The Global Challenge of Unhealthy Diets: Front-of-Package Labeling for America

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by Alice Bryk Silveira

The alarming rise in diabetes and obesity rates in the United States has placed significant strain on health care systems and poses a serious public health threat. Americans’ overconsumption of ultra-processed foods high in sugar, salt and unhealthy fats is a concerning contributor. Globally, poor nutrition from such dietary habits plays a major role in the global burden of chronic diseases. In response, many countries have implemented policies to reshape their food environments. A prominent strategy is front-of-package (FOP) labeling systems, designed to help consumers make more informed choices, encourage healthier lifestyles, and push food manufacturers to align with public health guidelines by reducing ingredients such as sugar and salt.

Despite international momentum and calls from public health experts, the United States remains behind. Since 2009, the U.S. government has discussed the potential adoption of a uniform FOP label, with Congress directing the Centers for Disease Control and Prevention and Institute of Medicine (IOM) to produce recommendations on the topic. No standardized system exists but the U.S. Food and Drug Administration (FDA) is expected to propose new rulemaking on front-of-package labeling in 2024.

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TikTok, Tobacco, and Addiction, Oh My!

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by Jessica Samuels

On October 8, 13 states and the District of Columbia sued TikTok, alleging that the social media company’s algorithm is designed to “promote excessive, compulsive, and addictive use” in children. While each state’s complaint was filed separately in state court, the cases are coordinated around the claim that TikTok’s design is deliberately addictive, exploiting kids’  dopamine reward circuitry to reinforce their use of the platform

These claims stem from a public reckoning of the effects of social media on children. New research has also led the surgeon general to announce a mental health crisis among young people. The lawsuits, arising from the desire to hold platforms accountable for exploiting children’s susceptibility to rewarding stimuli during development, present a novel theory of liability based solely on an algorithm’s ability to cause addiction rather than adverse mental health outcomes. Holding TikTok liable could lead to major changes in social media algorithms, reducing mental health harm.

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Third Places: A Framework for Communities AND Crisis Care

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by Spencer Andrews

What makes a city livable? The answer, some say, is more “third places,” spaces distinct from one’s home (the first place) and one’s workplace (the second place). A third place, like a café, park, or library, fosters the sense of community and connection that makes a neighborhood great to live in. This imprecise yet uncomplicated framing effectively refocuses a complex set of social, economic, and urban design issues on a simple solution to the “livability” problem.

I believe that the “third place” framework also can usefully reframe another discipline: emergency mental health care. Individuals experiencing mental health crises lack an appropriate setting to receive care. Typically, individuals experiencing acute, emergency mental health crises-–whether related to substance use or not-–end up in one of two places: the hospital emergency room (ER) or a jail cell. The problem is that neither of these two places is well-equipped to treat someone in the midst of a mental health crisis. A third option is needed.

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Introducing Petrie-Flom’s POPLAR and PULSE Affiliated Researchers on Psychedelics

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The Petrie-Flom Center is excited to announce our affiliated researchers for the Project on Psychedelics Law and Regulation (POPLAR) and our new project, Psychedelic Use, Law, and Spiritual Experience (PULSE). Through research, writing, workshops, and other projects, POPLAR and PULSE affiliated researchers will provide expertise and a range of perspectives on psychedelics law and policy. We look forward to learning from them and sharing their insights with our audiences.  

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A full circle moment: legal risks to mifepristone and evidence for abortion with misoprostol alone

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Photo credit: Farrah Skeiky

by Patty Skuster and Heidi Moseson

Medication abortion did not begin with a clinical trial; it began at home as self-managed abortion, or abortion without supervision from a clinician. Decades before the 2000 U.S. Food and Drug Administration’s (FDA) approval of mifepristone for abortion, which is taken alongside misoprostol, feminists in Brazil found an opportunity to self-manage abortion with misoprostol, based on warning labels that cautioned about the risk of miscarriage if taken while pregnant. The genesis of abortion pills was therefore in self-managed abortion with misoprostol alone. 

Today, after several decades of clinical trials and heavy regulation of medication abortion, the practice of self-managed abortion with misoprostol-only is once again driving clinical practice. While medication abortion has been increasing in the U.S. since its introduction, major changes in recent years have dramatically increased usage. In 2021, the FDA relaxed enforcement of the requirement for in-person dispensing of mifepristone. This revolutionary change allowed the pills to be sent by mail for the first time, making them much more accessible. When, in 2022, the Supreme Court eviscerated the federal constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, the resulting abortion clinic closures led to even larger numbers of abortion seekers turning to medication abortion through telehealth and mailed medication from providers in supportive abortion states and clinicians outside the U.S. Combined, medication abortion now accounts for more than half of all abortions in the US. 

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Rethinking Mental Health Reform: A case for reviving community-based care

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by Zain Khalid

October 10th marked the first anniversary of California’s Senate Bill 43 (SB 43), a major revision of the landmark Lanterman-Petris-Short Act of 1967, a de-institutionalization era law designed to “end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders.” The law loosened eligibility standards for civil commitment by expanding the existing “grave disability” criterion, making it easier to detain and hospitalize persons with mental illness against their will.

New York City’s mayor, Eric Adams, enacted a similar initiative in November 2022, the same year 40-year-old Michelle Alyssa Go, was tragically killed after being shoved onto the subway by an unhoused man with a long history of mental illness and patchy treatment. New York’s plan authorized emergency medical workers and police officers to involuntarily remove people with severe mental illness from the streets to be evaluated for hospitalization. Mayor Adams framed his plan in terms of the city’s “moral obligation” to help mentally ill citizens and California Governor Gavin Newsom spoke of a “life-and-death urgency” in advocating for SB 43.

These controversial initiatives are among the highest profile of a growing national trend toward expanding civil commitment laws: Ohio, DC, Tennessee, Alabama and Florida have introduced similar legislation in just the past year. Across the U.S., this turn toward civil commitment is driven by a triple whammy of unmitigated housing crises, an increasingly visible unhoused mentally ill population, and rising violent crime. But is civil commitment a defensible strategy in tackling this Gordian knot of intersecting social crises? Or does it merely serve to keep unseemly realities away from the public eye? To understand the role of civil commitment in addressing these challenges, we must begin by looking at how we got here. Read More

Doctors as Advocates for Self-Managed Abortion and Reproductive Justice

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Photo credit: Martina Šalov

by Jessica Morris

The International Federation of Gynecology and Obstetrics (FIGO) is the world’s largest alliance of national professional societies of obstetricians and gynecologists. FIGO supports comprehensive, equitable, and accessible sexual and reproductive health (SRH) for everyone, recognizing that these are fundamental human rights and essential components needed to achieve global health goals. 

FIGO works through its technical committee and its programmatic arm to improve access to abortion across the globe. Over the last two decades, FIGO has been a global advocate and played an important role in encouraging progressive, evidence-based thinking on abortion with its 130+ national professional societies and other stakeholder groups. FIGO has worked to strengthen and support these societies in becoming national leaders on SRH and driving important improvements, including  legal and policy developments, service provision, increasing supportive attitudes, and raising awareness and challenging bias.

What is the role of doctors in the de-medicalization of abortion?

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Health Care, AI, and the Law: An Emerging Regulatory Landscape in California

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by Rebekah Ninan

This past month, California Governor Gavin Newsom signed a wave of artificial intelligence-related legislation into law. Much public debate has been focused on SB 1047, a proposal ultimately vetoed by Governor Newsom, which would have held AI companies liable for “catastrophic harms” from AI models. Comparatively little attention has been paid to three new laws aimed at health care-related AI and data privacy. Three laws are AB-3030, SB-1223, and SB-1120. AB 3030 requires that health care providers disclose when they have used generative AI to create communications with patients. SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit. Finally, SB 1120 limits the degree to which health insurers can use AI to determine medical necessity for member health care services. This article seeks to summarize these developments in the law.

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Out of the Shadows: Menopause and the Law

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by Rupa Palanki

In May 2024, a bipartisan group of female senators introduced the Advancing Menopause Care and Mid-Life Women’s Health Act. The bill allocates $275 million over five years toward strengthening and expanding federal research, health care provider training, and public health education on menopause and mid-life women’s health issues. If enacted, it would be the most comprehensive federal effort to improve health care related to menopause. However, further action related to the labeling of low-dose estrogen and workplace support is still necessary to support individuals experiencing menopause.

Unmet Needs for Legislative and Policy Action

Menopause is the natural stage of life when an individual has not had a menstrual period for twelve consecutive months, signifying the end of their fertile years. Half of the American population will eventually experience this transition. Currently, 75 million American individuals are either in menopause, perimenopause (the time before menopause when menstrual cycles may become irregular), or postmenopause (when an individual has not had a menstrual period for longer than a year). Another 6,000 reach menopause daily. Read More

From Stigma to Diagnosis: How Medicalizing Obesity Empowers Individuals to Take Charge of their Lives

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by Jessica Samuels

It’s been all the rage — celebrities and physicians tout GLP-1 inhibitors, like Ozempic and Wegovy, as miracle drugs for diabetes management and weight loss. But some still believe weight loss is a function of personal control and view these drugs as taking the “easy way out.”

While the rise of weight loss drugs is controversial, medicalizing obesity shouldn’t be. Many who struggle with chronic weight-related conditions finally see a light at the end of the tunnel. Viewing obesity as a medical problem that can be treated with medication and as a chronic condition with complex causes more accurately reflects new research, destigmatizes seeking treatment, incentivizes the development of new treatment tools, and increases overall well-being.

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