Hot Topics: Public Health

Blog Posts (42)

April 18, 2014

Surge in Narcotic Prescriptions for Pregnant Women

[New York Times] Doctors are prescribing opioid painkillers to pregnant women in astonishing numbers, new research shows, even though risks to the developing fetus are largely unknown.Of 1.1 million pregnant women enrolled in Medicaid nationally, nearly 23 percent filled an opioid prescription in 2007, up from 18.5 percent in 2000, according to a study published last […]
April 17, 2014

Manslaughter conviction for ‘negligent breastfeeding’ puts other mums at risk

(The Guardian) A genetic defect may be the real culprit in the case of a woman taking painkillers whose baby died of a morphine overdose. Photograph: Yui Mok/PA On Thursday last week, a South Carolina jury convicted Stephanie Greene, a 39-year old nurse, of killing her six-week-old daughter by administering a morphine overdose in her breast […]
April 10, 2014

New Tools for HIV Prevention: Why I am a Truvada Whore

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership Although the epidemic likely started a decade or two earlier, AIDS wasn’t identified as a new disease until 1981. It took a few more years to isolate HIV, the virus that causes AIDS, and to develop reliable tests for diagnosing infection. In the thirty […]
April 10, 2014

Artistic Inquiry: Obesity on Stage in Boston

BEI Young Professionals member Betsy Campbell covers artful media around the world that touches upon topics in bioethics. In 2013 a Hastings Center article, bioethicist Dan Callahan proposed an “edgier” approach to America’s obesity epidemic. His views in that article — particularly his point about the power of public disapproval — proved to be controversial, […]
April 9, 2014

US jury orders Takeda, Eli Lilly to pay $9 billion in damages over Actos

[FirstWordPharma] A US jury ordered Takeda and Eli Lilly to pay a combined $9 billion in punitive damages after finding that the companies concealed the cancer risks associated with the diabetes therapy Actos (pioglitazone). The jury also awarded compensatory damages to the plaintiff of nearly $1.5 million in the first federal lawsuit related to the […]
April 8, 2014

In US, Vaccine Denial Goes Mainstream

This article provides a brief snapshot of the alarming trend of vaccine denial, with an especially insightful observation at its conclusion. For information on the importance of vaccination and links to further sources, see these blog posts from the Seattle Times and Discover. [Yahoo News] Washington (AFP) – Kathleen Wiederman is not staunchly against vaccines. She […]
April 8, 2014

Heavy Drinkers to be Considered for NHS Liver Transplants in the UK

[The Guardian] People with a severe drink-related liver disease are to be considered for transplant for the first time, reopening the debate over whether people who are thought to bring ill health on themselves deserve expensive treatment. The decision by the NHS‘s blood and transplant service (NHSBT) comes at a time when there is a national shortage […]
April 4, 2014

When Physicians Pay Attentions to Costs, They Promote Public Health!

This week, my good friend Reshma Jagsi and I published an article in the New England Journal of Medicine, in which we explain why physicians are doing their job, as physicians, when they pay attention to healthcare costs. Here is a … Continue reading
February 23, 2014

Criminalization of Drinking While Pregnant in UK?

A council on northwest England plans to bring legal action to establish liability for criminal damages by women who drink while pregnant, with resultant damage to their newborns. A tribunal in 2011 had ruled that a child had sustained personal injury "directly attributable to a crime of violence," and so was eligible for a payment from its mother. The holding came in spite of the fact that the mother had never been criminally convicted. The court simply held that, regardless of the lack of prosecution or conviction in her case, she had in fact committed the crime of maliciously administering poison so as to inflict grievous bodily harm, a crime under section 23 of the Offences Against the Person Act 1861. The upper tribunal of the Administrative Appeals Chamber reversed the holding, however. (The opinion can be downloaded here.) The Appeals Chamber agreed that there had been “administration of a poison or other destructive or noxious thing, so as thereby to inflict grievous bodily harm,” but found that the fetus who was damaged by the mother's drinking was not a "person" in legal terms at the time of her injury. The case now goes to the Court of Appeal.

It's important to recognize that the case at bar would set precedent for cases quite unlike it in the future. In the case at bar, adoptive parents of a child damaged by fetal alcohol syndrome are seeking payments from the child's biological mother--payments due them pursuant to criminal law. But if drinking-while-pregnant is criminal, the ordinary case of prosecution in the future may look rather different. It will involve not payment of damages by a biological mother to a third-party adoptive parent, but imprisonment of a new mother shortly after her child's birth.

Criminalization of drinking-while-pregnant seems like a terrible idea. It is obviously true that drinking while pregnant can damage one's fetus. It is also obviously true that the majority of women who drink while pregnant do not thereby damage their fetuses. The relevant studies seem to show no genuinely "safe" level of drinking during pregnancy, but also show that significant drinking during pregnancy often results in no harm to the fetus. In these circumstances--and given the addictive nature of alcohol--can it really be true that criminalization of drinking-while-pregnant is really the best, or even a reasonably good, method of reducing harm to fetuses from maternal drinking?

Criminalization will make it difficult for pregnant women to speak to their physicians or nurses about their drinking habits. Threat of criminal prosecution for drinking could be used as a lever against pregnant women by abusive men. Criminalization will subject visibly-pregnant women not only to prosecution, but also to public abuse and accusations from strangers, even though the actual danger to fetuses from moderate later-term drinking is minimal.

Women should be informed of the dangers to their fetuses of drinking. Alcoholic pregnant women should be offered help. The state's money is better spent on public service announcements and counseling sessions than on prosecutions and jail-cells. I'm guessing that no one who knows that drinking during pregnancy might damage her child, but who drinks anyway, does so with malicious intent, or does so without regard to the dangers to her child. People who don't know the damage they may be causing, or who simply cannot stop their drinking due to addiction, need help rather than punishment.


February 14, 2014

LIBERTY AND WHERE NOSES BEGIN--AN OPEN LETTER TO: The ACLU of Rhode Island Concerning Mandating Flu Vaccinations for Very Young Children Entering Daycare and Kindergarden

From: Arthur Caplan and Dorit Reiss

SUBJECT: requiring the vaccination of children and workers in daycare and pre-K against the flu

In recent testimony submitted to the Public Health Department of Rhode Island, a representative of the Rhode Island ACLU spoke against the requirement to vaccinate Rhode Island’s children age six months to 5 years of age against the flu in order to enter daycare or pre-kindergarten.…