Thanks, zeta. I'm glad you enjoyed the post.
I defend medical malpractice cases on occasion. I see some very bad things that do in fact happen, and I'm sure you have seen them, too, but the science on CP is simply too overpowering to suggest that CP due to malpractice is as routine as the trial lawyers would have juries believe.
And don't forget that these cases are unbelievably profitable.
Thee quote from the NE Journal of Medicine that kills the case for CP caused by malpractice follows:
Reviewing pooled data from nine industrialized countries, Clark and Hankins concluded that "despite a 5-fold increase in the rate of cesarean section based, in part, on the electronically derived diagnosis of `fetal distress,' cerebral palsy prevalence has remained stable"23
Although it seems intuitively reasonable that a speedy delivery might occasionally rescue an infant from potential harm, there is no evidence of good quality that surgical delivery can prevent cerebral palsy. Cesarean section during active labor, which may be performed on the basis of intrapartum electronic monitoring, has been associated with an increased risk of hemorrhage, infection, thromboembolic events, and air or amniotic-fluid embolization in the mother.24,25 Interventions that have been assumed to be capable of saving an occasional infant may, if undertaken on the basis of clinical observations such as findings on electronic monitoring, increase the risks to mothers; as Clark and Hankins note, "operative intervention based on electronic fetal monitoring has probably done more harm than good."23
Implications
The known causes of cerebral palsy account for only a minority of the total cases. Even for most of those cases, however, evidence of the preventability of the disorder is lacking.
For future research that may make cerebral palsy preventable, we need new hypotheses, animal models that will take into account the complexity often encountered clinically, and careful clinical research. Trials of preventive interventions will require strategies for term infants that are somewhat different from those used for very premature infants, but for both groups large base populations will be needed to ensure sufficient numbers of subjects.
Although cerebral palsy, especially in cases related to birth asphyxia, is not known to be preventable by means now available, lawsuits brought against obstetricians for not preventing its development are a major contributor to the high cost of malpractice insurance and the disruptive consequences of the climate of litigation.26 The courts often permit unsupported "expert" opinion to supersede the consistent evidence of randomized, clinical trials, meta-analyses, case–control studies, and population-based time trends.
Scum like Edwards have nevertheless profited from judges who allow junk science in the courtroom. Is this the kind of guy we want a heartbeat away from the Presidency? |
