bluuebunny/crossref_metadata_2025 huggingface dataset:
Professionalism in Forensic Bioethics
Authors: Spielman Bethany J.
Published: January 2007

As the public profile of bioethics rises, and as litigation about issues ranging from assisted reproduction to gene therapy multiplies, the presence of bioethics experts in a litigation context has become more common. Dozens of appellate opinions refer to bioethics testimony in the lower courts. Today's technical advisory services for attorneys advertise bioethics experts along with experts in scientific fields. A single bioethicist has served as an expert in more than fifty cases. In all likelihood, opportunities for bioethicists to fill the role of testifying expert will grow as medicine and biotechnology become more complex. Bioethics experts have also been involved in several other kinds of litigation-related activities, including investigation, consultation with attorneys, preparing reports that express expert opinions, and explaining and defending these opinions by deposition.

Despite the growth of these activities by bioethicists, they have never been free of controversy, have recently been received with little enthusiasm by the judiciary, and could become highly problematic in the future.
Solid Organ Donation Between Strangers
Authors: Ross Lainie Friedman
Published: January 2007

In August 2000, Arthur Matas and his colleagues de scribed a protocol in which their institution began to accept as potential donors, individuals who came to the University of Minnesota hospital offering to donate a kidney to any patient on the waiting list. Matas and his colleagues refer to these donors as nondirected donors by which is meant that the donors are altruistic and that they give their organs to an unspecified pool of recipients with whom they have no emotional relationship. This paper represents an ethical and policy critique of the nondirected donation protocol that was implemented at the University of Minnesota in August 1999. Specifically, I address the ethical questions: Whether altruistic living solid organ donations by strangers (nondirected donations) should be permitted? And if so, What are appropriate ethical guidelines for such donations?
Commentary: Making the Most of Strangers' Altruism
Authors: Kahn Jeffrey
Published: January 2007

Lainie Ross, in her article in this issue, criticizes on ethical grounds a number of factors in the University of Minnesota program that allows unrelated strangers to donate kidneys for transplant. I have to admit that when the transplant center at the University proposed allowing the practice of what came to be called nondirected donation, I was skeptical about a number of the same issues that trouble Dr. Ross. But as my colleagues and I examined and discussed the ethics of such a plan, along with the risks to prospective donors, their possible motivations, and the logistics of performing the surgeries under conditions of anonymity between donor and recipient, among other factors, we came to believe that such donations can be ethically acceptable. As a product of frequent meetings over the course of a year in advance of the first nondirected donation, we set out to craft a process that would first and foremost meet the test of an ethical approach to organ donation and transplant, the description of which was published in the New England Journal of Medicine in August 2000.
Currents in Contemporary Ethics: Reforming Medical Ethics Education
Authors: Martinez Serge A.
Published: January 2007

Biomedical advances of the past 20 years have stimulated a renewed interest in medical ethics. Transplantation of multiple human organs, implantation of artificial devices, advances in genetics, and stem cell research are a few of the medical procedures and discoveries that have awakened in both professionals and the public an awareness that medical discoveries often raise important ethical and societal issues. Today, members of the medical profession face issues that did not seem so pressing to their predecessors, and physician conduct in response to many of these issues involves decision-making based on ethical principles. Issues of informed consent, gifts from pharmaceutical companies, and patient rights to privacy were not of great concern to most physicians a generation ago. However, these and other topics that involve a physician's ethical conduct have become increasingly pertinent to the practice of medicine.

A renewed emphasis on ethics has been voiced by leaders in the field of medicine.
Taking Rights Seriously in Health
Authors: Burris Scott , Lazzarini Zita , Gostin Lawrence O.
Published: January 2007

Few now question that population health is significantly shaped by social ecology. Power, wealth, and social status clearly matter: Their enactment in daily life makes them fundamental social determinants of health. Important as it is that we accept the broad importance of social factors in health, it is not enough. Our current grasp of the importance of social factors in health has to be strengthened by research that more precisely delineates the workings of social health through social processes, and the investment in research must in turn be vindicated by interventions that make a difference. The work presented in this issue of the Journal of Law, Medicine & Ethics is intended to advance the agenda for research and action.

An ecological theory puts health everywhere. Population health is shaped in the hierarchies of the workplace, the neighborhood, and the home.
Integrating Law and Social Epidemiology
Authors: Burris Scott , Kawachi Ichiro , Sarat Austin
Published: January 2007

Social epidemiology has made a powerful case that health determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these “structural” factors are thepredominantinfluences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws, and legal practices are powerfully linked to health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited.
Health and Human Rights: Old Wine in New Bottles?
Authors: Oppenheimer Gerald M. , Bayer Ronald , Colgrove James
Published: January 2007

It is one of the remarkable and significant consequence of the AIDS epidemic that out of the context of enormous suffering and death there emerged a forceful set of ideas linking the domains of health and human rights. At first, the effort centered on the observation that protecting individuals from discrimination and unwarranted intrusions on liberty were, contrary to previous epidemics, crucial to protecting the public health and interrupting the spread of HIV But in fairly short order, the scope of the health and human rights perspective expanded dramatically to focus on the ways in which the most fundamental social arrangements rendered individuals and communities vulnerable to HIV Racial and ethnic minorities, those who were marginalized, and women were at risk because of their subordinate status. In the face of such an understanding, nothing short of social change could be adequate to the challenge posed by the AIDS epidemic.
HIV and the Law: Integrating Law, Policy, and Social Epidemiology
Authors: Lazzarini Zita , Klitzman Robert
Published: January 2007

In the foundational piece in this issue of the journal, “Integrating Law and Social Epidemiology,” Burris, Kawachi, and Sarat present a model for understanding the relationship between law and health. This article uses the case of a specific health condition, the human immunodeficiency virus (HIV) infection, as an opportunity to flesh out this schema and to test how the model “fits” the world of the HIV pandemic. In applying the model to this communicable disease, we hope to illustrate the multitude of ways that laws affect the course of the pandemic as well as the course of an individual’s vulnerability or resilience to the disease, and how the complexities of an individual’s life dealing with the virus interface with the world of laws and legal institutions.
Criminal Law, Policing Policy, and HIV Risk in Female Street Sex Workers and Injection Drug Users
Authors: Blankenship Kim M. , Koester Stephen
Published: January 2007

In public health and the social sciences, there is growing recognition of the role that social context plays in determining health. Frequently, social relations of inequality are among the most important features of social context identified in this work, and emphasis is placed on identifying and addressing these inequalities in order to improve health. Within the field of HIV/AIDS prevention as well, researchers have begun to look beyond individuals for an understanding of the structural causes of HIV-related risk. This research demands that greater attention be paid to the social mechanisms and contextual factors that lead to HIV risk. Among these factors are law and social policy, which form a part of the context in which risk-taking occurs and which can promote both HIV transmission and prevention. On the one hand, laws limiting access to sterile injection equipment have contributed to HIV-related risk behavioxs among injection drug users (IDUS).
Does Indebtedness Influence Health? A Preliminary Inquiry
Authors: Jacoby Melissa B.
Published: January 2007

In recent years, consumer debt and the bankruptcy filing rate have received substantial public and media attention in the United States. That attention pales in comparison with widespread concerns and media reporting about health. Yet, both sets of discussions may be relevant to individuals and families facing a combination of health problems and financial problems. In a recent study, nearly half of the sample of individual bankruptcy filers reported they also were dealing with illness, injury, or substantial medical debt.

Whether somethmg other than coincidence explains this correlation is worthy of consideration for those who study health. For some debtors, debt problems may be health-care finance issues; income interruption or financial obligations stemming from health ailments may contribute to financial downfall?

The opposite relationship, however, not only is possible, but potentially more pervasive.
Thinking About AIDS and Stigma: A Psychologist’s Perspective
Authors: Herek Gregory M.
Published: January 2007

As Jonathan Mann observed, the problem of AIDS-related stigma is inextricably bound to issues of health, human rights, and the law. Such stigma translates into feelings of fear and hostility directed at people with HIV. It finds expression in avoidance and ostracism of people with HIV, discrimination and violence against them, and public support for punitive policies and laws that restrict civil liberties while hindering AIDS prevention efforts. Being the target of stigma inflicts pain, isolation, and hardship on many people with HIV, while the desire to avoid it deters some from being tested for HIV, seeking treatment, or practicing risk-reduction.
The Impact of Law on Coronary Heart Disease: Some Preliminary Observations on the Relationship of Law to “Normalized” Conditions
Authors: Parmet Wendy E.
Published: January 2007

The relationship between law and a population’s health is complex and poorly understood. To the extent that scholarship exists on the subject, it has usually focused on epidemics that are concentrated in relatively vulnerable, marginalized communities. Often, individual behaviors are assumed to play a major role in the epidemiology of these diseases. Perhaps, as a result, these illnesses become stigmatized and the object of coercive laws, which in turn become the subject of litigation, legal debate, and ultimately scholarly analysis. Thus, to the extent that U.S. legal scholars have thought about public health in the last 30 years (and they seldom have), they have generally done so in the context of tuberculosis (TB), intravenous drug abuse, and a handful of similar conditions. Likewise, Jonathan Mann’s own appreciation of the importance of human rights to public health emerged in the wake of his work with HIV, which is perhaps the prototypical stigmatized disease.
Patents on Drugs: Manufacturing Scarcity or Advancing Health?
Authors: Loff Bebe , Heywood Mark
Published: January 2007

Respect for and promotion of the human rights of people with HIV/AIDS is now an entrenched component of the global response to HIV. However, as the global HIV epidemic has turned into a global AIDS epidemic, and as the death toll mounts, one area of human rights—the right to health care—has become fiercely contested. In particular, the degree to which patents on medicines impede what the United Nations High Commissioner for Human Rights has described as the “human right” of access to essential medicines is receiving close scrutiny. The controversy generated by a recent article that argues, “in Africa patents and patent law are not a major barrier to treatment access in and of themselves,” is indicative of the intensity of the debate.
Health and the Governance of Security: A Tale of Two Systems
Authors: Aral Sevgi , Burris Scott , Shearing Clifford
Published: January 2007

The provision of police services and the suppression of crime is one of the first functions of civil government. Article 3 of the Universal Declaration of Human Rights speaks of a right to “security of person.” “The term ‘police’ traditionally connoted social organization, civil authority, or formation of a political community—the control and regulation of affairs affecting the general order and welfare of society,” including the protection of public health. Civil dispute resolution is also an important part of a system that moves people away from self-help and toward reliance on collectively constituted, peaceful channels for working out problems.

A safe and secure environment is tied to health. Research in social epidemiology suggests that a shared sense of security from physical violence and interference with property can contribute to better community health.
Juridical Action for the Protection of Collective Rights and Its Legal Impact: A Case Study
Authors: Mac Dowell Enrique González
Published: January 2007

The development in 1996 of a new generation of antiretroviral drugs was a major pharmaceutical advancement in the struggle against the epidemics of HIV and AIDS. However, due to high costs, access to these new drugs was almost impossible for most people living with HIV or AIDS. This situatiowhas been even more dramatic for those living with HIV/AIDS in poorer countries. Many of the organizations that are fighting for the rights of those with HIV have since developed human rights advocacy and legal strategies to try to achieve universal access to treatment. These organizations are also fighting for states’ compliance with human rights obligations under health-related treatises and conventions. This paper draws upon the experience gained in Latin America, focusing on the legal strategies that have been explored in Venezuela and the legal consequences for domestic law.
Rethinking Health and Human Rights: Time for a Paradigm Shift
Authors: Farmer Paul , Gastineau Nicole
Published: January 2007

Medicine and its allied health sciences have for too long been peripherally involved in work on human rights. Fifty years ago, the door to greater involvement was opened by Article 25 of the Universal Declaration of Human Rights, which underlined social and economic rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
Regulation of the Global Marketplace for the Sake of Health
Authors: Danis Marion , Sepinwall Amy
Published: January 2007

Mounting evidence suggests that socioeconomic status is a determinant of health. As nations around the globe increasingly rely on market-based economies, the corporate sector has come to have a powerful influence on the socioeconomic gradient in most nations and hence upon the health status of their populations. At the same time, it has become more difficult for any one nation to influence corporate activities, given the increasing ease with which corporations relocate their operations from country to country, As a result of all of these factors, nations wishing to assure the health of their populations will need to both involve the corporate sector and cooperate with other nations.

In this article, we review the business ethics literature and consider what justification it might provide for requiring multinational corporations to attend to concerns about population health.
Human Rights and Public Health: Dichotomies or Synergies in Developing Countries? Examining the Case of HIV in South Africa
Authors: London Leslie
Published: January 2007

Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. Developing countries have been faced with declining expenditures in health and social services, increasing burdens posed by both communicable and non-communicable diseases, and economic systems poorly geared to fostering sustainable development for the poorest and most marginalized. Under such circumstances, the challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives. This is particularly so in relation to the development of public health policy, where equity, redress of past inequalities, and the god of social justice may seemingly be pitted against macroeconomic adjustments required for national economic development in an increasingly globalized economic order.

For example, pressures to deregulate as part of a market-oriented development philosophy will increase the risks from occupational hazards in populations desperate for paid employment.
How the Law Affects Gun Policy in the United States: Law as Intervention or Obstacle to Prevention
Authors: Vernick Jon S. , Mair Julie Samia
Published: January 2007

In our experience, public health practitioners (rather than scholars) seeking to address a health problem often have just two very basic questions about the law: (1) how can I use the law to create new interventions, or improve existing ones, to protect the public’s health; and (2) will the law prevent me from successfully implementing certain interventions? In this way, the law is seen as either an opportunity for intervention to affect a public health problem, or an obstacle to enacting or implementing a desired intervention.

In addition, because some public health practitioners may not fully understand the intricacies of a given legal area, some possible obstacles to intervention may be either real or perceived. A real legal obstacle is not necessarily an insurmountable one, but it does have genuine legal force. A perceived obstacle has little, if any, true legal application to a given kind of intervention.
Review of Methodologies Measuring Human Rights Implementation
Authors: Watchirs Helen
Published: January 2007

This article examines various methodologies used to measure implementation of human rights norms. As the above quotations demonstrate, society's need for measurement to evaluate progress and change over the centuries has not diminished. One of the purposes of measurement is to move human rights discourse beyond the aspirational, which has made achievement of these rights elusive, to an approach that makes them more concrete and practical through accurately testing the extent of their implementation. Measurement can simply involve the assignment of variable values - for example, numbers - to objects or events, such as law, according to rules. A link can then be provided between abstract concepts, such as human rights, to empirical indicants. This article aims to draw general principles to guide and make better use of measurement methodologies, such as statistical analysis and audits, in human rights areas generally, but with particular emphasis on the health area, especially HIV/AIDS.
Human Rights and Wrongs: Could Health Impact Assessment Help?
Authors: O’Keefe Eileen , Scott-Samuel Alex
Published: January 2007

While the importance of civil and political rights to health advocates is widely acknowledged, economic and social rights are not yet securely on advocates’ agenda. Health impact assessment is an approach that can promote an appreciation of their importance. This paper introduces health impact assessment, gives examples of how it is being used, links its development to a focus on inequalities in health status, indicates the insufficiency of civil and political rights to protect health, and shows that the use of health impact assessment draws attention to economic and social rights. While civil and political rights are an astonishing social achievement, they are not in themselves sufficient to promote health.
The Evolving Field of Health and Human Rights: Issues and Methods
Authors: Marks Stephen P.
Published: January 2007

The conference on Health, Law and Human Rights: Exploring the Connections held last fall in Philadelphia was a telling moment in the complex history of a movement — the “health and human rights movement” for want of a better term — inaugurated by the pioneering work of Jonathan Mann, whose memory the Conference honored. The François-Xavier Bagnoud Center for Health and Human Rights — founded by Mann and carrying on his legacy — was pleased to co-sponsor the conference. The conference and this symposium issue containing the main papers provide an excellent opportunity to take stock of that movement by means of a commentary based on the papers. This commentary is made from a resolutely human rights perspective, with the aim of engaging the authors in a dialogue on whether and to what extent each article advances knowledge about the interconnectedness and mutually reinforcing character of health and human rights, which is the lasting legacy of Jonathan Mann.
Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of State Medical Boards
Authors: Hoffmann Diane E. , Tarzian Anita J.
Published: January 2007

State medical boards are beginning to take a more balanced approach to monitoring and disciplining for prescribing of pain medications, according to this survey of state medical boards across the country. Overall, respondents indicated that they are becoming more educated and more sophisticated in their approach to complaints of opioid overprescribing. In addition, their responses reflect a heightened awareness of the appropriateness of treating chronic pain with controlled substances.

Yet, despite these inroads, boards generally demonstrate a continued tolerance of pain undertreatment, the survey found. There is a discrepancy in the weight given to violation of standard of care, patient harm, and gross negligence for opioid overprescribing versus undertreatment of pain. Boards appear to have a higher threshold for patient harm in cases involving pain undertreatment — particularly for chronic nonmalignant pain.
Providing Relief to Those in Pain: A Retrospective on the Scholarship and Impact of the Mayday Project
Authors: Johnson Sandra H.
Published: January 2007

Scholarship has intrinsic value, of course; but when good scholarship can stimulate change for the better in an area as fundamental to human dignity as health care and the relief of suffering, there is a special satisfaction. This has been our experience since 1996, when the first of now four special issues of this journal focused on legal, regulatory, ethical, professional, and financial issues in medical treatment for pain.

With the generous and steadfast support of the Mayday Fund, the American Society of Law, Medicine & Ethics (ASLME) has generated a significant body of scholarship published in theJournal of Law, Medicine & Ethics(JLME). This research has proven absolutely essential in changing public policy to support better care for those who suffer pain.

Over these years, the Mayday Project at ASLME has tackled many of the real and perceived barriers to effective pain relief. In pain management, both real and perceived obstacles can have a powerful negative effect.
Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of State Medical Boards
Authors: Hoffmann Diane E. , Tarzian Anita J.
Published: January 2007

Uncertainty regarding potential disciplinary action may give physicians pause when considering whether to accept a chronic pain patient or how to treat a patient who may require long-term or high doses of opioids. Surveys have shown that physicians fear potential disciplinary acrion for prescribing controlled substances and that physicians will, in some cases, inadequately prescribe opioids due to fear of regulatory scrutiny. Prescribing opioids for long-term pain management, particularly noncancer pain management, has been controversial; and boards have investigated and, in some cases, disciplined physicians for such prescribing. While in virtually all of these cases the disciplinary actions were successfully appealed, news of the success was not often as well-publicized as news of the disciplinary actions, leaving some physicians confused about their potential liability when prescribing opioids for pain. The confusion has perhaps increased as a result of two relatively recent cases, one where a physician was successfully disciplined by a state medical board for undertreatment of his patients’ pain, and another where the physician was successfully sued for inadequate pain treatment.
Maximizing the Value of Electronic Prescription Monitoring Programs
Authors: Brushwood David B.
Published: January 2007

There is general agreement that the “principle of balance” should guide controlled substance policy and regulation in the United States. Although the diversion of controlled substances from medical to nonmedical purposes is a significant public health problem, overly aggressive controlled substance regulation has been shown to have an unintended deterrent effect on appropriate controlled substance use, including pain management with opioid analgesics. The promotion of effective pain management and the reduction of substance abuse are equally important regulatory objectives. Neither regulatory objective need be sacrificed to achieve the other. Rather, the two objectives must be balanced with each other to assure that necessary pain management is encouraged while drug abuse is curtailed.

Approximately 75 million people in the United States suffer from severe pain. Fifty million of these suffer chronic pain, and 25 million suffer acute pain from trauma or surgery. Pain is not merely an uncomfortable symptom.
Challenges in the Federal Regulation of Pain Management Technologies
Authors: Noah Lars
Published: January 2007

Those who write about pain management have focused almost entirely on delivery issues, paying essentially no attention to the federal regulatory challenges that affect the development of pain relief technologies — namely, pharmaceuticals and medical devices indicated for analgesic uses. The academic literature is strangely devoid of any sophisticated discussion of the difficulties that attend, first, the product approval decisions of the Food and Drug Administration (FDA) and, second, the scheduling decisions made by the Drug Enforcement Administration (DEA). If a “bottleneck” develops upstream, it could have serious repercussions downstream — without pain relief technologies, the issues of access that have preoccupied previous commentators would have little practical consequence.

The modern pharmaceutical industry traces its origins back more than a century, around the time that the German company Bayer first synthesized aspirin (acetylsalicylic acid) and began marketing it as an analgesic.
Monitoring and Investigating Certified Registered Nurse Practitioners in Pain Management
Authors: Lazarus Jean B. , Downing Belinda (Wendy)
Published: January 2007

The Mayday Scholars Program for 2001-2002 provided an opportunity to boards of nursing to present their experiences in monitoring the prescribing practices of advanced practice nurses and to research ways for improving their own investigation processes as professional disciplinary agencies for prescribing practices related to pain management. The Alabama Board of Nursing was interested in participating in the program based on its commitment to accountability for public protection. A gradual increase in disciplinary cases involving violations of prescribing practices by certified registered nurse practitioners (CRNPs) prompted our inquiry as to whether a proactive monitoring system was needed to determine compliance with regulations for advanced practice nurses in collaborative practice.

In this article, we discuss selected elements related to pain management and regulatory factors, including nursing, that affect the treatment of pain. We present a brief overview of the evolution of advanced practice nursing, with an emphasis on the nurse practitioners movement, and prescription practices and pain management by nurse practitioners.
A Comparative Study of the Law of Palliative Care and End-of-Life Treatment
Authors: Mendelson Danuta , Jost Timothy Stoltzfus
Published: January 2007

Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.

This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan.
Criminal Law: Physician Convicted for Recklessly Prescribing OxyContin
Authors: Romanow Kathleen
Published: January 2007

Dr. James Graves was convicted of manslaughter, racketeering, and drug charges in association with overdose deaths of four of his patients from the painkiller OxyContin. A Florida court then sentenced the physician to 62.9 years in prison. This is the first criminal conviction of a doctor in the United States related to OxyContin deaths.

Dr. Graves, who ran a pain management office, was charged with recklessly writing prescriptions to those that could afford an office visit and failed to ask appropriate questions beforehand. Prosecutors in the case said that the physician prescribed drugs like OxyContin to as many as ninety patients a day, after only a short office visit. The prosecution claimed that Graves was “‘selling prescriptions for cash without any real examination, diagnostic testing, or follow-up, no consultation, no real assessment of their medical needs.’”
Prenatal Care: Revisions to SCHIP Extend Health Care to “Unborn Children”
Authors: Gutmann Valerie
Published: January 2007

Effective November 1, 2002, the federal Department of Health and Human Services (DHHS) reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program (SCHIP). By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood as beginning at conception.”

In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children.
Managed Care: Immunity for Peer Review under HCQIA
Authors: Klanica Kaley
Published: January 2007

In Singh v. Blue Cross/Blue Shield of Massachusetts, Inc., the U.S. Court of Appeals for the First Circuit held that defendant Blue Cross/Blue Shield's peer review practices satisfied the immunity standard for professional review actions according to the Health Care Quality Improvement Act (HCQIA), and the First Circuit affirmed the U.S. District Court for the District of Massachusetts's grant of summary judgment in favor of the defendant.

After Blue Cross/Blue Shield merged with Bay State Health Care, Blue Cross began to offer “Bay State Health Care” to former Bay State subscribers. Blue Cross denied the plaintiff, Dr. Kunwar Singh, participation in the Bay State Healthcare Network due to poor utilization review. Singh sought reconsideration, and Blue Cross agreed to audit his practices before making a final decision.
Tobacco Litigation: Statistics Permitted for Proof of Causation and Damages in Class Action
Authors: Dudzinski David M.
Published: January 2007

In an ongoing class action suit against large tobacco companies, including Philip Morris, Inc., and R.J. Reynolds Tobacco Co., Judge Jack B. Weinstein of the U.S. District Court for the Eastern District of New York issued an opinion on October 15, 2002 making statistical proof available to address plaintiffs’ common questions and prove required elements of consumer fraud.

The dilemmas inherent in tobacco litigation as a mass tort action include overcoming the collective action problem (in particular, the relative legal sophistication, experience, resources, and superior bargaining position of tobacco manufacturers as opposed to scattered individual plaintiffs with limited resources), mobilizing appropriate and persuasive legal theories for recovery, and meeting the standards of proof, all in a timely and cost-effective manner. While some tobacco cases have proceeded on products liability theories of defective or negligent design, many recent cases are grounded in consumer fraud laws.
ADA: Isolated Bouts of Depression Do Not Qualify as a Disability
Authors: Prieto-Gonzalez Mayelin
Published: January 2007

InOgborn v. United Food & Commercial Workers Union, Local No. 881, the U.S. Court of Appeals for the Seventh Circuit held that while major depression can constitute a disability under the Americans with Disabilities Act (ADA), isolated bouts of depression do not. Furthermore, the court held that an employee's firing after taking medical leave for depression does not violate the Family and Medical Leave Act (FMLA), where evidence shows that the employee would have been fired for poor performance even if he had not taken the leave.

Alleging that he was fired in violation of the ADA and the FMLA, Jerry Ogborn sued his former employer, Local 881 of the United Food and Commercial Workers Union, as well as the union's vice president. Beginning in 1980, Ogborn worked as a business agent for the union, which represents members employed primarily in the retail grocery industry. Ogborn's duties consisted of visiting retail grocery stores employing workers represented by the union, meeting with members about working conditions, and filing and processing members’ grievances.
Employment: Protecting Public Health Abrogates Due Process Requirement for Suspension Proceedings
Authors: Montero Guillermo A.
Published: January 2007

InPatel v. Midland Memorial Hospital & Medical Center,the U.S. Court of Appeals for the Fifth Circuit held that the defendant hospital did not violate the plaintiff's due process rights by suspending his clinical privileges without a pre-suspension hearing, where there were reasonable grounds for assuming that patient safety was at risk. Dr. P.V. Patel, a board-certified cardiologist, brought an action against Midland Memorial Hospital and several of its doctors, alleging that the suspension of his clinical privileges violated his right to a pre-suspension hearing; was the result of racial discrimination; and resulted in anticompetitive behavior in violation of antitrust laws. The U.S. District Court for the Western District of Texas granted Midland's motion for summary judgment. The parties filed cross appeals, Dr. Patel on the ground that there were genuine issues of fact for all of his claims, and Midland on the ground that, with the exception of the civil rights claim, it was immune from all of Dr. Patel's claims under the Health Care Quality Improvement Act of 1986 (HCQIA).
EMTALA: Screening Can Satisfy EMTALA, Despite Misdiagnosis
Authors: Gundavaram Hemanth
Published: January 2007

InDel Carmen Guadalupe v. Agosto,the U.S. Court of Appeals for the First Circuit held that a hospital fulfills its statutory duty to screen patiens in is emergency room if it provides for a “screening examination reasonably calculated to identify critical medical conditions” that may be afflicting symptomatic patients and if it “provides that level of screening uniformly to all those who present substantially similar complaints.” The First Circuit affirmed the lower court's decision to grant summary judgment to the hospital in a claim raised under the Emergency Medical Treatment and Active Labor Act (EMTALA).

Maria del Carmen Guadalupe brought her husband, Narciso Figueroa, to the Hospital Interamericano De Medicina Avanzada, Inc., (HIMA) on October 3, 1998, with symptoms of urinary retention, edema in the legs, high blood pressure, pain, increased respiratory difficulty, a dry cough, fever, and drowsiness.
The (Alternative) Medicalization of Life
Authors: Schneiderman Lawrence J.
Published: January 2007

The writers in this symposium are drawn together under the topic of medicine — not to discuss any new discovery in the prevention or treatment of disease. Quite the contrary. We are drawn here to consider a phenomenon. We are here to consider whether a collective romantic fantasy called alternative medicine that has seized our society really deserves the acclaim it is receiving. This, for the most part, is what people like us do when we gather in symposia or meetings to discuss alternative medicine. We argue about beliefs and claims, not results. Are the beliefs and claims of this collective romantic fantasy justified by empirical data? Or rather, will the beliefs and claims of this collective romantic fantasy be justified by empirical data because the fantasy is already securely in place in our political and fiscal, medical and educational, structures?
Evaluating Complementary and Alternative Medicine: The Limits of Science and of Scientists
Authors: Hufford David J.
Published: January 2007

Science provides the most important set of tools for the evaluation of complementary and alternative medicine (CAM). Nonetheless, there are important limits in science that constrain its ability to evaluate CAM effectively. Some are the limits encountered by science in conventional medical research. Others are peculiar to this controversial topic. The most important limits are not those inherent within the basic methods of science, but rather within the culture of science — the particular ways that scientific knowledge, theory, and method are configured and arrayed rhetorically, and in the social context in which science operates. It is the limitations of scientists as a group of human beings more than science as a set of methods that hamper scientific evaluation of CAM.
Modern Western Science as a Standard for Traditional Chinese Medicine: A Critical Appraisal
Authors: Fan Ruiping
Published: January 2007

It is generally recognized that China, while attempting to develop modern scientific medicine in carrying out its national policy for modernization, has also made significant efforts to integrate traditional Chinese medicine into its health care system. For instance, the World Health Organization's first global strategy on traditional and alternative medicine (released in May 2002) lists China as one of only four of its member states to have attained an integrative health care system. However, medical integration can take many different forms and involve quite different health care standards. A health care standard is a set of mechanisms by which distinct diagnostic and therapeutic practices and products are validated or accredited for use in health care delivery. Traditional Chinese medicine and modern scientific medicine adopt different sets of such mechanisms and thereby engage different health care standards. Accordingly, in appraising the Chinese integrative health care system, it is important to investigate which health care standard has been appealed to.
A Dose of Our Own Medicine: Alternative Medicine, Conventional Medicine, and the Standards of Science
Authors: Morreim E. Haavi
Published: January 2007

The discussion about complementary and alternative medicine (CAM) is sometimes rather heated. “Quackery!” the cry goes. A large proportion “of unconventional practices entail theories that are patently unscientific.” “It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.” “I submit that if these treatments cannot withstand the test of empirical research, … then we have wasted a lot of time and effort. The time has been wasted on all the people who have spent years learning falsehoods about acupuncture points and the principles of homeopathy. And the patients have wasted their time, money, and efforts receiving treatments that were not what they were represented to be or were harmful.”
Eliminating Scope of Practice and Licensing Laws to Improve Health Care
Authors: Holcombe Randall G.
Published: January 2007

Entry into the practice of medicine is heavily regulated through scope of practice and licensing laws that make it illegal for nonlicensed individuals to perform many medical services. As institutions are structured at the beginning of the twenty-first century, most regulation takes place at the state level, through state departments of health that establish criteria for performing different types of medical activities, and that restrict allowable activities for various types of health care professionals. The regulations over the activities of physicians are more uniform across states than for other health care professionals because, although the regulation is done by individual state governments, the standards for physicians are set by the National Board of Medical Examiners, a group controlled by physicians themselves. The justification for this regulation is that it produces higher quality health care. Some would make an even stronger argument that regulation is necessary because patients do not have sufficient knowledge to distinguish effective practitioners from ineffective ones.
Informed Consent, Shared Decision-Making, and Complementary and Alternative Medicine
Authors: Sugarman Jeremy
Published: January 2007

Complementary and alternative medicine (CAM) is used by many in hopes of achieving important health-related goals. Survey data indicate that 42 percent of the U.S. population uses CAM, accounting for 629 million “office” visits a year and expenditures of 27 billion dollars. This high prevalence of use calls for a careful evaluation of CAM so as to ensure the well-being of those using its modalities. Such an evaluation would obviously include assessments of the safety and efficacy of particular approaches, the training and integrity of practitioners, and the appropriateness of modalities for different conditions or uses. Given the lack of published data concerning many of these aspects of CAM, the likely unfamiliarity of its practitioners to the approaches available to clinicians practicing modern scientific medcine, and the need to respect the unique preferences of persons seeking assistance with achieving health-related goals, it is also important to assess the potential roles of informed consent for the use of CAM. Examining such roles is the central task of this paper.
National Policy on CAM: The White House Commission Report
Authors: Boozang Kathleen M.
Published: January 2007

In March 2000, President William Clinton signed Executive Order 13,147, establishing the White House Commission on Complementary and Alternative Medicine, to develop public policy proposals geared toward maximizing “the benefits to Americans of complementary and alternative medicine.” Disconcertingly, the Commission's charge presumed the safety and efficacy of complementary and alternative medicine (CAM). In so doing, it placed the proverbial cart before the horse by setting the Commission on a mission to “address education and training of health care practitioners in CAM; [coordinate] research to increase knowledge about CAM products; [provide] reliable and useful information on CAM to health care professions, and [provide] guidance on the appropriate access to and delivery of CAM.”

The Commission's final report (“Commission Report”), issued in March 2002, similarly skirts the fundamental question of whether evidence exists that CAM interventions are safe or offer sufficient benefit to justify their proliferation.
Resisting a Genetic Identity: The Black Seminoles and Genetic Tests of Ancestry
Authors: Johnston Josephine
Published: January 2007

In July 2000, the Seminole Nation of Oklahoma passed a resolution that would effectively expel a significant portion of its tribal members. The resolution amended the Nation's constitution by changing its membership criteria. Previously, potential members needed to show descent from an enrollee of the 1906 Dawes Rolls, the official American Indian tribal rolls established by the Dawes Commission to facilitate the allotment of reservation land. The amended constitution requires possession of one-eighth Seminole Indian blood, a requirement that a significant portion of the tribe's membership cannot fulfill. The members of the Nation who fail to meet this new membership criterion all have one thing in common: they are black.

Descendents of former slaves who came to live among the Seminole Indians of Florida in the seventeenth and eighteenth centuries, the black Seminoles have been officially recognized by the U.S. government as members of the Seminole Nation of Oklahoma since 1866.