Month: April 2014

Art Caplan: Condoms Should Be Encouraged, Not Used as Evidence

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Art Caplan has a new opinion piece up at NBC News on the increasing use of condoms as evidence of a crime by police in the United States. From the article:

Why do we shoot ourselves in the foot when it comes to public health? The latest example of what not to do in the war against disease comes from the world of sex: All over the United States, police and prosecutors are discouraging safer sex by using the possession of condoms as evidence of a crime.

For decades, police officers have been regularly confiscating condoms from people they believe are engaged in prostitution to either justify an arrest or to use as evidence at trial. District Attorneys routinely mention the number of condoms a person had on them when arrested to help cinch prostitution charges.

Prostitutes are far more likely to be infected with HIV and other sexually transmitted diseases than are the general population. That is why health departments spend a lot of money distributing condoms and trying to convince sex workers to use them.

Read the full article.

FRIDAY & SATURDAY: Petrie-Flom Center Annual Conference, “Behavioral Economics, Law, & Health Policy”

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Petrie-Flom Center 2014 Annual Conference: Behavioral Economics, Law, and Health Policy

May 2-3, 2014

Wasserstein Hall, Milstein East ABC, Harvard Law School, 1585 Massachusetts Ave.

Richard H. Thaler and Cass R. Sunstein’s book  Nudge: Improving Decisions About Health, Wealth, and Happiness brought behavioral economics to the masses, beginning a discussion of libertarian paternalism and the many ways that “choice architects” can help nudge people to make better choices for themselves without forcing certain outcomes on anyone. Some of their examples fall in the realm of health policy, as is also the case of Daniel Kahneman’s recent book, Thinking, Fast and Slow, which examines various cognitive errors people make in their judgments, choices, and conclusions, as well as how we might correct them.  But the conversation has only just begun.

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On Patents, Patients and the Public Interest

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By Michael Young

Earlier this month, a U.S. District Court in Delaware issued an injunction to bar sales of a minimally invasive Medtronic replacement heart valve that putatively infringed on competitor’s Edwards Lifesciences valve system patent.  After this ruling was issued, Medtronic filed an emergency motion requesting stay and expedited appeal of this injunction, contending that that “if the injunction were permitted to go into effect, treatable patients [with aortic annuli larger than 25mm for whom Edwards’ valve is not suited] may unnecessarily die in the name of already expired patent rights. Put simply, the calamity to public health that would result from the injunction is premised on a legally improper extension of patent rights” (Medtronic v. Edwards, 08-CV-0091, 2014).  Shortly thereafter, The Federal Court Circuit of Appeals agreed to postpone the injunction and to expedite Medtronic’s appeal.

While still unraveling, this case offers unique insights into the important yet often overlooked dialectic between patient safety and patent rights.

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The Alexis Shapiro Case: Divergent Perspectives on Coverage Decisionmaking

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Alexis Shapiro is a 12 year old girl who started gaining weight uncontrollably due to a rare condition caused by damage to her brain during the removal of a brain tumor.  Her and her parents’ struggle to get her gastric bypass surgery to curb the weight loss made national news for much of the winter in several outlets.  Happily, in March she had the surgery and she now appears to be doing well.  A good outcome, but boy was the process by which we got here a painful one, largely because the insurer understood the coverage decisionmaking process differently than the rest of us.  Here’s a timeline, and some reflections: Read More

Is Nonmedical Sex Selection Always Sexist?

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By John A. Robertson

Nonmedical sex selection is a thorny topic. Usually used to favor males, it has harmed women and resulted in sex ratio disparities in India, China, and other nations where son preference is strong. Sex selection is also troubling because it relies on infanticide, abortion, or the discarding of embryos based on their sex.

Since sex ratio imbalances are not a danger in the United States and equal rights and opportunities for women, though imperfect, are increasingly well-established, nonmedical sex selection in some circumstances, e.g., for gender variety in a family, may be more acceptable. That position, however, runs into the claim that any deliberate choice or preference about the sex/gender of offspring, even for a girl, is inherently sexist or gendered (see Glenn Cohen’s recent post). That position, however, is controversial.[1]

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Mental Health in Law School

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By Deborah Cho

I was recently pointed to this poignant post on mental health within the legal profession.  The post is the first of a three-part series that is titled “We Need To Start Talking About Why So Many Lawyers Are Killing Themselves.”  Parts 2 and 3 can be found here and here, respectively.  Please refer to the original posts for a deeper exploration of the original author’s experience with depression and anxiety as a legal professional.  I am by no means an expert on this topic, nor am I able to fully grasp everything the author has written about, but I want to explore some of what is touched upon as it relates to law students.

The author, law professor Brian Clarke from Charlotte School of Law, cites the following statistics: “[B]y the spring of their 1L year, 32% of law students are clinically depressed, despite being no more depressed than the general public (about 8%) when they entered law school. By graduation this number had risen to 40%. While this percentage dropped to 17% two years after graduation, the rate of depression was still double that of the general public.”

What this signals to me is confirmation of something I’ve suspected all along: There is something wrong with our law school experience.

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Petrie-Flom Intern’s Weekly Round-Up, 4/18-4/25

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By Chloe Reichel

This Thursday the Food and Drug Administration (FDA) proposed new regulations for the sale of e-cigarettes. These regulations would prohibit sales to minors and make health warnings on packages mandatory.

This Wednesday a law was passed in Vermont that requires the labeling of genetically modified foods. Vermont is the first state to pass such a regulation.

Estimations for state spending on Medicaid have been reduced by the Congressional Budget Office. The office is now predicting that the cost of Medicaid expansion will be $46 billion, compared with their previous estimate of $70 billion.

Researchers at King’s College London have grown human skin in the lab from stem cells. Animal rights proponents herald these developments as a potential end to testing on animals.

Sovaldi, a medication for hepatitis C that costs $1,000 for one day’s dosage, has had the most successful drug launch ever. From its FDA approval in December to March 31, its manufacturer sold $2.27 billion worth of the drug, though the drug has faced criticism for its high price.

The FDA is considering banning electrical stimulation devices, used to discourage aggressive behavior in people with disabilities. Students from the Judge Rotenberg Educational Center testified against the use of these devices, though some parents of children at the Center and administrators there defend the use of these devices.

Following an audit of Illinois Medicaid expenditures, it was found that the program paid $12 million for medical services for dead people. These findings have led some to support stricter scrutiny in determining Medicaid eligibility.

Pervasive use of pesticides and genetically modified seeds in Hawaii has led to unrest among the state’s residents. Groups have been organizing to prevent the cultivation of genetically modified crops, and in Hawaii County such a law has already been adopted.

How should we label these “cognitive errors” that are particularly common among MDs?

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Behavioral economists are really into giving the cognitive errors they study, and the corrective policy interventions they favor, labels. “Status quo bias,” “availability bias,” “recall bias,” etc., can all be fixed through “nudges” that involve “asymmetric paternalism” and the like.

Here’s an interesting “cognitive error” that I’m trying to crowd-source a label for: When America’s joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes.

And here’s another odd cognitive anomaly that seems to be especially limited to ophthalmologists: forgetting there’s a $50 dollar alternative that works just as well as the $2,000 injection they get 6% commission on. 

I’ve thought of my own labels (or rather, euphemisms) for the policy interventions I would suggest in response: “continuing medical education”  for the first of these neat little errors, and “resocialization” for the second.