Should health authorities offer risk-sharing contracts to pharmaceutical firms? A theoretical approach

In this paper, we characterise the risk-sharing contracts that health authorities can design when they face a regulatory decision on drug pricing and reimbursement in a context of uncertainty. We focus on two types of contracts. On the one hand, the health authority can reimburse the firm for each treated patient regardless of health outcomes (non risk-sharing). Alternatively, the health authority can pay for the drug only when the patient is cured (risk-sharing contract). The optimal contract depends on the trade-off between the monitoring costs, the marginal production cost and the utility derived from treatment. A non-risk-sharing agreement will be preferred by the health authority, if patients who should not be treated impose a relatively low cost to the health system. When this cost is high, the health authority would prefer a risk-sharing agreement for relatively low monitoring costs.     

The temporal fate of drugs in decomposing porcine tissue

Drug levels in decomposed individuals are difficult to interpret. Concentrations of 16 drugs were monitored in tissues (blood, brain, liver, kidney, muscle, and soil) from decomposing pigs for 1 week. Pigs were divided into groups (n = 5) with each group receiving four drugs. Drug cocktails were prepared from pharmaceutical formulations. Intracardiac pentobarbital sacrifice was 4 h after dosing, with tissue collection at 4, 24, 48, 96, and 168 h postdosing. Samples were frozen until assay. Detection and quantitation of drugs were through solid phase extraction followed by gas chromatograph/mass spectrometer analysis. Brain and kidneys were not available after 48 h; liver and muscle persisted for 1 week. Concentration of drugs increased during decomposition. During 1 week of decomposition, muscle showed average levels increasing but concentrations in liver were increased many fold, compared to muscle. Attempting to interpret drug levels in decomposed bodies may lead to incorrect conclusions about cause and manner of death.     

Mineralization of mandibular third molars can estimate chronological age--Brazilian indices

Forensic age estimation is an important element of anthropological research, as it produces one of the primary sources of data that researchers use to establish the identity of a person living or the identity of unknown bodily remains. The aim of this study was to determine if the chronology of third molar mineralization could be an accurate indicator of estimated age in a sample Brazilian population. If so, mineralization could determine the probability of an individual being 18 years or older. The study evaluated 407 panoramic radiographs of males and females from the past 5 years in order to assess the mineralization status of the mandibular third molars. The evaluation was carried out using an adaptation of Demirjian's system. The results indicated a strong correlation between chronological age and the mineralization of the mandibular third molars. The results indicated that modern Brazilian generation tends to demonstrate an earlier mandibular third molar mineralization than older Brazilian generation and people of other nationalities. Males reached developmental stages slightly earlier than females, but statistically significant differences between the sex were not found. The probability that an individual with third molar mineralization stage H had reached an age of 18 years or older was 96.8-98.6% for males and females, respectively.     

How to build European private law: an economic analysis of the lawmaking and harmonization dimensions in European private law

In the process of building a European Private Law, the lawmaking and harmonization dimensions??the modes of harmonization and even more, the scope and reach of the harmonizing effect of the European rules- appear as crucial issues. We show how the harmonization strategy is as important a question as whether we should have European Private Law at all. We present an economic discussion of the different modes of harmonizing Private Law in the abstract, and how they are likely to differently affect outcomes. We also present in informal terms a simple economic model of how to build optimal harmonized rules and standards in a setting of pre-existing separate and diverse national ones, and we systematically explore how the different harmonization regimes (maximum harmonization, minimum harmonization, and pure co-existence of harmonized and national standards) affect the outcomes of the harmonization process.     

A suicide by thiopentone infusion

A suicide by intravenous thiopentone infusion is described. A search of the literature revealed only four cases, but this paucity is possibly due to under-reporting, as these suicides occur amongst medical personnel.     

An unusual case of fatal accidental paraquat poisoning

Paraquat, a useful contact herbicide is now used in over 130 countries of the world, including Sri Lanka. The number of cases of accidental poisoning reported with paraquat is small, relative to instances of suicide. When a clear history is not available, accidental paraquat poisoning is sometimes difficult to diagnose. A 9-year-old boy was admitted to a peripheral hospital with a history of diarrhoea and vomiting. He later developed abdominal pain, subcutaneous emphysema and difficulty in breathing. Following transfer to a district hospital and then to a teaching hospital, poisoning with paraquat was suspected only on day 11 of the illness. On persistent questioning, on day 13 of the illness the child remembered that the day prior to the onset of illness, on his way from a shop, he felt thirsty and having found an empty bottle of Gramoxone (paraquat) on the wayside he used it to drink water from a water tank. The child died on day 17 and the histology of the lung showed typical changes of paraquat poisoning. This tragic episode emphasises the need for proper disposal of empty containers of all poisonous substances.     

Sudden unexpected death due to familial hypertrophic obstructive cardiomyopathy

Hypertrophic cardiomyopathy is a familial condition with a very distinct risk of sudden death in males in certain families. The disease appears to be not uncommon in Sri Lanka. A sudden death in a 26-year-old healthy man is reported: At autopsy the heart was 500 g due mainly to left ventricular hypertrophy, and showed histological changes consistent with cardiomyopathy. Symptomless family members of the deceased were subsequently referred to a cardiologist. Cardiomyopathy was diagnosed in one of them.     

Legal Reasoning and Legal Theory Revisited

This article deals with the relation between a theory of law and a theory of legal reasoning. Starting from a close reading of Chapter VII of H. L. A. Hart's The Concept of Law, it claims that a theory of law like Hart's requires a particular theory of legal reasoning, or at least a theory of legal reasoning with some particular characteristics. It then goes on to say that any theory of legal reasoning that satisfies those requirements is highly implausible, and tries to show that this is the reason why not only Hart, but also writers like Neil MacCormick and Joseph Raz have failed to offer a theory of legal reasoning that is compatible with legal positivism as a theory of law. They have faced a choice between an explanation of legal reasoning that is incompatible with the core of legal positivism or else strangely sceptical, insofar as it severs the link between general rules and particular decisions that purport to apply them.