Because of these trends, I and a number of my colleagues have, over the years, supported reasonable, commonsensical reforms that would discourage frivolous claims and encourage the settlement of legitimate claims. These reforms would reduce the need for the practice of defensive medicine and result in significant savings for patients. These proposals have taken a variety of forms, including caps on noneconomic damages (ie, those not associated with actual, calculable losses), limitations on joint and several liability, and heightened evidentiary standards for punitive damages. Efforts have been made to enact these ideas systemwide or even to limit them only to certain high-risk specialties, such as obstetrics. Unfortunately, trial lawyers associations have successfully blocked tort reform, arguing that people with low incomes will not be able to find lawyers to take their cases on contingency if settlements are capped. However, that has not been the case in states like California that have enacted meaningful tort reform.