Ross D. Silverman

Legislative Prescriptions for Controlling Nonmedical Vaccine Exemptions

This Viewpoint discusses types of exemptions from required vaccines and recent legislation to control numbers of nonmedical vaccine exemptions.

Social Distancing and the Unvaccinated

In January 2015, a federal appeals court ruled that New York State has the authority to bar unvaccinated children from school during outbreaks of vaccine-preventable illnesses, even if doing so overrides a familys religious freedom with regard to vaccination.

Access to Care: Who Pays for Health Care for the Uninsured and Underinsured?: A Symposium Introduction And Overview

The topic of how best to cover America’s uninsured population and address the needs of the underinsured has never been a more prominent part of the national discourse, nor has the need for relief ever been more pressing. Inconvenient truths about the United States health care delivery system were projected on movie screens worldwide in the Summer of 2007 thanks to Michael Moore’s documentary Sicko, which has gone on to become the third highestgrossing documentary film in American box office history. The debate also has become the most significant domestic issue of the 2008 election, and candidates on both sides of the aisle are staking out positions in preparation for what projects to be the most heated political battle over health insurance since at least the mid-1990s. Even Wal-Mart, long portrayed by health insurance reform advocates as the corporate equivalent of the Evil Empire,

Word Adjacency Graph Modeling Separating Signal From Noise in Big Data

There is a need to develop methods to analyze Big Data to inform patient-centered interventions for better health outcomes. The purpose of this study was to develop and test a method to explore Big Data to describe salient health concerns of people with epilepsy. Specifically, we used Word Adjacency Graph modeling to explore a data set containing 1.9 billion anonymous text queries submitted to the ChaCha question and answer service to (a) detect clusters of epilepsy-related topics, and (b) visualize the range of epilepsy-related topics and their mutual proximity to uncover the breadth and depth of particular topics and groups of users. Applied to a large, complex data set, this method successfully identified clusters of epilepsy-related topics while allowing for separation of potentially non-relevant topics. The method can be used to identify patient-driven research questions from large social media data sets and results can inform the development of patient-centered interventions.

Achieving an optimal childhood vaccine policy

Policies to remove parents’ ability to opt-out from school immunization requirements on the basis of religious or personal beliefs (ie, nonmedical exemptions) may be a useful strategy to increase immunization rates and prevent outbreaks of vaccine-preventable disease. However, there is uncertainty about the effectiveness of this strategy and the range of possible outcomes. We advocate for a more deliberative process through which a broad range of outcomes is scrutinized and the balance of values underlying the policy decision to eliminate nonmedical exemptions is clearly articulated. We identify 3 outcomes that require particular consideration before policies to eliminate nonmedical exemptions are implemented widely and outline a process for making the values underlying such policies more explicit.

Treatment Agreements, Informed Consent and the Role of State Medical Boards in Opioid Prescribing

The statistics regarding prescription drug overdose in the United States are shocking and clear. One hundred people die from prescription drug overdoses every day in the United States, with three out of four of these drug overdoses caused by prescription painkillers. Prescription drug deaths are, however, just the tip of the iceberg. For every death from prescription pain killers, 10 people are admitted to treatment for drug abuse, 32 emergency department visits take place, and 130 people abuse these drugs or are dependent upon them [1]. Notably, while 70% of people who abuse prescription pain medication report that they obtained the drugs from friends or relatives [2], long-term abusers of opioid pain relievers are most likely to acquire their drugs through a prescription from a physician [3]. In addition to the chronic pain and the prescription drug abuse epidemics that are well documented in the United States, another third interrelated epidemic is now requiring attention as well. Widespread opioid pain reliever abuse has been associated with a dramatic rise in heroin use in the United States. In March 2014, US Attorney General Eric Holder noted this connection while raising concern about the “urgent public health crisis”—a 45% increase in US heroin overdose deaths from 2006 to 2010 [4]. The Food and Drug Administration (FDA) recently has taken actions that both acknowledge these trends and raise new concerns. In October 2013, the agency recommended that many prescription opioids be reclassified as Schedule II drugs [5]. Later that month, the FDA approved for use a powerful new, pure hydrocodone painkiller, Zohydro ER, leading to an outcry from at least 28 state attorneys general and medical experts concerned about the medications potential for diversion and abuse [6]. As a response to this epidemic of prescription opioid deaths …

POINT: Should Childhood Vaccination Against Measles Be a Mandatory Requirement for Attending School? Yes

A measles outbreak linked to California’s Disneyland has led to > 300 cases in at least seven states, Mexico, and Canada through March 2015. Most cases occurred in people choosing to forego vaccination.1,2 The costs associated with this outbreak exceed those borne by individuals opting out of vaccination: > 10% of the California cases occurred in children too young to be vaccinated, schools and daycares were forced either to close or to enforce policies excluding unvaccinated and vulnerable children for multiple weeks, and health departments spent scores of personnel hours—and hundreds of thousands of dollars from limited budgets—containing the spread of this vaccine-preventable illness.1,2

EHRs, EMRs, and health information technology: to meaningful use and beyond: a symposium introduction and overview.

In 2000 and 2001, the Institute of Medicine (IOM) Committee on Quality of Health Care in America released two landmark reports, To Err Is Human, examining health care safety, and Crossing the Quality Chasm: A New Health System for the 21st Century, which investigated health care quality and the effects of our system on “the health, functioning, dignity, comfort, satisfaction, and resources of Americans.” With these reports, the IOM pulled back the curtain on our health care system, laying bare for all to see the myriad physical and moral harms occurring as a result of the structure and execution of the United States health care delivery system. These reports, which helped foster a revolution in the way that the safety and quality of health care is measured and perceived by those who offer and receive health services in the United

Should Smallpox Vaccine be Made Available to the General Public

In June 2002, the Advisory Committee on Immunization Practices (ACIP) approved draft recommendations concerning preparation for potential biological terror attacks that utilize the smallpox virus. ACIP recommends against both mandatory and voluntary vaccination of the general public. The present paper examines the moral and political considerations both for and against each of the general public vaccination options considered by the ACIP in the context of the states authority over vaccination for the purposes of protecting public health. Although it is clear that compulsory mass vaccination is not justified at this time, the issues surrounding voluntary vaccination are more complex. Should smallpox vaccination prior to an outbreak be made available to the general public? The paper concludes that the vaccine should not be made available at this time. This conclusion, however, is based upon contingent features of current circumstances, which would change once an outbreak occurred. In the event of a terror-related outbreak of smallpox, the general publics access to voluntary vaccination would become justified, even in areas beyond where the outbreak has occurred.

Enhancing Public Health Law Communication Linkages

Although interest in the field of public health law has dramatically increased over the past two decades, there remain significant challenges in communicating and sharing public health law-related knowledge. Access to quality information, which may assist in a public health departments efforts to protect the publics health, welfare, and safety, varies widely from jurisdiction to jurisdiction, and interjurisdictional communication remains at best a patchwork quilt with many holes. What follows is an analysis of several approaches the Public Health Law Association or other public health law-related organizations might undertake to serve as a conduit for the identification, gathering, and dissemination of extant public health law information, as well as the development of new public health law-related content, with a particular focus on the use of electronic means for such efforts.