Analysis of Your Professional Liability Insurance Policy

The most important lessons for the physician to learn in regard to his professional liability insurance coverage are the following:1. The physician should carefully read his professional liability policy and should secure the educated aid of his attorney and his insurance broker, if they are conversant with this field.2. He should particularly read the definition of coverage and carefully survey the exclusion clauses which may deny him coverage under certain circumstances.3. If the physician is in partnership or in a group, he should be certain that he has contingent partnership coverage.4. The physician should accept coverage only from an insurance carrier of sufficient size and stability that he can be sure his coverage will be guaranteed for “latent liability” claims as the years go along—certainly for his lifetime.5. The insurance carrier offering the professional liability policy should be prepared to offer coverages up to at least $100,000/$300,000.6. The physician should be assured that the insurance carrier has claims-handling personnel and legal counsel who are experienced and expert in the professional liability field and who are locally available for service.7. The physician is best protected by a local or state group program, next best by a national group program, and last, by individual coverage.8. The physician should look with suspicion on a cancellation clause in which his policy may be summarily cancelled on brief notice.9. The physician should not buy professional liability insurance on the basis of price alone; adequacy of coverage and service and a good insurance company for his protection should be the deciding factors.     

Who should benefit financially from a good idea?

The need to publish ideas so that they can be explored, debated and extended by others before they are fully tested in the lab or the clinic is in conflict with the need to patent those ideas to provide a commercial incentive to apply them. I discuss why this conflict occurs, why it is important, and suggest three ways to get round it: root-and-branch reform of patent law (which seems impossible), extension of the US system's ‘grace period’ between publishing and filing a patent to longer times in the US and implementing the same system in other countries (which seems unlikely to happen), and binding readers of journals with a network of optional confidentiality agreements that allow publication but not citation without the authors’ permission. This latter appears too complex and conflicting an idea to work either, but while many conflicts with common scientific practice exist, the complexity of the system need not deter us, as at root the idea is simple and so it could be managed by software instead of patent lawyers.     

Genetic information and insurance: some ethical issues.

Life is risky, and insurance provides one of the best developed ways of controlling risks. By pooling, and so transferring risks, those who turn out to suffer antecedently uncertain harms can be assured in advance that they will be helped if those harms arise; they can then plan their lives and activities with confidence that they are less at the mercy of ill fortune. Both publicly organized and commercial insurance can organize the pooling of risk in ways that are beneficial for all concerned. They provide standard ways of securing fundamental ethical values such as solidarity and mutuality. Although policy holders do not know or contract with one another, each benefits from the contribution of others to a shared scheme for pooling and so controlling risk. Although there is a limit to the degree to which commercially-based insurance, where premiums depend on risk level, can go beyond mutuality towards solidarity, in practice it too often achieves a measure of solidarity by taking a broad brush approach to pooling risk. However, the ordinary practices of insurance, and in particular of commercial insurance, also raise ethical questions. These may be put in simple terms by contrasting the way in which an insurance market discriminates between different people, on the basis of characteristics that (supposedly) determine their risk level, and our frequent abhorrence of discrimination, in particular on the basis on religious, racial and gender characteristics. Are the discriminations on which insurance practice relies upon as standard acceptable or not? The increasing availability of genetic information, which testing (of individuals) and screening (of populations) may provide, could lend urgency to these questions. Genetic information may provide a way of obtaining more accurate assessment of individual risks to health and life. This information could be used to discriminate more finely between the risk levels of different individuals, and then to alter the availability and the costs of health, life and unemployment insurance to them. Since all of these forms of insurance bear very directly on the way most people live, it will matter to them how (if at all) insurers take account of genetic information. Will use of this information improve or damage the capacity of insurance to provide confidence in the face of uncertain harms, and help if they happen? Will it discriminate in acceptable or in unacceptable ways? Will it support or damage the sorts of mutuality and solidarity various sorts of insurance schemes have successfully institutionalized?     

Quantifying effects of biodiversity on ecosystem functioning across times and places

Biodiversity loss decreases ecosystem functioning at the local scales at which species interact, but it remains unclear how biodiversity loss affects ecosystem functioning at the larger scales of space and time that are most relevant to biodiversity conservation and policy. Theory predicts that additional insurance effects of biodiversity on ecosystem functioning could emerge across time and space if species respond asynchronously to environmental variation and if species become increasingly dominant when and where they are most productive. Even if only a few dominant species maintain ecosystem functioning within a particular time and place, ecosystem functioning may be enhanced by many different species across many times and places (β‐diversity). Here, we develop and apply a new approach to estimate these previously unquantified insurance effects of biodiversity on ecosystem functioning that arise due to species turnover across times and places. In a long‐term (18‐year) grassland plant diversity experiment, we find that total insurance effects are positive in sign and substantial in magnitude, amounting to 19% of the net biodiversity effect, mostly due to temporal insurance effects. Species loss can therefore reduce ecosystem functioning both locally and by eliminating species that would otherwise enhance ecosystem functioning across temporally fluctuating and spatially heterogeneous environments.     

Are synthetic proteins relevant to the problem of protein folding?

The possibility to derive the analogs of native proteins by the chemical synthesis is considered to be a serious argument for the concept of posttranslational protein folding. The present paper analyzes for the first time chemically synthesized proteins to reveal whether they are relevant to the problem of protein folding. The results enable the following conclusions to be drawn. The acquisition of the peculiar conformations by the chemically synthesized proteins to exhibit the specific functions is conditioned by the highly marked features of the secondary and tertiary structures of the corresponding native proteins. These features will make themselves evident only if favorable conditions are carefully chosen during the experiments for each individual protein. Thus, in our opinion, the possibility to derive a synthetic protein is hardly evidence for the posttranslational folding of proteins.     

Unesco's proposed Declaration on Bioethics and Human Rights - a bland compromise

The latest (June 2005) draft of UNESCO's proposed Universal Declaration on Bioethics and Human Rights is a major disappointment. The committee of government 'experts' that produced it made sure that it would not introduce any new obligations for States, and so the document simply restates existing agreements and lists desirable goals without specifying how they can be achieved. This article focuses on the shortcomings of the document as it would apply to health care. These shortcomings are evident in the document's scope, aims and principles. The conclusion is that if UNESCO still thinks that such a declaration is needed, it should produce either an ethical document addressed to individuals and groups, which would be primarily educational in nature, or a legal document addressed to States, which should not have the word 'ethics' in its title.     

Biobanking and international interoperability: samples

In terms of sample exchange, international collaborations between biobanks, or between biobanks and their research partners, have two important aspects. First, the donors’ consent usually implies that the scope and purpose of any sample transfer to third parties is subject to major constraints. Since the legal, ethical and political framework of biobanking may differ substantially, even between countries of comparable jurisdictional systems, general rules for the international sharing of biomaterial are difficult, if not impossible, to define. Issues of uncertainty include the right to transfer the material, the scope of research allowed, and intellectual property rights. Since suitable means of international law enforcement may not be available in the context of biobanking, collaborators are advised to clarify any residual uncertainty by means of bilateral contracts, for example, in the form of material transfer agreements. Second, biobank partners may rightly expect that the biomaterial they receive for further analysis attains a certain level of quality. This implies that a biobank has to implement stringent quality control measures covering, in addition to the material transfer itself, the whole process of material acquisition, transport, pre-analytical handling and storage. Again, it may be advisable for biobank partners to claim contractual warranties for the type and quality of the biomaterial they wish to acquire.     

Evaluating conformational changes in protein structures binding RNA

Many protein-RNA recognition events are known to exhibit conformational changes from qualitative observations of individual complexes. However, a quantitative estimation of conformational changes is required if protein-RNA docking and template-based methods for RNA binding site prediction are to be developed. This study presents the first quantitative evaluation of conformational changes that occur when proteins bind RNA. The analysis of twelve RNA-binding proteins in the bound and unbound states using error-scaled difference distance matrices is presented. The binding site residues are mapped to each structure, and the conformational changes that affect these residues are evaluated. Of the twelve proteins four exhibit greater movements in nonbinding site residues, and a further four show the greatest movements in binding site residues. The remaining four proteins display no significant conformational change. When interface residues are found to be in conformationally variable regions of the protein they are typically seen to move less than 2 A between the bound and unbound conformations. The current data indicate that conformational changes in the binding site residues of RNA binding proteins may not be as significant as previously suggested, but a larger data set is required before wider conclusions may be drawn. The implications of the observed conformational changes for protein function prediction are discussed.     

Hawkeye: an interactive visual analytics tool for genome assemblies

Genome sequencing remains an inexact science, and genome sequences can contain significant errors if they are not carefully examined. Hawkeye is our new visual analytics tool for genome assemblies, designed to aid in identifying and correcting assembly errors. Users can analyze all levels of an assembly along with summary statistics and assembly metrics, and are guided by a ranking component towards likely mis-assemblies. Hawkeye is freely available and released as part of the open source AMOS project .     

Legal instruments in private land conservation: the nature and role of conservation contracts and conservation covenants

Management of private land for ecological outcomes has emerged as an important facet of biodiversity management and ecological restoration in Australia. Common law conservation contracts and conservation covenants are important tools within this framework of private land conservation. They can provide legal protections to biodiversity and natural assets on private land, as well as legal frameworks, in the form of obligations, to restoration programs. They can provide distinct qualities of binding obligation: fixed term or enduring. Conservation contracts and covenants need to be recognized as possessing both transactional and relational qualities, and these qualities should be considered and reflected in the design of agreements and in practices of conservation management and agreement‐making. Two design questions are considered in this article. Conservation agreements need to contend with dynamism in ecological and social realities and this may be accommodated in mechanisms for adjustment of obligations between or within agreements. Dispute management is a second field of practice and drafting requiring attention. Constructing disputes provisions that are adapted and appropriate to long‐term conservation actions and restoration initiatives is reflective of good faith principles and can include scope for graduated, independent, corrective, and fair arrangements, informed as necessary by expert input.     

Medical confidentiality: legal and ethical aspects in Greece

Respect for confidentiality is firmly established in codes of ethics and law. Medical care and the patients' trust depend on the ability of the doctors to maintain confidentiality. Without a guarantee of confidentiality, many patients would want to avoid seeking medical assistance The principle of confidentiality, however, is not absolute and may be overridden by public interests. On some occasions (birth, death, infectious disease) there is a legal obligation on the part of the doctor to disclose but only to the appropriate authorities. Permissible disclosure can be granted by the patients' consent, for example, for the purpose of insurance they may wish to take out. Moreover, there are some ambivalent situations (such as criminal acts, or notification of sexual partner in case of a patient with AIDS) for which Greek law does not include relevant provisions, and the Codes of Medical Ethics do not offer clear guidelines. Therefore, the Greek doctor is called to estimate the situation and assume full responsibility for his decision. Finally, new considerations have arisen in the context of the recent advances in the field of telemedicine and electronic archiving. The paper discusses the current situation and legislation in Greece.     

Biological safety in virological field with special considerations on class II biological safety cabinets

The most critical point for the biosafety is not sophisticated devices or facilities, but education of workers and their compliance to the regulation. Appropriate devices should be carefully selected in the introduction of new devices, and they should be properly maintained. The class II biosafety cabinet is one of the delicate safety equipments. It should be kept adequately maintained throughout the lifetime of the cabinet to insure safety of the laboratory. For the maintenance, appropriate measuring equipments should be used by trained technicians. The recently enforced law for control of recombinant DNA researches should be applied for the handling of pathogens even in non-recombinant DNA researches after proper modifications.     

Psychological aspects of atomic disaster

Dermatologists, employers, insurance carriers and patients often flounder in misunderstanding when dealing with industrial dermatosis. A large part of such misunderstanding stems from too limited a knowledge of compensation insurance law by physicians, employee-patients and many employers. Physicians dealing with industrial cases should not only familiarize themselves with compensation law and insurance practices, but take it upon themselves to interpret such considerations to their employee-patients and, where necessary, to their patients' employers. Present-day employer-employee relationships are frequently on a most impersonal basis, and great mutual benefit will accrue to all parties when the position and objectives of each are understood by the others and the provisions and limitations of the law are known to all. The dermatologist handling industrial cases must take the responsibility of bringing this about.     

Defining Disputes and Characterizing Claims: Subject-Matter Jurisdiction in Law of the Sea Convention Litigation

The Law of the Sea Convention (LOSC) is well-known for containing a compulsory dispute settlement system in Part XV, which allows most disputes to be submitted to binding adjudication or arbitration. Yet, the ability to bring a claim under the LOSC is premised upon meeting certain conditions contained in the Convention's compromissory clause. This article examines those requirements relating to jurisdiction ratione materiae or subject-matter jurisdiction under LOSC and how they have been interpreted in the recent jurisprudence of courts and tribunals.     

Phylogenetics and sequence analysis--some problems for the unwary

DNA sequence comparisons can provide deep insight into phylogenetic relationships, but can also present problems for the unwary. Alignment comparisons are not always as straightforward as they might seem, and comparative models applied to deduce relationships need to be carefully chosen with full regard to the assumptions on which they are based. Most importantly perhaps, genes are not organisms, so some sequence analyses can be poorly informative about relationships – especially if evolution of those organisms has involved significant epigenetic factors, for example, in controlling gene expression. This review highlights some of the most prevalent problems in sequence-based phylogenetic studies of parasite systems.     

Courts as communicators: Can doctors learn from judges' decisions?

The role of the courts in 'communicating' with those affected by their decisions is contentious. Some legal commentators maintain that courts and legislators are able to communicate decisions effectively and that attempts to 'dumb down' the law will not make such decisions more accessible to doctors and other professionals. Justice Michael Kirby, on the other hand, seems to share the present author's view that judges could improve their communication of their decisions to a wider audience: 'In future, it seems inevitable that proceedings [of the High Court] will be broadcast live. Maybe one of the judges will explain the decisions of the court in simple terms as they are handed down ... Adaptation to new ways and values is part of the genius of our law, although some if its practitioners need to be dragged kicking and screaming to accomplish the changes' (emphasis added).(1) This article explores the position in Australia.     

Rethinking the Legal Status of Sunken Warships

There is substantial doctrinal controversy today concerning the legal status of sunken warships. It has recently been asserted by claimant governments, and by certain commentators, that title in sunken warships may only be abandoned by an express renunciation by the owning state and that salvage of such vessels is absolutely barred. This article carefully canvasses the available customary international law and domestic maritime law authorities and concludes that sunken warships may be impliedly abandoned by their sovereign owners through a long lapse of time and a clear intention not to claim or recover the vessel. Even if express abandonment is the appropriate standard, it may often be found in such circumstances as cessions of territory and constructive confiscations at the outbreak of hostilities. Salvage of unabandoned sunken warships may also be proper.     

Response to a Respiratory Survey

Respondents to a respiratory survey of Berlin, New Hampshire, residents in 1961 have been studied to assess the relationship between co-operation and respiratory disease prevalence. Two hundred and forty-three unco-operative subjects, interviewed at home, had significantly more morning phlegm and a lower vital capacity than carefully matched subjects who attended the central clinic. Fifty-one volunteers had the same prevalence of respiratory disease symptoms and physiological abnormalities as carefully matched subjects drawn from a probability sample of the city.It is concluded that respiratory disease prevalence will be underestimated if calculated from studies of co-operative subjects who attend a clinic. Case-finding by respiratory disease screening clinics will also miss many persons who suffer from chronic bronchitis.     

A case study of the interpretation of linkage data using DNA fingerprinting probes

The statistical power of the technique of DNA fingerprinting relies greatly on the ability of the investigator to make an assumption that the presence or absence of different fingerprint bands are independent. Such linkage equilibrium is unlikely if bands are tightly linked to each other. Thus, when a new organism is to be investigated it is helpful to examine the segregation of parental bands into the offspring to confirm that the bands are not linked. By considering families of the tilapia Oreochrotnis niloticus , we produce statistical tests for linkage that can be applied to DNA fingerprint information. The use of these tests is more difficult and complicated if one parent is missing, but some progress can be made. We recommend that at least ten offspring are examined for segregation in families, since smaller numbers of offspring result in coincidental perfect agreements in band distributions in the absence of any linkage.     

The Obligation to Negotiate in the Philippines v. China Case: A Critique of the Award on Jurisdiction

The two states in the Philippines v. China Case have continually reaffirmed in multiple documents and the 2002 Declaration on the Conduct of Parties in the South China Sea that they agreed to resolve their disputes in the South China Sea through consultations and negotiations. However, the Arbitral Tribunal in its Award on Jurisdiction held that no obligation of negotiation was provided for in these instruments because they were not legally binding agreements. Moreover, the Tribunal found that the Philippines had satisfied the “obligation to seek a solution through pacific means, including negotiation.” There are problems and deficiencies in the reasoning of the Tribunal respecting these findings.