Category: Public Health

Breaking the Mold: Law and Mold Remediation after a Natural Disaster

Temple University Center for Public Health Law Research Leave a comment

By Nicolas Wilhelm, JD

We’re in the midst of the hurricane season here on the East Coast, and with hurricanes come a host of health-related concerns from emergency preparedness to the clean-up after a disaster.

One of the issues rarely discussed in the aftermath of hurricanes Katrina and Sandy —two of the costliest natural disasters in US history — is the mold growth that occurred in water-damaged homes. One study indicated that the concentration of mold in flooded areas after Hurricane Katrina was roughly double the concentration in non-flooded areas.

With natural disasters occurring with greater frequency in recent years (there were three times as many natural disasters occurring from 2000 through 2009 than from 1980 to 1989), law may play a role in keeping Americans safe.

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How to Destabilize Insurance Markets Without Really Trying

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Cross-posted from the Take Care blog. 

On Thursday, Senate Majority Leader Mitch McConnell released the latest draft of his effort to repeal the Affordable Care Act (ACA). As of last night, it appears that this version of the bill is dead, with four Senators declaring that they won’t vote to move it forward. But provisions of this bill are worth talking about, both for what they reveal about health insurance and for what they reveal about the process by which the Senate is considering ACA repeal.  The latest draft contains a number of new provisions, but two caught my eye: (1) Senator Ted Cruz’s attempt to bifurcate the individual insurance market and (2) a clause about membership in a health care sharing ministry as satisfying the requirement of “continuous creditable coverage.”

The Cruz amendment has received a large amount of coverage both in the popular press and by more specialized policy outlets. But there has been little attention to the clause about health care sharing ministries. Fortunately, I wrote a 5,000 word book chapter on the ministries as part of an academic conference in 2015 (here I am presenting on the topic, if you’re really interested). Read More

Copenhagen Conference: Legal Perspectives on Synthetic Biology and Gene Editing

Timo Minssen Leave a comment

Join us at the Centre for Information and Innovation Law (CIIR) Faculty of Law, University of Copenhagen on 20 November, 2017 to discuss Legal Perspectives on Synthetic Biology and Gene Editing.

CALL FOR PAPERS

Emerging technologies in Synthetic Biology and Gene Editing offer incredible opportunities and promising solutions to some of the most urgent challenges faced by humanity, such as climate change, environmental protection, growing population, renewable energy and improved health care. But the emerging applications also raise exceptional ethical, legal and social questions.

This conference marks the final phase of the participation of the Copenhagen Biotech and Pharma Forum (CBPF) Research Group at the Centre for Information and Innovation Law (CIIR) in the cross-faculty research project BioSYNergy. In accordance with the goals of this large cross-faculty project on Synthetic Biology, the event explores legal perspectives on synthetic biology, systems biology and gene editing. Dealing with the legal responses to ethical and scientific challenges raised by emerging life science technology. Read More

EPSDT: The little known acronym that helped millions of children

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By Emma Sandoe

This year marks the fiftieth anniversary of the passage of the legislation that created the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) program. The program requires states to provide screening and treatment to Medicaid eligible low-income children under the age of 21. In 2014 an estimated 40 million American children, or nearly one in every two kids, were eligible for this program. The Republican Obamacare repeal bills, the American Health Care Act (AHCA) and Better Care Reconciliation Act (BCRA) gives states the option to end this program for certain kids. EPSDT has improved the lives of millions of children and families in the Medicaid program over the last 50 years and has incidentally improved care for many millions more Americans.

As part of the first bill that made changes to Medicaid, this policy would become one of the most significant developments in the history the public health insurance program. Medicare and Medicaid were passed and signed into law in July of 1965 under the Medicare Act of 1965. A year later, the Medicaid program began to be implemented in states that took up the option. By the end of 1967, 38 states had opened their Medicaid programs to enrollment and begun providing services to low-income single-parent families and elderly and disabled individuals. Despite these coverage gains and medical treatment, many low and moderate-income children in two parent households lacked access to medical care. EPSDT was the first of many significant Medicaid coverage expansions to children. What was unforeseen at the time was the way that the benefits of EPSDT have been felt across the health care system and broader population. Read More

The Problematic Patchwork of State Medical Marijuana Laws – New Research

Temple University Center for Public Health Law Research 2 Comments

By Abraham Gutman

The legal status of medical marijuana in the United States is unique. On one hand, the Controlled Substance Act of 1970 classifies marijuana as a Schedule I drug with no acceptable medical use and high potential for abuse. On the other hand, as of February 1, 2017, 27 states and the District of Columbia have passed laws authorizing the use of medical marijuana. This discrepancy between federal and state regulation has led to a wide variation in the ways that medical marijuana is regulated on the state level.

In a study published today in Addiction, our team of researchers from the Temple University Center for Public Health Law Research and the RAND Drug Policy Research Center finds that state laws mimic some aspects of federal prescription drug and controlled substances laws, and regulatory strategies used for alcohol, tobacco and traditional medicines.

In the past, studies on medical marijuana laws have focused on the spillover effect of medical marijuana to recreational use and not on whether the laws are regulating marijuana effectively as a medicine. Using policy surveillance methods to analyze the state of medical marijuana laws and their variations across states, this study lays the groundwork for future research evaluating the implementation, impacts, and efficacy of these laws.

The study focuses on three domains of medical marijuana regulation that were in effect as of February 1, 2017: patient protections and requirements, product safety, and dispensary regulation.

Here’s some of what we found:

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Housing Equity Week in Review

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We’re back after a few weeks’ hiatus because of summer holidays. There was much ado this week about the Low Income Housing Tax Credit (LIHTC), spurred by an article in the NY Times (third bullet down). Some of the conversation circling that article are captured in the subsequent bullets.

Here are the latest news stories in housing law and equity for the week of July 2-10, 2017:

  • Given the local context of housing policy, it is hard to find “one glove fit all” solutions. There is a growing consensus that zoning and  land use regulations have made the affordability crisis in booming cities such as New York City and San Francisco worse. Could the policy that harmed one area saved another? Richard Florida of CityLab argues that land use regulation saved the Rust Belt.
  • Suburbia is still largely thought of as white and affluent, while inner cities are thought of as poor and black. A new book by Scott Allard of the University of Washington, called Places in Need, debunks misconceptions about suburban poverty. The author was interviewed by CityLab.
  • The United States spends $8 billion each year in tax credits to provide more affordable housing. A The New York Times article on the Low Income Housing Tax Credit (LIHTC) suggests the program entrenches segregation on the lines of class and race.
  • On the other hand, the Washington Post covers a Stanford study (originally published in NBER in April 2016) that shows that building LIHTC affordable housing developments into low income neighborhoods can increase property values and lead to income and racial integration.
  • Daniel Hemel, an assistant professor at University of Chicago school of Law, responds to the New York Times article, in his own post here.
  • In May 2016, Daniel Hertz of City Observatory responded to the Stanford study, pointing at methodological issues and challenging the study’s conclusion, here.

FDA v. Opana ER: Opioids, Public Health, and the Regulation of Second-Order Effects

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Earlier this month, the FDA announced that it is asking Endo Pharmaceuticals to remove the opioid Opana ER from the market.  Opana ER is an extended-release pain reliever often abused by those who take it.  While opioid abuse is nothing new, and many opioids leave those who take them addicted to narcotics or heroin, Opana ER is particularly dangerous because of how people misuse it.  The pill was designed to prevent would-be abusers from crushing and snorting it —  a popular means of ingesting prescription opioids.  Without the ability to crush and snort the drug, however, abusers turned to dissolving the pills and injecting them intravenously, leading to outbreaks of Hepatitis C, HIV, and other blood-borne diseases.  In Indiana’s Scott County, for instance, the prevalence of HIV has skyrocketed since the introduction of Opana ER to the local population, with 190 new cases since 2015.

While this foray into public health is somewhat surprising — given the anti-regulatory stance of the current administration and its billionaire backers — it is precisely the type of initiative the FDA should be taking.  Public health is a central part of the FDA’s mission statement, which notes that the agency “is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices.”  Traditionally, though, the FDA’s efforts to ensure safety and efficacy have been limited to the narrow context of individual patients taking medications as directed under physician supervision.  As the FDA noted in its Opana ER press release, this is the first time it has requested that an opioid be taken off the market as a result of its susceptibility to abuse and the associated public health consequences.

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Better Care Act Targets Immigrants

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If you need yet another reason to conclude that the Senate Republicans’ proposed health care bill – the so-called Better Care Reconciliation Act (BCRA)– is designed more to appease different parts of the Republican base than improve the health care financing system, look no further than page 2 of the draft. There hiding in plain sight are provisions barring certain classes of documented immigrants from participating in health insurance exchanges. To understand why the bill includes these provisions, and why they make no sense from a health policy perspective, a bit of history is helpful.

As Patricia Illingworth and I document in our recent book, The Health of Newcomers: Immigration, Health Policy, and the Case for Global Solidarity, anti-immigrant sentiment has long distorted health policy. That was the case during the summer of 2009, when opponents of what became the ACA rallied in town hall meetings charging that President Obama wanted to provide coverage to undocumented immigrants. When Obama pledged to a joint session of Congress that undocumented immigrants would not be covered by his plan, Rep. Joe Wilson of South Carolina shouted out “You lie.” Read More

Making Health Care Safer: What Good Looks Like

John Tingle Leave a comment

It’s fair to say that patient safety and health quality reports in recent years have tended to focus on what is going wrong in the NHS and what needs to be done to put things right.We have had some dramatic health care systems failures which have resulted in unnecessary deaths of patients.The naming and shaming of errant health care providers has taken place and we have now through the CQC (Care Quality Commission), a much more open, stronger, intelligent and transparent way of regulating health care quality than we have ever had before.

The health care regulatory system does seem to be making a positive difference to NHS care judging from recent CQC reports with some good examples of health quality and safe care practices taking place. Other trusts can learn from these practices.

The CQC have just published a report which includes several case studies illustrating some of the qualities shown by care providers that are rated good or outstanding overall. These hospitals known as hospital trusts in the NHS have been on a journey of improvement some going from special measures to good (CQC inspection ratings). The views of some of the people involved in the care improvement initiatives are stated in the case studies revealing important insights on improvement strategies and the nature of the problems overcome. Read More

Housing Equity Week in Review

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Our latest round-up of the biggest stories in housing law and equity, for the week of June 12-18, 2017:

  • The Joint Center for Housing Studies of Harvard University released the yearly State of the Nation Housing report. The report encourages a renewed national commitment to expand the range of housing options available.
  • A NY State Appellate Court struck down a chronic nuisance ordinance in Groton, NY, because of provisions that led to the eviction of those who seek emergency services. Story via Ithaca.com
  • The Out of Reach report and tool that was published a couple of weeks ago by the National Low Income Housing Coalition is getting press around the country for showing the gap between current wages and rents in most US cities. This article, from CNBC highlights the lack of affordable housing for minimum wage workers.
  • An opinion piece in The Hill makes, again, the case for investment in housing as an investment in childhood development and health.
  • 79 people are presumed dead in the fire at Grenfell Tower in London. Some argue that the tragedy should be a red light for distressed public housing in the US.
  • The Philadelphia Inquirer posted its second article in its Toxic City series. This most recent article investigates lead-poisoned soil in the city’s River Wards neighborhoods. While lead paint is often considered the biggest danger to children, in these areas and others, the soil may be a great danger.