Wednesday, August 16, 2017

Medical Liability - Prospects for Federal Reform

 2017 May 11;376(19):1806-1808. doi: 10.1056/NEJMp1701174. Epub 2017 Mar 29.

Medical Liability - Prospects for Federal Reform.

Author information

1
From Stanford Law School (M.M.M., D.M.S.) and the Departments of Medicine (D.M.S.) and Health Research and Policy (M.M.M.), Stanford University School of Medicine, Stanford, CA; and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston (A.K.).


"How promising are these reform ideas? Safe harbors for physicians who adhere to evidence-based practice is an idea that dates back to the 1980s. It has attracted interest from health care provider groups, health insurers, and health policy experts. Theoretically, it could reduce the practice of defensive medicine while encouraging wider adherence to guidelines — responses that harmonize with improving the quality of care.
However, the limited evidence base does not suggest that guideline-based safe harbors are effective in reducing liability claims or costs (see table). In states that have tried them, they do not appear to have had an impact, and the programs have withered. One key reason is the surprisingly small overlap between aspects of care disputed in malpractice litigation and aspects addressed by CPGs. One recent simulation study showed that safe harbors would have eliminated defendants’ malpractice payments in less than 1% of claims; in 85% of cases no guideline applied, and when one did, physicians generally prevailed regardless.3 A surge in availability and use of CPGs could enlarge the overlap, but the effects of safe harbors on liability costs would probably be modest at best. Nevertheless, safe harbors are appealing for other reasons: they promote quality of care and safety by providing incentives for practicing evidence-based medicine, and they may accelerate claim resolution."

Tuesday, August 15, 2017

FCC Chair Ajit Pai "...seems to have never met a regulation he didn’t want to kill..."

Congress starts work on net neutrality — but does it understand the issue?

"Puushed by its new Republican chairman, Ajit Pai, who seems to have never met a regulation he didn’t want to kill, the Federal Communications Commission has proposed repealing the tough net neutrality rules his predecessor, Democrat Tom Wheeler, adopted in 2015 and replacing them with … well, that part’s not clear. One possibility Pai floated is to have the FCC punt oversight of broadband providers such as Comcast and AT&T to the Federal Trade Commission, which can do little more to first-time offenders than tell them they’ll be punished if they transgress again."

HT:LR

Saturday, August 12, 2017

Immunohistochemistry of Pulmonary Biomarkers: A Perspective From Members of the Pulmonary Pathology Society

 2017 Jul 7. doi: 10.5858/arpa.2017-0106-SA. [Epub ahead of print]

Immunohistochemistry of Pulmonary Biomarkers: A Perspective From Members of the Pulmonary Pathology Society.

Abstract

The use of immunohistochemistry for the determination of pulmonary carcinoma biomarkers is a well-established and powerful technique. Immunohistochemisty is readily available in pathology laboratories, is relatively easy to perform and assess, can provide clinically meaningful results very quickly, and is relatively inexpensive. Pulmonary predictive biomarkers provide results essential for timely and accurate therapeutic decision making; for patients with metastatic non-small cell lung cancer, predictive immunohistochemistry includes ALK, (ROS1, EGFR in Europe), and programmed death ligand-1 (PD-L1) testing. Handling along proper methodologic lines is needed to ensure patients receive the most accurate and representative test outcomes.

“Elvis could focus better than any artist I ever worked with..."

Elvis Presley’s friends feel love, pain, 40 years after his death


Putnam, a bass guitarist and member of the renowned Muscle Shoals rhythm section, played on 120 Presley songs. He recalls how much energy Presley displayed during the marathon recording sessions that ran all night at RCA Studio B in Nashville in 1970.

“Elvis could focus better than any artist I ever worked with,” Putnam said. “He would learn a new song in five to 10 minutes, and was ready to deliver a killer vocal on the first take. That was very unusual.”

"Insurers attempting to price their plans and determine which states and counties they will service next year face a great deal of uncertainty."

An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges


"Insurers attempting to price their plans and determine which states and counties they will service next year face a great deal of uncertainty. They must soon sign contracts locking in their premiums for the entire year of 2018, yet Congress or the Administration could make significant changes in the coming months to the law – or its implementation – that could lead to significant losses if companies have not appropriately priced for these changes. Insurers vary in the assumptions they make regarding the individual mandate and cost-sharing subsidies and the degree to which they are factoring this uncertainty into their rate requests."

"All the old nostrums about independence suddenly seemed like unaffordable luxuries."

When Silicon Valley Took Over Journalism

The pursuit of digital readership broke the New Republic—and an entire industry.

"At the beginning of this century, journalism was in extremis. Recessions, coupled with readers’ changing habits, prodded media companies to gamble on a digital future unencumbered by the clunky apparatus of publishing on paper. Over a decade, the number of newspaper employees dropped by 38 percent. As journalism shriveled, its prestige plummeted. One report ranked newspaper reporter as the worst job in America. The profession found itself forced to reconsider its very reasons for existing. All the old nostrums about independence suddenly seemed like unaffordable luxuries."

Eat right. Work out.

Exercise does so much for you. Why won’t it make you lose weight?


Exercise helps keep lost pounds off, but exercise alone can’t do the initial job of losing it.
“I think the role of exercise in weight loss is highly overrated,” says Marc Reitman, chief of the diabetes, endocrinology and obesity branch of the National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK. “I think it’s really great for being healthy, but I’m a strong believer that overeating is what causes obesity. To exercise your way out of overeating is impossible.”

Human Genome Editing: Science, Ethics, and Governance

Human Genome Editing: Science, Ethics, and Governance.

Editors

National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; National Academy of Sciences; Committee on Human Gene Editing: Scientific, Medical, and Ethical Considerations.

Source

Washington (DC): National Academies Press (US); 2017 Feb.

Excerpt

Genome editing is a powerful new tool for making precise alterations to an organism's genetic material. Recent scientific advances have made genome editing more efficient, precise, and flexible than ever before. These advances have spurred an explosion of interest from around the globe in the possible ways in which genome editing can improve human health. The speed at which these technologies are being developed and applied has led many policymakers and stakeholders to express concern about whether appropriate systems are in place to govern these technologies and how and when the public should be engaged in these decisions. Human Genome Editing considers important questions about the human application of genome editing including: balancing potential benefits with unintended risks, governing the use of genome editing, incorporating societal values into clinical applications and policy decisions, and respecting the inevitable differences across nations and cultures that will shape how and whether to use these new technologies. This report proposes criteria for heritable germline editing, provides conclusions on the crucial need for public education and engagement, and presents 7 general principles for the governance of human genome editing.

Rosie Roach

FROM DECEMBER 2015:


Funeral shrine celebrates fallen Texas A&M cockroach


Published 2:00 pm, Monday, December 21, 2015


"There has been a dead cockroach in the anthropology building's stairwell for at least two weeks," professor Michael Alvard wrote on Facebook on December 3, along with a picture of Rosie laid beside her mini-headstone. "Some enterprising person has now made her a little shrine."




Friday, August 11, 2017

Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group

Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group.


 2017 Jul 7. doi: 10.5858/arpa.2017-0124-RA. [Epub ahead of print]

Abstract

CONTEXT:

- Malignant mesothelioma (MM) is an uncommon tumor that can be difficult to diagnose.

OBJECTIVE:

- To provide updated, practical guidelines for the pathologic diagnosis of MM.

DATA SOURCES:

- Pathologists involved in the International Mesothelioma Interest Group and others with an interest and expertise in the field contributed to this update. Reference material included up-to-date, peer-reviewed publications and textbooks.

CONCLUSIONS:

- There was discussion and consensus opinion regarding guidelines for (1) distinguishing benign from malignant mesothelial proliferations (both epithelioid and spindle cell lesions), (2) cytologic diagnosis of MM, (3) recognition of the key histologic features of pleural and peritoneal MM, (4) use of histochemical and immunohistochemical stains in the diagnosis and differential diagnosis of MM, (5) differentiating epithelioid MM from various carcinomas (lung, breast, ovarian, and colonic adenocarcinomas, and squamous cell and renal cell carcinomas), (6) diagnosis of sarcomatoid MM, (7) use of molecular markers in the diagnosis of MM, (8) electron microscopy in the diagnosis of MM, and (9) some caveats and pitfalls in the diagnosis of MM. Immunohistochemical panels are integral to the diagnosis of MM, but the exact makeup of panels employed is dependent on the differential diagnosis and on the antibodies available in a given laboratory. Depending on the morphology, immunohistochemical panels should contain both positive and negative markers for mesothelial differentiation and for lesions considered in the differential diagnosis. Immunohistochemical markers should have either sensitivity or specificity greater than 80% for the lesions in question. Interpretation of positivity generally should take into account the localization of the stain (eg, nuclear versus cytoplasmic) and the percentage of cells staining (>10% is suggested for cytoplasmic and membranous markers). Selected molecular markers are now being used to distinguish benign from malignant mesothelial proliferations. These guidelines are meant to be a practical diagnostic reference for the pathologist; however, some new pathologic predictors of prognosis and response to therapy are also included.

Ready Player One: Proponents of Later School Start Times See Momentum

Proponents of Later School Start Times See Momentum

With students getting ready to hit the books again, some will be getting some more sleep first.



"A key factor in the push for later school start times is the changing sleep pattern of children when they reach puberty. Research shows that as a result of shifting melatonin levels, adolescents need an increased amount of sleep, can have trouble falling asleep before 11 p.m. and function best when allowed to sleep until 8 a.m. or later."

Sunday, August 6, 2017

Nannystate: Toddlers to be banned from having fruit juice at nursery

JUICE NO MORE 

Toddlers to be banned from having fruit juice at nursery in new crackdown on child obesity


Experts fear the young kids may not get their recommended five-a-day fruit and veg intake


"The new menus recommend that nurseries only offer water or milk to youngsters at meal times.
Before the shakeup, The Children’s Food Trust – which drew up the new guidelines – said kids could have some juice at meals, if diluted with water."
























Overfat

Is 'overfat' the new obesity?



What is overfat?

"Overfat is a term created to describe if you have a body fat level that can actually hurt your health. Even people who are considered 'normal weight' or 'non-obese' by traditional standards can fall into this category.

The authors of this new study argue that BMI misses about 50% of the people who still have dangerous amounts of fat. Those are typically people who have the proverbial beer belly, but are otherwise in decent shape."

"...the well-documented need for effective clinical communication tools and therapeutic interventions where a child's mother is diagnosed with life-threatening gynecological cancer."

 2017 Aug 4. doi: 10.1089/jpm.2017.0058. [Epub ahead of print]

My Kite Will Fly: Improving Communication and Understanding in Young Children When a Mother Is Diagnosed with Life-Threatening Gynecological Cancer.

Author information

1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Parkville, Victoria, Australia .
2
2 Social Work and Cultural Diversity, The Royal Melbourne Hospital , Parkville, Victoria, Australia; Department of Cancer Experience Research, Peter MacCallum Centre, Parkville, Victoria, Australia .
3
3 Department of Social Work, Faculty of Medicine, Dentristry and Health Sciences, The University of Melbourne , Parkville, Victoria, Australia .
4
4 Department of Social Work, Faculty of Medicine Nursing and Health Sciences, Monash University and Monash Health , Clayton, Victoria, Australia .
5
5 My Kite Will Fly Research Project, The Writing Practice , Melbourne, Victoria, Australia .
6
6 Centre for Women's Mental Health, Royal Women's Hospital , Parkville, Victoria, Australia .
7
7 Department of Psychiatry, The University of Melbourne , Parkville, Victoria, Australia .
8
8 International Gynecologic Cancer Society (IGCS) , Louisville, Kentucky.

Abstract

STUDY AIMS:

The My Kite Will Fly (MKWF) research program is built on the well-documented need for effective clinical communication tools and therapeutic interventions where a child's mother is diagnosed with life-threatening gynecological cancer.

METHODS:

The Dignity Model and Child-Centered approach were two key study foundations in this pilot cohort. Quantitative survey and qualitative semistructured methods were employed to gather data from patient families at three distinct phases: Diagnosis, Treatment, and Palliative care. Participants were identified from patient groups at The Royal Women's Hospital and Peter MacCallum Cancer Center, Melbourne, Australia. A purposive sample (n = 36 children) (24 girls and 12 boys aged between 3 and 12 years) drawn from 19 families completed structured art therapy workbook activities. The principal researcher and a specialist educational assistant undertook cross-case thematic analysis of all interviews and children's drawings.

RESULTS:

Five central themes were profiled in six illustrative case studies. Interviews with all families (n = 19) showed 86.1% positive evaluation of the MKWF workbook template at diagnosis. During treatments, 66.6% of parents reported better understanding of the chemotherapy process and better communication with younger family members. At palliative care, 97.3% of families reported stabilization of family routines and improved illness coping. Exit interviews with six children and surviving parents (n = 4) showed that the program substantially prepared them for parental bereavement.

CONCLUSIONS:

Results from this pilot cohort confirm the importance of enhanced parent-child communication and stabilized family routines. Current results provide an important platform for future evaluative research among larger patient-family populations across multisite oncology settings.

Saturday, August 5, 2017

Think opera's boring?

Think opera's boring?

Still my favorite Gangnam Style parody

Houston, what's the problem?

Poor sleep habits increase risk for obesity, study says



Poor sleep habits increase risk for obesity, study says


According to study co-author Greg Potter, "The number of people with obesity worldwide has more than doubled since 1980. Obesity contributes to the development of many diseases, most notably type 2 diabetes. Understanding why people gain weight has crucial implications for public health."


Combination Therapy of Radiotherapy and Anti-PD-1/PD-L1 Treatment in Non-Small-cell Lung Cancer

 2017 Jul 6. pii: S1525-7304(17)30202-4. doi: 10.1016/j.cllc.2017.06.015. [Epub ahead of print]

Combination Therapy of Radiotherapy and Anti-PD-1/PD-L1 Treatment in Non-Small-cell Lung Cancer: A Mini-review.

Author information

1
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
2
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: gouji104kawa@gmail.com.

Abstract

Immune checkpoint inhibitors against programmed cell death-1 (PD-1) or programmed cell death-ligand 1 (PD-L1) are a standard pharmacologic therapy for patients with non-small-cell lung cancer (NSCLC). Substantial data have accumulated in recent years showing that radiotherapy combined with immunotherapy is more effective than monotherapy alone. Preclinical studies have shown that PD-L1 expression is upregulated on tumor cells after radiotherapy, resulting in the synergistically enhanced antitumor effect of irradiation and PD-L1 blockade. In the clinical setting, patients receiving radiotherapy before anti-PD-1 treatment have had a significantly better prognosis than those who have not undergone radiotherapy. In the present report, we reviewed previous studies of the combination of radiotherapy and anti-PD-1/PD-L1 treatment for NSCLC. In addition, we report our case of a patient whose PD-L1 expression gradually increased in brain metastases from NSCLC after repeated radiotherapy. In the perspectives portion, we focused on the questions of how to integrate radiotherapy into anti-PD-1/PD-L1 agent regimens and described several ongoing clinical trials.

Human Germline Genome Editing

 2017 Aug 3;101(2):167-176. doi: 10.1016/j.ajhg.2017.06.012.

Human Germline Genome Editing.

Author information

1
Department of Genetics and Stanford Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, CA 94305, USA. Electronic address: kormond@stanford.edu.
2
Vanderbilt Genetics Institute and Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN 37232, USA.
3
American Society of Human Genetics, Bethesda, MD 20814, USA.
4
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5B 1W8, Canada.
5
Division of Genomics and Society, National Human Genome Research Institute, Bethesda, MD 20892, USA.
6
Genomic Medicine Institute, Geisinger Health System, Danville, PA 17822, USA; National Society of Genetic Counselors.
7
Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA 98101, USA; Division of Bioethics, Department of Pediatrics, University of Washington, Seattle, WA 98101, USA.
8
National Society of Genetic Counselors; Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, NY 10708, USA.
9
Dr. John T. Macdonald Foundation Department of Human Genetics and Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
10
Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK; Association of Genetic Nurses and Counsellors.
11
Cardiovascular Institute, Departments of Medicine and Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
12
Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892, USA; International Genetic Epidemiology Society.
13
Provincial Health Service Authority of British Columbia and Department of Medical Genetics, University of British Columbia, BC V6H 3N1, Canada; Canadian Association of Genetic Counsellors.

Abstract

With CRISPR/Cas9 and other genome-editing technologies, successful somatic and germline genome editing are becoming feasible. To respond, an American Society of Human Genetics (ASHG) workgroup developed this position statement, which was approved by the ASHG Board in March 2017. The workgroup included representatives from the UK Association of Genetic Nurses and Counsellors, Canadian Association of Genetic Counsellors, International Genetic Epidemiology Society, and US National Society of Genetic Counselors. These groups, as well as the American Society for Reproductive Medicine, Asia Pacific Society of Human Genetics, British Society for Genetic Medicine, Human Genetics Society of Australasia, Professional Society of Genetic Counselors in Asia, and Southern African Society for Human Genetics, endorsed the final statement. The statement includes the following positions. (1) At this time, given the nature and number of unanswered scientific, ethical, and policy questions, it is inappropriate to perform germline gene editing that culminates in human pregnancy. (2) Currently, there is no reason to prohibit in vitro germline genome editing on human embryos and gametes, with appropriate oversight and consent from donors, to facilitate research on the possible future clinical applications of gene editing. There should be no prohibition on making public funds available to support this research. (3) Future clinical application of human germline genome editing should not proceed unless, at a minimum, there is (a) a compelling medical rationale, (b) an evidence base that supports its clinical use, (c) an ethical justification, and (d) a transparent public process to solicit and incorporate stakeholder input.

HOW TO LOSE WEIGHT AND KEEP IT OFF? ETERNAL DIETING VIGILANCE

HOW TO LOSE WEIGHT AND KEEP IT OFF? ETERNAL DIETING VIGILANCE



"Although cutting calories can cause weight loss, it does not follow that if a person returns to their usual diet they will maintain their new low weight. In fact, studies have found that after a low calorie diet, between one- and two-thirds of people regain more weightthan they had lost initially.

The fundamental problem with cutting calories is that the human body defends its original weight. Evolution has produced a body that anticipates future famine, with the result that when you reduce calorie intake there are strong physiological pressures to replace the lost energy.

For example, dieting causes the gut to release a range of hormones that increase appetite: changes that are still apparent after the diet is over. Leptin—which makes one feel satisfied and full—has been found to be still reduced a year after dieting has finished, while ghrelin, a hormone which stimulates appetite, remains raised. So even a year after a person finishes their diet, they will feel hungrier than when they started dieting, and still anticipate a higher food consumption than before the diet."

Saturday, July 22, 2017

"...today’s 19-year-old is as sedentary as a 60-year-old."

Pittsburgh Post-Gazette: Turn off the game, then get up and move



"A group of economists released a paper recently suggesting that young men are working fewer hours because they are spending so much time playing video games.
Video games might also help explain a study last month from Johns Hopkins University researchers who said today’s 19-year-old is as sedentary as a 60-year-old."

Democrats demand more 'nutrition education' in public schools to fight obesity

Democrats demand more 'nutrition education' in public schools to fight obesity


"More than two dozen House Democrats proposed legislation Thursday that would require any school participating in the national school lunch program to teach students 50 hours of nutrition education per year."

"...drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014..."

Opioids and Obesity Driving Increased Death Rates for White Men, Not Despair



"Those reports claim “despair deaths” — by suicide, alcohol, and drugs — are on the rise among white Americans, particularly men, facing a lack of economic opportunity and an increase in chronic pain.
Instead, the new study from researchers at the University of Colorado at Boulder finds that drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available.
“We find little empirical support for the pain-and distress-based explanations for rising mortality in the U.S. white population,” said lead author Ryan Masters, an assistant professor of sociology at University of Colorado’s Institute of Behavioral Science. “Instead, recent mortality increases have likely been shaped by the U.S. opiate epidemic.”
Masters said metabolic diseases, including heart disease, obesity, and diabetes, also play a key role. After years of declining death rates for such diseases, thanks to new drugs and procedures, that progress has slowed for men and stalled for women, according to the study’s findings.
“When it comes to mortality, we are just starting to see the real health consequences of the obesity epidemic,” he said"

"The causative agent of Q fever, Coxiella burnetii, has the potential to be developed for use in biological warfare and it is classified as a bioterrorism threat agent by the Centers for Disease Control and Prevention (CDC) and as a category B select agent by the National Institute of Allergy and Infectious Diseases (NIAID)."

 2017 Jun 15. pii: S1755-4365(16)30048-2. doi: 10.1016/j.epidem.2017.06.001. [Epub ahead of print]

A human time dose response model for Q fever.

Author information

1
Public Health England, Porton, Wiltshire SP4 0JG, United Kingdom. Electronic address: Charles.Heppell@phe.gov.uk.
2
University of Southampton, Hampshire SO17 1BJ, United Kingdom. Electronic address: J.R.Egan@soton.ac.uk.
3
Public Health England, Porton, Wiltshire SP4 0JG, United Kingdom. Electronic address: Ian.Hall@phe.gov.uk.

Abstract

The causative agent of Q fever, Coxiella burnetii, has the potential to be developed for use in biological warfare and it is classified as a bioterrorism threat agent by the Centers for Disease Control and Prevention (CDC) and as a category B select agent by the National Institute of Allergy and Infectious Diseases (NIAID). In this paper we focus on the in-host properties that arise when an individual inhales a dose of C. burnetii and establish a human time-dose response model. We also propagate uncertainty throughout the model allowing us to robustly estimate key properties including the infectious dose and incubation period. Using human study data conducted in the 1950's we conclude that the dose required for a 50% probability of infection is about 15 organisms, and that one inhaled organism of C. burnetti can cause infection in 5% of the exposed population. In addition, we derive a low dose incubation period of 17.6 days and an extracellular doubling time of half a day. In conclusion this paper provides a framework for detailing the parameters and approaches that would be required for risk assessments associated with exposures to C. burnetii that might cause human infection.

Minimum Age of Sale for Tobacco Products and Electronic Cigarettes: Ethical Acceptability of US "Tobacco 21 Laws"

 2017 Jul 20:e1-e5. doi: 10.2105/AJPH.2017.303900. [Epub ahead of print]

Minimum Age of Sale for Tobacco Products and Electronic Cigarettes: Ethical Acceptability of US "Tobacco 21 Laws".

Author information

1
Stephanie Rubino Morain and Janet Malek are with the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.

Abstract

Several US jurisdictions have recently passed laws that raise the minimum age of sale for tobacco products and electronic cigarettes to 21 years (Tobacco 21 laws). Although these laws have been demonstrated to be an effective means to reduce youth smoking initiation, their passage and potential expansion have provoked controversy. Critics have objected to these laws, claiming that they unduly intrude on individual freedom and that they irrationally and paternalistically restrict the freedom of those aged 18 to 20 years, who were previously able to legally purchase tobacco products. We have examined the ethical acceptability of Tobacco 21 laws. First, we have described ethical support for such a restriction grounded in its public health benefit. We have then offered arguments that raise doubts about the soundness of critics' objections to these regulations and described an additional ethical justification arising from concern about preventing harm to others. On the basis of this analysis, we conclude that Tobacco 21 laws are ethically justifiable.

"Some of the advice is straight up harmful. A lot of health trends like detoxing, cleansing, cryotherapy, IV therapy, I think those things wouldn't exist but for celebrity endorsement."

SECOND OPINION | It's war! Debunkers take on actress Gwyneth Paltrow's GOOP and celebrity pseudoscience

War on GOOP breaks out into the open

By Kelly Crowe & CBC Health Unit, CBC News Posted: Jul 22, 2017 8:00 AM ET Last Updated: Jul 22, 2017 8:00 AM ET

"They just want to create noise, and the more noise, the better," he said. "They don't care if it's positive noise or negative noise. The jade vagina eggs are still going to sell out. And that's what history tells us."
Still, Caulfield believes the war on Goop is important.
"I think setting the scientific record straight matters. It may not change people's minds tomorrow, but ensuring the facts are out there will make a difference long term," he said.
"Some of the advice is straight up harmful. A lot of health trends like detoxing, cleansing, cryotherapy, IV therapy, I think those things wouldn't exist but for celebrity endorsement."