Tobacco liability and public health policy

Article Abstract:

In this article, the legal case of Cipollone v Liggett Group is discussed. This case is pending before the Supreme Court. The Court's decision will be important for tobacco use and policy as well as for the relationship between product liability law and public health. The role of tobacco litigation in reducing smoking is discussed. Rose Cipollone was a pack-and-a-half-a-day smoker for 40 years who had tried to stop but failed. She continued to smoke even after developing a malignancy that led to the removal of part of a lung, then the entire lung. Advertising by the cigarette companies (specifically, Liggett and Myers), according to the plaintiff, led Ms. Cipollone to consider their product safe. The complaint, filed in 1983, one year before her death from cancer, claimed the manufacturers had not informed consumers adequately of the health risks of smoking. The Liggett Group maintained Ms. Cipollone's claims were preempted by the Cigarette Labeling and Advertising Act of 1965, which mandated warning labels on cigarette packages. The preemption provision stated that no warning other than the Congressionally mandated one would be required on cigarette packages. The federal District Court ruled in Cipollone's favor, but a Court of Appeals reversed the decision. The preemption doctrine is explained and discussed. The authors believe the Supreme Court should rule against the tobacco industry in this case. Their reasons are defended. One important issue is the duty of the tobacco companies to not mislead consumers. If the Supreme Court rules in favor of Ms. Cipollone, the decision would allow plaintiffs to claim that the manufacturers did not adequately warn and avoid misleading consumers. Tobacco litigation fulfills a social function when the courts offer a forum for discussing complex issues; when they offer compensation to injured smokers; when they function as regulatory mechanisms for industries that make dangerous products; and when they allocate responsibility within society for disease due to unsafe products. Social costs will be high if the Supreme Court preempts the majority of tobacco litigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social policy, Labeling, Tobacco industry, Cigarettes

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Public health strategies for confronting AIDS: legislative and regulatory policy in the United States

Article Abstract:

Legislation stemming from the AIDS epidemic should contribute to the public health effort to combat the disease. Legislation can help combat the disease by promoting appropriate health care services and public education, particularly in sensitive areas such as sex education in schools, condom advertising, and outreach programs for drug-dependent people. Furthermore, legislation is useful in funding research and developing public policies, such as those that safeguard confidentiality and protect against discrimination. On the other hand, legislation can subvert public health efforts by dictating the content of educational messages based on moral disapproval of sexual practices and drug use. Legislation can also be used to weaken the principle of confidentiality by creating criminal penalties for those members of "high-risk" groups who transmit the human immunodeficiency virus (HIV), the virus that is held to be responsible for AIDS. AIDS legislation in the U.S. varies a great deal from state to state. The author asserts that public health officials will not gain the confidence and cooperation of HIV infected persons if these individuals are not legally protected from stigma and irrational prejudice. While state legislatures have responded well to health service research, in the opinion of the author they have been highly susceptible to the attitude that the primary modes of HIV transmission are immoral and even criminal. Educational efforts need to be focused on teaching safer behaviors (e.g, use of condoms) as opposed to the unrealistic goal of sexual abstinence. Legislation for compulsory screening, isolation of HIV-infected individuals, and criminalization of certain high-risk behaviors, has proceeded despite evidence that it is not useful in countering the spread of AIDS.

Political aspects, Health planning, Medical screening, Health screening, AIDS (Disease), column

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Mandatory reporting of infectious diseases by clinicians

Article Abstract:

Physicians are required to report certain specified diseases to either local or state surveillance programs under the authority of state regulations. Data from all states concerning 49 different infectious diseases and conditions are conveyed to the Centers for Disease Control where the data are analyzed. The list of infectious diseases includes illnesses which are communicable from person to person, such as AIDS and tuberculosis, and illnesses which are spread by nonhuman hosts, such as Lyme disease and malaria. In most developed countries, similar systems are used to provide a national authority; the data are utilized to alert health agencies of the presence of communicable diseases and conditions within the country. The system in the United States is fragmented and irregular because the authority for mandating such reports is vested in the states and not in a centralized authority. Tables presented by the authors clarify the mandatory reporting of these 49 diseases on a state-by-state basis. Data collected from the state agencies are published in a weekly surveillance report (the Morbidity and Mortality Weekly Report) and in an annual summary (Summary of Notifiable Diseases). The participation of individual physicians in the reporting effort is critical to the collection of data that supports disease surveillance efforts in the United States.

Prevention, Statistics, Communicable diseases, Epidemics

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