ClickCease Have Medical Malpractice Lawsuits Lead to More C Sections?
07/24/14   |   By

Have Medical Malpractice Lawsuits Caused a Dangerous Rise in C Sections? (Part 2) | DC Metro Area Medical Malpractice Law Blog

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In our last post, we discussed the curious implications of a highly cited, provocative medical paper, Yang et. al’s “Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section,” which obliquely blames medical malpractice attorneys for skyrocketing rates of C-Sections.

The New York Post also recently brazenly asked: “Do Medical Malpractice Threats, Real Or Imagine, Lead to More C-Sections?”

As tantalizing as the thesis that “pressure from medical malpractice attorneys –> more C-Sections” may seem based on superficial analysis, upon deeper inspection, it just doesn’t hold up.

There are two compelling problems with the thesis.

Problem #1. The correlation could be spurious.

Just because two trends “go together” does not mean that one causes the other. Correlation, as they say, does not imply causation. Spurious correlations happen all the time, for many different reasons. A popular website,, lists a whole bunch of ridiculous correlations. For instance, the consumption of organic food has been correlated very, very tightly with increasing rates of childhood autism over the past decade. But no one would say that eating more organic food causes babies to be autistic or that autistic children somehow make people more crave organic food. The correlation is just an odd statistical artifact with no meaning.

Problem #2. We could be overlooking other, better explanations for the trend.In some cases, one unseen driver can cause both trends. In other words, some third force can lead to more malpractice pressure AND more C-Sections at the same time. That would nicely explain any correlation. Tellingly, Yang et al included, as one of their metrics, “increased malpractice insurance premiums.”

So maybe the insurance companies’ decisions to raise their rates — which may or may not have been caused by any actual, real changes in lawsuits filed — caused both the “increase in malpractice pressure” and the spike in C-Sections. By this read, the real “bad guys” would be the insurance companies, not the trial lawyers.

As this blog and many other more objective sources have confirmed, insurance companies have their own agenda and often work very hard to blame malpractice attorneys for problems that they, themselves, either create or exacerbate.

Perhaps the insurance companies raised premiums for their own insurance company reasons, which in turn scared doctors into taking overly-precautionary methods (such as opting for C-Sections instead of VBACs). Meanwhile, the medical malpractice attorneys were innocent. The broader point is that, to understand the cause and effect relationships in complex systems, you need hard science, not just epidemiological observations. (For a more detailed explanation of the problems with many epidemiological studies, see journalist Gary Taubes’ fascinating 2007 New York Times piece, “Do We Really Know What Makes Us Healthy?“)

For thorough, effective assistance dealing with your potential case, call the medical malpractice attorneys here at Regan, Zambri & Long for a confidential consultation at (202) 463-3030.

Regan Zambri Long
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