tobacco-related diseases.
Sarah Williams of Cancer Research UK said: “It’s well established that smoking causes at least 14 different types of cancer, including bowel cancer. “For men and women, the evidence is clear – being a non-smoker means you’re less likely to develop cancer, heart disease, lung disease and many other serious illnesses.” Clearly this goes double for women smokers.
The Lewis Law Firm has a history of representing women who are diagnosed with cancer. If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with cancer contact the Lewis Law firm today for a FREE consultation.
Neoadjuvant Therapy for Breast Cancer -Treating Before Treatment.
Sources: National Cancer Institute; Journal of Clinical Oncology; Lancet
NEOADJUVANT therapy is treatment given before primary therapy. For example, a woman may receive neoadjuvant chemotherapy for breast cancer to shrink a tumor that is inoperable or a woman whose breast tumor can be removed by mastectomy may receive neoadjuvant therapy to shrink the tumor enough to allow breast-conserving surgery.
Adjuvant therapy, or additional treatment (ie. chemotherapy, radition) has long been advocated for women with breast cancer. This takes place after the primary treatment, be it surgical, chemical or radiological. Neoadjuvant chemotherapy is given in the same manner as adjuvant chemotherapy. If a tumor does not respond (shrink) or continues to grow or even spread (metastasize) during neoadjuvant chemotherapy, the doctor may stop treatment and try another type of chemotherapy or perform surgery instead, depending on the stage of the cancer.
Clinical trials are examining whether hormonal thereapies or traditional chemotherapy agents, such as Tamoxifen, are benefecial to women diagnosed with breast cancer and even to women -very young women (under age 40) in particular, who have not yet been diagnosed with breast cancer but have a strong family history or genes of significance. “It is extremely encouraging to know there is a very simple technique that can make a really big difference in terms of coming out the other end with no disease,” said Lori Redmer, former executive director of the Triple Negative Breast Cancer Foundation.
The majority of breast cancers are driven by one of three causes – the hormone estrogen, another hormone called progesterone, or a gene called human epidermal growth factor receptor 2 (HER2). Triple negative isn’t caused by any of these – and it isn’t helped by the many targeted drug treatments that have been developed to fight the other three causes. Triple-negative cancer is more likely to strike young women, they aren’t checking for cancer the way older women are, they aren’t getting regular mammograms, and they often don’t find the tumors until they are large and have spread.
Breast cancer is the second-leading cancer killer of women, after lung cancer. The American Cancer Society projects that 226,870 women will be diagnosed with breast cancer this year and that 39,510 will die of it. In the United States, 93 percent of women with Stage 1 breast cancer survive for at least five years, but this falls to 15 percent for women with stage 4 – the type that has metastasized (spread).
The Lewis Law Firm has a history of representing women who are diagnosed late with breast cancer. If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.
Breast Cancer Treatment -MALE Hormones.
Sources: Colorado Cancer Blogs; American Association for Cancer Research; BBC Health News
MALE sex hormones, androgens, may provide another tool to fight breast cancer in women. Researchers from the University of Colorado Cancer Center have discovered that many breast cancers possess androgen receptors on their surface, and that male hormones like testosterone fuel the tumour’s growth. Their research was presented to a meeting of the American Association for Cancer Research.
Hormones, primarily female hormones, Estrogen and Pogesterone, have long been thought to be involved in breast cancer growth and limtation. The widely-used, and highly toxic, breast cancer drug Tamoxifen works by blocking Estrogen receptors to stop the growth of breast cancer cells. Adding anti-androgen drugs has the potential to improve treatment of women with breast cancer.
According to lead researcher, Dr. Jennifer Richer, Patients who who relapse while on Tamoxifen but who also have androgen receptors might have the most to gain from this new type of treatment.” “We are excited to move toward clinical trials of anti-androgen therapies in breast cancer,” Richer says. “And this study shows that patients with a high AR/ER ratio who relapse while on estrogen targeting therapies might be good candidates for this kind of therapy.”
The finding of androgen receptors (AR) as a potential target in breast cancer is especially important in light of its prevalence in breast cancers that don’t express other hormone receptor targets or have developed resistance to treatments that target estrogen dependence. 77% of breast cancers are positive for AR, including 88% of cancers that are estrogen receptor positive, 59% of those that are HER2 positive, and 20-32% of triple negative breast cancers.
The trials are in their infancy, however, positive breast cancer research news is always welcomed as breast cancer continues to be a leading killer of women.
The Lewis Law Firm has a long history of representing women with Ovarian, Cervical, Endometrial and breast cancer and their families in Pennsylvania and New Jersey. If you or a loved one have been diagnosed with breast cancer which was misdiagnosed or diagnosed late, contact the Lewis Law Firm for a FREE consultation and review of your case, today.
Breast Cancer, Ovarian Cancer and Prostate Cancer Same Gene
Sources: BBC Health News; Jorunal Oncology
THE BRCA2 gene has been linked to hereditary breast cancer and ovarian cancer. Now scientists say that as well as being more likely to get prostate cancer, men with BRCA2 are also more likely to develop aggressive tumours and have the poorest survival rates. Men with the gene should be treated quickly to save lives. More than 40,000 men are diagnosed with prostate cancer every year. 1 in every 100 men with prostate cancer have the BRCA2 mutation.
Prostate cancer can grow either extremely slowly or very quickly. Some men may live symptom-free for a lifetime, despite having this cancer. Those with BRCA2 and prostate cancer should be treated early and aggressively because their tumour is more likely to spread.
Quick Facts about Prostate Cancer: 1.) The prostate is a small gland in the pelvis found only in men. It’s job is to make the fluid part of semen; 2.) Prostate cancer does not normally cause symptoms until the cancer has grown; 3.) Prostate cancer can be diagnosed by taking a biopsy (a small tissue sample of the prostate gland); 4.) Some men may be advised to delay having treatment if the tumour is very slow growing; 5.) Others may want to have surgery to remove the entire prostate; 6.) For some, treatment may offer the best chance of cure but it can cause serious side effects including impotence and incontinence
Patients with BRCA2-mutations were significantly less likely to survive their cancer, living an average of 6.5 years after diagnosis compared with 12.9 years for non-carriers. They were also more likely to have advanced disease at the time of diagnosis. Men with a significant family history of breast and/or ovarian cancer in addition to prostate cancer should be offered BRCA1/2 testing at diagnosis, but it is not routinely offered to all patients diagnosed with prostate cancer.
The Lewis Law Firm has a history of representing patients with Breast, Ovarian and Prostate Cancers. Have you or a loved one been diagnosed and treated for prostate cancer? Contact the Lewis Law Firm for a free consultation.
Medical Information -WHO Guidelines Potassium (and Salt)
Sources: World Health Organization; BBC Health News; British Medical Journal
THE World Health Organisation has issued its first guidelines on potassium intake, recommending that adults should consume more than 4g of potassium (or 90 to 100mmol) per day. This follows recent publication in the British Medical Journal which adds to the body of evidence suggesting that increasing potassium in our diets as well as cutting down on salt will reduce blood pressure levels and the risk of stroke.
The BMJ study on the effects of potassium intake, produced by scientists from the UN World Food Programme, Imperial College London and Warwick Medical School, among others, looked at 22 controlled trials and another 11 studies involving more than 128,000 healthy participants. Results showed that increasing potassium in the diet to 3-4g a day reduced blood pressure in adults. Increased potassium intake was also linked to a 24% lower risk of stroke.
Potassium is an important mineral that controls the balance of fluids in the body and helps lower blood pressure. It is found in most types of food, but particularly in fruit, such as bananas, vegetables, pulses, nuts and seeds, milk, fish, chicken and bread. For the first time the WHO has recommended that adults consume around 4g of potassium a day (or at least 90-100mmol) which is equal to five portions of fruit and vegetables a day.
Our early ancestors would have had a diet very high in potassium – but food processing has markedly reduced the potassium content of food. The modern diet centers on grains -the anchor of the food pyramid, including bread, one of the biggest sources of salt into our diet. It is thought that the average potassium consumption in many countries is below 70-80mmol/day.
The World Health Organisation recommends that adults should not consume more than 5g of salt a day (about one teaspoon).
Skin Cancer, Aspirin Cuts Risk?
Source: Cancer (online Journal, March 11, 2013); American Cancer Society
ASPIRIN is one of the most widely used medications in the world, with an estimated 40,000 tons of it being consumed each year. In countries where Aspirin is a registered trademark owned by Bayer, the generic term is acetylsalicylic acid (ASA).
Plant extracts, including willow bark and spiraea, of which salicylic acid was the active ingredient, had been known to help alleviate headaches, pains, and fevers since the father of modern medicine, Hippocrates (460 BC and 377 BC) described the use of powder made from the bark and leaves of the willow tree. A French chemist, Charles Frederic Gerhardt, was the first to prepare acetylsalicylic acid in 1853. Synthetic Aspirin was first isolated by Felix Hoffmann, a chemist with the German company Bayer in 1897, and was thereafter copyrighted.
The aspirin study included 59,806 postmenopausal Caucasian women aged 50 to 79 years. During a median follow-up of 12 years, 548 incident melanomas were confirmed by medical review. Women who used ASA had a 21% lower risk of melanoma relative to nonusers. Increased duration of ASA use (<1 year, 1-4 years, and ≥5 years) was associated with an 11% lower risk of melanoma for each categorical increase and women with ≥5 years of use had a 30% lower melanoma risk. In contrast, use of non-ASA NSAIDs and acetaminophen were not associated with melanoma risk.
The obvious conclusions are that postmenopausal women who used ASA had a significantly lower risk of melanoma, and that longer durations of ASA use are associated with greater protection. Although this study was limited by the observational design and self-report of NSAID use, the findings suggest that ASA may have a chemopreventive effect against the development of melanoma and warrant further clinical investigation.
The Lewis Law Firm has a long history of representing patients with cancer, and their families in Phildelphia and New Jersey. If you or a loved one have been diagnosed with cancer, contact the Lewis Law Firm for a FREE consultation and review of your case, today.