On the 25th Anniversary of the Enactment of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act

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IMG_3633This post is adapted from remarks made by Tim Westmoreland at a celebration convened by the Office of National AIDS Policy at the White House on September 9, 2015. Professor Westmoreland is Professor from Practice, Georgetown University Law Center; Senior Scholar, O’Neill Institute for National and Global Health Law; and Former Counsel, Subcommittee on Health and the Environment, U.S. House of Representatives (1979-1995).  Any comments on this post should be directed to Professor Westmoreland at westmort@law.georgetown.edu.

On the 25th Anniversary of the Enactment of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, we celebrate a law that has made a huge difference in the lives of millions of people. We celebrate the women and men, sometimes anonymous and frequently unacknowledged, who work in places like NIH, CDC, FDA, HRSA, SAMHSA, and CMS, and who fought to get the facts out and to take action when so many were frozen by fear. We celebrate the thousands of activists who banged on the doors and demanded attention. We celebrate the leaders who overcame the fear and prejudice and acted. And, we celebrate a boy who gave his life and his name to the fight to conquer an epidemic.

But we also must remember the millions of people in this country and around the world who have died because of AIDS and the millions who loved and lost their family and friends. And we must remember the lessons we learned 25 years ago when the law we are celebrating was first enacted.  Read More

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


A proposal for the UN General Assembly: To achieve the SDGs, focus on the refugees

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NYT Sept. 6, 2015 http://www.nytimes.com/2015/09/06/opinion/sunday/nicholas-kristof-refugees-who-could-be-us.html

Syrian refugees in Greece. Courtesy of the New York Times.

Last month, the World Food Programme reported that it can only afford $13.50/month for food rations for Syrian refugee families in Lebanon, down from $27/month. This month, September, 200,000 Syrians in Jordan will stop receiving food aid, joining hundreds of thousands of other Syrian refugees in the region who have stopped receiving food vouchers because of insufficient funds. And the Office of the UN High Commissioner for Refugees estimates that 750,000 Syrian refugee girls are not in school because of lack of money.

We have all seen how the refugee crisis in Europe continues to deepen. Elsewhere, refugees, such as the 600,000 refugees in Kenya from South Sudan and Somalia, suffer away from the world’s cameras. Read More

Posted in Human Rights; Tagged: , , , , , .


From M&E to M&E&A: Accountable action to realize the Sustainable Development Goals

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NYT 2-26-14 http://www.nytimes.com/2014/02/26/world/asia/aid-group-in-afghanistan-says-many-still-lack-access-to-health-care.html

Some of the lucky ones -- these children did have access to health care in Afghanistan. Picture courtesy of the New York Times.

A survey in Afghanistan last year found that an incredible 18% of the 800 respondents – patients at Médecins Sans Frontières (MSF) hospitals in four different parts of the country – reported that in the course of just the previous year (2013), a friend or relative had died because they could not access health care. As the MSF detailed in its report, the top reasons for lack of access were cost, distance, and insecurity.

Besides the sheer human toll and indictment of the health system (and security situation), this was shocking because it wasn’t what we were being told. And therein is an important lesson as we approach the launch of the Sustainable Development Goals, and the reasons we need good data. And it isn’t just for monitoring progress. It’s for making progress.

But first, back to Afghanistan.

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Posted in Uncategorized;


Protecting our kids from all-pervasive tobacco advertising

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Tobacco products seem to be pretty much everywhere: pharmacies (except CVS, which stopped selling tobacco products one year ago yesterday), supermarkets, gas stations, and convenience stores. Since the 1998 Master Settlement Agreement (MSA) between U.S. states and the tobacco industry restricted outdoor cigarette advertising, the tobacco industry has turned its focus, and increased its marketing expenditure, on advertising at the point-of-sale.

Point-of-sale advertising, including product displays, is a highly effective form of tobacco advertising and promotion. According to research in Australia, Canada, and New Zealand, point-of-sale displays stimulate smokers to purchase cigarettes, make it harder for recent quitters to abstain, and increase the likelihood that young people will start smoking.

It is time for governments around the United States to ban or restrict point-of-sale advertising. Tackling these creative and enticing displays is a crucial step towards properly protecting kids from the endless cycle of tobacco marketing.

tobacco displays

Point-of-sale displays

Governments in many countries, including Australia, Canada, Norway, and Thailand have banned all tobacco advertising and promotion in retail outlets, including the display of tobacco products. In the state of Victoria, Australia, for example, it is illegal to display any tobacco products or packaging in retail outlets (with exceptions for “certified specialist tobacconists”). Retailers are permitted to display one A4 sign in a prescribed format that states “We Sell Tobacco Here”. Further, they may display one price board providing information about the tobacco products for sale (i.e., brands, pack sizes, and prices). The size, format, and contents of price boards are strictly regulated and boards must be accompanied by prescribed graphic health warnings.

Victorian legislation

Legal challenges

U.S. governments considering enacting bans will likely face strong opposition and legal challenges based on the argument that point-of-sale advertising bans violate First Amendment protections for commercial speech. In 2013, two proposed point-of-sale advertising bans were dropped. The village of Haverstraw, NY, the first jurisdiction to adopt a ban on cigarette displays in the United States, rescinded its municipal ordinance after the tobacco industry filed a complaint in federal court. In the same year, Mayor Michael Bloomberg withdrew a display ban provision from his package of anti-tobacco measures proposed for New York City.

There is no doubt that the tobacco industry will challenge future efforts towards point-of-sale tobacco advertising bans. Governments must work together with tobacco control attorneys to draft laws carefully to withstand challenges under the First Amendment, including application of the four part test set out in Central Hudson Gas & Electric Corp. v. Public Service Commission of New York. Tobacco control attorneys identify parts 3 and 4 of the Hudson test as the most difficult hurdles. To satisfy part 4 of the test in Hudson, any product display ban would need to allow for an alternative means for retailers and manufacturers to communicate information about tobacco products available for sale. An alternative means of communication could be developed along the lines of the signage and price boards permitted in Victoria, Australia. Governments should also work together with tobacco control researchers to build a strong evidence base to satisfy part 3 of the Hudson test, including evidence that product displays entice children to try or use tobacco products.

Although the United States has stronger protections for commercial speech than many other countries, it would be a costly mistake for law-makers to perceive the First Amendment as an insurmountable barrier to restricting point-of-sale advertising and displays. Meaningful restrictions are the only way to properly protect kids from the endless cycle of tobacco marketing.

Posted in Tobacco; Tagged: , , .


Welcome Global Health Law LL.M. Students

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"Global Health Law"Today marks the start of classes at Georgetown Law—the classrooms and hallways will once again be filled with students. As the law school welcomes the new class of students, the phrase "we have been waiting for you" found its way in many of the speeches made during orientation. And we have indeed.

For the O'Neill Institute for National and Global Health Law, we celebrate this class as the ninth in the history of the Global Health Law LL.M. Program. Our students come from varying backgrounds and levels of experience, and we can proudly say that we have at least one student from each region of the world. For us, this is a tremendous accomplishment.

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Posted in Global Health; Tagged: , , .


“I’d like to see the last Guinea worm die before I do”

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The Carter Center/L. Gubb

The Carter Center/L. Gubb

Former U.S. President, Noble Peace Prize winner and member of The Elders, Jimmy Carter, recently announced he was diagnosed with cancer. We wish him well. During his press conference announcing his diagnosis, he made the following comment when asked about his remaining priorities for the Carter Center:

"I would like to see Guinea worm completely eradicated before I die – I would like the last Guinea worm to die before I do."

Guinea worm is set to become the second human disease to be eradicated, after smallpox. We are so close to eradication that an expert commission advised WHO to prepare a plan for implementing a global reward as soon as transmission is interrupted, as was done with smallpox! Further, in May 2015, health ministers in affected countries reiterated their commitment to interrupting transmission of the disease by the end of 2015. Read More

Posted in Global Health, Human Rights, WHO;


Synthetic drugs: prohibition’s latest creation

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article-2518793-19DEF12F00000578-497_634x482The last months in DC have seen a huge spike in emergency room cases due to overdoses from so-called synthetic drugs. Fire and EMS departments reported 21 cases in August of 2012 and 50 in May 2014. In June of this year that number had risen to 439. This problem is not unique to DC – in the last decade, the DEA has tracked more than 300 types of synthetic drugs, the effects of which aren’t predictable or well understood. Through national emergency-room visits, the accepted metric for drug trends, a record 49 novel compounds were found in 2011.

Based on their chemical make-up these drugs are commonly divided into two categories:

  • Cannabinoids: chemically formulated versions of synthetic marijuana that consist of lab-manufactured THC.
  • Cathinones: also known as “bath salts”, they contain chemical compounds that mimic the effects of cocaine or crystal meth.

Apart from these two distinctions, no one currently really knows what is in the new synthetic drugs that are leading to this increase in hospitalizations. But that is not a problem unique to these substances; it is an intrinsic problem with all illegal drugs. A side effect of prohibition has always been adulteration and intoxication. When driving a drug underground, its production and sale falls into the hands of dodgy enterprises with no quality control standards. Read More

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“That Sugar Film”: The O’Neill Institute Goes to the Movies

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Photo courtesy of thatsugarmovie.com

Photo courtesy of thatsugarfilm.com

Each summer, staff at the O’Neill Institute gather to informally enjoy and discuss films covering events in public health. This summer, the majority of the movies - Food, Inc.Fed Up and Food Chains - focused on the role that the food industry plays in shaping American eating habits. 

The O'Neill Institute wrapped up its summer movie series with a screening of the recently released That Sugar Film, Damon Gameau’s debut as a feature film-maker. The film documents Damon's shift from a diet free of refined sugars to a diet that involves consuming the average Austrailian’s intake of sugar. For 60 days, Damon consumes 40 teaspoons of sugar each day but does so without drinking any soda or eating any candy. He consumes only foods that are marketed as “healthy,” such as low-fat yogurt, granola bars, juices and cereal, but which in fact are laden with hidden sugars.

The results are staggering. Within just 3 weeks, Damon starts to develop fatty liver disease. And by the end of the experiment he has early Type 2 diabetes, increased heart-disease risks, 11 centimeters of extra girth around his midriff and violent mood swings.

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Posted in Tobacco, Uncategorized, Updates; Tagged: , , , , , , .


Why I oppose Amnesty International’s sex work policy

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Photo courtesy of lawc.on.ca

Photo courtesy of lawc.on.ca

Last week, Amnesty International approved a policy to advocate for the decriminalization of the sex trade worldwide. Some countries such as Sweden, Iceland and Norway have adopted what is known as the Swedish or Nordic model, which makes buying sex, pimping or operating brothels illegal, while protecting women who sell sex. Amnesty’s position is to advocate for decriminalization of both buying and selling of sex, as is the case in the Netherlands. Their position is that decriminalizing all aspects of consensual sex work helps create a legal and regulated market that would protect the rights of sex workers and allow access to services. Sounds simple, right?

If only. This policy has been incredibly controversial and triggered enormous debate, even leading members of Amnesty to quit over the resolution. I was also incredibly disappointed to hear about this decision. Let me explain why.

‘Sex work’ is a choice for the privileged few

Amnesty’s policy only applies to consensual adult sex work “that does not involve coercion, exploitation or abuse”. They seem to be talking about a situation where only fully empowered, consenting women freely choose to sell their bodies for money. The problem is, this nice libertarian ideal of individual choice completely ignores the power dynamics that drive the commercial sex industry. Things like race, poverty, childhood sexual abuse, coercion by pimps and the vast power imbalances between men and women in almost every society.

And we have evidence about how these things play out: studies show that between 65% and 95% of prostitutes were sexually assaulted as children, 95% have experienced sexual harassment that would be legally actionable in other job settings, while 85-95% want to escape prostitution but can’t get out or have no other options for survival. The majority of prostitutes enter the industry before they are 18 years old, and over two thirds have post-traumatic stress disorder (PTSD).

As pointed by the Guardian,

There is nothing intrinsically repugnant to human rights in sex work if you exclude violence, deceit and the exploitation of children. But these aren’t fringe phenomena. They are central parts of the trade in most places round the world. To take as normative the experience of protected western adults is a morally disabling form of privilege.

One of Amnesty’s main arguments is that it is has carried out extensive consultations and is listening to, and representing the views of sex workers. Deciding which sex workers to listen to is problematic enough, and even more so when your definition of sex worker excludes victims of trafficking, those who have managed to leave and are no longer considered ‘sex workers’ or women who are not in a position to openly discuss their sexual histories in order to have their voices heard.

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Posted in Human Rights; Tagged: , , , .


Remembering Dr. Frances Oldham Kelsey, the Regulator Who Saved a Generation of American Children

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Photo Courtesy of the National Institutes of Health

Photo Courtesy of the National Institutes of Health

In the late 1950s, a new over-the-counter sedative, thalidomide was introduced in Germany. At the time, it was the only non-barbiturate sedative on the market and it was marketed as an extraordinarily safe sleeping aid. The drug company “advertised their product as ‘completely safe’ for everyone, including mother and child, ‘even during pregnancy,’ as its developers ‘could not find a dose high enough to kill a rat.’” Besides being used as a sedative and sleeping aid, doctors frequently prescribed thalidomide, off-label, for the treatment of morning sickness associated with pregnancy. At its peak, sales of the drug “nearly match[ed] those of aspirin.”

In 1961, Dr. W.G. McBride wrote a letter to The Lancet documenting cases of birth defects associated with the use of the drug. He noted that, while the ordinary rate of congenital defects was 1.5%, he had noticed that the rate among those who used thalidomide was closer to 20%. He queried readers of the medical journal, “Have any of your readers seen similar abnormalities?” This marked the first recognition of the drug’s devastating side effects. Read More

Posted in FDA, National Healthcare; Tagged: , , .

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