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Abstract:
Epigenetics is one of the most scientifically important, and legally and ethically significant, cutting-edge subjects of scientific discovery. Epigenetics link environmental and genetic influences on the traits and characteristics of an individual, and new discoveries reveal that a large range of environmental, dietary, behavioral, and medical experiences can significantly affect the future development and health of an individual and their offspring. This article describes and analyzes the ethical and legal implications of these new scientific findings.

Epigenetics, genetic, environmental

Abstract:
Broad definitions of public health, including all societal factors that affect health, may undermine efforts to deal with traditional public health issues. A narrower and more practical definition involves public officials taking appropriate measures, pursuant to legal authority, after balancing public rights and private interests to protect the health of the public.

Abstract:
It is not clear whether the Americans with Disabilities Act (ADA) applies to genetic discrimination in employment. State legislation often does not apply to genetic information based on family health histories. Neither the ADA nor state laws prohibit employers from requiring access to genetic information contained in individuals' medical records.

A 1983 Minnesota law limits employer-mandated medical examinations and inquiries, including releases of information in the individual's personal medical files, to job-related information. We examined case filings with the Minnesota Department of Human Rights and interviewed employment lawyers, human relations directors, and occupational physicians. Because few individuals were aware of the law, it was impossible to gauge its effects. Nevertheless, we believe that the Minnesota approach is preferable to either the ADA or genetic-specific state laws.

Abstract:
Theodiosius Dobzhansky was one of the leading population geneticists of the twentieth century. Born in 1900 in a small town in the Ukraine, he came to the United States in 1927 on a fellowship to study with Thomas Hunt Morgan at Columbia University - another giant in genetics who is best known for his work with Drosophila melanogaster (fruit flies). Dobzhansky remained in the United States the rest of his life, researching, teaching, and writing about genetics. Dobzhansky's greatest, enduring contribution to genetics is his work (along with such luminaries as R.A. Fisher, J.B.S. Haldane, Julian Huxley, Ernst Mayr, and Sewall Wright) in formulating the Modern Synthesis of Evolutionary Theory. The Modern Synthesis integrated Darwinian principles of natural selection with Mendelian principles of inheritance to establish the evolutionary foundations of modern genetics.

genetics, genomics, equality, civil rights, employment discrimination, OSHA, discrimination

Abstract:
We sought to determine whether workplace health risk reduction programs (HRRPs) using health risk assessments (HRAs), individually focused risk reduction, and financial incentives succeeded in improving employee health and reducing employer health benefit costs. Methods: We reviewed the proprietary HRA available to us and conducted a literature review to determine the efficacy of HRRPs using HRAs, individualized employee interventions, and financial incentives for employee participation. Results: There is some evidence that HRRPs in employer-sponsored programs improve measures of employee health, but the results of these studies are somewhat equivocal. Conclusion: Employer-sponsored HRRPs may have some benefits, but problems in plan design and in the studies assessing their efficacy complicate drawing conclusions. (J Occup Environ Med. 2009;51:943–950)

Occupational Health, Employee Benefits, Health Risk Assessment, Wellness Programs, Health Risk Reduction Programs

Abstract:
In an article published in 2002, Rethinking the Meaning of Public Health (Rothstein, 2002), I criticized the growing trend in the public health literature and professional discourse of considering human rights violations, economic inequalities, health disparities and numerous other social problems as public health issues. Although recognizing the importance of addressing these issues aggressively and immediately, I asserted that the remediation of a wide range of political, economic and social conditions was beyond the jurisdiction, expertise and mandate of public health officials and public health professionals. I wrote about my concern that by claiming such a vast social agenda public health scholars and officials risked undermining their scientific credibility and popular support to perform in their traditional public health roles, such as sanitation, immunization and controlling infectious disease. I advocated a narrow efinition of public health based on the legal authority granted to public health agencies.

Public health, population health, human rights

Abstract:
We sought to examine the legal and ethical implications of workplace health risk reduction programs (HRRP's) using health risk assessments, individually focused risk reduction, and financial incentives to promote compliance. Methods: We conducted a literature review, analyzed relevant statutes and regulations, and considered the effects of these programs on employee health privacy. Results: A variety of laws regulate HRRP's, and there is little evidence that employer-sponsored HRRP's violate these provisions; infringement on individual health privacy is more difficult to assess. Conclusion: Although current laws permit a wide range of employer health promotion activities, HRRP's also may entail largely unquantifiable costs to employee privacy and related interests. (J Occup Environ Med. 2009; 51:951–957)

HIPAA Privacy Rule, Employee Benefits, Health Risk Assessment, Wellness Programs, Health Risk Reduction Programs, ADA, GINA, Smokers Rights, Ethics

Abstract:
The Genetic Information Nondiscrimination Act of 2008 (GINA) was signed into law on May 21, 2008, after a 13-year struggle in Congress. GINA prohibits genetic discrimination in employment and health insurance, thereby supplementing existing federal protections against genetic discrimination in employersponsored group health plans contained in the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and state laws prohibiting genetic discrimination in employment and individual health insurance.

Genetic Information Nondiscrimination Act, GINA, Americans with Disabilities Act, ADA

Abstract:
For thousands of years, civilized societies have attempted to prevent the spread of communicable diseases by preventing those already afflicted from having contact with those who were still well.The term quarantine is derived from the Italian words quarantina and quaranta giorni, which were used in the fourteenth and fifteenth centuries and referred to a forty-day period in which certain ships entering the port of Venice were obliged to wait in isolation before any persons or goods were permitted to go ashore.The practice of quarantine, as well as the Italian-derived word itself, was widely adopted by other countries to separate potentially exposed individuals from the rest of society until there was reasonable certainty that the suspected individuals were unaffected.

Public Health, Quarantine, SARS, employment, ADA, FMLA, Wrongful discharge, Pandemic, Income replacement, job security

Abstract:
In spite of recent legislation, tougher laws are needed to prevent insurers and employers from discriminating on the basis of genetic tests.

genetics, privacy, electronic health laws, GINA, NHIN, genetic test, nationwide health information network, genetic information nondiscrimination act

Abstract:
On May 21, 2008, President Bush signed into law the Genetic Information Nondiscrimination Act (GINA). Because the issue of genetic discrimination had been considered for 13 years in Congress, and even longer in genetics circles, many of the advocates who worked on this legislation expressed an understandable sense of relief and exhilaration. Now that the ink has dried on the President’s signature, and before GINA takes effect, it is appropriate to consider what GINA does and — perhaps more importantly — what it does not do.

Genetic Information Nondiscrimination Act, GINA, genetics, discrimination

Abstract:
In 2004, President Bush called for widespread adoption of interconnected electronic health records (EHRs) within 10 years. The US Department of Health and Human Services (HHS) has been charged with leading these efforts, including developing the Nationwide Health Information Network (NHIN). Although the specifics of the NHIN and its component organizations are still being developed, it is envisioned as a public-private partnership of health information organizations using common electronic formats, thereby enabling ease of access to EHRs through any secure portal. The NHIN will link health records maintained in hospitals, physicians’ offices, clinics, and other locations.

electronic health records, EHRs, health information technology HIT, privacy, HIPAA Privacy Rule, american disabilities act, ADA, authorizations, nationwide health information network, NHIN

Abstract:
Each year individuals are required to execute millions of authorizations for the release of their health records as a condition of employment, applying for various types of insurance, and submitting claims for benefits. Generally, there are no restrictions on the scope of information released pursuant to these compelled authorizations, and the development of a nationwide system of interoperable electronic health records will increase the amount of health information released. After quantifying the extent of these disclosures, this article discusses why it is important to limit disclosures of health information for non-medical purposes as well as how it may be possible to do so.

electronic health records, EHRs, health information technology, HIT, Privacy, HIPAA Privacy Rule, authorizations, employment, life insurance, nationwide health information network, NHIN

Abstract:
A human influenza virus is considered the most likely source of a andemic in the near future. Quarantine has the potential to be the most effective measure for limiting the spread of infection. The major obstacles to compliance for those asked to enter quarantine include loss of income during quarantine and loss of employment after quarantine. We discuss current antidiscrimination and compensation laws, as well as options to expand coverage for quarantined individuals to encourage public cooperation by guaranteeing job security and providing income replacement.

Public Health, quarantine, job security, income replacement, sars, employment, pandemic

Abstract:
Health care expenditure in the United States exceeds $2 trillion a year, and on a per capita basis far exceeds the expenditure of any other country. Much of this money is not well spent, as many studies have documented the inefficiency and waste in the public and private health care systems. Furthermore, despite the high cost of American health care, key measures of the nation’s health, such as infant mortality and life expectancy, lag well behind other developed countries.

Electronic Health Records, EHR, Privacy, Nationwide Health Information Network, NHIN, HIPPA Privacy Rule, Personal Health Records, PHRs, Health Privacy

Abstract:
It has been pending in Congress for twelve years, despite the support of the last Presedential Adminstrations and the National Institutes of Health. It has been the subject of extensive lobbying by acedemic medical centers, pharmaceutical and biotech companies, genetic advocacy groups, and civil rights organizations. It has overcome vehement objections by employers and insurers. Its final passage however, has been thwarted by a few Congressional leaders, who have prevented enactment despite overwhelming bi-patisian support in both houses of Congress.