This paper explains why informed consent for randomized comparative effectiveness research (CER) must include risks of standard care. Disclosures of such risks are both legally and ethically required and, for reasons discussed in the paper, should remain so.

This article discusses the disability insurance industry in order to provide context regarding the potential impact of genetic testing on disability insurance. It describes disability income insurance, exploring both the protection it offers and its main contract provisions. It goes on to describe the private insurance market and the differences between group and individual insurance, and concludes with implications of genetic testing with respect to the private disability insurance market. The individual disability income insurance market is theoretically of great interest as a matter of public policy since there is potential for unfair discrimination through genetic testing although this remains very unlikely as a matter of practice, however.

It is more likely that a person will become disabled than die before age 65. The loss of income during a disability can be quite devastating. In contrast to the high risk and high impact of disability are the realities of the disability market.

Is it ever fair to limit treatment for diseases like glioblastoma for which prognosis is poor? Because resources are finite and health care spending limits the other possible uses for those resources, limiting access to an intervention that does not generate benefits is ethically sound. Ignoring the balance of benefits and burdens associated with treatment ignores opportunity costs and leads us to treat some lives as more valuable than others. It also ignores evidence that patients and families, when presented with adequate information about the benefits and burdens of aggressive treatment compared with palliative care, often prefer the palliative care option.

Should the limitations we set on the availability of care be greater for older people than younger people? Since the 1980s, scholars have called for strong age rationing of medical care in which Medicare would not pay for anything other than palliative care after they have achieved average life expectancy (usually 75 or 80 years of age).

It has now been 10 years since the framework for public health legal preparedness was put forth as a model to meet new public health challenges in the 21st century. Public health legal preparedness is defined as the “attainment by a public health system of specified legal of standards essential to the preparedness of the public health system.” The framework has continued to develop over time and four core elements have emerged to make up the basis for public health legal preparedness. The four core elements are: (1) laws and legal authorities; (2) competency in using laws effectively and wisely; (3) coordination of legally based interventions across jurisdictions and sectors; and (4) information on public health laws and best practices.

The development of photodynamic therapy and anti-vascular endothelial growth factor agents have revolutionized the treatment of retinal diseases, transforming the retina subspecialty by ushering in an age of pharmacological treatments for a wide range of diseases, including age-related macular degeneration (AMD).

Does a hospital bear a responsibility independent of that of the attending physician to ascertain that a patient has given an informed consent? Until recently, state appellate courts have provided a decidedly negative answer to this question. However, in Magana v. Elie, an Illinois appellate court recently adopted a different position, opening the door to a new area of hospital responsibility and, therefore, increased potential liability for hospitals. This column provides a brief review of the informed consent doctrine, discusses the traditional and the Magana approaches to the issue of hospitals‘ responsibility to obtain informed consent, and analyzes the implications, particularly for nurses, should the Magana approach be more widely followed.

Mark Twain once said of Wagner's music, “It's not as bad as it sounds.” Likewise, it may be said of Peter Singer and Helga Kuhse's stroll through the issues involving embryo research: “It's not as easy as it sounds.”

Today it seems clear that Aldous Huxley's version of a Brave New World is much closer to the mark than George Orwell's 1984. We will not have to be dragged into a technologically dominated future by a totalitarian government; we will go willingly, cheering almost any change as “better” and accepting science as always “improving” on nature. This childlike faith in science is at the heart of Prof. Singer and Dr. Kuhse's hymn to embryo research. They seem to believe that embryo research will not only lead to the prevention and cure of genetic disorders but also to a cure for cancer, and cultured tissues for transplantation. Even if one accepts this rosy view, the acquisition of important scientific knowledge is only a necessary, not a sufficient justification for experimentation.

Despite considerable declines in the early 1980’s, drunk driving remains a major public health problem in the US. In 1986, 46,050 people were killed on the nation's highways. Traffic crashes are the leading cause of death in the age group 1-34 years. Alcohol is unquestionably a major contributor to these crashes. In 1986, 23,987 traffic deaths, 52 percent of the total, involved a driver or pedestrian who had been drinking, and 16,728, 36 percent of the total, involved someone with a blood alcohol level above 10 percent. Many of the victims of drunk driving crashes were not drinking at the time of the event; more than one third of alcohol related vehicular deaths were persons other than drinking drivers: passengers, other drivers or pedestrians.

Legislation may influence drinking and driving behavior, and the consequences thereof, in a variety of ways: limiting access to alcohol; restricting access to vehicles; making vehicles and roadways safer; separating drinking and driving. Taxation, dram shop laws, minimum drinking ages, server liability, land use laws pertaining to the location of alcohol outlets, and prohibitions on advertising alcoholic beverages affect the driver's access to alcohol.

Skyrocketing health care costs are endemic during inflationary periods, affecting not only health care consumers, but also health care providers. Virtually all governmental policymakers recognize spiraling health care costs, but hospital costs continue to escalate faster than the general rate of inflation. In response, alternatives to the traditional physician-patient and hospital-patient relationships have experienced a dramatic resurgence in the last decade, competing for the health care dollar. Two health care alternatives, the health maintenance organizstion (HMO) and the ambulatory surgical center (surgicenter) at which minor surgical procedures can be performed on an out-patient basis. have emerged to provide health care services in a more cost-efficient manner, thereby increasing price competition in the health care sector. The most recent alternative health care system on the health care horizon is the free standing emergency center or “emergicenter.” The growth of these emergicenters within the last few years has heen dramatic—500 in existence as of March 1982.

Although in its 1986 Report on medical malpractice, the General Accounting Office found “No Agreement on the Problem or Solution,” it is readily apparent to any participant in or informed observer of health care delivery in the United States today that problems do exist regarding both the occurrence of medically-induced patient injuries and the management and resolution of medical liability claims. Public policymakers, on both the federal and state levels, have devoted a great amount of attention and energy in the past several years to attempts to devise solutions to these troubling patient injury and provider liability difficulties, difficulties that arguably impact negatively on the quality of medical care, its accessibility, its costs, the physician/patient relationship, and the progress of medical innovation. Private organizations have also undertaken initiatives in this area.

Abortion is the most divisive issue in American society today, but that is not unique because the issue troubles many other Western countries as well. Acrimonious debate has ensued in America in the wake of the Supreme Court's latest pronouncement in Webster v. Reproductive Health Services. Anxiety about the future of the law in America has been widely expressed by pro-life and prochoice groups alike. These could well be the visible skirmishes of the abortion battle and the conflict over the existence of a woman's right to choose in almost any Western jurisdiction. Perhaps only the intensity of debate and venue of battle vary.

In the wake of Roe v. Wade the American battle fronts have mainly been in the courts. A plethora of cases in both state and federal courts has tested the constitutionality of legislation passed by State legislatures restricting the availability of abortion.

Cochrane has developed a linked data infrastructure to make the evidence and data from its rich repositories more discoverable to facilitate evidence-based health decision-making. These annotated resources can enhance the study and understanding of biomarkers and surrogate endpoints.

Surrogate endpoints are a common application of biomarkers to estimate clinical benefit in clinical trials, despite questions about reliability. This article discusses ongoing opportunities for their validation, in the context of a regulatory environment in which they are increasingly championed.

America is burning at a faster rate than any other industrialized nation. Approximately 2.3 million fires costing $40 billion were reported in 1984. Over 5,400 American citizens are killed as a result of these fires and an estimated 130,000 are seriously injured. The leading cause of fire death and injury is cigarette initiated fires with the 1984 toll being 1,570 deaths and 7,000 serious injuries.’ Property damage alone totals over $390 million.

These numbers do not portray the human devastation caused by fires. No other injury causes more pain and suffering. Movies, television and radio have rarely documented the emotional and physical sequelae of a severe burn injury. One day's headline proclaims the devastation of a house fire, and then the story disappears at the point when the survivors begin the agonizing process of healing. The daily routine of burn treatment in America's burn centers is hidden from public view.