The DTC microbiome testing industry needs more regulation.

Tests lack analytical and clinical validity, requiring more federal oversight to prevent consumer harm.

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death.

Context: No national data exist on hospice medication shortages, the frequency that opioid medications go missing, and drug disposal practices.

Objectives: To provide national estimates for hospices on: drug shortages; frequency of missing medications; and opioids left in the home post-death.

Methods: A national survey of 600 randomly selected hospices stratified by state and profit status (data collection 2018).

Patient and Family Descriptions of Ethical Concerns.

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals.

Emergency Declarations for Public Health Issues: Expanding Our Definition of Emergency.

Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse.

Understanding and Addressing Women's Use of Force in Intimate Relationships: A Retrospective.

This article surveys an evolving understanding of women's use of force in their intimate heterosexual relationships. It explores the common characteristics of women who use force and, using an intersectional lens, considers the experiences of women in marginalized communities. It also examines how the legal response to intimate partner violence has affected this population.

Legal Evidence of Subjective States: A Brain-Based Model of Chronic Pain Increases Accuracy and Fairness in Law.

Advances in structural and functional neuroimaging offer new ways to conceptualize chronic pain disorders and to prevent, diagnose, and treat chronic pain. Advances in pain science, though, do not entail changes in the concepts of chronic pain in law and culture. Authoritative legal and cultural conceptions of chronic pain continue to promote abstruse theories, characterizing these disorders as arising out of everything from a person's unmet need for love to resistance to "patriarchy.

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations.

Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. Brain imaging (for example, functional MRI, PET, EEG and magnetoencephalography) is widely considered to have potential for diagnosis, prognostication, and prediction of treatment outcome in patients with chronic pain. In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of its use in this way.

Exploring Social Justice in Mixed/Divided Cities: From Local to Global Learning.

Background: University of Haifa and the University of Maryland, Baltimore faculty developed a parallel binational, interprofessional American-Israeli course which explores social justice in the context of increasing urban, local, and global inequities.

Objectives: This article describes the course's innovative approach to critically examine how social justice is framed in mixed/divided cities from different professional perspectives (social work, health, law). Participatory methods such as photo-voice, experiential learning, and theatre of the oppressed provide students with a shared language and multiple media to express and problematize their own and others' understanding of social (in)justice and to imagine social change.

Finding Fault? Exploring Legal Duties to Return Incidental Findings in Genomic Research.

The use of whole-genome sequencing in biomedical research is expected to produce dramatic advances in human health. The increasing use of this powerful, data-rich new technology in research, however, will inevitably give rise to incidental findings (IFs)-findings with individual health or reproductive significance that are beyond the aims of the particular research-and the related questions of whether and to what extent researchers have an ethical obligation to return IFs. Many have concluded that researchers have an ethical obligation to return some findings in some circumstances but have provided vague or context-dependent approaches to determining which IFs must be returned and when.

Quality attestation for clinical ethics consultants: a two-step model from the American Society for Bioethics and Humanities.

Given the importance of clinical ethics consultation to patient care, the people doing it should be asked to show that they do it well. An ASbH task force proposes a method for assessing them.

Are changes to the common rule necessary to address evolving areas of research? A case study focusing on the human microbiome project.

This article examines ways in which research conducted under the Human Microbiome Project, an effort to establish a "reference catalogue" of the micro-organisms present in the human body and determine how changes in those micro-organisms affect health and disease, raise challenging issues for regulation of human subject research. The article focuses on issues related to subject selection and recruitment, group stigma, and informational risks, and explores whether: (1) the Common Rule or proposed changes to the Rule adequately address these issues and (2) the Common Rule is the most appropriate vehicle to provide regulatory oversight and guidance on these topics.

Pain as a fact and heuristic: how pain neuroimaging illuminates moral dimensions of law.

In legal domains ranging from tort to torture, pain and its degree do important definitional work by delimiting boundaries of lawfulness and of entitlements. Yet, for all the work done by pain as a term in legal texts and practice, it has a confounding lack of external verifiability. Now, neuroimaging is rendering pain and myriad other subjective states at least partly ascertainable.

Putting together the pieces: recent proposals to fill in the genetic testing regulatory puzzle.

The idea that genetic information is different from other medical information and therefore needs special protection has led to a regulatory puzzle where genetic testing is currently regulated under three separate schemes. Although genetic tests for over 2,000 diseases are available, less than 10% of these tests have been reviewed for clinical validity or utility. Recent action by some genetic testing companies has prompted the federal government to propose changes to the current regulatory scheme.