http://www.ncbi.nlm.nih.gov/pubmed/23433450

BMC Health Serv Res. 2013 Feb 21;13(1):73. [Epub ahead of print]

Classification of patients based on their evaluation of hospital outcomes: cluster analysis following a national survey in Norway.

Bjertnaes O, Skudal KE, Iversen HH.

Abstract

ABSTRACT:

BACKGROUND: A general trend towards positive patient-reported evaluations of hospitals could be taken as a sign that most patients form a homogeneous, reasonably pleased group, and consequently that there is little need for quality improvement. The objective of this study was to explore this assumption by identifying and statistically validating clusters of patients based on their evaluation of outcomes related to overall satisfaction, malpractice and benefit of treatment.

METHODS:

Data were collected using a national patient-experience survey of 61 hospitals in the 4 health regions in Norway during spring 2011. Postal questionnaires were mailed to 23,420 patients after their discharge from hospital. Cluster analysis was performed to identify response clusters of patients, based on their responses to single items about overall patient satisfaction, benefit of treatment and perception of malpractice.

RESULTS:

Cluster analysis identified six response groups, including one cluster with systematically poorer evaluation across outcomes (18.5% of patients) and one small outlier group (5.3%) with very poor scores across all outcomes. One-Way ANOVA with post-hoc tests showed that most differences between the six response groups on the three outcome items were significant. The response groups were significantly associated with nine patient-experience indicators (p < 0.001), and all groups were significantly different from each of the other groups on a majority of the patient-experience indicators. Clusters were significantly associated with age, education, self-perceived health, gender, and the degree to write open comments in the questionnaire.

CONCLUSIONS:

The study identified five response clusters with distinct patient-reported outcome scores, in addition to a heterogeneous outlier group with very poor scores across all outcomes. The outlier group and the cluster with systematically poorer evaluation across outcomes comprised almost one-quarter of all patients, clearly demonstrating the need to tailor quality initiatives and improve patient-perceived quality in hospitals. More research on patient clustering in patient evaluation is needed, as well as standardization of methodology to increase comparability across studies.

From U Zurich: Human enhancement and perfection

http://www.ncbi.nlm.nih.gov/pubmed/23436909

J Med Ethics. 2013 Feb 22. [Epub ahead of print]

Human enhancement and perfection.

Roduit JA, Baumann H, Heilinger JC.

Source

Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland.

Abstract

Both, bioconservatives and bioliberals, should seek a discussion about ideas of human perfection, making explicit their underlying assumptions about what makes for a good human life. This is relevant, because these basic, and often implicit ideas, inform and influence judgements and choices about human enhancement interventions. Both neglect, and polemical but inconsistent use of the complex ideas of perfection are leading to confusion within the ethical debate about human enhancement interventions, that can be avoided by tackling the notion of perfection directly. In the recent debates, bioconservatives have prominently argued against the 'pursuit of perfection' by biotechnological means. In the first part of this paper, we show that-paradoxically-bioconservatives themselves explicitly embrace specific conceptions of human perfection and perfectionist assumptions about the good human life in order to argue against the use of enhancement technologies. Yet, we argue that the bioconservative position contains an untenable ambiguity between criticising and endorsing ideas of human perfection. Hence, they stand in need of clarifying their stance on human perfection. In the second part of the paper, we ask whether bioliberals in fact (implicitly) advocate a particular conception of perfection, or whether they are right in holding that they do not, and that discussing perfection is obsolete anyway. We show that bioliberals also rely on a specific idea of human perfection, based on the idea of autonomy. Hence, their denial of the relevance of perfection in the debate is unconvincing and has to be revised.

CPRIT: Another grant snafu at Texas’ cancer-fighting agency

http://watchdogblog.dallasnews.com/2013/02/another-grant-snafu-at-texas-cancer-fighting-agency.html/

Another grant snafu at Texas’ cancer-fighting agency

By James Drew
jdrew@dallasnews.com
6:15 pm on February 25, 2013

AUSTIN  – Texas’ cancer-fighting agency said Monday it has found another problem with how a grant was awarded.

The Cancer Prevention and Research Institute of Texas, in reviewing awards approved last August and December, said it recently discovered that a $1.2 million grant to a Baylor College of Medicine researcher was ratified by the oversight committee last year with a partial, but not full, scientific review.

................

Hamilton, who was appointed to his post late last year after the resignation of Executive Director Bill Gimson, said it was unclear who made that call. At the time, Dr. Alfred Gilman was CPRIT’s chief scientific officer. He stepped down last October.

“We really don’t have any records,” Hamilton said.

Hamilton said the award was the sole problem found in CPRIT’s review of about  $182.6 million in grants approved at the August and December oversight committee meetings.

http://www.ncbi.nlm.nih.gov/pubmed/23435968

HEC Forum. 2013 Feb 23. [Epub ahead of print]

Research Ethics Committee Auditing: The Experience of a University Hospital.

Marchetti D, Spagnolo A, Cicerone M, Cascini F, La Monaca G, Spagnolo AG.

Source

Istituto di Medicina Legale, University Hospital "Agostino Gemelli" 1, Largo F. Vito, 00168, Rome, Italy, d.marchetti@rm.unicatt.it.

Abstract

The authors report the first Italian experience of a research ethics committee (REC) audit focused on the evaluation of the REC's compliance with standard operating procedures, requirements in insurance coverage, informed consent, protection of privacy and confidentiality, predictable risks/harms, selection of subjects, withdrawal criteria and other issues, such as advertisement details and justification of placebo. The internal audit was conducted over a two-year period (March 2009-February 2011) divided into quarters to better value the influence of the new insurance coverage regulation that came into effect in March 2010 (Ministerial Decree of 14 July, 2009) and expand the requirements to safeguard participants in clinical drug trials including other critical items as information and consent and the risks to benefits ratio. Out of a total of 639 REC's opinions and research studies, 316 were reviewed. Regarding the insurance policy requirements, Auditor/REC non-compliance occurred only in one case. The highest number of Auditor/REC non-compliance was in regard to information and consent, which should have incurred a suspended decision rather than a favorable opinion. This internal audit shows the importance and the difficulty of the review process. For this reason, specific courses for members of the research ethics committee and for those who aspire to become auditors will be provided. There may also be efforts to improve the standard operating procedures already in place.

"need for additional training for doctors to address deficiencies in initial and follow-on diagnoses" (Isn't this what med school is for?)

http://www.forbes.com/sites/daviddisalvo/2013/02/25/study-missed-diagnoses-in-the-doctors-office-are-leading-to-thousands-of-deaths/

PHARMA & HEALTHCARE 

|

 

2/25/2013 @ 11:16PM 

Study: Missed Diagnoses in the Doctor's Office are Leading to Thousands of Deaths

A new study published in JAMA indicates that primary care doctors are increasingly missing diagnoses at the office, resulting in thousands of deaths and disabilities per year.

................

The study also points to the need for additional training for doctors to address deficiencies in initial and follow-on diagnoses.

Curse of cursive handwriting

http://www.prospectmagazine.co.uk/magazine/cursive-handwriting-philip-ball/

Curse of cursive handwriting

by Philip Ball 

/ FEBRUARY 20, 2013 / 30 COMMENTS

It’s absurd to teach children this way

It’s not necessarily cursive per se that’s the problem, but the practice of teaching children two different systems, perhaps in the space of so many years, without good reason. Research seems to show that it may not much matter how children learn to write, so long as it is consistent.

http://www.ncbi.nlm.nih.gov/pubmed/23430562

J Youth Adolesc. 2013 Feb 21. [Epub ahead of print]

Understanding Adolescent and Family Influences on Intimate Partner Psychological Violence During Emerging Adulthood and Adulthood.

Lohman BJ, Neppl TK, Senia JM, Schofield TJ.

Source

Department of Human Development and Family Studies, Iowa State University, 4389 Palmer Suite 2356, Ames, IA, 50011, USA, blohman@iastate.edu.

Abstract

The intergenerational transmission of violence directed toward intimate partners has been documented for the past three decades. Overall, the literature shows that violence in the family of origin leads to violence in the family of destination. However, this predominately cross-sectional or retrospective literature is limited by self-selection, endogeneity, and reporter biases as it has not been able to assess how individual and family behaviors simultaneously experienced during adolescence influence intimate partner violence throughout adulthood. The present study used data from the Iowa Youth and Families Project (IYFP; N = 392; 52 % Female), a multi-method, multi-trait prospective approach, to overcome this limitation. We focused on psychological intimate partner violence in both emerging adulthood (19-23 years) and adulthood (27-31 years), and include self and partner ratings of violence as well as observational data in a sample of rural non-Hispanic white families. Controlling for a host of individual risk factors as well as interparental psychological violence from adolescence (14-15 years), the results show that exposure to parent-to-child psychological violence during adolescence is a key predictor of intimate partner violence throughout adulthood. In addition, negative emotionality and the number of sexual partners in adolescence predicted intimate partner violence in both emerging adulthood and adulthood. Exposure to family stress was associated positively with intimate partner violence in adulthood but not in emerging adulthood, whereas academic difficulties were found to increase violence in emerging adulthood only. Unlike previous research, results did not support a direct effect of interparental psychological violence on psychological violence in the next generation. Gender differences were found only in emerging adulthood. Implications of these findings are discussed in light of the current literature and future directions.

http://www.ncbi.nlm.nih.gov/pubmed/23429172

Iran J Pediatr. 2012 Dec;22(4):435-44.

Key ethical issues in pediatric research: islamic perspective, Iranian experience.

Mobasher M, Salari P, Larijani B.

Source

Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran ; Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

Abstract

OBJECTIVE:

The importance of pediatric research especially in the ethically proven trials resulted in considerable legislative attempts in association with compiling ethical guidelines. Because of children's vulnerability conducting pediatric research raises different ethical issues; the two most important of which are informed consent and risk-benefit assessment. Differences in religious and socio-cultural context limit implication of ethical standards.

METHODS:

At the aim of finding a solution we critically reviewed guidelines, and literatures as well as Islamic points in addition to comparing different viewpoints in application of ethical standards in pediatric research.

FINDINGS:

The literature review showed that pediatric research guidelines and authors' viewpoints have the same basic ethical core, but there are some variations; depend on cultural, religious, and social differences. Furthermore, these standards have some limitations in defining informed consent according to child's age and capacity upon application.

CONCLUSION:

In this regard Islamic approach and definition about growth development and puberty sheds light and clarifies a clearer and more rational address to the issue.

http://www.ncbi.nlm.nih.gov/pubmed/23426798

JAMA Psychiatry. 2013 Feb 20:1-8. doi: 10.1001/jamapsychiatry.2013.504. [Epub ahead of print]

Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence.

Copeland WE, Wolke D, Angold A, Costello EJ.

Abstract

IMPORTANCE Both bullies and victims of bullying are at risk for psychiatric problems in childhood, but it is unclear if this elevated risk extends into early adulthood. 

OBJECTIVE To test whether bullying and/or being bullied in childhood predicts psychiatric problems and suicidality in young adulthood after accounting for childhood psychiatric problems and family hardships. DESIGN Prospective, population-based study. 

SETTING Community sample from 11 counties in Western North Carolina. 

PARTICIPANTS A total of 1420 participants who had being bullied and bullyingassessed 4 to 6 times between the ages of 9 and 16 years. Participants were categorized as bullies only, victims only, bullies and victims (hereafter referred to as bullies/victims), or neither. 

MAIN OUTCOME MEASURE Psychiatric outcomes, which included depression, anxiety, antisocial personality disorder, substance use disorders, and suicidality (including recurrent thoughts of death, suicidal ideation, or a suicide attempt), were assessed in young adulthood (19, 21, and 24-26 years) by use of structured diagnostic interviews. 

RESULTS Victims and bullies/victims had elevated rates of young adult psychiatric disorders, but also elevated rates of childhood psychiatric disorders and family hardships. After controlling for childhood psychiatric problems or family hardships, we found that victims continued to have a higher prevalence of agoraphobia (odds ratio [OR], 4.6 [95% CI, 1.7-12.5]; P &lt; .01), generalized anxiety (OR, 2.7 [95% CI, 1.1-6.3]; P &lt; .001), and panic disorder (OR, 3.1 [95% CI, 1.5-6.5]; P &lt; .01) and that bullies/victims were at increased risk of young adult depression (OR, 4.8 [95% CI, 1.2-19.4]; P &lt; .05), panic disorder (OR, 14.5 [95% CI, 5.7-36.6]; P &lt; .001), agoraphobia (females only; OR, 26.7 [95% CI, 4.3-52.5]; P &lt; .001), and suicidality (males only; OR, 18.5 [95% CI, 6.2-55.1]; P &lt; .001). Bullies were at risk for antisocial personality disorder only (OR, 4.1 [95% CI, 1.1-15.8]; P &lt; .04). 

CONCLUSIONS AND RELEVANCE The effects of being bullied are direct, pleiotropic, and long-lasting, with the worst effects for those who are both victims and bullies.

Agatha Christie's The Mysterious Affair at Styles

http://www.pagebypagebooks.com/Agatha_Christie/The_Mysterious_Affair_at_Styles/

http://www.ncbi.nlm.nih.gov/pubmed/23283330

J Neurosci. 2013 Jan 2;33(1):156-63. doi: 10.1523/JNEUROSCI.2936-12.2013.

Why mental arithmetic counts: brain activation during single digit arithmetic predicts high school math scores.

Price GR, Mazzocco MM, Ansari D.

Source

Numerical Cognition Laboratory, Department of Psychology and Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada N6G 2K3.

Abstract

Do individual differences in the brain mechanisms for arithmetic underlie variability in high school mathematical competence? Using functional magnetic resonance imaging, we correlated brain responses to single digit calculation with standard scores on the Preliminary Scholastic Aptitude Test (PSAT) math subtest in high school seniors. PSAT math scores, while controlling for PSAT Critical Reading scores, correlated positively with calculation activation in the left supramarginal gyrus and bilateral anterior cingulate cortex, brain regions known to be engaged during arithmetic fact retrieval. At the same time, greater activation in the right intraparietal sulcus during calculation, a region established to be involved in numerical quantity processing, was related to lower PSAT math scores. These data reveal that the relative engagement of brain mechanisms associated with procedural versus memory-based calculation of single-digit arithmetic problems is related to high school level mathematical competence, highlighting the fundamental role that mental arithmetic fluency plays in the acquisition of higher-level mathematical competence.

http://www.ncbi.nlm.nih.gov/pubmed/23429407

Curr Opin Clin Nutr Metab Care. 2013 Feb 20. [Epub ahead of print]

Intentional weight loss in older adults: useful or wasting disease generating strategy?

Darmon P.

Source

aDepartment of Nutrition, Metabolic Diseases and Endocrinology, Sainte-Marguerite University Hospital bINRA UMR1260/INSERM UMR1062, 'Nutrition, Obesity and Risk of Thrombosis', Aix-Marseille University, Marseille, France.

Abstract

PURPOSE OF REVIEW:

Strategies for weight management in older adults remain controversial as overweight may protect them against mortality whereas weight loss may have harmful effects by promoting sarcopenia and bone loss. It has been suggested that weight management for obese older adults should focus more on maintaining weight and improving physical function than promoting weight loss. This review aims to specify whether intentional weight loss in older adults is a useful or a wasting disease generating strategy.

RECENT FINDINGS:

Recent randomized controlled studies have shown that a supervised, moderate caloric restriction coupled with regular exercise (both aerobic and resistance) in obese older adults do not increase mortality risk and may conversely reduce insulin resistance, metabolic complications, and disabilities without exacerbating lean mass and bone mineral density loss.

SUMMARY:

In obese older adults, moderate weight loss may have beneficial effects on comorbidities, functional performances, and quality of life provided that regular physical activity can be associated. An individual approach considering life expectancy, chronic comorbidities, functional status, personal motivation, and social support should be preferred. More research is needed to define the circumstances in which cautious dietary restrictions are reasonably justified in older adults. In any case, in the oldest (≥80 years) as in frail individuals, it seems reasonable to abstain from recommending weight loss.

http://www.ncbi.nlm.nih.gov/pubmed/23428972

Pediatrics. 2013 Feb 21. [Epub ahead of print]

Ethical and Policy Issues in Genetic Testing and Screening of Children.

COMMITTEE ON BIOETHICS; COMMITTEE ON GENETICS; THE AMERICAN COLLEGE OF MEDICAL GENETICS; GENOMICS SOCIAL; ETHICAL; LEGAL ISSUES COMMITTEE.

Abstract

The genetic testing and genetic screening of children are commonplace. Decisions about whether to offer genetic testing and screening should be driven by the best interest of the child. The growing literature on the psychosocial and clinical effects of such testing and screening can help inform best practices. This policy statement represents recommendations developed collaboratively by the American Academy of Pediatrics and the American College of Medical Genetics and Genomics with respect to many of the scenarios in which genetic testing and screening can occur.

From U Louisville: Computer-aided diagnosis systems for lung cancer

http://www.ncbi.nlm.nih.gov/pubmed/23431282

Int J Biomed Imaging. 2013;2013:942353. doi: 10.1155/2013/942353. Epub 2013 Jan 29.

Computer-aided diagnosis systems for lung cancer: challenges and methodologies.

El-Baz A, Beache GM, Gimel'farb G, Suzuki K, Okada K, Elnakib A, Soliman A, Abdollahi B.

Source

BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA.

Abstract

This paper overviews one of the most important, interesting, and challenging problems in oncology, the problem of lung cancer diagnosis. Developing an effective computer-aided diagnosis (CAD) system for lung cancer is of great clinical importance and can increase the patient's chance of survival. For this reason, CAD systems for lung cancer have been investigated in a huge number of research studies. A typical CAD system for lung cancerdiagnosis is composed of four main processing steps: segmentation of the lung fields, detection of nodules inside the lung fields, segmentation of the detected nodules, and diagnosis of the nodules as benign or malignant. This paper overviews the current state-of-the-art techniques that have been developed to implement each of these CAD processing steps. For each technique, various aspects of technical issues, implemented methodologies, training and testing databases, and validation methods, as well as achieved performances, are described. In addition, the paper addresses several challenges that researchers face in each implementation step and outlines the strengths and drawbacks of the existing approaches for lung cancerCAD systems.

From the Bulletin of Health Policy and Law: Financing Medical Care in Underdeveloped Nations

http://www.bullhpl.org/resources/Publications/VanLangendonckOrigArtBHPL-Prod.pdf

Financing Medical Care in Underdeveloped Nations: Reflections from the Past and Context for the FutureJozef Van Langendonck, PhD 

Abstract: Global healthcare financing continues to create challenges for underdeveloped nations at the present time. Yet efforts to address the challenges of providing the necessary resources still continue to focus upon ad hoc solutions rather than a systemically focused, member state, mandatory contributions that build upon extant infrastructures such as WHO, WTO, the Global Fund, and other bodies. Yet it is important to realize these structures continue to need quality assurance, measurement, and evaluation, while a system of global social security oversight still needs creation that can effectively govern such efforts. A funding system based on stable funding and appropriate, governance-based structure can promote more focused, targeted financing, leading to improved global health. 
Published: 10 January 2013
Cite as: Van Langendonck J. Financing Medical Care in Underdeveloped Nations: Reflections from the Past and Context for the Future Bull Health L Policy. 2012;1(2).

http://annals.org/article.aspx?articleid=710767

The Nazi Doctors and Nuremberg: Some Moral Lessons Revisited

Edmund D. Pellegrino, MD

Ann Intern Med. 15 August 1997;127(4):307-308

Exactly 50 years ago, the world learned of the moral depravity of the 20 Nazi physicians who were tried and convicted in Nuremberg for the part they played in the brutal human experiments at Auschwitz. Ethicists have since expounded on the moral lessons to be learned from the Nuremberg Trials. So obvious these moral lessons seem now, and so gross the malfeasance, that it seems redundant to revisit them. Certainly we do not need to study such gross moral pathology that could never happen again.

http://www.ncbi.nlm.nih.gov/pubmed/23286191

Isis. 2012 Sep;103(3):527-36.

The origins of pure and applied science in Gilded Age America.

Lucier P.

Source

Department of History, Brown University, Providence, Rhode Island 02912, USA. Paul_Lucier@brown.edu

Abstract

"Pure science" and "applied science" have peculiar histories in the United States. Both terms were in use in the early part of the nineteenth century, but it was only in the last decades that they took on new meanings and became commonplace in the discourse of American scientists. The rise in their currency reflected an acute concern about the corruption of character and the real possibilities of commercializing scientific knowledge. "Pure" was the preference of scientists who wanted to emphasize their nonpecuniary motives and their distance from the marketplace. "Applied" was the choice of scientists who accepted patents and profits as other possible returns on their research. In general, the frequent conjoining of "pure" and "applied" bespoke the inseparable relations of science and capitalism in the Gilded Age.

From U Toledo: Negligence, genuine error, and litigation

http://www.ncbi.nlm.nih.gov/pubmed/23426783

Int J Gen Med. 2013;6:49-56. doi: 10.2147/IJGM.S24256. Epub 2013 Feb 15.

Negligence, genuine error, and litigation.

Sohn DH.

Source

Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA.

Abstract

Not all medical injuries are the result of negligence. In fact, most medical injuries are the result either of the inherent risk in the practice of medicine, or due to system errors, which cannot be prevented simply through fear of disciplinary action. This paper will discuss the differences between adverse events, negligence, and system errors; the current medical malpractice tort system in the United States; and review current and future solutions, including medical malpractice reform, alternative dispute resolution, health courts, and no-fault compensation systems. The current political environment favors investigation of non-cap tort reform remedies; investment into more rational oversight systems, such as health courts or no-fault systems may reap both quantitative and qualitative benefits for a less costly and safer health system.

Digital pathology: Management and archiving of data (it is now time for the FDA to approve digital pathology)

http://www.ncbi.nlm.nih.gov/pubmed/23402499

Diagn Pathol. 2013 Feb 12;8:22. doi: 10.1186/1746-1596-8-22.

Open source tools for management and archiving of digital microscopy data to allow integration with patientpathology and treatment information.

Khushi M, Edwards G, de Marcos DA, Carpenter JE, Graham JD, Clarke CL.

Source

Australian Breast Cancer Tissue Bank, University of Sydney at the Westmead Millennium Institute, Darcy Road, Westmead, NSW, 2145, Australia. mkhushi@uni.sydney.edu.au.

Abstract

ABSTRACT:

BACKGROUND:

Virtual microscopy includes digitisation of histology slides and the use of computer technologies for complex investigation of diseases such as cancer. However, automated image analysis, or website publishing of such digital images, is hampered by their large file sizes.

RESULTS:

We have developed two Java based open source tools: Snapshot Creator and NDPI-Splitter. Snapshot Creator converts a portion of a largedigital slide into a desired quality JPEG image. The image is linked to the patient's clinical and treatment information in a customised open source cancer data management software (Caisis) in use at the Australian Breast Cancer Tissue Bank (ABCTB) and then published on the ABCTB website (http://www.abctb.org.au) using Deep Zoom open source technology. Using the ABCTB online search engine, digital images can be searched by defining various criteria such as cancer type, or biomarkers expressed. NDPI-Splitter splits a large image file into smaller sections of TIFF images so that they can be easily analysed by image analysis software such as Metamorph or Matlab. NDPI-Splitter also has the capacity to filter out empty images.

CONCLUSIONS:

Snapshot Creator and NDPI-Splitter are novel open source Java tools. They convert digital slides into files of smaller size for further processing. In conjunction with other open source tools such as Deep Zoom and Caisis, this suite of tools is used for the management and archiving of digital microscopy images, enabling digitised images to be explored and zoomed online. Our online image repository also has the capacity to be used as a teaching resource. These tools also enable large files to be sectioned for image analysis. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5330903258483934.

Mackey, Liang, Novotny: Evolution of Tobacco Labeling and Packaging (again, I expect cigarette cases will return to fashion)

http://www.ncbi.nlm.nih.gov/pubmed/23409884

Am J Public Health. 2013 Feb 14. [Epub ahead of print]

Evolution of Tobacco Labeling and Packaging: International Legal Considerations and Health Governance.

Mackey TK, Liang BA, Novotny TE.

Source

Tim K. Mackey is with the Institute of Health Law Studies, California Western School of Law, San Diego, California, and the Joint Doctoral Program on Global Health, University of California San Diego and San Diego State University. Bryan A. Liang is with the Institute of Health Law Studies, California Western School of Law, San Diego Center for Patient Safety, University of California San Diego School of Medicine, and the Department of Anesthesiology, University of California San Diego School of Medicine. Thomas E. Novotny is with the Joint Doctoral Program on Global Health, University of California San Diego and San Diego State University.

Abstract

Numerous national governments have recently adopted packaging and labeling legislation to curb global tobacco uptake. This coincides with the World Health Organization's 2011 World No Tobacco Day, which recognized the extraordinary progress of the Framework Convention on Tobacco Control (FCTC). The tobacco industry has presented legal challenges to countries, including Australia, Uruguay, and the United States, for enacting legislation meeting or exceeding FCTC obligations. We argue that national governments attempting to meet the obligations set forth in public health treaties such as the FCTC should be afforded flexibilities and protection in developing tobacco control laws and regulations, because these measures are necessary to protect public health and should be explicitly recognized in international trade and legal agreements.