Climate Change is Harming Health and the Treatment is Medicine, Law, and Bioethics

By Renee N. Salas

The flurry of media around recent climate change reports may have left your head spinning. These were all released in anticipation of the United Nation’s 24th Convention of the Party (COP24), in follow-up to the Paris Agreement, where the actual nuts and bolts of achieving this historic public health commitment was to be ironed out.

There are two key messages from these reports for the United States. First, climate change is human caused, happening today, and is worse than predicted. Second, climate change is harming the health of Americans now.

As an emergency medicine doctor, telling a patient a diagnosis is something I do frequently. Thus, if America were my patient, I would say that while the health diagnosis of climate change is grave, there is reason to be optimistic — because treatment exists. That treatment is the reduction of greenhouse gas emissions and switching from fossil fuels to solar and wind.

To achieve this treatment in our current political environment, we need historic teamwork that involves every discipline. This includes medicine, law, and bioethics joining together in novel collaborations that work to improve health and save lives.

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Administration’s Guidance on State Innovation Waivers under the ACA Violates the Act’s Statutory Guardrails

By Joel McElvain

This post was originally published on Take Care. 

The Affordable Care Act reformed the individual health insurance market to protect persons with pre-existing conditions. Insurers who participate in this market must sell plans with a standard set of comprehensive benefits, and may not deny coverage to, or impose higher premiums on, persons with pre-existing conditions.

Through legislative, regulatory, and litigation efforts, the Trump Administration has sought to depart from the ACA’s regime to allow the sale of plans that are medically-underwritten, offer more limited health benefits, or both.

The Administration’s latest such effort comes in the form of guidance by the Departments of Treasury and Health and Human Services that adopts a broader reading of the Act’s provision for state innovation waivers. Read More

Ebola… again: What have we learned?

By Alicia Ely Yamin

As Susan Sontag eloquently noted decades ago, illness conjures metaphors that reveal a great deal about how we think about, and, in turn, address them. None more so than the lethal Ebola, which monstrously disfigures bodies before killing the infected person and spreading rapidly through the routines of everyday life.

In the West, Ebola evokes images of illness as a deadly foreign invasion, while in the West African pandemic we know that first those who were afflicted—and later those who survived—were stigmatized as possessing demons.

The growing outbreak in the DRC has produced calls for greater physical and financial involvement from the US government by a number of health law scholars, citing the potential for exponential spread if it reaches highly populated areas, and underscoring it as a global health security issue.  Thus far, WHO’s Director General has not declared it a “Public Health Emergency of International Concern” (PHEIC), which triggers consideration of both trade and travel restrictions, as well as international assistance and under the International Health Regulations. Read More

Friday: FDA Chief Counsel Stacy Cline Amin and more at 7th Annual Health Law in P/Review

This year brought with it a wave of interesting issues in the health law arena—be it questions of limiting health care access to immigrants, the ongoing challenges of the opioid epidemic, or the ever-changing landscape of drug pricing.

Join us as we unpack the major health law developments of 2019 and discuss what to watch for in the year to come. Over the course of the day, leading experts will consider hot topic issues such as, health policy under the current administration, pharmaceutical policy, and global health. Featured panel discussions include “Challenges Facing Health Care General Counsels” and “AI in Health Care.”

In addition to panel discussions and speaker presentations, the conference will feature a special Fireside Chat between Glenn Cohen and Stacy Cline Amin, who serves as Chief Counsel of the Food and Drug Administration and Deputy General Counsel of the Department of Health and Human Services. She previously served as Special Assistant to the President and Senior Associate Counsel to the President, serving as the senior legal advisor on matters relating to the Department of Health and Human Services. Stacy will offer a window into what 2019 holds for the FDA.

 

This event is free and open to the public, but seating is limited and registration is required. Register now!

The Seventh Annual Health Law Year in P/Review is sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the Center for Bioethics at Harvard Medical School, with support from the Oswald DeN. Cammann Fund at Harvard University.

ohio statehouse from the front

Ohio’s “Fetal Heartbeat” Bill and the Effort to Restrict Abortion Access

By Hailey Cleek

The Ohio House recently voted to pass a controversial bill in effort to restrict abortion access for women. H.B. 258 would prohibit an abortion for pregnant women in Ohio if the presiding physician detects a fetal heartbeat. Gov. Kasich vetoed a similar bill in 2016, describing such efforts as “clearly contrary to the Supreme Court of the United States’ current rulings on abortion.”

Under H.B. 258, a physician who knowingly and purposefully performs or induces an abortion after detecting the fetal heartbeat could face a fifth-degree felony, punishable by up to a year in prison. The bill would not apply to a physician who performs a medical procedure that is intended to “prevent the death” or a “serious risk of the substantial and irreversible impairment of a major bodily function” of the pregnant individual. Yet the bill does not provide exceptions for rape, incest, or domestic violence. Representative Christina Hagan, who sponsored the bill, recently commented on the bill, stating, “We believe Ohio is best positioned to send this through the Circuit Courts and to the federal Supreme Court.” The bill was crafted in direct efforts to challenge Roe v. Wade.

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Toxic Breastmilk: When Substance Abuse Relapse Means Death for Baby

Recently, a nursing mother in Pennsylvania made national headlines when her infant died from ingesting a combination of fatal drugs through breastmilk.  According to the coroner’s report, the infant died from a combination of methadone, methamphetamine, and amphetamine toxicity. The Bucks County District Attorney charged the mother, Samantha Jones, who also has a two-year old child, with criminal homicide. According to published reports, Jones was undergoing Medication Assisted Treatment (MAT) and receiving doses of methadone to treat her addiction to opioid painkillers.

Multiple commentators swiftly voiced opposition to the District Attorney, decrying the criminal charges against Jones, arguing it is “highly problematic” to levy criminal charges against a person undergoing treatment for Substance Use Disorder.

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Can Computer Simulations Enhance Vaccine Trials?

Infectious disease emergencies are opportunities to test the efficacy of newly developed interventions—for example, drugs, vaccines, and treatment regimens. Yet they raise many intertwined challenges around politics, logistics, ethics, and study design.

It is essential to advance the discussion of how such products can and should be tested while remaining consistent with the efforts of CEPI, WHO, and others who encourage development and testing of candidate vaccines in advance of emergencies. Read More

Medicine doctor and stethoscope in hand touching icon medical network connection with modern virtual screen interface, medical technology network concept

Data-driven Medicine Needs a New Profession: Health Information Counseling

By Barbara Prainsack, Alena Buyx, and Amelia Fiske

Have you ever clicked ‘I agree’ to share information about yourself on a health app on your smartphone? Wondered if the results of new therapy reported on a patient community website were accurate? Considered altering a medical device to better meet your own needs, but had doubts about how the changes might affect its function?

While these kinds of decisions are increasingly routine, there is no clear path for getting information on health-related devices, advice on what data to collect, how to evaluate medical information found online, or concerns one might have around data sharing on patient platforms.

It’s not only patients who are facing these questions in the age of big data in medicine. Clinicians are also increasingly confronted with diverse forms of molecular, genetic, lifestyle, and digital data, and often the quality, meaning, and actionability of this data is unclear.

The difficulties of interpreting unstructured data, such as symptom logs recorded on personal devices, add another layer of complexity for clinicians trying to decide which course of action would best meet their duty of beneficence and enable the best possible care for patients.

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