HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

A Member of the Law Professor Blogs Network

Saturday, November 5, 2005

Maine's Prisoner Case: Right to Die? To Commit Suicide?

Here's a follow-up on our earlier report about a prisoner in Penobscot County, Maine, who has refused most food and fluids for the 30 days.  On Thursday Superior Court Justice Andrew Mead upheld his previous order to force-feed prisoner James Emerson.  As reported by the Bangor Daily News, the judge handed down a four-page ruling, which said:

The sheriff cannot - by law - turn a blind eye to circumstances within his knowledge which threaten the wellbeing of individuals in his custody.  This applies equally to circumstances which such individuals bring on themselves. If an overt threat of suicide is brought to his attention, the sheriff must take reasonable measures to prevent the inmate from following through on his threat.

In [this] matter, the sheriff has concluded, and the court agrees, that the defendant's stated intention to discontinue life-sustaining sustenance constitutes a suicide threat.  If the sheriff fails to take reasonable steps to intervene after he is aware that a suicide attempt is being undertaken, he fails to discharge his constitutional duties. Among a host of repercussions is the fact that he (and the county) would be immediately liable in a civil wrongful death action.

This doesn't make a lot of sense to me.  If a prisoner dies while on a hunger strike, after the county tried all reasonable means, including an application for a court order to authorize force-feedings, and a court sided with the prisoner, would the prisoner's next of kin really have a wrongful death cause of action?  I don't see it.  I also don't see that there's an 8th Amendment compulsion to administer unwanted nutrition and hydration.  At least as long as the prisoner is competent, isn't it plausible that the duty to provide medical care doesn't extend beyond the willingness of the prisoner to accept it?  I would assume that the 8th Amendment imposes a duty upon the state to provide medical care that is needed and wanted (presumptively or otherwise).  But when the prisoner says no, is it obvious that the 8th Amendment requires treatment over the objections of the prisoner?

A more plausible rationale for the forced-feeding of prisoners is that the state has an interest in punishing the prisoner, including seeing that the prisoner lives long enough to carry out his sentence.  This interest is sufficiently important that it trumps the prisoner's interest in being left alone.  On this account of the matter, the prisoner's privacy rights pretty much cease at the entrance to the jail. 

There are obvious limits to this argument.  Plenty of cases hold that prisoners have the right to avoid forced administration of psychotropic medications, even when the state's rationale relates to its interest in carrying out a sentence or rendering the prisoner competent to stand trial.  In the Emerson case, perhaps the court has a duty to balance the state's penal interest against the prisoner's right of autonomy.  Emerson may still lose, especially since his own decision to thwart the county's interest in punishing him is responsible for the medical need for more nutrition and hydration, but shouldn't the court at least have its eye on the right ball? [tm]

November 5, 2005 | Permalink | TrackBack (0)

Tamiflu Questions

The New York Times business section has an article on how difficult the manufacture of Tamiflu may be.  It reports,

The National Health Research Institutes of Taiwan took only 18 days to produce a small quantity of Tamiflu, with guidance from published papers and patents. But producing large quantities is "another story" said K. S. Shia, who headed the project. Officials in Taiwan would not say how long it would take to achieve larger production.

Even if companies can make the drug, they might not have enough shikimic acid. That ingredient is extracted from the fruit of star anise trees, which grow in Southern China. Most of the star anise is now used for Roche's production, but it is also an Asian cooking spice and is used in herbal medicines and in the production of the liqueur pastis.

Since demand for Tamiflu started growing recently, the price of shikimic acid from China has soared to more than $400 a kilogram, from $40.

"We managed to corner a few tons but it won't go very far," said Mr. Hamied of Cipla. The company hopes by March to have produced enough oseltamivir to treat 100,000 to 200,000 people, he said.

Majikthise has some further information on the vaccine and whether it will even be effective against the bird flu.[bm]

November 5, 2005 | Permalink | TrackBack (0)

Friday, November 4, 2005

Cost of Flu Plan for States

CNN.com has an article on the costs to the states of President Bush's recently announced Bird Flu plan.  It states,

In particular, lawmakers take issue with the Bush administration's plans for the purchase of certain medicines. The plan says states would pay about $510 million for enough anti-flu drugs such as Tamiflu and Relenza, which can reduce the severity of the illness, to treat 31 million people.

The federal government would give states an incentive to make those purchases by providing a 25 percent match, or $170 million. Rep. Nita Lowey, D-New York, said the proposal amounted to an unfunded mandate on the states and might mean that some states would not be able to buy enough drugs. "This is a national emergency. I believe very strongly it should not depend upon where you live as to what sort of protection you get," Lowey told Leavitt at a House hearing Wednesday.

Leavitt unveiled the administration's pandemic preparedness plan during two separate hearings before congressional appropriators. Sen. Patty Murray, D-Washington, broached the issue of state funding, too. "States are extremely nervous about what's going to be required of them," she said.

[bm]

November 4, 2005 | Permalink | TrackBack (0)

Paying More in America

The Washington Post reports further on the study in Health Affairs which examines the high cost of medical care in the United States as compared to other countries.  According to the Post, the study demonstrates that:

Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.

The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated. . . .

The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period. The survey was aimed at evaluating care across varying types of health care systems, including the market-driven U.S. system and those that have more government controls and subsidies.

The survey, published in the journal Health Affairs, questioned 6,957 adults who had recently been hospitalized, had surgery or reported health problems between March and June of this year.

"These patients are the canary in the coal mine of any health care system," Schoen said.

Nearly a third of U.S. patients reported spending more than $1,000 in out-of-pocket expenses for their care, far outpacing all other nations. Canadians and Australians came next, with 14 percent of patients spending that much. The proportion reporting similarly high costs was far lower in the other countries.

[bm]

November 4, 2005 | Permalink | TrackBack (0)

Thursday, November 3, 2005

The New Republic and HSAs

The New Republic has two articles discussing Health Savings Accounts (HSAs).  The first one is by Jonathan Cohn entitled, "The Dangers of Consumer-Driven Health Care."  The second piece is entitled "Health Care in South Africa" and is by David Adler.  Both pieces are terrific.  Unfortunately, they are subscription only. 

Ezra Klein's blog examined the Adler piece briefly today and quotes it stating,

The South African story, then, is a move from a noncompetitive insurance environment to a competitive one, but the competition wasn't by hospitals to provide the best or cheapest care, but rather among insurers to get the healthiest patients. Consumer-driven plans are central to this process, because they are ideal for "risk-selecting" the young and fit, who have flocked to the new plans. Not in need of expensive medical care, the healthy could watch their account balances grow, leaving the truly sick behind in traditional plans.

This particular type of competition--to attract the healthy--in turn led to price increases, because insurers had little incentive to control the prices medical providers charged. After all, it was no longer their problem. It was up to the patient to worry about costs, and the patient hardly had the same bargaining power as the insurers once did.[...]

Ezra will have more in the upcoming future on the HSA issue.  [bm]

November 3, 2005 | Permalink | TrackBack (0)

US: Leader in Medical Errors

Professor Ross Silverman, University of Southern Illinois School of Law and School of Medicine, points to an interesting new study by Commonwealth Fund examining the rate of certain medical errors in the United States as compared to other countries.  It found,

Thirty-four percent of U.S. patients received wrong medication, improper treatment or incorrect or delayed test results during the last two years, the Commonwealth Fund found.

Thirty percent of Canadian patients reported similar medical errors, followed by 27 percent of those in Australia, 25 percent in New Zealand, 23 percent in Germany and 22 percent in Britain, the health care foundation said.

"Driven up by relatively high medication and lab or test errors, at 34 percent, the spread between the United States and the countries with the lowest error rates was wide," Cathy Schoen, senior vice president of Commonwealth Fund, wrote in the journal Health Affairs, which published the study on its Web site.

The Commonwealth Fund says its mission is to support independent research on health care issues.

The full article discussing this study is entitled:  "Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries" and is available here -- http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.509?ijkey=10nPOyqgRXKAM&keytype=ref&siteid=healthaff

Thanks to Ross for these sites!.  [bm]

November 3, 2005 | Permalink | TrackBack (0)

Too Many Law Schools . . .

Inside Higher Education reports on the increase in the number of law schools over the past few years.  Who knew?  It reports,

There is no shortage of jokes about the United States having too many lawyers. If there are any corollaries about law schools, the punch lines are falling on deaf ears at a host of institutions that have plans to open law schools.

Since 2003, at least seven new law schools have opened, and several more are on the way, including three that were announced this month at Drexel and Elon Universities and Mills College. Officials at some of those institutions said the new law schools are not just adding more desks, but will fill particular niches. Student demand suggests that the new schools are welcomed. . . .

John A. Sebert, the consultant on legal education to the American Bar Association, said that new law schools have generally been started by for-profit or religious institutions, or in states that perceive a dearth of lawyers. Liberty University School of Law, which opened in 2004, is one of the young religiously affiliated schools. On the blog of Bruce W. Green, the dean of the Liberty law school, the April 8, 2003 entry points out that the opening of law schools has not kept pace with population growth.

Still, some people, and not just bankers in need of lawyer jokes, wish there were less need to open more law schools.

Robert J. D’Agostino, a professor at the John Marshall Law School, thinks that, while the job market may suggest a need for more lawyers, an unfortunate trend of lawyers and judges effectively “becoming legislators,” he said, is pushing the need for more lawyers.

D’Agostino pointed to high profile class action suits – often against gun and cigarette manufacturers – where lawyers have “attempted to legislate by running companies out of business. It’s expanding tort law to blend into the legislative arena,” he said. “We had to have the vaccine companies threaten to pull out of the country” before the government stepped in, he said, referring to cases in which a small number of people adversely affected by a useful vaccine stood to win massive amounts of money in court.

[bm]

November 3, 2005 | Permalink | TrackBack (0)

Wednesday, November 2, 2005

Mesopotamian Medicine Superior to Colonial America's

Funky but true: "Chicago researchers JoAnn Scurlock and Burton Andersen found the physicians of the earliest civilizations were delivering surprisingly sophisticated, knowledgeable and effective health care 2,000 years before Christ lived" (Chicago Tribune):

In the world's first cities 4,000 years ago, people came to doctors for help with much the same problems they do today--everything from impotence, depression, tuberculosis and cancer to gluten hypersensitivity, hemorrhoids, narcolepsy and migraines.

The treatment they received in ancient Mesopotamia is also familiar in many respects, with medical specialists writing prescriptions for pills, potions and patches that patients would take to a pharmacist. . . .

In fact, citizens received treatment superior to what Americans got in George Washington's time, according to the researchers. The first president died in 1799 after doctors bled him in an effort to rectify the "imbalance" of his bodily "humors" . . . .

[The authors] may well upend conventional wisdom about the history of medicine, which has always given a hallowed place to ancient Greek physicians and dismissed medicine in ancient Mesopotamia as primitive superstition.

Mesopotamian treatments evolved through hundreds of years of careful experimentation and observation, the authors say. Some are still in use, such as surgically draining the pus that sometimes develops between the lungs and chest wall of pneumonia patients. Their precise instructions to "make an opening in the fourth rib [with] a flint knife" to insert a lead drainage tube pretty well match present-day procedures.

The ancient Greeks, by contrast, subscribed to the idea that the body is composed of four "humors"--yellow bile, black bile, water and phlegm. The Greek model of medicine persisted in Europe and America as late as the 1850s.

"Their best known treatments were bleeding, purging with laxatives, puking and starving," said Andersen, a retired professor and chief of infectious diseases at the University of Illinois at Chicago. "We now know, of course, all four of those are injurious and very seldom helpful in any circumstance."

"The Greeks are our intellectual ancestors, but these Mesopotamians are the true ancestors of modern medicine," said Scurlock, a professor of ancient history at Elmhurst College.

Scurlock and Andersen describe their findings in a newly published book entitled "Diagnoses in Assyrian and Babylonian Medicine" (900 pp., $150). [tm]

November 2, 2005 | Permalink | TrackBack (0)

President Bush's Bird Flu Plans

The New York Times reports on President Bush's Bird Flu plan.  It states,

President Bush announced Tuesday that he would ask Congress for $7.1 billion to prepare the nation for the possibility of a worldwide outbreak of deadly flu. Most of the money would be spent on research and a national stockpile of vaccines and antiviral drugs.

 

 

"Our country has been given fair warning of this danger to our homeland and time to prepare," Mr. Bush said. "It's my responsibility as the president to take measures now to protect the American people."

Mr. Bush made his announcement in a speech at the National Institutes of Health, in nearby Bethesda, Md., before an audience that included six cabinet secretaries and the nation's top health care officials. He spoke for nearly 28 minutes and gave a detailed summary of the history and risks of flu pandemics.

"A flu pandemic would have global consequences," he said as he jabbed his lectern, "so no nation can afford to ignore this threat, and every nation has responsibilities to detect and stop its spread."

In the wake of the government's poor response to Hurricane Katrina, the Bush administration has been at pains to reassure the country that it is taking seriously the threat of a pandemic flu, which some experts see as the next calamity that could befall the United States.

But in the Senate, where a measure to spend $8 billion on pandemic flu preparations passed on a vote of 94 to 3 last week, Democrats immediately criticized the president's plan Tuesday as inadequate. One of them, Senator Edward M. Kennedy of Massachusetts, said Mr. Bush's proposal "needs to be stronger," and called for more spending to ensure that hospitals and other health care facilities have the capacity to handle a flood of patients. Another, Senator Charles E. Schumer of New York, said the president's plan did not envision buying enough Tamiflu, an antiviral drug, to protect the United States.

For some futher responses to the President's plans, see here and here. [bm]

November 2, 2005 | Permalink | TrackBack (0)

Tuesday, November 1, 2005

Upcoming Disability Law Symposium

The University of Mississippi School of Law is hosting an interesting and informative symposium on the 15th year anniversary of the Americans with Disabilities Act.  Entitled, "The Americans with Disabilities Act at 15:  Past, Present and Future," the conference will be held in the William N. Etheridge Jr. Moot Court Room at the University of Mississippi School of Law on November 4, 2005 from 9:30 until 12N. 

Featured speakers include:  Professors Peter Blanck, Syracuse University and University of Iowa College of Law; Kaaryn Gustafson, University of Connecticut Law School; Ann Hubbard, University of Cincinnati College of Law; Miranda McGowan,University of San Diego School of Law; Camille Nelson, St. Louis University School of Law; Michael Stein, Harvard University Law School and the College of William and Mary School of Law; and Michael Waterstone, University of Mississippi School of Law.  It should be a terrific symposium! 

The symposium is free and open to the public. 

For more information, please see www.law.olemiss.edu

For those of you who cannot make the conference, the papers presented will be published in the Mississippi Law Journal.  [bm]

November 1, 2005 | Permalink | TrackBack (0)

New Law School Rankings Information

We are delighted to announce the launch of Leiter’s Law School Rankings ( www.leiterrankings.com), by Brian Leiter, Joseph D. Jamail Centennial Chair in Law at the University of Texas School of Law, in association with our Law Professor Web Services LLC ( www.lawprofessorblogs.com/webservices)

Leiter’s Law School Rankings (1) contains two brand new law school quality rankings, and (2) expands and redesigns the rankings material formerly maintained on the University of Texas School of Law web site.

1.  The new 2005 rankings are:

• Faculty Quality Rankings: Scholarly Impact (Citations), summarized below

• Student Quality Rankings

2.  Leiter’s Law School Rankings presents law school rankings material in seven categories:

•  Newest Rankings contains the latest 2005 rankings (Faculty Quality Rankings: Scholarly Impact (Citations) and Student Quality Rankings)

•  Faculty Rankings contains rankings of scholarly quality (as measured by reputation, productivity, and impact) and teaching quality, as well as a listing of faculty moves

•  Student Rankings contains rankings of student quality (as measured by LSAT scores and undergraduate GPAs)

•  Job Placement contains rankings of placement of students at elite law firms, a well as listings of where faculty went to law school and Supreme Court clerkships

•  U.S. News Rankings contains discussions of the U.S. News & World Report Law School Rankings and how the rankings on this site differ from U.S. News

•  Archives contains Educational Quality Rankings of U.S. Law Schools from earlier years

•  Links contains links to law review articles on law school rankings (the links are to the articles on SSRN, Hein-on-Line, and Westlaw, in that order of priority)

Here are the latest July 2005 faculty rankings, listing the Top 30 law school faculties as measured by mean and median per capita scholarly impact (citations):                                                                
       

Rank 

School

Score

   1

Chicago

100

   2

Yale

  77

   3

Harvard

  68

   4

Stanford

  61

   5

Berkeley

  50

   6

NYU

  45

   7

Columbia

  43

   8

Georgetown

  37

   9

Duke

  31

Texas

  31

11

Cornell

  29

12

Northwestern

  28

13

Michigan

  27

Virginia

  27

15

UCLA

  26

16

George Washington

  24

17

Colorado

  23

18

Boston University

  22

 

Emory

  22

Illinois

  22

21

Penn

  20

Vanderbilt

  20

23

George Mason

  19

Arizona

  19

Hastings

  19

Minnesota

  19

San Diego

  19

28

Arizona State

  18

Ohio State

  18

Iowa

  18

Others

Brooklyn

  17

Pittsburgh

  17

USC

  17

Chicago-Kent

  16

Washington University-St. Louis

  16

Cardozo

  15

Fordham

  15

North Carolina

  14

William & Mary

  11

Our goal is to make Leiter’s Law School Rankings the premier Internet site of law school rankings for prospective, current, and former law students; law school faculty and administrators; and practicing lawyers in law firms, government, and public interest organizations. Please email us comments or suggestions for improvement.

Law Professor Web Services LLC

Paul L. Caron
Charles Hartsock Professor of Law
University of Cincinnati College of Law
paul.caron@uc.edu

Joseph A. Hodnicki
Associate Director for Library Operations      
University of Cincinnati College of Law
joe.hodnicki@gmail.com

November 1, 2005 | Permalink | TrackBack (0)

Common Sense About Avian Flu

From Tuesday's on-line Wall Street Journal comes this common-sense (and free) article about avian flu and the risks associated with travel abroad, consumption of bird products, and the purchase of birds as pets, among other things.

Meanwhile, Japan plans to kill 82,000 chickens "after signs of bird flu were detected at a farm northeast of Tokyo, and authorities in Thailand said a woman was diagnosed with the disease after cleaning out a chicken coop" (AP), and China's public health chief conceded Monday that "it must work hard to prevent bird flu from spreading around the world" (AP).  [tm]

November 1, 2005 | Permalink | TrackBack (0)

Monday, October 31, 2005

SCOTUS: Action in 2 Pharm Patent Cases

From Monday's SCOTUSblog:

In [a] patent case, Laboratory Corp. of America v. Metabolite Laborities, Inc., et al. (04-607), the Court granted review of one of three questions presented. The case asks the Court to clarify the legal standard for patentability for a medical process. The question granted involves whether a patent may be granted on a process for detecting a scientific relationship between a medical test result and a medical condition in a patient -- in other words, whether a natural correlation between a scientific fact and a medical condition can be patented, or whether that is a phenomenon of nature that cannot be patented.

In another major patent law case, the Court asked for the views of the U.S. Solicitor General on Federal Trade Commission v. Schering-Plough (05-273). That case tests whether it is a violation of federal antitrust law for the maker of a brand-name drug to pay a potential maker of a competing generic drug to delay putting that alternative drug on the market. The Court had a similar issue before it last term, but denied review after the Justice Department said that the lower court there had gone too far in finding a "per se" violation of antitrust law in such a deal. In the Schering-Plough case, the 11th Circuit ruled that neither a rule-of-reason nor a per se mode of analysis was apprropriate in an antitrust case involving patents. There is no time limit for the Solicitor General to respond. (Justice Stephen G. Breyer is recused in the case.)

[tm]

October 31, 2005 | Permalink | TrackBack (0)

Women's Health and Conservative Political Agenda

First, Plan B and now cervical cancer vaccine . . . .  According to the Washington Post, some members of the abstitence movement have made know that they have some concerns about a new cervical cancer vaccine.   The Post states,

A new vaccine that protects against cervical cancer has set up a clash between health advocates who want to use the shots aggressively to prevent thousands of malignancies and social conservatives who say immunizing teenagers could encourage sexual activity.. . . .

The vaccine protects women against strains of a ubiquitous germ called the human papilloma virus. Although many strains of the virus are innocuous, some can cause cancerous lesions on the cervix (the outer end of the uterus), making them the primary cause of this cancer in the United States. Cervical cancer strikes more than 10,000 U.S. women each year, killing more than 3,700.

The vaccine appears to be virtually 100 percent effective against two of the most common cancer-causing HPV strains. Merck, whose vaccine is further along, plans to ask the Food and Drug Administration by the end of the year for approval to sell the shots.

Exactly how the vaccine is used, however, will be largely determined by the Advisory Committee on Immunization Practices, a panel of experts assembled by the Centers for Disease Control and Prevention in Atlanta. The panel issues widely followed guidelines, including recommendations for childhood vaccines that become the basis for vaccination requirements set by public schools.

Officials of both companies noted that research indicates the best age to vaccinate would be just before puberty to make sure children are protected before they become sexually active. The vaccine would probably be targeted primarily at girls but could also be used on boys to limit the spread of the virus.

"If you really want to have cervical cancer rates fall as much as possible as quickly as possible, then you want as many people to get vaccinated as possible," said Mark Feinberg, Merck's vice president of medical affairs and policy, noting that "school mandates have been one of the most effective ways to increase immunization rates."

That is a view being pushed by cervical cancer experts and women's health advocates.

"I would like to see it that if you don't have your HPV vaccine, you can't start high school," said Juan Carlos Felix of the University of Southern California in Los Angeles, who leads the National Cervical Cancer Coalition's medical advisory panel.

At the ACIP meeting last week, panel members heard presentations about the pros and cons of vaccinating girls at various ages. A survey of 294 pediatricians presented at the meeting found that more than half were worried that parents of female patients might refuse the vaccine, and 11 percent of the doctors said they themselves thought vaccinating against a sexually transmitted disease "may encourage risky sexual behavior in my adolescent patients."

Conservative groups say they welcome the vaccine as an important public health tool but oppose making it mandatory.

"Some people have raised the issue of whether this vaccine may be sending an overall message to teenagers that, 'We expect you to be sexually active,' " said Reginald Finger, a doctor trained in public health who served as a medical analyst for Focus on the Family before being appointed to the ACIP in 2003, in a telephone interview.

"There are people who sense that it could cause people to feel like sexual behaviors are safer if they are vaccinated and may lead to more sexual behavior because they feel safe," said Finger, emphasizing that he does not endorse that position and is withholding judgment until the issue comes before the vaccine policy panel for a formal recommendation.

[bm]

October 31, 2005 | Permalink | TrackBack (0)

Maine Docs Refuse to Force-Feed Prisoner

According to a recent article in the Bangor Daily News, James Emerson is a county jail inmate in Penobscot County who has been on a hunger strike for 17 days.  Subsisting on a diet of water and a few crackers, he has lost 20% of his body weight, which led a local judge to order the county sheriff to take him to Eastern Maine Medical Center (where I was born, more years ago than I would care to count) to get him fed against his will.  Once there, however, the hospital and its docs balked, saying the prisoner doesn't meet their medical criteria for insertion of an involuntary naso-gastric tube:

EMMC spokeswoman Jill McDonald said hospitals, in general, perform procedures only with the permission of the patient.

"We are not parties to court orders; we are under a different set of obligations," McDonald said late Friday night.

The whole field of incarceration and health care, including mental health treatments to make a patient competent to stand trial or to be punished, is fascinating.  Thanks to college classmate Rick Goggans for passing this story along.  I'll keep you posted on the results of this as the case unfolds.  [tm]

October 31, 2005 | Permalink | TrackBack (0)

Political Agendas and Health

The Washington Post contains an article today discussing the new cervical cancer vaccine that should be available next year.  According to the Post, the vaccine appears to be almost 100 percent effective against the most common cancer-causing strains. By the end of the year, Merck hopes to be in the process of gaining FDA approval to sell the shots.  Sounds good to me --- but wait --- this vaccine might somehow encourage girls to have sex so we need to be extra careful not to make it mandatory . . . . . . 

Groups working to reduce the toll of the cancer are eagerly awaiting the vaccine and want it to become part of the standard roster of shots that children, especially girls, receive just before puberty.

Because the vaccine protects against a sexually transmitted virus, many conservatives oppose making it mandatory, citing fears that it could send a subtle message condoning sexual activity before marriage. Several leading groups that promote abstinence are meeting this week to formulate official policies on the vaccine. . . . .

The vaccine protects women against strains of a ubiquitous germ called the human papilloma virus. Although many strains of the virus are innocuous, some can cause cancerous lesions on the cervix (the outer end of the uterus), making them the primary cause of this cancer in the United States. Cervical cancer strikes more than 10,000 U.S. women each year, killing more than 3,700. . . .

Exactly how the vaccine is used, however, will be largely determined by the Advisory Committee on Immunization Practices, a panel of experts assembled by the Centers for Disease Control and Prevention in Atlanta. The panel issues widely followed guidelines, including recommendations for childhood vaccines that become the basis for vaccination requirements set by public schools.

Officials of both companies noted that research indicates the best age to vaccinate would be just before puberty to make sure children are protected before they become sexually active. The vaccine would probably be targeted primarily at girls but could also be used on boys to limit the spread of the virus.

"If you really want to have cervical cancer rates fall as much as possible as quickly as possible, then you want as many people to get vaccinated as possible," said Mark Feinberg, Merck's vice president of medical affairs and policy, noting that "school mandates have been one of the most effective ways to increase immunization rates."

That is a view being pushed by cervical cancer experts and women's health advocates.

"I would like to see it that if you don't have your HPV vaccine, you can't start high school," said Juan Carlos Felix of the University of Southern California in Los Angeles, who leads the National Cervical Cancer Coalition's medical advisory panel.

At the ACIP meeting last week, panel members heard presentations about the pros and cons of vaccinating girls at various ages. A survey of 294 pediatricians presented at the meeting found that more than half were worried that parents of female patients might refuse the vaccine, and 11 percent of the doctors said they themselves thought vaccinating against a sexually transmitted disease "may encourage risky sexual behavior in my adolescent patients."

Conservative groups say they welcome the vaccine as an important public health tool but oppose making it mandatory.

"Some people have raised the issue of whether this vaccine may be sending an overall message to teenagers that, 'We expect you to be sexually active,' " said Reginald Finger, a doctor trained in public health who served as a medical analyst for Focus on the Family before being appointed to the ACIP in 2003, in a telephone interview.

Someone please make this stop! [bm]

October 31, 2005 | Permalink | TrackBack (0)

New Supreme Court Nomination

President Bush has nominated Judge Samuel A. Alito, Jr., who currently sits on the Third Circuit Court of Appeals.  Scotusblog has some further information here and here.

October 31, 2005 | Permalink | TrackBack (0)

Sunday, October 30, 2005

Leon Kass part 2 of Courtship

Leon Kass has published the second part of his The End of Courtship series.  I am not sure that this is a good career move for him to publish these pieces.  He comes across rather sexist (something I wasn't aware of previously).  Here is a small sample,

Her sexuality unlinked to procreation, its exercise no longer needs to be concerned with the character of her partner and whether he is suitable to be the father and co-rearer of her yet-to-be-born children. Female sexuality becomes, like male, unlinked to the future. The new woman's anthem: Girls just want to have fun. Ironically, but absolutely predictably, the chemicals devised to assist in family planning keep many a potential family from forming, at least with a proper matrimonial beginning.

[bm]

October 30, 2005 | Permalink | TrackBack (0)

Boutique Medicine, Redux

There's a good article in today's NY Times about boutique (or concierge) medicine.  It raises the ethical and regulatory issues early and gets back to them later in the article in slightly more depth.  Overall, a pretty good, balanced piece.  [tm]

October 30, 2005 | Permalink | TrackBack (0)