There are an estimated 80,000 chemicals used in products on the market today. The EPA regulates only 5 of those chemicals through the Toxics Substance Control Act of 1976 (15 U.S.C. §2601 et seq.). How safe are the rest of those 79,095 chemicals? Could they be to blame for rising cancer rates, birth defects, and learning disabilities?

Of recent concern is the unregulated chemical known as Bisphenol A or BPA. BPA is used in products such as baby bottles, sippy cups, water bottles, and the lining of canned foods. In 2008, the National Toxicology Program, under the U.S. Department of Health and Human Services, completed a comprehensive brief compiled from existing studies showing that BPA affects the brain, behavior and prostate gland in fetuses, infants and children at doses lower that the FDA's current standards.1 The NTP Brief found that the highest daily intake of BPA occurs in infants and children.2

The National Toxicology Program Brief, as well as other peer-reviewed studies led consumers to push for legislation in several states to ban the chemical from use in baby bottles and other children's products. Currently Connecticut, Minnesota, Chicago and Suffolk County in New York have passed legislation to ban BPA. The California's Senate defeated a bill to ban BPA in baby products by a narrow margin in September of this year. Major corporations such as Wal-Mart and Toys R Us have also agreed to take products containing BPA off the shelves by next year.

In addition, consumers are filing product liability claims against manufacturers who use BPA in their products.3 In late August, consumers learned that SIGG aluminum water bottles made prior to August 2008 contain BPA in their linings.4 This was particularly alarming to some consumers as SIGG markets to the "eco-conscious" with logos on their bottles such as "Eco-Logical" or "Rise Above Plastic" and have an entire line of mini-size SIGG bottles for children.5 The lawsuit against SIGG alleges that the plaintiffs paid more for the SIGG bottles because SIGG's marketed the bottles as BPA-free. SIGG responded to the litigation by setting up a limited time exchange program that will run through October 31, 2009.6

Indeed the public outcry over the vast number of unregulated chemicals in our products has led the EPA to propose an overhaul of the Toxic Substance Control Act. On September 29, 2009 EPA Administrator, Lisa Jackson, announced plans to reform the 33 year old law in order to allow for stricter review of chemicals for their effects on human health and the environment, require manufacturers to demonstrate that new and existing chemicals are safe, give the EPA greater authority to take action when chemicals do not meet safety standards, and promote green chemistry, transparency and public access to information.7

The recent consumer pressure on corporations, state legislatures and the EPA is proving to be a powerful force for change. It is essential that consumers recognize that it is not only our right to demand that chemicals used in products are safe for human health and the environment, but that it is our responsibility to use our democratic system and our buying power to create that change in the market.

1 The 2008 National Toxicology Program / Center For The Evaluation of Risks To Human Reproduction report " can be found at: http://cerhr.niehs.nih.gov/chemicals/bisphenol/bisphenol.pdf
2 Id.
3 See eg. In Re Bisphenol A (BPA) Polycarbonate Plastic, MDL No. 4:08-CV-1967- (N.D. MO. Coordinated Aug. 13, 2008); Johnson v. Sigg, No. 3:09cv-669-H (W.D. KY. filed Aug. 28, 2009)
4 Steve Wasik, SIGG CEO: I'm Sorry, Huffington Post, Sept. 7, 2009, http://www.huffingtonpost.com/steve-wasik/sigg-ceo-im-sorry_b_278291.html
5 See eg. SIGG Design, http://www.sigg.com/ch-shop/index.php/en/design.html, and SIGG Kids, http://www.sigg.com/ch-shop/index.php/en/kids.html
6 Go to http://mysigg.com/bulletin/exchange_program.html for more information on the exchange program.
7 EPA Administrator Jackson Unveils New Administration Framework for Chemical Management Reform in the United States, News Release (September 29, 2009)

Medical malpractice tort reform is repeatedly cited as an immediate and necessary means of bringing down skyrocketing health care costs in this country. We hear over and over again that doctors are closing their practices, hospital emergency rooms are shutting down, pregnant women cannot find physicians to deliver their babies and exorbitant malpractice insurance premiums are being passed on to the consumer in the form of higher medical bills. Doctors are forced to practice defensive medicine in order to reduce the chances of getting sued. The cost of health care can be reduced by 10 to 15% by reforming the system to prevent greedy lawyers and misguided patients from filing "frivolous" lawsuits that result in runaway jury verdicts and outrageous settlements in cases where doctors have done nothing wrong. Assertions such as these are repeated so frequently in the political forum and make such logical, intuitive sense, that they are widely accepted as true by the general public. But does the objective evidence support the conclusion that medical malpractice lawsuits force up the cost of medical care?

Are there too many frivolous medical malpractice lawsuits?
A 1999 study showed that one serious medical injury due to negligence occurs per 100 hospitalizations. Only 4-7% of injured patients brought a claim. According to the Institute of Medicine of the National Academy of Science report To Err is Human, 99,000 patients die every year from medical negligence. The study was completed in 1999. Since that time, the utilization of health care has gone up but the number of medical malpractice lawsuits filed each year has remained unchanged since the 1980s. The percentage of lawyers who practice personal injury has remained the same since 1975. The data shows that the number of patient injuries due to negligence has actually increased while the number of lawsuits has fallen off.

One of the reasons for a reduction in the number of lawsuits is that personal injury lawyers have become so highly case selective. Forty-six states have enacted caps on pain and suffering damages in medical malpractice cases. These caps are in the range of $250,000 to $500,000. Medical malpractice cases are expensive to prosecute because of the need to hire multiple medical experts who charge at least $300.00 to $500.00 per hour and in some cases much more. Fees can easily top $10,000 per expert through trial. Most cases do not settle prior to taking expert depositions. Additionally, caps mean that only cases where there are significant lost wages or future medicals are worth the financial risk for a lawyer whose fee is contingent.

In California, on average 80% of medical malpractice lawsuits return a defense verdict. All these reasons combine to force lawyers to file only meritorious cases. In reality, the notion that an experienced personal injury attorney would knowingly file a frivolous medical malpractice lawsuit is a myth.

Do medical malpractice lawsuits force doctors to practice defensive medicine?
Perhaps the better question is "What is defensive medicine?" In order to practice defensive medicine, doctors must be ordering tests and procedures they feel are not clinically indicated. The concept makes no sense. If it is possible that a patient has a disorder that can be detected by a certain test, how is it not indicated? A study in Florida found that certain physicians ordered cardiac tests that may have forced up costs by 5 to 7 percent. However, a subsequent study showed that managed care forced the costs back down to 2.5 percent. No study has clearly shown what constitutes defensive medicine and what it actually costs. Furthermore, maybe the benefit outweighs the increased cost, if they exist. No one really knows. Some have also complained that nurses have to spend too much time documenting patient care and this drives up costs. As a former critical care nurse, I believe thorough documentation leads to better nursing care and actually protects nurses if lawsuits are filed. It is much like having a camera on the dashboard of a police cruiser. If a policeman if falsely accused of misconduct, the camera will exonerate him. If he is culpable, it proves the plaintiff's case. The benefits to a patient of thorough, contemporaneous charting far outweigh any additional costs incurred.

How much do medical malpractice lawsuits add to health care costs?
Medical malpractice litigation and insurance premium costs in 2007 were $30.4 billion dollars. That sounds like a lot of money and it is, as a stand alone number. But we spend $2 trillion per year in this country for health care. Medical malpractice costs represent only about 1% to 1.5% of the total monies spent on health care each year. Tort reform enacted in 46 states has not reduced health care costs and additional reforms cannot save 10 to 15% of the annual cost of health care. Medical malpractice lawsuits are a factor in overall costs, but a very insignificant one.

These numbers do not take into consideration the financial losses suffered by the 93% of patients injured by medical negligence who do not sue. If reform should be undertaken at all, it should be reform that creates a level playing field for all injured patients and their heirs to be able to recover. Under the current system, only the catastrophic case gets filed even when liability is "slam dunk". The injured patient pays the uncompensated costs when medical malpractice occurs.

On May 22, 2009, in an attempt to mitigate the devastating consequences that unfair and deceptive credit card practices have had on the U.S. credit market, President Obama signed into law The Credit Card Accountability, Responsibility and Disclosure Act of 2009 ("The CARD Act of 2009"), P.L. 111-24. The CARD Act was first introduced by Connecticut Senator Dodd, Chairman of the Senate Committee on Banking, Housing, and Urban Affairs, to increase the transparency of lending, improve lending practices generally, protect under age consumers from predatory practices, and further encourage borrowers to manage credit responsibly. The CARD Act, which takes full effect in February 2010, attempts to supplement and strengthen existing legislation and address traditionally unregulated areas of the credit market, to eliminate the mass marketing strategy that lenders have utilized in the past. The CARD Act arose from the concerns expressed by the GAO (Government Accountability Office), the OCC (Office of the Comptroller of the Currency) and other regulatory agencies that were not fully addressed by the December 2008 revisions to Regulation Z and Regulation AA, including, unilateral increases in interest rates, imposition of additional transaction fees, inconspicuous disclosures, and the issuance of credit to young people.

Interest Rates
By amending the Truth in Lending Act, The CARD Act imposes new requirements when creditors want to increase interest rates. First, lenders must provide notice to consumers at least 45 days before applying an increase in a borrower's Annual Percentage Rate (APR), or making any other significant changes to the terms and conditions of Cardholder's Agreements. The notice must clearly disclose that a borrower has the right to cancel credit instead of accepting the changes. In addition, creditors may generally only increase fees after the first year of the opening of the account, and even then only under certain circumstances, which include (1) limiting the increase until after a previously disclosed time period has lapsed, such as a promotional period;(2) a change in the index rate not under the creditor's control; (3) payment not received by the creditor within 60 days of payment due date; and (4) after completion of a temporary hardship agreement, which is a negotiated repayment plan during a period of financial hardship. Moreover, the increased fee may not be applied retroactively to existing balances, and if a consumer does choose to cancel their card, these increased APRs may not be applied to the remaining balances. Specifically, these new rates may only be applied to new charges after the appropriate disclosures are made.

In addition to these preliminary safeguards, the CARD Act mandates that interest charges may not be applied to any portion of a balance that is paid by the due date, or to any miscellaneous fees-including overlimit and late fees.

Credit Card Transaction Fees/Application of Payments
Another significant change is the limitation on miscellaneous transaction fees. For example, the CARD Act prohibits overlimit charges, unless a borrower opts-in to allow overlimit transactions to the account. Moreover, lenders are prohibited from assessing an additional fee associated with a particular form of payment, whether over the internet, the phone, or in the mail.

The CARD Act also provides that no late fees may accrue, unless creditors mail a credit statement to the borrower at least 21 days in advance of the payment due date, as opposed to the current 14 days. Early morning payment deadlines are also prohibited, and lenders must ensure that payments made in person are credited the same day. The CARD Act further prohibits lenders from applying any late fees if there is a delay in crediting a timely payment, and any payments higher than the minimum must first be applied to balances with higher interest rates.

Disclosures
In addition to the various payment and interest protections imposed by the CARD Act, lenders are required to make better disclosures to borrowers. The disclosures must inform and educate cardholders of their terms and conditions, and of the implications of maintaining debt. Specifically, card issuers must provide borrowers with statements explaining the length of time and the amount in total interest they will pay if the borrower only makes the minimum monthly payments.

There must also be full disclosures stating the payment due dates and times, along with the applicable late penalty or increased interest rate if the payment is untimely.

Safeguards for Young People
The CARD Act directly addresses the common credit issuers' practice of mass targeting youth by setting crucial guidelines for the issuance of credit to persons under the age of 21. First, applications for persons under the age of 21 must have the signature of a parent, guardian, or another individual who will be responsible for the debt. Moreover, the prescreened offers commonly targeted to young people are limited, including prohibitions on inducements to open accounts with offers of free tangible goods. Most importantly, the legislation aims at protecting college students by limiting the credit card marketing on university campus and increasing the transparency of agreements between Universities and card issuers.

Many worry that these upcoming changes will adversely affect consumers, with credit issuers extending less credit with higher rates and perhaps yearly fees. However, mandating transparency in an industry that has had only cursory regulation until now is undoubtedly a step in the right direction.