Think only of that charlatan John Edwards making vast millions of stolen money “channelling” unborn babies crying for c-sections, before slack jawed North Carolina juries of 12 certifiable idiots.

“Are you saying there is a panel of witnesses for the persecution, all of whom expert radiologists?”

There is no persecution or prosecution. It’s a civil matter. There is a plaintiff, who has the burden of proving that the actions of the defendant fell below the standard of care and were the proximate cause of their injuries. There is a defendant who says no, either by arguing that the standard of care wasn’t breached, that they were not the proximate cause, or that the damages aren’t as great as stated, or some combination of those. Whether it’s a car wreck or med mal, that’s the case. Only thing about med mal is that physicians have added the hurdle that you must have an expert witness support your case if you are the plaintiff.

“Or is it still the duel between two experts with persecution’s witness being the one claiming this is the standard of care and the other saying, no it’s not?”

It’s not simply their word without support. Again, one doesn’t simply stand up and say “This is it because I say it is”. They wouldn’t last long as an expert that way. I would encourage you to go watch expert witness testimony before you form too many more firm conclusions.

“Also, let’s keep to subject at hand i.e. mammograms. Give me an example of how the fact that a detection of specific early cancer can be proven to be the standard of care in court.”

I can’t off the top of my head – I’ve never had a case involving a mammogram. Do you know of one? Surely there is one you can review for the answers you’re looking for.

“Another aspect is the injury itself and weather earlier detection would’ve made a difference. “
Absolutely. And in many cases that is effectively utilized as a defense. We don’t know in this case because we don’t have the details.
Are you saying that an evidence presented in a particular case could prove something that science hasn’t discovered yet? What kind of evidence can be presented to prove that earlier diagnosis would’ve made a difference if there is currently no way to determine it? A small tumor can be more aggressive too than a larger one.

Who knows? But if they did overestimate such effectiveness, do you think that could be because of the claims of the product makers and of the advocates of mammograms?
Absolutely. This was the main point of my posts – sometimes I wonder if you read it. This was also the main point of Dr Berlin’s “Manifesto for the Truth in Mammography Advertising” that I referenced – not providing the disclaimers mentioned in the introduction, but telling the truth. That instead of blaming the jurors for the past decisions, doctors should provide honest information about tests effectiveness and risks. As far as “who knows”, I don’t have time to look for references now, but there have been studies as to public perception of mammograms effectiveness that showed that. You could see it for yourself you bother to research the evidence on mammograms, and compared it with the information presented to the public.

I agree with you that the public should be educated. But I think you underestimate the amount of education that is involved in a med mal trial – from both sides.
This would be applicable if you could find a jury that had never heard of mammograms and early detection before the trial. You couldn’t find such a jury in the US. The jurors already have the “knowledge” they got from the advertising. The defense witness has to go against this “knowledge” while the persecution withness can use it. So the defense witness has an uphill battle.

No, that’s not the standard of care at all. One person does not establish it. If one person were to stand up and say “this is the standard because I say so”, the other side’s counsel would rather quickly carve them up, as would their expert.

“Another aspect is the injury itself and weather earlier detection would’ve made a difference. “

Absolutely. And in many cases that is effectively utilized as a defense. We don’t know in this case because we don’t have the details.

” But I would also bet serious money that the vast majority of jurors vastly overestimate the true effectiveness of mammograms, and the test’ limitations.”

Who knows? But if they did overestimate such effectiveness, do you think that could be because of the claims of the product makers and of the advocates of mammograms?

I agree with you that the public should be educated. But I think you underestimate the amount of education that is involved in a med mal trial – from both sides.

If you read the article I linked to in my first post on the subject, cancer is visible in hindsight in the majority of cases. But unless you know where to look, there are a number of other similar spots. Investigating every one of them would result sending most women for biopsies. No, I am not repeating simply what doctors told here, I am just using basic logic. Biopsies have risks. Additional investigation would also increase overdiagnosis, and may even increase mortality of other causes. Keep in mind, that the judgement of a test being effective is based on desease-specific mortality for statistical reasons. So increase in all-cause mortality due to say heart desease or secondary malignancy due to radiation treatment for “overdiagnosed” cases is almost impossible to judge. With benefit being so small in absolute terms, even a “rare” complication is important.

If your “expert witness” hadn’t known where to look in advance, or better yet if you were to sent past mammograms to a number of experts, and hadn’t warned them that it even was abnormal and had asked for their opinion and they had all found it – then and only then could you have claimed “standard of care”. If the court had really been interested in determining “the standard of care” this would’ve been done. But we don’t hear about such tests, do we?

Another aspect is the injury itself and weather earlier detection would’ve made a difference. If you know anything at all about evidence on mammograms (look up summary of evidence – USPSTF or PDQ; also compare the probability of a woman getting breast cancer with that of dying of it on NCR website), you’ll see that mammograms really make a difference in only a small percentage of cases: a) with modern treatment most women survive breast cancer even if it is found later b) most touted 30% mortality reduction (this is above USPSTF or PDQ estimates by the way) means that out of 10 women who would’ve died without mammograms, 7 will still die even with them. There is currently no test to say whether in each particular case the earlier detection would’ve made a difference. This is a fact, not an opinion. Regardless of what your expert witness says, there is no way he can say with any certainty that earlier diagnosis would’ve made a difference. If he claims that he is certain early detection would’ve made a difference in a particular case, you can already see that he is lying. He can tell that because it is smaller it would have, but it could’ve just increased the length of time from detection to death. I assume you heard of lead-time bias.

The reason your mother was disqualified is because we’re obliged to follow the law even if we disagree with it.
This wasn’t a question – this ironic comment was directed at people who say that juries are not required to follow instructions. Obviously, I know that the moment you say “I cannot follow instructions” you are guaranteed to be thrown out. I am not stupid.

You think they (jurors) are all ignorant of the tort reform PR nonsense of lost doctors? Remember, this is the voting public, 50% of whom are Republican voters.
I am absolutely sure the jurors heard about tort reform and the like. Which is why I think these letters to the jury are useless. But I would also bet serious money that the vast majority of jurors vastly overestimate the true effectiveness of mammograms, and the test’ limitations. They probably also underestimate the risks of sending too many women for biopsies. They also have no clue about overdiagnosis and the resulting harm. There have been studies checking public perceptions on mammograms. You cannot honestly claim that jurors opinions as to the effectiveness of early detection in general and the risks of “overdetection” is irrelevant in the opinion they form in each particular case, can you?
This is really the main reason why I think that reducing the knowledge gap referred to in “The knowledge gap” section of Dr. Leonard Berlin’s article is way more effective in changing the verdicts than all the tort reforms and words about implications combined. It is also the information public has a right to know.

The standard of care will differ depending on the type of case and the circumstances. Generally, in med mal, it’s the actions a reasonably prudent physician would have taken faced with the same situation.

The reason your mother was disqualified is because we’re obliged to follow the law even if we disagree with it. The place to change the law is in the legislature.

And you attribute too much sympathy to jurors. They are as complex in their thinking as all the second guessers. You think they are all ignorant of the tort reform PR nonsense of lost doctors? Remember, this is the voting public, 50% of whom are Republican voters.

Of course, since you live in Norway, your experience with regard to US cases is, shall we say, limited.

When, in the context of med mal cases, has the judicial branch ever legislated?

Do tell.