Substantial Shifts in Supreme Court Health Law Jurisprudence

President Trump’s nomination of jurist Brett Kavanaugh to the U.S. Supreme Court presents significant, potential changes on health law and policy issues. If confirmed by the U.S. Senate, Kavanaugh’s approaches as a federal appellate court judge and scholar could literally shift the Court’s balance on consequential health policies. Judge Kavanaugh has disavowed broad discretion for federal agency authorities, cast significant doubts on the constitutionality of the Affordable Care Act, and narrowly interpreted reproductive rights (most notably abortion services). He has supported gun rights pursuant to the Second Amendment beyond U.S. Supreme Court recent interpretations. His varying positions related to consumer protections, environmental regulation, and antidiscrimination protections lend further to major concerns on the maintenance of settled positions of the Court on these and other critical health issues

Steroid resistant CD8(+)CD28(null) NKT-like pro-inflammatory cytotoxic cells in chronic obstructive pulmonary disease

This article is part of the Research Topic On the Origin and Function of Human NK-like CD8+ T Cells: Charting New TerritoriesCorticosteroid resistance is a major barrier to effective treatment in chronic obstructive pulmonary disease (COPD), and failure to suppress systemic inflammation in these patients may result in increased comorbidity. Although much of the research to date has focused on the role of macrophages and neutrophils involved in inflammation in the airways in COPD, recent evidence suggests that CD8+ T cells may be central regulators of the inflammatory network in this disease. CD8+ cytotoxic pro-inflammatory T cells have been shown to be increased in the peripheral blood and airways in patients with COPD, whereas smokers that have not progressed to COPD only show an increase in the lungs. Although the mechanisms underlying steroid resistance in these lymphocytes is largely unknown, new research has identified a role for cytotoxic pro-inflammatory CD8+ T-cells and CD8+ natural killer T-like (NKT-like) cells. Increased numbers of these cells and their significant loss of the co-stimulatory molecule CD28 have been shown in COPD, consistent with findings in the elderly and in clinical conditions involving chronic activation of the immune system. In COPD, these senescent cells expressed increased levels of the cytotoxic mediators, perforin and granzyme b, and the pro-inflammatory cytokines, IFNγ and TNFα. They also demonstrated increased cytotoxicity toward lung epithelial cells and importantly were resistant to immunosuppression by corticosteroids compared with their CD28+ counterparts. Further research has shown these cells evade the immunosuppressive effects of steroids via multiple mechanisms. This mini review will focus on cytotoxic pro-inflammatory CD8+CD28(null) NKT-like cells involved in COPD and novel approaches to reverse steroid resistance in these cells.Greg Hodge and Sandra Hodg

Handling Cases of Willful Exposure Through HIV Partner Counseling and Referral Services

Cases of willful exposure reveal the existing and future risks to the public health (especially women) which may be presented by individuals who willfully expose others to HIV through unsafe sexual or needle-sharing behaviors. In response to a documented case of willful exposure, a PCRS counselor or other public health official may, in his or her professional judgment, decide to act to avert a legitimate public health threat to known or unknown persons in the community. Yet handling such cases raises difficult issues in law, ethics, and public health practice. Public health authorities may be unable or ill-equipped to successfully control risks of this type for several reasons: (1) they may lack sufficient resources to properly investigate these cases; (2) they may lack knowledge or jurisdiction over the individual who willfully exposes others to HIV once his behaviors extend into other communities; and (3) they are bound to maintain the confidentiality of sensitive information they obtain from PCRS. How do health care workers and public health departments balance the duty to maintain the privacy of public health information related to PCRS against their obligation to fulfill a partner\u27s right to know of their exposure to infection? What are the legal powers and duties of public health departments to protect the health and safety of individuals as part of their mission to protect the public health? What is the role of the criminal law concerning persons who may intentionally or knowingly attempt to infect others with HIV or other communicable diseases

Is the United States Prepared for a Major Zika Virus Outbreak?

Zika virus has emerged as a global public health crisis with active transmission in the Americas and Caribbean. The World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC), and recently WHO reported there is a scientific consensus that Zika is a cause of microcephaly and Guillain-Barré syndrome (GBS). In the U.S. the Centers for Disease Control and Prevention (CDC) activated its emergency operations center at its highest capacity. President Obama requested $1.86 billion in emergency funding. Shamefully, Congress has yet to appropriate the funding needed for Zika preparedness, and the President has had to reallocate Ebola funding for Zika prevention. Although none of the continental states has reported local mosquito-borne transmission, federal authorities are amplifying the potential for Zika to affect national security. The virus already severely threatens Puerto Rico. Travelers visiting or returning to the United States could likely escalate the spread of Zika via sexual transmission. The virus may spread across a majority of US states including large cities where Aedes species mosquitos are active. Is the U.S. prepared for Zika? America\u27s highly functioning health system will help, but signs of unpreparedness remain due to insufficient resources and variable legal authorities

Personal Privacy and Common Goods: A Framework for Balancing Under the National Health Information Privacy Rule

In this Article, we discuss how these principles for balancing apply in a number of important contexts where individually identifiable health data are shared. In Part I, we analyze the modern view favoring autonomy and privacy. In the last several decades, individual autonomy has been used as a justification for preventing sharing of information irrespective of the good to be achieved. Although respect for privacy can sometimes be important for achieving public purposes (e.g., fostering the physician/patient relationship), it can also impair the achievement of goals that are necessary for any healthy and prosperous society. A framework for balancing that strictly favors privacy can lead to reduced efficiencies in clinical care, research, and public health. We reason that society would be better served, and individuals would be only marginally less protected, if privacy rules permitted exchange of data for important public benefits. In Part II, we explain the national health information privacy regulations: (1) what do they cover?; (2) to whom do they apply?; and (3) how do they safeguard personal privacy? Parts III and IV focus on whether the standards adhere, or fail to adhere, to the privacy principles discussed in Part I. In Part III, we examine two autonomy rules established in the national privacy regulations: informed consent (for uses or disclosures of identifiable health data for health-care related purposes) and written authorization (for uses or disclosures of health data for non-health care related purposes). We observe that the informed consent rule is neither informed nor consensual. The rule is likely to thwart the effective management of health organizations without benefiting the individual. Requiring written authorization, on the other hand, protects individual privacy to prevent disclosures to entities that do not perform health-related functions, such as employers and life insurers. In Part IV, we examine various contexts in which data can be shared for public purposes under the national privacy rule: public health, research, law enforcement, familial notification, and commercial marketing. We apply our framework for balancing in each context and observe the relative strengths and weaknesses of the privacy regulations in achieving a fair balance of private and public interests

Zika Virus and Global Health Security

Americans are largely apathetic about the risks of Zika virus and Congress cannot agree on preparedness funding. Strategies to counter the spread of Zika by the World Health Organisation (WHO) grossly underestimate the disease’s impact. WHO and member countries lack sufficient resources to respond. Consequences of fiscal apathy can be measured in lives lost and long-term disabilities. Zika prevention is a matter of global health security. The epidemiologic brunt of Zika in South America falls largely on vulnerable women at heightened risk of exposure through mosquitoes and sexual transmission. Resulting transmission to fetuses and infants will have generational impacts in South American and Caribbean countries, as well as the U.S. Global costs to address Zika infections among infected infants will exceed hundreds of billions (U.S. dollars). WHO and some U.S. leaders, including President Obama, correctly assert that Zika threatens national and global security similar to humanitarian crises, climate change, and war. Words alone, however, are not enough. Global recognition of this public health crisis must stimulate greater investment in preventing negative repercussions

Arbuscular mycorrhizal fungi in organic systems

Arbuscular mycorrhizal fungi (AMF) are potential contributors to plant nutrition and pathogen suppression in low input agricultural systems, although individual species of AMF vary widely in their functional attributes. Recent studies at HRI and elsewhere have suggested that in some agricultural systems inoculum of AMF is substantially lower under conventional management relative to that under organic management. Further studies have suggested that conventional management selects AMF communities with limited benefits to their plant hosts relative to those in organic systems. There is a need to investigate the generality of these findings, and their implications for the productivity of organic systems, particularly during the period following conversion to organic management. The current project was designed to pull together existing understanding of the role, and potential role, of AMF in organic systems, and to identify sites and develop methods for use in a subsequent research programme. The project had three objectives: 01 To deliver a literature review covering current knowledge of the role of AMF in conventional and organic agricultural systems. The review considered the ways in which management influences the structure and functioning of AMF communities, including their contributions under conventional and organic management, and recommendations for future research needs. 02 To establish the extent of differences in AMF inoculum between organic and conventional systems, covering a range of management practices. Paired organic and conventional fields at 12 sites from across England were selected to investigate the relationships between management, AMF communities and soil chemistry. Organic and conventionally managed soils showed no significant difference in soil chemical properties (Organic C, total N, total P, extractable P, K, Mg). However, organically managed soils had greater AMF spore numbers and root colonisation potential, and therefore higher AMF inoculum potential, than conventionally managed soil. The relative difference in AMF spore numbers between organic and conventionally managed fields increased with time since conversion. Differences in AMF inoculum potential between organic and conventionally managed fields, and between farm sites, could not be related to differences in soil chemistry. 03 To develop a method suitable for characterising AM fungus communities in soil libraries, based on 18S rRNA terminal restriction fragment length polymorphism (T-RFLP) T-RFLP was shown to provide a rapid semi-quantitative method for analysis of AMF community diversity. However it was clear that primers currently used to amplify AMF are selective and do not allow diversity of the whole AMF community to be determined. Additionally these primers amplify contaminant fungi which need to be removed from the T-RFLP profile prior to analysis. However, contaminant diversity was shown to be low. The project has identified sites and techniques which could be valuable in future research to study the role of AMF under organic management. The study has also highlighted a number of key areas in which further research is needed in order to harness AMF to improve sustainability and productivity of organic and other agricultural systems. In particular, there is a need to determine the extent to which AMF diversity varies between organic and conventional management, the rate and mechanisms by which AMF diversity increases following conversion to organic production, the relationships between AMF diversity and crop nutrition/ pathogen control, and the soil factors controlling the effectiveness of AMF inoculum

Reframing the Opioid Epidemic as a National Emergency

On August 10, 2017 President Trump announced his intention to declare a national emergency following the recommendation of the White House Commission on Combating Drug Addiction and the Opioid Crisis. Opioid abuse is among the most consequential preventable public health threats facing the nation. More than 600,000 deaths have occurred to date, with 180,000 more predicted by 2020. Of the 20.5 million US residents 12 years or older with substance use disorders in 2015, 2 million were addicted to prescription pain relievers. A national emergency declaration authorizes public health powers, mobilizes resources, and facilitates innovative strategies to curb a rapidly escalating public health crisis

Supervised Injection Facilities: Legal and Policy Reforms

The US Centers for Disease Control and Prevention reported that more than 70 000 deaths from drug overdoses occurred in 2017, including prescription and illicit opioids, representing a 6-fold increase since 1999. Innovative harm-reduction solutions are imperative. Supervised injection facilities (SIFs) create safe places for drug injection, including overdose prevention, counseling, and treatment referral services. Supervised injection facilities neither provide illicit drugs nor do their personnel inject users. Supervised injection facilities are effective in reducing drug-related mortality, morbidity, and needle-borne infections. Yet their lawfulness remains uncertain. The Department of Justice (DOJ) recently threatened criminal prosecution for SIF operators, medical personnel, and patrons