Check Up

Low-carbohydrate diets seemed perfect for me. I could lose weight and enjoy burgers, pork, and chicken.

Turns out, I might be doing myself long-term harm. A study in the Annals of Internal Medicine found that those with low-carb diets based on animal sources of protein died earlier.

On the other hand, low-carb diets that emphasize vegetable proteins (brussels sprouts, tofu, lentils, and kidney beans) were "associated with lower all-cause and cardiovascular disease" death.

Sad news for meat lovers who need to lose a few pounds.

If we really want to save money in health care, we should fix the malpractice system and cut the amount spent on defensive medicine, right?

That was a popular line during the debate over health reform last spring and a frequently heard argument in the Philadelphia region, periodically an epicenter of skyrocketing malpractice costs.

But how much is really spent on malpractice and how much would tort reform save?

A study in Health Affairs by experts from Harvard University and elsewhere reported that the amount spent on medical liability in the United States, including defensive medicine, was $55.6 billion in 2008. That's a lot of money by any measure, but just 2.4 percent of America's national health bill - $2.40 of every $100.

And the bulk of that total, $45.6 billion, was an estimate of defensive medicine costs. Payments for medical malpractice totaled $5.7 billion, and legal and other costs amounted to $4.3 billion.

Two other studies in the journal suggest legal changes would do little to reduce the $45 billion spent on defensive medicine. They found that several "tort reforms" would not stop doctors from ordering tests and treatments due to a fear of lawsuits.

Researchers from the University of Southern Maine estimated that a 10 percent decline in medical malpractice premiums for doctors would reduce cost of care by less than 1 percent. "These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care cost may be overstated," the researchers said.

The third study compared the amount spent on defensive medicine in states with and without tort reforms, such as caps on awards for pain and suffering and other "non-economic" damages. The researchers found little difference in the "levels of malpractice concerns" of doctors and hence on the practice (or cost) of defensive medicine.