My guest blogging stint is drawing to a close. Thanks Glenn, Holly, and the rest of the Bill of Health family! Here’s a recap:
Worth Reading This Week
- Samantak Ghosh, The Taking of Human Biological Products, SSRN/Calif L. Rev
- Mark Rothstein & Abigail Shoben, Does Consent Bias Research? SSRN/Am.J.Bioethics
- David Hyman, Why Did Law Professors Misunderestimate the Lawsuits against PPACA? SSRN/U. Ill. L. Rev.
- Aaron S. Kesselheim, et al, Distributions of Industry Payments to Massachusetts Physicians, NEJM
Hair, Stress, and the Law
A new study has found a relationship between cortisol levels in our hair and prevalence of metabolic syndrome (a cluster of abnormalities that increase the likelihood of developing diabetes and heart disease). Here’s how the New York Times describes the study:
High levels of cortisol — the so-called stress hormone — have been associated with cardiovascular disease in some studies, but not in others. This may be because measuring cortisol in blood or saliva at one point in time may pick up acute stress, but it fails to account for long-term stress. . . . Now Dutch researchers have assessed cortisol levels over several months by analyzing scalp hair samples. . . . The researchers measured the cortisol content in hair samples corresponding to roughly three months of growth from 283 older men and women, average age 75. They also gathered self-reported data about coronary heart disease, stroke, peripheral artery disease, Type 2 diabetes, lung disease, cancer and osteoporosis. . . . Compared with those in the lowest quarter for cortisol, those in the highest quarter had about three times the risk for cardiovascular disease and diabetes.
In the actual paper, the researchers say little or nothing about “stress,” and if I recall correctly, the relationship between cortisol and stress can be complicated. But the research raises the possibility that we will someday identify reliable measurements of chronic stress over time. Of course, we may need more than just your hair. But in what I call the experiential future, such evidence—combined perhaps with other physiological, neurological, and psychiatric data—may enable us to make better assessments of chronic stress levels than we can now.
Better measurements of chronic stress could transform the way we measure damages in tort cases and measure punishment severity in criminal cases. Billions of dollars change hands every year based on difficult-to-verify assertions about pain and stress. Similarly, we adjust the severity of incarceration by changing the duration of sentences and pay almost no attention to the very different ways in which prisoners experience confinement. Measurements of stress levels could also help determine when an interrogation tactic constitutes torture.
Of course, forensic techniques encourage people to use countermeasures. In the cortisol-hair study, for example, one measurement was apparently affected by rates of shampooing while another was not. So I’m not suggesting there will be a silver bullet that solves all measurement problems. When evaluating the scientific research, however, it is important to remember just how bad we are at measuring stress levels now, despite the fact that we make such assessments every day. The technology need hardly be perfect to represent an improvement.
Financial Conflicts of Interest
By Joanna Sax
A recent article in the Journal of Law, Medicine & Ethics (Vol. 41:1, pp. 315-22) nicely describes the contours of Physician Payment Sunshine Act (PPSA) on pharmaceutical marketing. Similar to other policies addressing financial conflicts of interest, the lion’s share of the PPSA focuses on disclosure. That is, pharmaceutical companies will be required to disclose how much money they are “giving” to physicians. A financial conflict of interest can arise when the gifts of money unduly influence a physician’s prescribing habits.
I’ve previously argued here, here and here that the system of disclosure is inadequate to properly address financial conflicts of interest. Disclosure does only that; it discloses. So now people know about it – that’s it. Instead of a system that increases disclosure, I’ve proposed changes to the underlying environment to decrease or eliminate the possibility of a conflict of interest arising.
My research on financial conflicts of interest focuses on scientists at academic medical centers. I’ve suggested that if academic scientists are in stressful situations, such as worrying about funding, they might be more likely to enter into a situation in which a conflict of interest might arise. For this reason, if we change the underlying environment of our academic scientists such they are not living in a state of chronic stress, then they might make different decisions, which in turn should lead to fewer situations in which a conflict of interest might arise.
Private physicians operate in a different world than scientists at academic medical centers. I’m curious if readers have suggestions to change the environment of private physicians such that they will be less likely to enter into situations in which a conflict of interest might arise.
Public Health Law Research Call for Proposals Coming in June
Public Health Law Research (PHLR) program of the Robert Wood Johnson Foundation will be opening its fifth call for proposals (CFP) in early June. Short-term studies are no more than 18 months long, and will be funded up to $150,000 each. Applicants are expected to submit a detailed proposal of no more than 23 pages.
As with past CFPs, PHLR will look favorably on multidisciplinary teams that seek to investigate laws broadly impacting public health.
More information about the call is available on PHLR’s website, and more detailed instructions outlining the proposal elements, selection criteria and eligibility criteria will be released in June.
A New Collection of PHLR
By Scott Burris
The latest issue of the Journal of Health Politics, Policy and Law showcases the range of projects and researchers filling out the field of Public Health Law Research. An excellent introduction by the editors, Michelle Mello and Wendy Parmet, says it better than I could, but here’s a taste:
Two studies look at public health policy-making – Abiola et al on HPV vaccination, and VanSickle-Ward and Amanda Hollis-Brusky on statutory ambiguity in contraceptive mandates. Two studies evaluate local legal interventions to address lead poisoning – a sweeping ordinance in Rochester and a novel specialty enforcement court in Philadelphia. Sampat and Amin quantitatively examine the impact of a provision of Indian patent law that was widely expected to prevent evergreening, finding signs that the law on the books may not be working as advertised in practice. Finally, Cannon and colleagues bring new methods and attention to the question of whether zoning laws can deliver better health, in this instance through increasing the walkability of neighborhoods.
The group of authors includes doctors, lawyers, economists, sociologists, historians and health researchers. Mello and Parmet offer some pithy thoughts on what all this shows us about the current state of PHLR’s development. Worth a read.
The Oregon Health Study and the Medicalization of Health Policy
According to the website, the Oregon Health Study “is the first randomized controlled experiment to examine the causal effects of having some type of insurance coverage versus having no insurance at all.” The findings, released a few days ago, have unleashed a storm of commentary on what the investigators did and did not find in terms of links between coverage and health outcomes. Writing over at The Incidental Economist, Harold Pollack quotes Joseph Newhouse for the notion that the “Oregon Medicaid experiment ‘is a Rorschach test of people’s views on the ACA.’” After the jump, I am going to try to defend that claim, although likely not in the way that good readers of Bill of Health might expect.
So here’s the funny thing: even though I am an attorney, an historian, and a bioethicist who researches health inequalities, stigma, and social justice, I actually am less of an expert on the delivery of health care services than virtually every blogger here, and likely a goodly portion of the readership, too. When interviewing for a job as a prawf some years ago, I was asked for my opinion on the fate of the ACA (then still in Congress), and I had to shrug and say that I really was not up to date on all of the provisions of the bill nor of its likely passage, nor of its potential impact. (No, I did not get the job!).
This is not because of anti-intellectualism, I believe (and hope!). This is rather because of my engagement with the overwhelming evidence that access to health care services is simply not a prime determinant of health and its distribution in human populations. In a seminal 2007 essay in Health Affairs, Paula Lantz, Richard Lichtenstein, and the good Dr. Pollack himself note that “Lack of access to health care is not the fundamental cause of health vulnerability or social disparities in health” (p. 1256).* The authors go on to warn of the limits of medicalizing health policy, and suggest that if we want to use laws and policies to improve overall population health and compress health inequities, we need to go way beyond simply expanding access to basic health care services.
Talking to Your Baby
By Joanna Sax
In President Obama’s State of the Union address, he discussed creating affordable pre-school to all children. Studies have shown that early childhood education is associated with academic success. This is an important policy initiative; it’s also very expensive.
In an effort to reduce the disparity in the academic profiles of children, there may be some initiatives that can be started while the proposal for publicly funded early childhood education works its way through Congress. One approach that is being tested is talking to your baby.
A recent NY Times article described a scientific study concerning how talking to your baby is correlated with achievements in school. It turns out, according to the article, that low-income parents of children speak fewer words to their babies compared to high-income parents and that by the time the children are of school-age, the children from poorer families have heard millions of fewer words. This means that by the time the child is 3, they have heard 10s of millions of fewer words and the article suggests that this is correlated with IQ and academic success.
This is an issue that can be addressed! Creative problem solving can be used to create programs to educate lower-income parents to talk more to their babies. The increase in words alone might provide advantages to lower-income children that they didn’t have before. This study provides a good example of the application of a scientific study to address social, health and economic issues.
Fox on DNA Forensic Error and the Execution of Innocents
By Dov Fox
Willie Jerome Manning, a 44-year-old black man, is scheduled to die by lethal injection on Tuesday for the 1992 kidnapping and murder of white college students Jon Steckler and Tiffany Miller in Mississippi. No physical evidence has ever linked Manning to the crime. And the Justice Department has just come clean that the forensic science used to prosecute Manning was fundamentally flawed.
A jury convicted Manning almost 20 years ago based on three kinds of circumstantial evidence. First was the testimony of his cousin and a jailhouse informant who claimed that he confessed the crime to them. The cousin had accused two other men before Manning, however, and the informant has since recanted altogether. Second were Steckler’s jacket, ring, and CD player from his car that Manning was arrested for trying to sell. Manning told police from the beginning that he had acquired the stolen property from someone he didn’t know.
Critical to the prosecution’s case was the last piece of evidence against Manning: expert testimony by an FBI agent that African American hair fragments were found in Miller’s car. Not only did DNA and fingerprints found at the crime scene never incriminate Manning himself, however. Two days ago, the Justice Department notified Manning’s lawyer and the County District Attorney that “testimony containing erroneous statements regarding microscopic hair comparison analysis was used in this case.” Federal officials have yet to detail the precise errors involved, but made clear in their letter that the FBI’s forensic evidence was unsound not least because it “exceeded the limits of science” at the time.
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