Petrie-Flom Interns’ Weekly Round-up: September 16-28

[Ed. Note: We have a few weekly round-ups available here at Bill of Health (from Yale’s Interdisciplinary Center for Bioethics, and from Nic Terry‘s list of what’s worth reading each week), but we’ll give you one more from our Petrie-Flom interns for good measure.  And this week – a bonus!  A two-week round-up…]

By Hyeongsu Park and Kathy Wang

  • On Thursday, September 20, the Appellate Court of Illinois ruled that pharmacists can refuse to dispense emergency contraceptives because of religious beliefs. The court’s opinion can be found here. (And Nadia Sawicki’s post here.)
  • An article published on guardian.co.uk introduces Ben Goldacre’s book Bad Pharma: How drug companies mislead doctors and harm patients. The book describes how drug manufacturers do not disclose full information about the drugs they produce to doctors and patients, resulting in potential harms to patients.
  • The Inter-American Court of Human Rights will decide within the next few months whether Costa Rica, the only country that forbids in vitro fertilization, has infringed basic rights with its ban.
  • Two Swedish women have donated their wombs to their daughters hoping that the daughters will be able to bear children. These are the world’s first mother-to-daughter uterus transplants.
  • A BioEdge blog introduces Tom Koch’s book Thieves of Virtue: When Bioethics Stole Medicine. The book unsparingly attacks the entire discipline of bioethics and questions its raison d’etre.
  • A recent Congress-mandated report by the National Research Council voiced concerns over the implications of a growing, aging population on the economy and federal policy. The Council and corresponding experts expressed their doubts over the sustainability of programs such as Medicare, Social Security, and Medicaid and urged for policy makers to find alternatives to these programs.

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Obama v. Romney on Health Care

Ok, so we’ll have a NEJM-heavy day today! But you’ve got to check out one more thing, statements from the presidential candidates on the future of American health care.  This was the topic of a hugely successful Petrie-Flom Center event earlier this week, which was – sadly – off the record.  We heard from the candidates’ representatives, but here it is directly from the source(s):

NEJM: Cutting Family Planning in Texas (and more)

Our friends over at the New England Journal of Medicine just alerted us to a new perspectives piece addressing the impact of cutting family planning funds in Texas (the piece was also picked up by Politico).  The authors interviewed 56 leaders of organizations throughout the state that provided reproductive health services using public funding before cuts went into effect, and what they found was disturbing:

  • Most clinics have restricted access to the most effective contraceptive methods because of their higher up-front costs (choosing pills over IUDs or subdermal implants).
  • Clinics have started to turn away those who canot pay, when previously their visits would have been covered by public funds, and women who can pay the newly instated fees are choosing less effective methods and fewer tests to save money.
  • A number of clinics have lost their exemption from Texas’ law requiring parental consent for teens under 18 who seek contraceptives.

Overall, the authors conclude that laws intended to defund Planned Parenthood in an attempt to limit access to abortion (even though federal and state funding cannot be used for abortion anyway) have resulted in policies limiting women’s access to range of preventative reproductive health services and screenings.

Alta Charo weighs in via a NEJM podcast, discussing the future of reproductive health care for women in the US, particularly in light of upcoming elections (as well as the article we discussed last week on conscientious action, and other general issues in reproductive health policy).  Take a listen!

And one more NEJM plug for now: our Bill of Health blogger Kevin Outterson also has a podcast online discussing the record-breaking settlements of pharmaceutical fraud cases and the need for further regulation.

Needing a Lawyer on the Team

by Wendy Parmet

It’s easy to see the value of including scientists in public health law research teams; most public health lawyers lack the training to conduct rigorous empirical research.  It may be harder to see the need for adding lawyers to the research team, but their presence is no less critical. Sometimes scientists have as much trouble understanding the law as the lawyers have understanding the science.

The value of involving lawyers in public health law research became clear to me recently as I was working on a project relating to health policies affecting immigrants. One question I wanted to know was how the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) affected immigrants’ access to health insurance in the United States.  So I decided to review the scientific literature. The results were dismaying.

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Some Thoughts on Sandel’s “What Money Can’t Buy”

By Cansu Canca

Last Wednesday, I went to Michael Sandel’s lecture introducing his new book What Money Can’t Buy: The Moral Limits of Markets. His talk focused on two main arguments: There should be certain norms that govern our relationship with certain goods; and markets corrupt these norms.

I think Sandel’s position fails in three respects:

  1. The book does not provide a theoretical basis for these norms. In other words, the book does not explain where these norms come from, which norms are suitable for which relationships, or how they are violated.
  2. Given the lack of theoretical basis, the book cannot identify a stopping point for its suggestion to preserve and cultivate virtues related to these norms. There would seem to be many more activities to which the book’s suggestions could be expanded, yet even Sandel does not seem willing to go there. To the extent one accepts it, Sandel’s argument thus proves too much.
  3. Instead of presenting a theoretical basis, the book proceeds by analogy. But the analogies seem unconvincing in that their source and target situations seem materially different.

Let me flesh out these points.

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Upcoming Event at the JFK Jr. Forum: Health Care in 2013: Why the Race for the Presidency Matters

This Monday, October 1, 2012 @ 6PM, our friends at the John F. Kennedy Jr. Forum at the Harvard Kennedy School are hosting a panel on Health Care in 2013: Why the Race for the Presidency Matters. The event will feature:

  • Robert Blendon, Menschel Professor; Senior Associate Dean, Harvard School of Public Health
  • Vivek Murthy, President, Doctors for America
  • Thomas Scully, Administrator, Centers for Medicare and Medicaid Services (2001-2003)
  • Sheila Burke, Adjunct Lecturer in Public Policy; Faculty Research Fellow, Malcolm Wiener Center for Social Policy (moderator)

Location: John F. Kennedy Jr. Forum at the John F. Kennedy School/Harvard
79 JFK Street
Cambridge, MA
(corner of JFK and Eliot Streets)

Can’t make it? Watch the event live.

When Is An Emergency Not an Emergency?

By Nadia N. Sawicki

In 2010, Illinois issued an administrative rule requiring that pharmacies dispense all lawfully prescribed drugs, including emergency contraception, or face sanctions.  Last week, an Illinois appellate court in Morr-Fitz v. Quinn held that Illinois’ Conscience Act prohibits enforcement of the rule as applied to the plaintiffs, pharmacy owners with ethical convictions against distribution of emergency contraception.

The case was decided on state law grounds, and involved a rather thorough textual analysis of the Illinois Conscience Act and the administrative rule regarding pharmacies’ obligations to dispense.  The most interesting part of the court’s analysis, in my opinion, was its discussion of whether the need for emergency contraception qualifies as an emergency.

By its terms, the Illinois Conscience Act does not relieve medical providers from their legal obligations to provide “emergency medical care.”  The state defendants in this case argued that “because ‘every hour counts’ in the effectiveness of Plan B contraceptives, the provision of emergency contraceptives falls within this exception.”  The court, however, concluded that emergency medical care necessarily involves “an element of urgency and the need for immediate action,” and that a woman’s need for emergency contraception does not fall within this definition.  According to the court, unlike a ruptured appendix or surgical shock, “unprotected sex does not place a woman in imminent danger requiring an urgent response.”

What do you think?

More (or less) on Male Circumcision

Thanks to Pablo de Lora for pointing us to a new article from Bijan Fateh-Moghadam on the Cologne decision regarding male circumcision.

From the article’s conclusion:

Summing up, the Cologne Judgment misjudges the constitutional framework of the criminal law defense of proxy consent. Male circumcision in children, if performed lege artis and with the consent of the parents, is lawful, because it does not exceed the general legal limits of parental consent. Parents who circumcise their sons following Jewish or Muslim tradition do not claim for a legal privilege or “reasonable accommodation”, they rather utilize the parental right to the care and custody of the child and freedom of religion as guaranteed by the general law. The justification of male circumcision therefore does not follow from a religious or cultural defense but from the well-established principles of parental proxy consent. Hence, also the – circular – argument of the Cologne Judgment with reference to Art. 140 GG in conjunction with Art. 136(1) of the Weimar Constitution is misleading, because male circumcision does not exceed the limits of the general law in the first place.

 

Infrastructural Law: The Lesser-Known Cousin

by Jennifer Ibrahim, PhD, MPH

An article by Julia Costich, MPA, JD, PhD, and Dana Patton, PhD, in the October 2012 edition of the American Journal of Public Health reveals the tip of the iceberg on a highly discussed and yet insufficiently researched topic: the legal infrastructure. While the team reports a significant impact of the legal infrastructure of local health departments on population health outcomes, the paper also raises questions regarding the role of law more generally in the functioning of health departments.

While we “see” law all the time in action, we rarely “see” law as an important factor influencing the way health agencies operate. Sure, we understand law as a way to drive the behavior of individuals by regulating sugar-sweetened beverages or prohibiting texting while driving or preventing smoking in indoor spaces — this is called interventional law — but there is a lesser-known cousin, infrastructural law, that desperately needs our attention.

While public health officials, policy-makers, advocates and academics regularly discuss the funding and organization of health departments at both the state and local levels, they less often step back to think about what is driving the process — law. As states are facing significant fiscal crisis, funds are a major concern, but it is important to remember that appropriations are made through law. Additionally, in recent years, during natural disasters such as hurricanes in the south and major floods in New England, there were questions in the news about which agencies should be doing what and when. The authority for a health department to act and/or to act in concert with another agency is derived from law.

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