An International Meeting of Public Health and Law Enforcement

By Scott Burris

We know, and now most people acknowledge, that police activity has some clear, and in some instances intentional, effects on health.  To start with the obvious, police are instrumental in reducing the number of people who are murdered, assaulted, raped, or otherwise terrorized. Policing – like any form of social intervention – can also have unintended consequences. There is, for example, considerable evidence that criminal law and legal practices can increase risks of HIV and other harms among drug users.

These facts are well-established and pretty well recognized. So now the question is not whether policing has health consequences, but rather whether social and health work is to be seen as an integral element of law enforcement in the 21st century.  In much of their day to day work, police are engaged in far more than the prevention of crime or the maintenance of social order.  This is something we all know, something that has probably always been true of police work, something that is shaping a lot of programs around the world, and yet something we need to talk more openly about.

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Twitter Round-Up (11/4-11/10)

By Casey Thomson

[Ed. Note. 11/12/12: Just to be clear, retweeting should not be read as an endorsement of or agreement with the content of the original tweet.]

With Election Day now come and gone, our bloggers were tweeting this week about the results, in addition to the greater happenings in health law and ethics. Read below for this week’s round-up:

  • Arthur Caplan (@ArthurCaplan) retweeted a post about the recent clinical trial done on chelation, a “fringe” heart disease treatment whose popularity often hinges on a patient’s distrust of conventional medicine. Evidence of the treatment’s effectiveness looks to be marginal, at best. (11/4)
  • Michelle Meyer (@MichelleNMeyer) retweeted an article that explained the problems in the intersection between neuroscience and law, namely how emerging technologies in neuroscience are not being used appropriately to understand criminal behavior. The author advocates for a renewed look at how neuroscience and law can work together, not only to evaluate defendants effectively, but also to customize plans that can serve the interests of both the defendant and the public. (11/5)
  • Dan Vorhaus (@genomicslawyer) linked to a new piece he co-authored on clinical data and genetics, entitled “The Next Controversy in Genetic Testing: Clinical Data as Trade Secrets?” (11/6)
  • Michelle Meyer (@MichelleNMeyer) aptly summarized the results of Massachusetts’ ballot questions with her tweet: “Sick folk in MA can now smoke pot but, it seems likely, not have the aid of their doc in controlling the timing & nature of their death.” (11/6)
  • Daniel Goldberg (@prof_goldberg) linked to a study done on children with epilepsy  and their families. Goldberg noted that the study’s results indicate a serious “ethically pernicious” problem that in fact worsens the condition of those afflicted with epilepsy more so than may be originally perceived: stigmatization. (11/7)
  • Frank Pasquale (@FrankPasquale) tweeted a blog post that talked of the need to increase the FDA’s power in order to curb the fungal meningitis outbreak now affecting individuals nationwide. Lamentations of the state-based system’s inability to handle the problem had undertones of concern for future situations similar to this one sprouting up again. (11/8)
  • Frank Pasquale (@FrankPasquale) also published a news update from Georgia, where legislators are ending the discount on license renewal prices that had previously been given to motorists who signed up to be organ donors. While many expressed fear that the policy would decrease the number of donors, others in the medical community admitted that there had been no demonstrated link between the policy and increases in donor sign-ups. (11/10)

Upcoming Event – The Guatemala STD Inoculation Studies: What Should We Do Now?

Tuesday, November 13, 2012
12:30-2:00
Wasserstein Hall, Classroom 3019
Harvard Law School

In the late 1940s, US and Guatemalan researchers conducted a host of experiments on vulnerable Guatemalan subjects, purposefully exposing them to and infecting them with a number of STDs without their consent.  The experiments were kept hidden for more than half a century, until they were discovered and exposed only recently by historian Susan Reverby.  The US government has since apologized for what happened, but a class action suit brought on behalf of the Guatemalan subjects was dismissed in June and efforts to directly compensate the victims have not been forthcoming.   Please join Harvard Law School’s Petrie-Flom Center and Human Rights Program for a panel discussion of the study and possible legal and political responses that may be available now, both domestically and from an international human rights perspective.  Panelists will include:

  • Susan Reverby, Marion Butler McLean Professor in the History of Ideas, Professor of Women’s and Gender Studies, Wellesley College
  • I. Glenn Cohen, Assistant Professor of Law, Faculty Co-Director, Petrie-Flom Center, Harvard Law School
  • Holly Fernandez Lynch, Executive Director, Petrie-Flom Center, Lecturer on Law, Harvard Law School
  • Wendy Parmet,  George J. and Kathleen Waters Matthews Distinguished University Professor of Law, Northeastern University School of Law
  • Fernando Ribeiro Delgado, Clinical Instructor and Lecturer on Law, Human Rights Program, Harvard Law School

This event is free and open to the public.  Lunch and refreshments will be served.

 

Occupy Public Health? A Social Determinants Tea Party?

By Scott Burris

Kathy Ward is a veteran public health worker in Nebraska. She has a neat idea, which I summarize here in mostly her words:

Public health policy needs more proponents who are knowledgeable and able to express their positions freely. The shortage of advocates presents a danger for public health in a time of anti-government attitudes, uninformed public health policies, deficit reduction efforts, and looming budget cuts to the public health programs that protect our country.
A 2008 study by the Association of Schools of Public Health indicated that 23% of the current public health work force–almost 110,000 workers–will be eligible to retire by 2012. This generation of baby boomer public health workers has a high level of expertise in public health; passion for improving the public’s health; and strong partnerships with nonprofit, government, and private health organizations. They have the credibility to be effective spokespersons for public health and to influence its partners.
Why not use these assets to build a movement of public health advocates?

• Enlist national public health organizations such as ASTHO, the Chronic Disease Directors Association, and the Association of Maternal and Child Health Programs in finding and enlisting public health advocates.
• Find advocates through similar organizations at state and local levels, such as state public health associations and nonprofits such as the American Cancer Society and the American Heart Association.
• Build linkages with other national associations such as AARP. Consider public health in the broader sense, including in this effort retired Medicaid professionals who can knowledgeably describe the losses that will occur to the public from cutting Medicaid programs.
• Provide training in advocacy through webinars conducted with public interest lobbyists and health associations that employ advocacy staff

Sounds like a sensible idea to me. Mobilizing a lot of effective volunteers at a low cost. What do you think?

Bleg: IRBs & Health Disparities Research

By Michelle Meyer

As most readers of this blog well know, health disparities of various kinds are rampant in the U.S. — in obesity, infant mortality and morbidity, cardiovascular health, and many other areas. In most cases, however, we seem to know more about the extent of health disparities than we do about what causes and what is most likely to ameliorate them.

To rectify this situation, we need to conduct research — and lots of it. Typically, however, health disparities research will have to occur with the same populations who are most likely to be considered vulnerable and in need of extra protections from research. Often, moreover, health disparities research will need to occur in the clinical setting (as opposed to the lab), where patients normally rightly expect that everything done there is designed to serve their individual best interests, rather than to produce generalizable knowledge. Health disparities research might involve research methodologies that are relatively unfamiliar to IRBs, such as community-based participatory research (CBPR), which blurs the traditional distinction between investigator and subject on which the regulations are built. To the extent that disparities are thought to derive from provider discrimination or bias, researchers may face difficulties from a research review system that is designed to protect all “subjects,” including professionals who are incompetent or worse. Eventually, health disparities research scales up to multiple research sites, which usually requires approval from multiple, often conflicting, IRBs. Many interventions to address health disparities, finally, will take the form of public policy rather than clinical treatment. If we want such policies to be evidence-based (and we should), they will have to be tested, perhaps in ways that raise legal or ethical issues (say, randomizing a state’s Medicaid recipients to receive or not receive particular benefits, or randomizing the businesses in a jurisdiction to be required to display nutrition information on the food they sell — or not).

I’m delighted to have received so many comments, both on- and offline, on my last IRB post from those with experience in the research trenches. As I begin a new project along these lines, I would be very interested in hearing again from both researchers and research reviewers with experience in health disparities research, whether you have struggled with these or similar issues (or have abandoned research plans at least partly out of fear of such problems), or have experienced smooth sailing. Feel free to leave comments here, anonymously if you wish, or contact me directly at mmeyer at law dot harvard dot edu. Many thanks in advance.

How About a Clean-Air Shave?

By Scott Burris

Somewhere along the way, environmental law and public health law got separated.  Despite the importance of clean air and water to public health – not to mention parks, recreation, salubrious zoning – the two fields developed independently in the law. That’s changing in a lot of ways, and one very good example is a study proceeding now in New York City.

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Art Caplan on Liability for Non-Vaccinators

Art Caplan has a new article out in the Journal of Law, Medicine, and EthicsFree to choose but liable for the consequences: should non-vaccinators be penalized for the harm they do?” (subscription required)

Here’s the abstract: Can parents who choose not to vaccinate their children be held legally liable for any harm that results? The state of laboratory and epidemiological understanding of a disease such as measles makes it likely that a persuasive causal link can be established between a decision to not vaccinate, a failure to take appropriate precautions to isolate a non-vaccinated child who may have been exposed to measles from highly vulnerable persons, and a death. This paper argues that, even if a parent chooses to not vaccinate a child under a state law permitting exemptions, that decision does not create complete protection against liability for the adverse consequences of that choice.

Good Science and Bad Verdicts

By Nadia N. Sawicki

On Monday, an Italian court convicted six scientists and a government official of manslaughter for providing the townspeople of L’Aquila with “inaccurate, incomplete and contradictory” information about risk of a 2009 earthquake in which 309 residents subsequently died. The prosecutors in the case successfully alleged that the scientists, all members of the National Commission for the Forecast and Prevention of Major Risk (La Commissione Nazionale per la Previsione e Prevenzione dei Grandi Rischi), downplayed the risks to the town at a meeting in which they described the possibility of a large earthquake “unlikely” despite a series of minor tremors.  Interestingly, the prosecutor in the case cited a 2009 ruling by the U.S. District Court for the Eastern District of Louisiana holding that the U.S. Army Corps of Engineers’ negligent maintenance of a navigation channel contributed to the flooding after Hurricane Katrina.

The defendants were sentenced to six years in prison and ordered to pay $10.2 million in damages and costs, a result one of the convicted defendants, a physicist, has decried as “medieval.”

The decision to criminally punish scientists for failing to predict a natural disaster that is inherently unpredictable is likely to have a chilling effect on critical research.  More importantly, it may lead to reluctance on the part of the scientific community to collaborate with government agencies for the public good. Indeed, the Department of Civil Protection (Dipartimento della Protezione Civile), of which the National Commission is a part, suggested that the first consequence of the court’s ruling would be a “paralysis of forecasting and prevention activities” (translation my own).  “This is the death of public service on the part of professors and professionals,” said Luciano Maiani, president of the National Commission, who, along with a number of colleagues, resigned his post on Tuesday.

Preventing Teen Crashes with Stickers

By Scott Burris

Graduated Drivers’ License Laws have apparently been a major success in reducing crashes among novice drivers. (A couple of studies have suggested the laws might just be postponing crashes, but so far that hypothesis remains unproved, and the weight of expert opinion seems to be that the association is spurious.)  There has been a weak link in enforcement, though, which is that in the dark of night and flow of traffic, police officers can’t always spot an underage driver out past the curfew or chauffeuring too many passengers.

Enter the decal.  A number of European and Asian countries require new drivers to decorate their car with a special decal indicating probationary status. That way it is easy for police to detect possible GDL violations.

In 2010, New Jersey became the first state to require the decal, and this week a PHLR study published in the American Journal of Preventive Medicine found robust evidence of seriously positive impact.

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Tools for Teaching the Fungal Meningitis Outbreak

By Jennifer S. Bard

I’m sure many of us are talking about the contaminated steroid injections which have spread a fungal form of meningitis Exserohilum rostratum across the country.   The CDC, which as is usually the case is doing an excellent job of providing clear and current information,  reports that as of “October 17, 2012, a total of 47 patients have laboratory-confirmed fungal meningitis.”  They offer some reassuring information—that “this form of fungal meningitis is not contagious”  and some scary information—that  there are 257 cases and ten deaths in 15 states and that incubation periods last up to a month.

The most recent legal news is that the pharmacy was visited earlier this week by the FDA’s criminal investigative unit and that the first law suit has already been filed in Minnesota Federal District Court by a woman who received a vaccine from the pharmacy but who does not know yet if she has meningitis. Read More