The effect of 1980s tort reform legislation on general liability and medical malpractice insurance

A large number of states adopted tort reforms in the mid-1980s to limit the dramatic surge in insurance losses and premiums. Evidence based on liability insurance data by state indicates that these reforms substantially influenced general liability insurance. The levels of losses, premiums, and loss ratios (a measure of insurance profitability) all reflected the impact of the reforms. The large-scale reform efforts in 1986 were particularly influential. Medical malpractice insurance was much less sensitive to the reform efforts.     

A SCALE IN SEARCH OF A CONSTRUCT: COMMENTS ON GAVIN AND WAMBOLDT

The article examines some issues raised in Gavin and Wamboldt's (1992) recent study on the Family-of-Origin Scale (FOS) (Hovestadt, Anderson, Piercy, Cochran, & Fine, 1985). The discussion centers on unresolved concerns regarding the validity and utility of the FOS and on unsubstantiated and potentially misleading claims made in the Gavin and Wamboldt article. A case is made for conceptual and methodological precision in the study of family phenomena.     

Potential exposures and risks from beryllium-containing products.

Beryllium is the strongest of the lightweight metals. Used primarily in military applications prior to the end of the Cold War, beryllium is finding new applications in many commercial products, including computers, telecommunication equipment, and consumer and automotive electronics. The use of beryllium in nondefense consumer applications is of concern because beryllium is toxic. Inhalation of beryllium dust or vapor causes a chronic lung disease in some individuals at concentrations as low as 0.01 microg/m3 in air. As beryllium enters wider commerce, it is prudent to ask what risks this might present to the general public and to workers downstream of the beryllium materials industry. We address this question by evaluating the potential for beryllium exposure from the manufacturing, use, recycle, and disposal of beryllium-containing products. Combining a market study with a qualitative exposure analysis, we determine which beryllium applications and life cycle phases have the largest exposure potential. Our analysis suggests that use and maintenance of the most common types of beryllium-containing products do not result in any obvious exposures of concern, and that maintenance activities result in greater exposures than product use. Product disposal has potential to present significant individual risks, but uncertainties concerning current and future routes of product disposal make it difficult to be definitive. Overall, additional exposure and dose-response data are needed to evaluate both the health significance of many exposure scenarios, and the adequacy of existing regulations to protect workers and the public. Although public exposures to beryllium and public awareness and concern regarding beryllium risks are currently low, beryllium risks have psychometric qualities that may lead to rapidly heightened public concern.     

A response to “the emotional consequences of physical child abuse” by Annaclare van Dalen

The author responds to the article by Annaclare van Dalen (1989), disputing her statement that there is little in the literature about the emotional consequences of child abuse. The author reviews the pertinent literature, which is abundant. The author disagrees with van Dalen's statement that the child experiences physical abuse outside the body, and with the statement that the child experiences sexual abuse as pleasurable. In addition the author disagrees with van Dalen's sharp differentiation between physical abuse and sexual abuse, and proposes that sexual abuse be regarded as a variant of physical abuse.     

What to Do at Low Doses: A Bounding Approach for Economic Analysis

To quantify the health benefits of environmental policies, economists generally require estimates of the reduced probability of illness or death. For policies that reduce exposure to carcinogenic substances, these estimates traditionally have been obtained through the linear extrapolation of experimental dose-response data to low-exposure scenarios as described in the U.S. Environmental Protection Agency's Guidelines for Carcinogen Risk Assessment (1986). In response to evolving scientific knowledge, EPA proposed revisions to the guidelines in 1996. Under the proposed revisions, dose-response relationships would not be estimated for carcinogens thought to exhibit nonlinear modes of action. Such a change in cancer-risk assessment methods and outputs will likely have serious consequences for how benefit-cost analyses of policies aimed at reducing cancer risks are conducted. Any tendency for reduced quantification of effects in environmental risk assessments, such as those contemplated in the revisions to EPA's cancer-risk assessment guidelines, impedes the ability of economic analysts to respond to increasing calls for benefit-cost analysis. This article examines the implications for benefit-cost analysis of carcinogenic exposures of the proposed changes to the 1986 Guidelines and proposes an approach for bounding dose-response relationships when no biologically based models are available. In spite of the more limited quantitative information provided in a carcinogen risk assessment under the proposed revisions to the guidelines, we argue that reasonable bounds on dose-response relationships can be estimated for low-level exposures to nonlinear carcinogens. This approach yields estimates of reduced illness for use in a benefit-cost analysis while incorporating evidence of nonlinearities in the dose-response relationship. As an illustration, the bounding approach is applied to the case of chloroform exposure.     

Benchmark Analysis: Shopping with Proper Confidence

We discuss the issue of using benchmark doses for quantifying (excess) risk associated with exposure to environmental hazards. The paradigm of low-dose risk estimation in dose-response modeling is used as the primary application scenario. Emphasis is placed on making simultaneous inferences on benchmark doses when data are in the form of proportions, although the concepts translate easily to other forms of outcome data.     

Betrayal and repetition: Understanding aggression in sexually abused girls

Betrayal by a significant object is seen as primary in causing behavioral and emotional disturbances in incest victims, leading to a pervasive identification with the aggressor and disturbances in object relations development. Identification with the aggressor is understood not as a uniform defense mobilized against a specific affect but as a complex compromise formation which defends against anxiety, while also providing libidinal, aggressive and superego gratifications. Far from simply attempting to overcome the past, identifications thus preserve affects that have become pleasurable and self-defining. Two case studies of adolescent girls illustrate how treatment can help victims recognize and begin to forego the sadomasochistic pleasure derived from these identifications, a relinquishment necessary for true mastery.