The “Great” Generation and a Not-So-Great Health System

My travels usually take me to far-flung places, but today is different. I\u27m on a train to New York City, shuttling back and forth from Washington, DC. My father is 101 years old, and just one year ago he gave a 30-minute speech without notes at his centenary birthday celebration. He ended his speech saying, “I\u27m often asked how I lived so long. The answer is I just lived.” An uncomplicated man who lived a long and complicated life, staying mindfully in the present. Here is his story about a 101-year-old, decorated World War II Veteran, who our country and health system cannot seem to offer care and dignity at life’s end

Lawrence O. Gostin on Biosecurity Policy: Are We Safer Today?

World-acclaimed authority Lawrence O. Gostin analyzes biosecurity policy since 9/11. He begins with the question: Are we safer now? Then comes a review of biosecurity legislation, followed by discussion of planning to deal with specific diseases and the problems with such an approach, and then an explanation of what the right approach is. He concludes by covering the Model State Emergency Health Powers Act and related civil liberties questions

The Right to Bear Arms: A Uniquely American Entitlement

In District of Columbia v. Heller the Supreme Court held that individuals have a constitutional right to own firearms, notably to keep a loaded handgun at home for self-protection. The historic shift announced by Heller was the recognition of a personal right, rather than a collective right tied to state militias. In McDonald v. Chicago, the Supreme Court – in a familiar 5-4 ideological split – held that the 2nd Amendment applies not only to the federal government, but also to state and local gun control laws. In his dissent, Justice Stevens predicted that “the consequences could prove far more destructive to our nation’s communities and constitutional structure.” Justice Alito, writing for the Court in McDonald, found that the 2nd Amendment is “fundamental to our system of ordered liberty,” justifying its extension to the states. Why is the right to bear arms “fundamental,” when it appears that firearms – designed to cause injury or death – are antithetical to social order and public safety? Firearms cannot be intrinsic to liberty because they have a unique potential to cause serious injury and death, posing a distinctive threat to social order. Unlike other liberties, carrying firearms directly puts the gun owner, family, and community at risk. “Your interest in bearing a firearm may diminish my interest in being and feeling safe from armed violence,” wrote Stevens. Possessing a functioning handgun at home, moreover, does not enhance the right to self-defense. A homeowner’s gun is substantially more likely to kill the gun owner or a family member (through accidental firing or suicide) than it is to harm an intruder. Going forward, state and local legislatures must remain determined in the face of litigation threats as they craft laws that comply with McDonald while also safeguarding the populace against gun violence. If not, firearm injury and death statistics will show the cost we have paid for McDonald

Contemporary Social Historical Perspectives on Mental Health Reform

The argument presented in this article is that a new role has been developing in law which can and should be used as a strategy in the provision of services. It will be further argued that there is an important place for the law in setting limits on established psychiatric measures relating, for example, to compulsory admission and treatment, and even to particularly hazardous measures taken with the consent of the patient. The final role of law is to ensure the civil status of those who are the consumers of psychiatric services. One must accept the fact that pernicious legal and social consequences sometimes are secondary features of the receipt of psychiatric services. Here the law can make a distinctive contribution to uphold a person\u27s personal status and dignity. This approach does not pretend to offer a solution to the more collective problems relating to deficiency in services, but the more individualistic approach of the law has its own legitimacy in upholding the integrity of people who have felt dehumanized by institutions, by the opprobrium of society and by the discriminatory character of legislation

A Moment in Human Development: Legal Protection, Ethical Standards and Social Policy on the Selective Non-Treatment of Handicapped Neonates

Selective non-treatment decisions involving severely handicapped neonates have recently come under renewed judicial and legislative scrutiny. In this article, the author examines the legal, ethical and social considerations attendant to the non-treatment decision. In Part II he discusses the predominant ethical viewpoints relating to this issue and proposes a new moral standard based on personal interests. Part III presents a survey of the jurisprudence relating to selective non-treatment decisions. Parts IV and V of this article provide a critical examination of the recently enacted Child Abuse Amendments of 1984, a federal legislative initiative designed to regulate treatment decisions relating to handicapped infants. The author suggests that the ethical standards and treatment criteria proposed in this article may prove useful to courts seeking to balance the handicapped neonate\u27s constitutional right to privacy with the requirements of the new federal law

Law as a Tool to Facilitate Healthier Lifestyles and Prevent Obesity

Public health agencies face considerable challenges trying to prevent overweight and obesity in society, primarily because a person\u27s own behavior is often the root cause of the disease. Individuals make personal choices about their diet, exercise, and lifestyle, so disease is often thought of as a matter of personal, not governmental, responsibility. This Commentary shows how law can be used as a tool to prevent overweight and obesity (see Table). The tools discussed in this article include: - Disclosure - e.g., labels and consumer information - Tort liability - e.g., inadequate disclosure of risks, misleading advertisements, and targeting children - Surveillance - e.g., reporting of glycosylated hemoglobin for diabetes management - Targeting children and adolescents - e.g., restricting food advertising during children\u27s programs; counter advertising to promote good nutrition and physical activity; limiting the use of cartoon characters; and restricting web-based games and promotions - Taxation of unhealthy food - e.g., junk food, snack, or Twinkie tax provides disincentive for purchasing calorie-dense, nutrient-poor foods; tax revenue could also be used to promote healthy nutrition - School policies - e.g., require schools to adhere to dietary guidelines and portion size; increase opportunities for nutrition education and physical activities - Built Environment - e.g., limit fast food restaurants, build recreational parks and bike paths, expand mass transportation, and provide lighting and playgrounds in housing developments - Food Prohibitions - e.g., ban trans fat from restaurants Despite the undoubted political risks, should public health agencies push for strong measures to control obesity, perhaps even banning hazardous foods? The justification lies with the epidemic rates of overweight and obesity, the preventable morbidity and mortality, and the stark health disparities based on race and socioeconomic status. Although the public dislikes paternalism, it is at least worth considering whether such an approach is ever justified to regulate harms that are apparently self-imposed, but which are deeply socially embedded and pervasively harmful to the public

The Tobacco Wars - Global Litigation Strategies

The Framework Convention on Tobacco Control (FCTC) identifies civil and criminal litigation as a public health strategy and promotes international cooperation (reporting, technical assistance, and information exchange). Holding the tobacco industry accountable through civil and criminal liability serves a number of public health objectives: punishes companies for hiding known health risks, manipulating nicotine content, and misleading the public; deters and preve nts future harmful behavior; compensates individuals and stake-holders for health care and other costs associated with smoking and exposure to environmental tobacco smoke (ETS); raises prices, resulting in lower tobacco consumption; increases disclosure of health risks, through labeling and advertising restrictions; and promotes transparency, by compelling discovery of internal industry documents. Tobacco litigation frequently has been used as a method for promoting tobacco control in the United States. Litigation is less common outside the United States, but increasingly advocates have brought innovative lawsuits abroad. This commentary explores global tobacco litigation strategies, with 4 key elements: compensation/recovery, advertising restrictions, criminal liability, and public interest writ litigation. The commentary argues that perhaps the most important effect of tobacco litigation has been to transform public and political perceptions about risk and responsibility in smoking, making clear what manufacturers knew, how they concealed this knowledge, and how they manipulated consumers. Tort law has reframed the debate from personal to corporate responsibility. However, the industry still manages, at least in the political realm, to alter the discourse to one involving freedom of choice for the smoker, the evils of big government, unfair taxation, and the influence of trial lawyers. Furthermore, now that the tobacco industry is aggressively seeking new markets in the poorest, least-regulated countries, litigation will take on new importance. The most promising strategies will use a human rights framework, arguing that tobacco is so detrimental that it violates the rights to health, life, and a sanitary environment

Mandatory HPV Vaccination and Political Debate

Vaccinations are among the most cost-effective and widely used public health interventions, but have provoked popular resistance, with compulsion framed as an unwarranted state interference. When the FDA approved a human papillomavirus (HPV) vaccine in 2006, conservative religious groups strongly opposed a mandate, arguing it would condone pre-marital sex, undermine parental rights, and violate bodily integrity. Yet, Governor Rick Perry signed an executive order in 2007 making Texas the first state to enact a mandate — later revoked by the legislature. Mandatory HPV vaccination reached the heights of presidential politics in a recent Republican debate. Calling the vaccine a very dangerous drug that could lead to mental retardation, Michele Bachmann asserted, To have innocent little 12-year-old girls be forced to have a government injection through an executive order is just wrong. Rick Santorum added, There is no government purpose served for having little girls inoculated at the force and compulsion of the government. Governor Perry almost immediately disavowed his action, saying first that the vehicle of an executive order was wrong and then vaccination should be opt-in. This political theater could frighten parents from vaccinating their children, causing preventable suffering and death. The scientific evidence demonstrates that population-based HPV vaccination is highly safe and effective, justifying widespread adoption of the vaccine. The only question is whether a state mandate would increase vaccination rates or result in a backlash against HPV and wider childhood vaccinations. Given the political divisiveness, states should launch health education campaigns before resorting to compulsion

The FDA, Preemption, and Public Safety: Antiregulatory Effects and Maddening Inconsistency

Most people think of preemption as a technical constitutional doctrine, but it is pivotally important to health and safety, while also opening the door to broad judicial discretion. The Rehnquist and Roberts Courts’ pro-business/pro-preemption jurisprudence is distinctly antiregulatory, invalidating major state public health rules, such as in occupational safety, tobacco control, and motor vehicle safety. Apart from the antiregulatory effects, there is maddening inconsistency. Consider three relatively recent Supreme Court cases. In Riegel v. Medtronic, Inc. (2008), the Court held that federal law bars injured consumers from challenging the safety or effectiveness of FDA-approved medical devices. A year later, in Wyeth v. Levine, the Court came to the opposite conclusion, ruling that injured consumers could sue pharmaceutical companies for failing to warn about the risks of taking brand-name drugs. On June 23, 2011 in PLIVA, Inc v. Mensing, the Court found that injured consumers could not bring failure-to-warn claims for injuries caused by FDA-approved generic pharmaceuticals. Thus, in less than four years, the Court barred state health and safety litigation for FDA-approved medical devices, allowed failure-to-warn claims for branded pharmaceuticals, and then barred those claims for generic pharmaceuticals. What is the rational basis for treating branded and generic medicines differently even though, by law, the products must be equivalent? Or treating branded drugs and medical devices differently even though they go through similar approval processes? As Justice Sotomayor (dissenting in PLIVA) put it, this “leads to so many absurd consequences that I cannot fathom that Congress would have intended to preempt state law,” while even Justice Thomas writing for the Court admitted this outcome “makes little sense.” This article examines the Supreme Court’s perversion of the preemption doctrine, the newest ruling on generic medicines, and the public health value of litigation

The International Migration and Recruitment of Nurses: Human Rights and Global Justice

The international migration of health workers – physicians, nurses, midwives, and pharmacists – leaves the world’s poorest countries with severe human resource shortages, seriously jeopardizing the achievement of the U.N. health Millennium Development Goals (MDGs). Advocates for global health call active recruitment in low-income countries a crime. Despite the pronounced international concern, there is little research and few solutions. This commentary focuses on the international recruitment of internationally educated nurses (IENs) from the perspective of human rights and global justice. It explains the complex reasons for nurse shortages in rich and poor countries; the duties of source and host countries; the human rights of health workers; and offers principles for responsible recruiting, focusing on national and global solutions