The Long March for Life and Dignity: Can a lesson learned in Paraguay help protect Bolivian indigenous communities in the TIPNIS?

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On August 15, 2011, at least 1,000 members of indigenous communities living in the Bolivian Indigenous Territory of the National Park Isiboro-Sécure (TIPNIS) began their long and treacherous march on foot to the capital city of La Paz in hopes of engaging the Bolivian government in a peaceful dialogue to prevent the government from building a highway directly through their territory.  To date, armed with nothing but their will to protect their homes and the park, they continue to march despite the Bolivian government’s violent attempts to disintegrate and stop the movement.  On September 25, as the movement gained momentum with thousands of other Bolivians from different backgrounds supporting what has been called the “VIII Great Indigenous March to Protect the TIPNIS,” the Bolivian government clandestinely sent 500 members of its police force to attack the marchers’ camp at night.  The police beat and sequestered hundreds of men and women, as well as separated children from their parents.  The attack resulted in many injured and led children to flee and disappear for days in the surrounding forests. Hundreds of marchers who were captured and separated from the movement were able to rejoin after their capturers were met with resistance in a town of TIPNIS-supporters.  During the course of their journey, hundreds of people belonging to other indigenous communities joined the march in support of the TIPNIS movement – more than two hundred of them from the Andean region arrived in La Paz two days ago. Now consisting of approximately 2,000, the TIPNIS marchers have walked well over 400 km and are now less than 100 km from La Paz.  Because their arrival would have coincided with judicial elections scheduled to take place on Sunday, October 16, the TIPNIS marchers have postponed their arrival until MondayRead More

Posted in Global Health, Uncategorized; Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , .


A Bad News Week for Women and HIV Prevention–and What’s Next

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It started Wednesday, Sept. 28 when the Microbicide Trials Network—a clinical trials network funded by the U.S. National Institutes of Health (NIH)—announced that one arm of its VOICE study was being discontinued for futility.  VOICE follows 5000 sexually active, HIV-negative women in Uganda, South Africa and Zimbabwe, testing the safety and effectiveness of HIV prevention strategies involving antiretroviral drugs.  Each of these two strategies has shown promise in other research: antiretroviral pills (pre-exposure prophylaxis or “PrEP”) and a vaginal gel microbicide.  Originally VOICE contained five arms: (1) a 1% tenofovir gel microbicide, the same one that showed efficacy in the CAPRISA 004 study, but used daily instead of just before and after intercourse; (2) a placebo gel; (3) tenofovir pills; (4) Truvada pills (a combination of tenofovir and emtricitabine); and (5) a placebo pill. 

After a recent peek at the ongoing data, the study’s data safety monitoring board recommended closing the oral tenofovir arm.  While the other two ARV arms continue, indicating at least a chance that those products are working as expected, the announcement evoked bad memories of last April, when Family Health International (now FHI 360) announced that the FEM-PrEP study was being closed early for futility.  In that study—another large, well-funded and apparently well-run trial—oral Truvada could not demonstrate efficacy in preventing HIV acquisition among women.  The FEM-PrEP result has widely been considered an outlier, not enough to convince anybody that PrEP doesn’t work among women—but, while VOICE could still show efficacy for Truvada, the closure of the tenofovir arm is not good news for PrEP as a possible strategy in women. Read More

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Medicaid Before the Supreme Court Today

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With Starbucks Venti in hand to ease the pain of waking up at 6:00 a.m. and the 45 degree weather, I eagerly lined up this morning to hear oral arguments at the Supreme Court with fellow health law fans, associates too far down the food chain to earn a seat at the counsel table, Mormon missionaries, a jury consultant, the Supreme Court’s biggest fan, and a (seemingly less eager) high school group.  Before the Court was Douglas v. Independent Living Center.  This case arose after the California government responded to the state’s 2008 “fiscal crisis” by cutting Medicaid provider reimbursement rates by 10%.  Providers and beneficiaries claimed that the rate cut contravened the equal access provision, which states that Medicaid provider payments “must be sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.” 

At issue before the Supreme Court is whether Medicaid beneficiaries and providers have a private right of action to challenge state budget cuts affecting access to health services.  The 9th Circuit Court found that the plaintiffs could challenge the rate cut under the Supremacy Clause, granting an injunction to enjoin the rate reduction pending the resolution of the litigation.  More broadly, this case raises several significant policy issues including the protection of vulnerable Medicaid beneficiaries, governmental health sector accountability, federalism and the status of co-operative funding programs, and institutional competence to adjudicate matters of complex social policy.     Read More

Posted in Health reform, National Healthcare;


Unanswered Questions of the UN Summit on Non-communicable Diseases

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 The United Nation’s High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (NCDs), convened at UN Headquarters September 19-20, brought with it high expectations. The only previous UN General Assembly Special Sessions on a health issue had been on HIV/AIDS, with the first, in 2001, credited with helping spur the global AIDS response. NCDs – the four categories that the summit addressed being heart disease, cancer, diabetes, and chronic respiratory illnesses – already are responsible for more than 60% deaths globally [Political Declaration, para. 14], and are the leading cause of death even in many developing countries. They are on track to be responsible for 70% of deaths in developing countries by 2020 [Abdesslam Boutayeb and Saber Boutayeb, “The Burden of Non Communicable Diseases in Developing Countries,” International Journal for Equity in Health 4(1) (2005): 2]. 

Until now low on the global health agenda – consider that a mere 3% of WHO’s 2010-2011 budget was programmed to address NCDs – NCDs are certainly worthy of a special session at the United Nations. The question is, will the summit mobilize a global response against NCDs?

The honest answer may be the least satisfying: time will tell. Read More

Posted in Global Health, Tobacco, Trade, WHO; Tagged: , .


After Several Other Circuits Split on the Constitutionality of Health Reform, Which Way Will the D.C. Circuit Go?

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This post was authored by O’Neill Institute research assistant and second-year Georgetown University Law Center student Dinesh Kumar.

For more information on all of the pending challenges to the Affordable Care Act, visit http://www.healthlawandlitigation.com.  The website, a joint effort by the O’Neill Institute and the National Health Law Program, tracks the progress of litigation through the federal courts and provides a compendium of related academic literature.   

On the morning of September 23, 2011, a crowd of about 150 members of the press and public filed steadily into the E. Barrett Prettyman Federal Courthouse to hear oral arguments for Seven-Sky v. Holder, the latest challenge to the Affordable Care Act (ACA) to be heard at the circuit level.  

As with the other ACA cases, Seven-Sky focused on the constitutionality of the ACA’s minimum coverage provision (a.k.a. the “individual mandate”), which requires all U.S. citizens and legal residents to purchase health insurance or, beginning in 2014, pay a fine to the IRS that increases annually.  Three appellate courts had previously ruled in three different ways.  The Sixth Circuit upheld the individual mandate in Thomas More Law Center v. Obama, the Eleventh Circuit struck it down in Florida v. HHS, and the Fourth Circuit rejected the challenge outright in Liberty University v. Geithner, saying the court had no jurisdiction to hear the case under the Anti-Injunction Act (more on the AIA later).  In a fourth case, Virginia v. Sebelius, the Fourth Circuit said the state of Virginia had no standing to bring suit.  Read More

Posted in Health reform, National Healthcare; Tagged: , , .


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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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