The evidence linking tobacco product advertising to adolescent smoking initiation and resulting long-term addiction, premature death, and disability is well established. Each link in the causal chain has been substantiated: children and adolescents are especially vulnerable to advertising; point-of-sale advertising comprises 92.1% of cigarette advertising and marketing expenditures by manufacturers and 71.3% of smokeless tobacco advertising; tobacco companies have targeted youth through advertising; advertising exposure causes adolescents to start and to continue smoking; among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age; adolescents who smoke are at high risk for long-term addiction because their brains are still developing; and long-term addiction results in the tremendous personal, social and financial costs of tobacco-related illnesses.

Beginning in the 20th century, scientific research came to be dominated by a growing class of credentialed, professional scientists who overwhelmingly displaced the learned amateurs of an earlier time. By the end of the century, however, the exclusive realm of professional scientists conducting research was joined, to a degree, by “citizen scientists.” The term originally encompassed non-professionals assisting professional scientists by contributing observations and measurements to ongoing research enterprises. These collaborations were especially common in the environmental sciences, where citizen scientists participated in counting wildlife and measuring environmental conditions. Later, patient groups began to play a more active role in supporting clinical trials and collecting health records from affected individuals.

Following the tragic shootings in Newtown (Connecticut), Aurora (Colorado), Isla Vista (California) and others, increased national attention has focused on the relationship between mental illness and gun violence. While some have called for enhanced regulation of firearm possession by persons with mental illness, others have argued that such actions would be ineffective and enhance stigma associated with mental illness while discouraging treatment seeking.

In 1954, American women experienced an unwanted pregnancy as presenting a difficult choice between bearing an unwanted child and risking an illegal abortion. Yet obstetrician/gynecologist Alan Guttmacher described abortion as “the doctor’s dilemma.” Guttmacher and his medical colleagues experienced a dilemma when their professional judgment that pregnancy termination was warranted clashed with the laws criminalizing most abortions. In that situation, the law constrained their ability to make a decision they felt to be in the best interest of a patient. To doctors, such paternalist decision-making was a bedrock principle of 20th-century medicine. Doctors had an obligation to provide, or deny, treatment to patients for their own good. This duty arose from medical expertise and separated the medical profession from lesser medical practitioners.

Wolf et al. define an incidental finding (IF) as “... a finding concerning an individual research participant that has potential health or reproductive importance and is discovered in the course of conducting research but is beyond the aims of the study...” Wolf et al. also propose that researchers “... should consider what kinds of IFs the protocol may produce and how rapidly the identification and evaluation process needs to proceed to provide timely information to the research participant and avoid harm.”

Recently, the U.S. Presidential Commission for the Study of Bioethical Issues considered the matter of IFs. In the Commission's December 2013 report on this topic, “Anticipate and Communicate–Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to-Consumer Contexts,” the panel further defines two categories of IFs, anticipatable and un-anticipatable, as well as introduces the concept of secondary findings. The commission recommends that researchers should develop plans to manage anticipatable IFs, and should consider to actively look for secondary findings.

Preventable diseases not only cause suffering and physical harm, they also impose financial costs on private individuals and public authorities. By disregarding evidence of the safety and effectiveness of vaccines and choosing not to vaccinate their children, some parents are increasing the risk of outbreaks and their attendant costs. In a very real sense, since those families are not currently required to cover the full costs of outbreaks, they are externalizing those costs onto others – individuals affected and society at large. Since non-vaccinating can directly lead to costly outbreaks, this paper argues that it is both fair and desirable to impose those costs upon those making the choice not to vaccinate. There are, in fact, strong policy reasons to support doing so regardless of whether we use an approach based on fault or a no-fault framework. Not only can the decision not to vaccinate be seen as culpable, aside from the culpability consideration, it is appropriate to compel those deciding not to vaccinate to internalize the costs in order to prevent free riding and to mitigate harms to others.

Reducing greenhouse gas emissions is an urgent priority. While few would argue that action to mitigate the causes of climate change should be led by public health practitioners, public health has a critical role in adaptation efforts. Adaptation seeks to lessen human vulnerability to extreme weather and to increased variability in temperature and precipitation. Climate change as an emerging health issue provides a test case for new approaches to public health: approaches that emphasize both collaboration with other government and private entities and application of innovative legal strategies.

Since its inception in 2010, the Network for Public Health Law (Network) has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation (RWJF) has invited the Network and other partners to consider new ideas and strategies toward building a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations.

Kara Swanson has painted a textured portrait of Alan Guttmacher, showing the tension between his embrace of medical paternalism and simultaneous rejection of the legal paternalism that regulated women’s access to abortion before Roe v. Wade. Swanson explains Guttmacher’s route, navigating the troubled waters between “what was medically indicated and what was legally permissible” in the realm of reproductive medicine, the path that Guttmacher identified as the “doctor’s dilemma.” She takes us from his 1930s practice, creatively assisting in his patient’s use of reproductive technologies such as artificial insemination, to the era post Roe v. Wade, after which he seems to have come to terms with a fuller commitment to autonomous reproductive choices. We learn that Guttmacher’s early career provided opportunities to exercise some of his prerogatives as a doctor in the absence of clear legal constraints. By the end of his life, the Supreme Court came close to having endorsed his preference, as Swanson notes, “privileging the doctor/patient relationship and medical expertise.”

The diversity of state confidentiality laws governing public health data presents a significant challenge for public health initiatives. This challenge is further complicated by the array of confidentially laws that are relevant within a state as disclosure and usage standards vary depending upon data holder, type, and source. These laws often have not been updated to address modern confidentiality risks such as unlawful data linkage or breach, leaving many public health organizations without clear guidance in the contentious area of individual privacy. To address these challenges, public health organizations have increasingly turned to the science of de-identification, but whether de-identification adequately meets the many and varied state confidentiality legal requirements remains an unanswered question.

A mother new to my general pediatrics practice says that she wants no vaccines for her infant because she says, “I have read on the internet…,” or “I heard from a nurse…,” or “So-and-so celebrity says they can cause autism, brain damage, poisoning, cancer, neurological disorders, and even death.” Perhaps she has read about “the dangers” of vaccines in the first edition of Dr. Sears’ The Vaccine Book. Or people on her Facebook page also say that the “preventable” diseases are just too rare anymore to ever take “the risk” of a vaccine with “known” risks. These vaccine risks are clearly explained, and even sometimes overstated (such as a risk of death for Haemophilus influenzae type B (HIB) vaccine) in the routinely distributed Centers for Disease Control and Prevention (CDC) Vaccine Information Sheet (VIS). On the other hand, the families typically overlook the risks of “omission,” or non-vaccination, such as brain damage or meningitis, etc., which are also clearly stated in the VIS.

Today, multiple legal theories of parenthood interact to encompass all sorts of families. Adults and children bound through adoption, step-parenting, and assisted reproductive technologies (ART) demand familial recognition through some combination of biology, functionality, technology, and intent.

In the context of children born through ART, many scholars have proposed a more robust use of intent as a rule for identifying legal parents. When used to identify parents, intent asks who planned to become the parent of a child, and is often helpful when multiple adults simultaneously agreed to bring a child into the world. For example, in the case of surrogacy, as many as five adults — two intended parents, a gestational surrogate, and both a sperm and egg donor — could all contribute to bringing a single child into the world. Not only does intent provide a practical answer to such modern parentage dilemmas, but it recognizes the often-minimized emotional investment of men who wish to be fathers.

Childhood vaccination has made an important contribution to the health of children, preventing millions of deaths worldwide each year,1 yet thousands of U.S. parents choose to refuse or delay the administration of selected vaccines to their children. Some choose not to vaccinate their children at all. This can be frustrating for physicians, especially for those who have personally witnessed the positive impact of vaccines on child health during their lifetime. While most physicians continue to care for these families over time, using each visit as an opportunity to educate and encourage vaccination, an increasing number of physicians report dismissing these families from their practice unless they agree to vaccinate their children. This paper will examine this emerging trend along with the reasons given by those who advocate such an approach. I will argue that the strategy of refusing to allow families into a clinic unless they agree to vaccinate their children is misguided, and the arguments for adopting such a policy fail to stand up to close scrutiny.

This article advances, for the first time, a framework for situating public health law interventions as occurring in a predictable four-stage process. Whether the intervention is related to mandatory seat-belt laws, HIV prevention through needle-exchanges, or distracted-driving laws, these public health law interventions have generally been characterized by the following four stages. First, a series of publicized incidents, observances, or outcomes generate significant media attention, and are framed as public health harms. Then, a few select states evaluate such harms and proactively seek testimony or evidence designed to support a law-based intervention. After this initial public engagement, states enact legal frameworks designed to minimize or reduce the harm, often in the absence of full information about the scope of harm or potential effectiveness of the intervention. In contrast, scholars have proposed that at these early stages, lawmaking should be evidence-based and “developed through a continuous process that uses the best available quantitative and qualitative evidence.”5 Our experience evaluating youth sports traumatic brain injury (TBI) lawmaking suggests that, like other public health issues with sudden and intense media (and, therefore, constituent) attention, an evidence-based approach was lacking during these early stages.

In “Expectant Fathers, Abortion, and Embryos,” Dara Purvis considers the interests of “expectational fathers,” as she calls them, in the related contexts of abortion and the disposition of pre-embryos in assisted reproductive technologies (ART). Her thought-provoking essay contributes to a subject — men and reproductive decision-making — that is too little studied. I embrace her emphasis on respect for both men’s equal role in parenting and women’s right to decide whether to terminate or continue pregnancy. In this Comment, I examine her central concern that abortion discourse promotes harmful gender stereotypes by minimizing expectational fathers’ interests. I suggest that Purvis’s own analytic focus on intent, properly applied and extended, actually ameliorates her concern and points instead to a more direct, unapologetic acknowledgement of men’s (and women’s) desires to avoid parenthood in particular circumstances and at particular times in their lives.

In an emergency, challenges faced by disabled individuals may be exacerbated by ineffective communication, power outages, transportation shortcomings, and inhospitable shelters. During Hurricanes Katrina and Rita, Gulf Coast shelters did not routinely provide closed captioning or sign language interpreters; for individuals with auditory disabilities, understanding instructions issued in these shelters was extremely difficult. Individuals with mobility-related disabilities experienced challenges evacuating from their homes due to public transportation that could not accommodate wheelchairs. After the hurricanes, difficulties arose in identifying wheelchair-accessible trailers and in communicating with disabled trailer residents. Failing to anticipate these challenges intensifies the disadvantaged situation of those with disabilities during an emergency.

The rise of managed care initiated a steady decline in solo and small group physician practices and the emergence of new delivery models built around large health care organizations (HCOs). Health care reform has only accelerated this trend as public and private payors shift to new payment methodologies that reward clinical and financial integration among providers. As a result, patients increasingly receive care from physicians and other health professionals organized into collaborative partnerships with one another and institutional providers, such as hospitals. As described below, this new organizational dynamic profoundly influences the clinical judgment of physicians. No longer can society simply depend on the professionalism of individual physicians to ensure ethical integrity in the health care setting. Rather, ethical integrity in the health care setting also requires a strong foundation of organizational ethics.

Most people identify Roe v. Wade with a single landmark judgment. It extended the constitutional right of individual privacy to a woman’s decision about whether to terminate a pregnancy. Indeed, political, judicial, and scholarly debates about the case have focused on the origin, content, and balancing of that substantive due process right to abortion.

Largely missing from these debates is Roe’s distinct holding, on the other side of the constitutional ledger, that the government has a valid reason to regulate reproductive conduct in the name of “potential life.” Despite decades of intensive litigation and academic commentary on the metes and bounds of reproductive privacy, scholars have paid little attention to the state’s interest in potential life that it is routinely found to implicate.

In the 20th century, public health was responsible for most of the 30-year increase in average life expectancy in the United States.1 Most of the significant advances in public health (e.g., vaccinations, water fluoridation) required the combined effort of scientists and attorneys. Scientists identified public health threats and the means of controlling them, but attorneys and policymakers helped convert those scientific discoveries into laws that could change the behavior of industries or individuals at a population level. In tobacco control, public health scientists made the groundbreaking discovery that smoking caused lung cancer, but attorneys and policymakers developed and implemented the policies and litigation strategies that helped reduce smoking rates by more than half over the past 50 years.