Malpractice liability, along with medical technology and payment system distortions, regularly figures among the most-cited reasons for escalating health-care spending in the United States. On the one hand, Harvard economist Amitabh Chandra conservatively estimates that upwards of $60 billion, or 3 percent of total health care costs ($1.8 trillion), is spent annually as a result of direct litigation and indi­rect defensive medicine costs. On the other hand, tort reform advocates place the figure at $200 billion by extrapolating, to the entire U.S. population, the results of research conducted by Stanford professor Dan Kessler and Mark McClellan. Their 1996 study shows that tort reforms reduced provider liability costs for Medicare heart patients by 5 to 9 percent.

At the heart of these debates is the following question. Does medical malpractice liability achieve its dual goal of compensating victims of medical injuries and deterring medical errors, or does it merely encourage wasteful defensive medicine without improving patient health? Despite considerable empiri­cal research, there is little evidence that malpractice litigation deters medical negligence. The evidence is much stronger—though still hotly debated—that malpractice fears actually encourage physicians to engage in defensive medicine.

The newest release in the Asia health Policy Program working paper series, AHPP working paper #13 by Brian Chen, explores whether malpractice pressures affect physician behavior, patient health, and health care costs in Asia. Studying physicians’ response to legal changes in Taiwan, he finds that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

Dr. Chen investigates how physicians’ test-ordering behavior and propensity to perform cesarean sections were affected first by a series of court rulings in Taiwan that increased physicians’ liability risks, and then by a subsequent amendment to the law that reversed the courts’ rulings. He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected but unexpectedly reduced cesarean sections. The reduction in cesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings. After the law was amended to negate the court decisions, physicians reversed their previous behavior, reducing laboratory tests and increasing cesarean deliveries. This pattern of behavior strongly suggests that physicians in Taiwan practice defensive medicine.

The New York-based Korea Society and Stanford University's Walter H. Shorenstein Asia-Pacific Research Center launched the nonpartisan "New Beginnings" policy study group on January 10, 2008, to offer recommendations on how U.S. policymakers could expand and strengthen the alliance between the United States and the Republic of Korea (ROK, or South Korea). Composed of former senior U.S. government officials, scholars, and other American experts on U.S.-Korean relations, the New Beginnings project team premised its efforts on the belief that the inauguration of a new South Korean president in February 2008 and a new American president in January 2009 would provide a special opportunity for the two countries to increase mutual understanding and transform the alliance into a global partnership. In a coincidence occurring only once every twenty years, the two new presidents' terms of office would overlap for a full four years. Moreover, the alliance needed renewal and revitalization after years of strain and tension that arose from divergent worldviews of progressive governments in Seoul and a conservative administration in Washington.

Since its establishment, the New Beginnings policy study group has issued a report to the U.S. administration each year. New Beginnings' reports and recommendations reflect insights gained from group conferences as well as individual members' continuing engagement with U.S.-Korean affairs.

Leaders from different sectors came together this past Friday to tackle the challenges of transforming the way we produce and consume energy, as well as discussing ways of supporting small businesses and entrepreneurs in the energy sector.

The Energy Innovation Conference was a partnership of the White House, federal agencies, businesses, and the Kauffman Foundation, to address how to advance innovations in (clean) energy.

The Stanford Daily - April 23, 2010

By Caity Monroe

“The important thing is not to let your heart grow cold while keeping your head cool.”

It was with this assertion that Helen Stacy, a senior lecturer in law, introduced José Zalaquett, Chilean lawyer, legal scholar and human rights defender, at his lecture on Thursday evening.

The quote, spoken by Zalaquett in a previous interview, was an apt way to acquaint the audience with a man who, despite being exiled for 10 years and having encountered thousands of stories of oppression and mass atrocity, demonstrated a mastery of balancing idealism and realism — all while maintaining an evident sense of morality and empathy.
“I do believe that law and ethics correlate a lot,” he said. “They are in my view like overlapping circles…and that area of overlap may be more or less considerable.”
Most of Zalaquett’s lecture focused on transitional justice and the various options for repairing and reconstructing a nation in the aftermath of mass atrocity. Zalaquett is renowned for his work defending human rights in his home country during General Augusto Pinochet’s oppressive regime. Having served on Chile’s National Truth and Reconciliation Commission, Zalaquett has first-hand experience with the importance of acknowledging atrocities and revealing the truth — however grim it may be.

“The idea that these atrocities may be left in the dark is repugnant to basic moral principles,” he said.

Stanford history Prof. James Campbell and political science Prof. Terry Karl provided commentary on Zalaquett’s lecture. Both sided with him on the importance of truth and recognition post-atrocity. However, all three also agreed that there are certain restrictions on truth’s ability to prevail and on the capacity of post-conflict societies to both uncover and subsequently handle such knowledge.

“One of the things that alarms me is that the more normal truth commissions become and the more normal some qualified amnesty provisions become…the more difficult it becomes to bring persecution to perpetrators of mass atrocity,” Campbell said, highlighting, as all three speakers did at some point during the event, one of the commonly-cited problems of such situations.

Dealing with complex issues of ethnic cleansing, mass atrocity and genocide is difficult and it appears that the general consensus on the matter is that there is no ideal solution.
Zalaquett depicted the transitional justice dilemma as necessary and promising, yet did so in a realistic framework.

“It’s a human endeavor, and human endeavors fail more than they succeed. Which is all the more reason to try over and over again,” he said.

This acknowledgment of some of the political and logistical restrictions that limit post-atrocity negotiations was one thing that students most appreciated about the lecture.
“This guy is amazing…He is one of the first people who acknowledged the idea that you have political constraints in post-conflict scenarios, and you have to deal with it,” said Cristina Brandao, a student SPILS fellow in the law school’s masters program. “This is, in my opinion, what makes him so important… somebody has to say this.”

Another part of the talk that appealed to many in attendance was the way in which Zalaquett spoke of acknowledgement. He emphasized that there is knowledge, and there is acknowledgement. In her comments after Zalaquett’s presentation, Karl added that such acknowledgement is particularly difficult for big powers like the United States that have been complicit in many different human rights violations.

“I really liked his distinction between acknowledgment and knowledge,” said Lila Kalaf ‘10. “We know that our government does some pretty messed up things all the time, but we don’t acknowledge it. And the step between knowledge and acknowledgment is so huge for Americans…it probably causes a lot of upheaval because once you acknowledge something, it usually starts to require action.”