NHS logo on the side of a building

Update on the Future Direction of Patient Safety in the National Health Service

Matt Hancock, the Secretary of State for Health and Social Care on February 6 gave a wide-ranging speech on the future direction of patient safety in the NHS. The speech is important as it gives key insights into government priorities for patient safety policy development in the NHS.He stated that we all trust nurses and doctors more than any other profession. He spoke about the importance of a “just culture” in the NHS and openness, honesty, and trustworthiness. Read More

US servicemembers pictured from behind, saluting

“Homecoming” to a History of Servicemember Experimentation

Much ado has been made about Amazon’s new hit, “Homecoming,” which recently received three Golden Globe nominations, including one for best drama series. The psychological thriller, directed by “Mr. Robot” creator Sam Esmail and starring Julia Roberts, has been characterized as “an irresistible mystery-box drama” and “the good kind of ‘what the hell is going on here?’ TV.” Tim Goodman described the show, which was adopted from Eli Horowitz and Micah Bloomberg’s Gimlet Mediacult hit” podcast of the same moniker, as a “dazzling” play “on memory, the military industrial complex, conspiracy and unchecked government privilege.”

The series revolves around novice caseworker Heidi Bergman’s (Roberts) experiences administering the Tampa, Florida-based Homecoming Transitional Support Center (HTSC). HTSC is a privately-run, Department of Defense (DoD) contract facility, which purports to assist combat-traumatized servicemembers readjust from the battlefield and reintegrate to civilian life. Indeed, Bergman opens the drama’s aptly-titled pilot, “Mandatory,” by explaining to her “client,” three-tour-combat-veteran Walter Cruz (Stephan James), that the treatment facility is “a safe space for you to process your military experience and re-familiarize yourself with civilian life in a monitored environment, which, just means getting you situated now that you’re back home, rear-wise, health-wise, basically, I just work for you.” Read More

Opportunity Atlas Creates Opportunities for Legal Epidemiology

By Amy Cook

Public health experts know that the social determinants of health—the environments in which we live, work, learn, and play—all have important effects on our health and well-being. As further evidence of this, in October 2018, researchers from Opportunity Insights collaborated with the Census Bureau to unveil the Opportunity Atlas, an interactive tool tracking data from more than 20 million Americans from childhood through their mid-30s, across each of the country’s 70,000 census tracts. The Opportunity Atlas gives us crucial insight into the level of geography that can impact adult outcomes: beyond the state and city, the neighborhood matters, sometimes tremendously. Read More

Close up on a pile of yellow pain pills

Addressing the Opioid Epidemic Starts with How We Treat Pain

As a nurse practitioner in a busy suburban emergency department, pain is my job. Pain is one of the most common reasons people come to an emergency department (ED). It could be abdominal pain, chest pain, back pain or even emotional pain, including depression or suicidal ideations. Pain is a driver for people seeking medical care. We have made pain into a vital sign, and we ask, “How would you rate your pain on a scale of 1 to 10?” a mandatory question for any patient who steps through our door.

This whole concept evolved circa 1987 when the Institute of Medicine urged healthcare providers to use a quantified measure for pain. It gained even more traction in 1990 when then president of the American Pain Society, Dr. Mitchell Max, called for improved means to assess and treat pain. The term “oligoanalgesia” gained popularity in the published literature, meaning that we weren’t giving enough pain medication to patients in the ED, in clinics or in any other healthcare setting. Healthcare providers responded. We asked about and we thought, more effectively treated pain to address this issue.

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The bottom half of a robotic face, featuring nose and mouth in blue lighting

Sex Robots are Here, But Can the Law Keep Up The With Ethics and Privacy Issues?

The robots are here. Are the “sexbots” close behind?

From the Drudge Report to The New York Times, sex robots are rapidly becoming a part of the national conversation about the future of sex and relationships. Behind the headlines, a number of companies are currently developing robots designed to provide humans with companionship and sexual pleasure – with a few already on the market.

Unlike sex toys and dolls, which are typically sold in off-the-radar shops and hidden in closets, sexbots may become mainstream. A 2017 survey suggested almost half of Americans think that having sex with robots will become a common practice within 50 years.

As a scholar of artificial intelligence, neuroscience and the law, I’m interested in the legal and policy questions that sex robots pose. How do we ensure they are safe? How will intimacy with a sex robot affect the human brain? Would sex with a childlike robot be ethical? And what exactly is a sexbot anyway? Read More

A woman holds a baby by a window

Paid Leave as a Public Health Issue

Earlier this month, Claire Cain Miller and Jim Tankersley wrote for the New York Times Upshot about Gavin Newsom’s anticipated paid leave proposal for California. Their piece highlights economic research showing that the absence of paid leave policies in the U.S. hinder women’s participation in the workforce and, in turn, hurts the U.S. economy. (For example, Miller and Tankersley cite a letter from the Federal Reserve Bank of San Francisco projecting that a national parental leave policy could result in 5 million more workers joining the labor force.)

As politicians like Newsom grapple with the question of how to pay for more robust paid leave policies at the state-level, defining the costs of our current systems will be an important part of the process.

The health costs of not providing parental leave are another—and under-explored—part of the equation. Two recently published papers point to the negative public health outcomes of our current leave policies, specifically for new mothers.

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Privacy as a concept: shadowy opaque faces overlaid with 1s and 0s

HIPAA RFI Comments: Patient Privacy Rights

By Adrian Gropper and Deborah C. Peel

Among other rich nations, US healthcare stands out as both exceptionally privatized and exceptionally expensive. And taken overall, we have the worst health outcomes among the Western Democracies.

On one hand, regulators are reluctant to limit private corporate action lest we reduce innovation and patient choice and promote moral hazards. On the other hand, a privatized marketplace for services requires transparency of costs and quality and a minimum of economic externalities that privatize profit and socialize costs.

For over two decades, the HIPAA law and regulations have dominated the way personal health data is used and abused to manipulate physician practice and increase costs. During these decades, digital technology has brought marvels of innovation and competition to markets as diverse as travel and publishing while healthcare technology is burning out physicians and driving patients to bankruptcy.

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Is Narrative Real?

At the end of last semester, I conducted an online survey and series of interviews seeking to understand the perspectives of seniors on questions of dementia and decision-making. In particular, I asked people to consider what things about themselves they wouldn’t want to make decisions without: what kinds of changes to who you are and to mental capabilities, induced by dementia or otherwise, would you want your family to be allowed to step in and prevent you from making?

The answers, perhaps unsurprisingly, showed no real consensus. Some people cared only about their cognitive abilities at the time the decision was being made. Others saw their personality as a determinate set of values without some of which they would consider themselves a different person. Still others were concerned only about the safety of themselves and their loved ones.

If I was looking for any clear answers to what people care about (I was), then that seems to be a fool’s errand.  Read More

A User-Focused Transdisciplinary Research Agenda for AI-Enabled Health Tech Governance

By David Arney, Max Senges, Sara Gerke, Cansu Canca, Laura Haaber Ihle, Nathan Kaiser, Sujay Kakarmath, Annabel Kupke, Ashveena Gajeele, Stephen Lynch, Luis Melendez

A new working paper from participants in the AI-Health Working Group out of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the Berkman Klein Center for Internet & Society at Harvard University sets forth a research agenda for stakeholders (researchers, practitioners, entrepreneurs, policy makers, etc.) to proactively collaborate and design AI technologies that work with users to improve their health and wellbeing.

Along with sections on Technology and a Healthy Good Life as well as Data, the authors focus a section on Nudging, a concept that “alters people’s behavior in a predictable way without forbidding any options,“ and tie nudging into AI technology in the healthcare context.     Read More