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Legal trigger for chronic fatigue syndrome
USA takes another whack at tort reform
Controversial blueprint for Canadian science
Congress and courts are efforts to curb a continuing flurry of product-liability suits against manufacturers of pharmaceuticals, medical devices, and other products. Republicans sweeping into Congress in November, 1994, made tort reform a priority, and on March 13 they achieved bipartisan agreement on a bill to cap punitive damages, among other things. The US manufacturing and medical communities have been lobbying for overhaul of the tort system for at least two decades. Drug and device makers claim that the system enables frivolous suits that retard research and development, particularly in contraception. Physicians say that malpractice litigation and massive payouts have led to unaffordable malpractice insurance premiums and to "defensive" medicine. Several higherprofile class-action suits, including those filed against the makers of the Dalkon Shield intrauterine device and silicone breast implants, have ended up bankrupting the manufacturers. The Norplant contraceptive implant seems to be headed for the same fate, as it is soon to be subject to a class-action suit. On March 7, a federal judge struck back at plaintiffs’ attorneys, issuing a ruling in the ongoing litigation over the defective Bjork-Shiley heart valve, that the claimants’ attorneys could receive only a third of the fees requestedUS$10 million, rather than$33 million. Congress’ proposal also targets payouts, saying that, for punitive damages, plaintiffs’ could receive only the greater of$250 000 or twice the amount awarded in actual economic
science
US
The renewing
that Ottawa’s primary and technology priority must be to get its own house in order so that it can be a partner in a national system of innovation, the federal government unveiled its longoverdue science blueprint last week. The blueprint is designed to organise federal science spending "in a way that makes it responsive to clear objectives and clear principles", Industry Minister John Manley said. The pragmatic spin the Liberals put on the science and technology plan belies the reality that it falls short of the sort of comprehensive S&T strategies introduced abroad and is primarily devoted to rejigging the management regime that governs federal science outlays (see Lancet Jan 27 p 256). The strategy focuses on the creation of a predominantly decentralised regime, in which responsibilities for decision-making and S&T coordination are broadly diffused. Although the blueprint sets out broad objectives and priorities, it also creates a series of administrative mechanisms, such as annual departmental S&T plans and an annual federal S&T outlook, in a bid to make the system more accountable. Other proposals include more
Arguing
stringent operational requirements federal
on
laboratories
and
programmes.
The plan is dressed up with a modest Can$600 million (over 3
years) technology superfund to develop new technologies such as telemedicine. In addition, the cabinet’s Economic Development
Legal trigger for
chronic
Committee will become responsible for S&T policy and priority setting, advised by 10-12 members of the private sector’s Advisory Council on and will "review the nation’s S&T, performance in S&T, identify emerging issues and advise on a forward-
looking agenda". Manley argued
that the Liberals constrained in the measures they could adopt in the blueprint because of the magnitude of deficiencies within the existing management regime. At the most basic level, the system lacks proper accounting for exactly how much, and what sort of, research and development is supported by Ottawa, he said. When asked what Ottawa’s next step will be in the development of a comprehensive science strategy, Manley replied, "our next challenge of reinvestment is going to be to deal with the universities, the basic research infrastructure of the country, and whether it’s strong enough and sustainable enough. And part of dealing with that is going to have to be to ensure that the criteria applied to the granting councils address what we see to be the real needs of the
were
country". Yet it remains to be seen whether these proposals will include such measures as a requirement that universities improve their intellectual property policies and processes for transferring scientific discoveries to industry, or lose eligibility for government research grants.
Wayne Kondro
fatigue syndrome
damages. Besides the caps, manufacturers scored in other areas. The bill would restrict how punitive blame is apportioned. The bill also addresses an aspect of the breast-implant suit. Dow Chemical may face liability because it supplied silicone for implants. Saying that many makers of such materials may stop supplying them, the bill would exempt, in most cases, the suppliers from liability. While Congress may vote on the legislation this week, it is not expected to muster the votes needed to override a Clinton veto. Liability reform may end up being shelved because of
presidential election-year politics. Alicia Ault Barnett
824
In
a
landmark
nervous shock,
case a
last
legal if
week, not
a
medical condition, was held to have triggered chronic fatigue syndrome (CFS). It marks the end of a 9-year legal battle. In 1987, Ronald Page claimed that the nervous shock he suffered in the course of a minor road-traffic accident caused his CFS (which had been improving) to become chronic, and that as a result he was incapable of work. Otton accepted the medical evidence and awarded C 162 000. The Court of Appeal overturned Otton y"s findings on grounds that Page’s injury had not been foreseeable-but failed to consider the evidence on causation.
On May 11, 1995, the House of Lords, by a majority of 3:2 (see Lancet 1995; 345: 1430) held that the injury had been legally foreseeable, pointing out that the law does not distinguish between physical and psychiatric injury per se. The case was referred back to the Court of Appeal to consider the evidence on causation and compensation. Having reviewed the evidence, the Court of Appeal held that Otton J’s original findings were justified and reinstated the award. Had Page merely viewed the accident, it is probable that his nervous shock would not have been foreseeable. Diana Brahams
Controversial blueprint for Canadian science
Congress and courts are efforts to curb a continuing flurry of product-liability suits against manufacturers of pharmaceuticals, medical devices, and other products. Republicans sweeping into Congress in November, 1994, made tort reform a priority, and on March 13 they achieved bipartisan agreement on a bill to cap punitive damages, among other things. The US manufacturing and medical communities have been lobbying for overhaul of the tort system for at least two decades. Drug and device makers claim that the system enables frivolous suits that retard research and development, particularly in contraception. Physicians say that malpractice litigation and massive payouts have led to unaffordable malpractice insurance premiums and to "defensive" medicine. Several higherprofile class-action suits, including those filed against the makers of the Dalkon Shield intrauterine device and silicone breast implants, have ended up bankrupting the manufacturers. The Norplant contraceptive implant seems to be headed for the same fate, as it is soon to be subject to a class-action suit. On March 7, a federal judge struck back at plaintiffs’ attorneys, issuing a ruling in the ongoing litigation over the defective Bjork-Shiley heart valve, that the claimants’ attorneys could receive only a third of the fees requestedUS$10 million, rather than$33 million. Congress’ proposal also targets payouts, saying that, for punitive damages, plaintiffs’ could receive only the greater of$250 000 or twice the amount awarded in actual economic
science
US
The renewing
that Ottawa’s primary and technology priority must be to get its own house in order so that it can be a partner in a national system of innovation, the federal government unveiled its longoverdue science blueprint last week. The blueprint is designed to organise federal science spending "in a way that makes it responsive to clear objectives and clear principles", Industry Minister John Manley said. The pragmatic spin the Liberals put on the science and technology plan belies the reality that it falls short of the sort of comprehensive S&T strategies introduced abroad and is primarily devoted to rejigging the management regime that governs federal science outlays (see Lancet Jan 27 p 256). The strategy focuses on the creation of a predominantly decentralised regime, in which responsibilities for decision-making and S&T coordination are broadly diffused. Although the blueprint sets out broad objectives and priorities, it also creates a series of administrative mechanisms, such as annual departmental S&T plans and an annual federal S&T outlook, in a bid to make the system more accountable. Other proposals include more
Arguing
stringent operational requirements federal
on
laboratories
and
programmes.
The plan is dressed up with a modest Can$600 million (over 3
years) technology superfund to develop new technologies such as telemedicine. In addition, the cabinet’s Economic Development
Legal trigger for
chronic
Committee will become responsible for S&T policy and priority setting, advised by 10-12 members of the private sector’s Advisory Council on and will "review the nation’s S&T, performance in S&T, identify emerging issues and advise on a forward-
looking agenda". Manley argued
that the Liberals constrained in the measures they could adopt in the blueprint because of the magnitude of deficiencies within the existing management regime. At the most basic level, the system lacks proper accounting for exactly how much, and what sort of, research and development is supported by Ottawa, he said. When asked what Ottawa’s next step will be in the development of a comprehensive science strategy, Manley replied, "our next challenge of reinvestment is going to be to deal with the universities, the basic research infrastructure of the country, and whether it’s strong enough and sustainable enough. And part of dealing with that is going to have to be to ensure that the criteria applied to the granting councils address what we see to be the real needs of the
were
country". Yet it remains to be seen whether these proposals will include such measures as a requirement that universities improve their intellectual property policies and processes for transferring scientific discoveries to industry, or lose eligibility for government research grants.
Wayne Kondro
fatigue syndrome
damages. Besides the caps, manufacturers scored in other areas. The bill would restrict how punitive blame is apportioned. The bill also addresses an aspect of the breast-implant suit. Dow Chemical may face liability because it supplied silicone for implants. Saying that many makers of such materials may stop supplying them, the bill would exempt, in most cases, the suppliers from liability. While Congress may vote on the legislation this week, it is not expected to muster the votes needed to override a Clinton veto. Liability reform may end up being shelved because of
presidential election-year politics. Alicia Ault Barnett
824
In
a
landmark
nervous shock,
case a
last
legal if
week, not
a
medical condition, was held to have triggered chronic fatigue syndrome (CFS). It marks the end of a 9-year legal battle. In 1987, Ronald Page claimed that the nervous shock he suffered in the course of a minor road-traffic accident caused his CFS (which had been improving) to become chronic, and that as a result he was incapable of work. Otton accepted the medical evidence and awarded C 162 000. The Court of Appeal overturned Otton y"s findings on grounds that Page’s injury had not been foreseeable-but failed to consider the evidence on causation.
On May 11, 1995, the House of Lords, by a majority of 3:2 (see Lancet 1995; 345: 1430) held that the injury had been legally foreseeable, pointing out that the law does not distinguish between physical and psychiatric injury per se. The case was referred back to the Court of Appeal to consider the evidence on causation and compensation. Having reviewed the evidence, the Court of Appeal held that Otton J’s original findings were justified and reinstated the award. Had Page merely viewed the accident, it is probable that his nervous shock would not have been foreseeable. Diana Brahams