Assisted reproductive technologies (“ARTs”) have enabled many infertile couples to have children but have long been controversial. Opposition initially focused on the “unnaturalness” of laboratory conception and the doubts that healthy children would result. Once children were born, ethical debate shifted to the status and ownership of embryos and the novel forms of family that could result.

The new century has brought forth both new and old ethical concerns. The growing capacity to screen the genomes of embryos has sparked fears of eugenic selection and alteration. In addition, concerns about safety have reasserted themselves. Several studies suggest that in vitro fertilization (“IVF”) may be associated with lower birth weights and major malformations. Ethical attention has also focused on whether all persons seeking ARTs should be granted access to them, regardless of their child-rearing ability, age, disability, health status, marital status, or sexual orientation.

Society benefits from physicians who seek truth and healing for the good of humanity. Despite ethical admonishments to “do no harm,” however, physicians have caused some of the most appalling human rights abuses of the twentieth century. Physicians, alone or in concert with the state, have willfully abused their medical knowledge and debauched their profession in furtherance of human rights violations. Compounding their crimes, physicians often have been complicit in following oppressive regimes in abusive practices against their citizens. Ironically, it is their knowledge of this healing art that allows physicians to take part in this injurious conduct; and it is this knowledge that states seek to harness in buttressing violative policies. In fact, for nations bent on violating human rights, it is “much easier for governments to adopt inherently evil and destructive policies if they are aided by the patina of legitimacy that physician participation provides.”

Pregnancy is a biological process that usually takes forty weeks. The more advanced pregnancy is in terms of gestational age, the higher the chances that the fetus would survive in case of a premature and unnatural delivery. Hence, when a pregnant woman is struck by brain death, the fetus’ chances of survival are seriously and immediately threatened. Until recently, there were two choices in such a situation: letting the mother (and the fetus) naturally die without further intervention or delivering the fetus through a cesarean section when the death of the fetus was a tragic but likely result.

Recent advances in medical technology, however, have provided physicians with an ability to control over the time and manner of death in ways that were never previously considered by their patients.

Between 1.7 and 4% of the world population is born with intersex conditions, having primary and secondary sexual characteristics that are neither clearly male nor female. The current recommended treatment for an infant born with an intersex condition is genital reconstruction surgery to render the child as clearly sexed either male or female. Every day in the United States, five children are subjected to genital reconstruction surgery that may leave them with permanent physical and emotional scars. Despite efforts by intersexed people to educate the medical community about their rejection of infant genital reconstruction surgery, the American medical community has not yet accepted the fact that differences in genital size and shape do not necessarily require surgical correction.

Genital reconstruction surgery may involve removing part or all of the penis and scrotum or clitoris and labia of a child, remodeling a penis or creating a vaginal opening. While the initial surgery is typically performed in the first month of a child's life, genital reconstruction surgery is not only performed on infants.

The imperative that agencies use sound science in developing their regulations has become a major preoccupation of the political branches. In only a few years, Congress passed two appropriations riders that provide extensive new mechanisms for the public to critique the science used by agencies. The executive branch quickly followed suit, promulgating regulations to implement these two laws, as well as proceeding on its own sound science missions. In the space of less than one year, the Office of Management and Budget (OMB) circulated for public comment draft peer review requirements for the scientific review of agency science, and the Environmental Protection Agency (EPA) launched a full scale program to improve the quality of the models it uses in regulation, as well as Assessment Criteria to be used by agency officials in reviewing the quality of third-party (primarily state) science.

When scholars and policymakers think about the relationship between public health and environmental law and policy, they likely think first about controlling pollution and other toxic substances. As other articles have amply demonstrated, water pollution, air pollution, and other environmental toxins can have significant deleterious effects on the public's health. Scholars rightly pay serious attention to these relationships, and policymakers wisely devise methods and strategies to ameliorate the public health risks posed by these polluting substances.

Although pollution control might be the most obvious and important intersection between environmental policy and public health, legal and policy decisions regarding the management and preservation of the nation's natural resources potentially also significantly affect the public's health. Preserving plant and animal species, allocating water resources, and managing the nation's public lands, just to name a few examples, all potentially bear on matters of public health and safety.

The medical liability crisis is affecting our healthcare system. Medical liability and limited physician and hospital access to malpractice insurance have pushed many providers to leave their states, reduce their services, or simply retire. For many, a labor of love has become an agonizing search for insurance to ensure continued practice in an industry for which they trained eight, fifteen, or even twenty years. Limited insurance and potential liability has also led to defensive medicine, in which providers try to avoid lawsuits by ordering tests, procedures, and anything else that might help protect against liability. Moreover, providers may also attempt to avoid high-risk patients or practices altogether to limit opportunities for lawsuits. Although it is questionable whether these efforts actually help, the provider perception of self-preservation through defensive medicine is undeniable—and providers, like everyone, act on their perceptions.

The most complex issues in the field of healthcare policy can often be reduced to the simple question “who is going to pay?” Legislatures, whether at the state or national level, are generally the entity responsible for allocating healthcare costs. When a legislative body acts to allocate healthcare costs, it simultaneously amends a society-wide, interwoven web of regulation and incentives that is steeped in decades of tradition. Further, and perhaps more importantly, healthcare cost allocation affects each individual in our society on an intimate level. Medicare is one of the most controversial elements in this grand scheme of cost allocation policy.

Medicare serves approximately 37 million senior citizens in the United States. Of course, Medicare benefits are limited. With minor exceptions, Medicare fully covers only the first ninety days of hospitalization for an eligible citizen. After such period, a Medicare-eligible citizen may draw upon a non-renewable lifetime reserve, which provides Medicare hospitalization coverage for an additional sixty days.

Hospitals in the United States rely on peer review committees to make credentialing decisions and to conduct ongoing evaluations of all medical care, thereby ensuring the quality of the physicians they employ. Physicians, however, may be reluctant to serve on peer review committees for fear of retaliatory litigation. In response, and in an effort to improve the quality of healthcare in the United States, Congress passed the Health Care Quality Improvement Act of 1986 (“HCQIA”).

Congress designed the HCQIA to improve the quality of healthcare in two ways. First, it increased the effectiveness of peer review by providing review committees with immunity from lawsuits filed in response to professional review actions. Second, it authorized the Secretary of Health and Human Services (“HHS”) to create the National Practitioner's Data Bank (“NPDB”). Any disciplinary action taken by a review committee must, as a condition to immunity, be reported for listing in the NPDB.

The effects of environmental exposure, broadly defined as any exposure from outside the body, on human health are unquestionably the most important determinants of public health. While important genetic determinants of disease exert their effects irrespective of exposure from outside the body, these do not contribute as much to the overall public health burden of disease as factors such as tobacco smoke, poor quality water, inadequate or contaminated food, occupational exposures to dusts and chemicals, motor vehicle accidents, interpersonal violence, air pollution, and other factors external to the body. In many cases, genetic predisposition and environmental exposures combined cause disease in an individual, so it may be impossible to separate out individual biological contributions from various external factors. Nevertheless, it is widely understood that public health concerns populations and communities, and that environmental determinants of health have been paramount throughout human history.

Fat. Many love to eat it, but hate to carry it. The majority of people in the United States struggle to get out of this love/hate bond. Unfortunately, they find themselves stuck in an abusive relationship.

Obesity is the “fastest-growing major health problem in the United States.” Approximately two thirds of American adults are overweight or obese. In addition, 15 percent of children are overweight. The number of people suffering from this chronic ailment dwarfs the number of people afflicted with other diseases such as HIV/AIDS, cancer, diabetes and heart disease. Obesity leads to over 400,000 deaths a year, and it costs the United States over $117 billion per year. The prevalence and cost of the disease “warrants an increased emphasis on prevention and treatment.”

The environment and public health goals hold a common value of healthy populations. The threat of bioterrorism requires a partnership of both, building upon the long history of the link between public health and the environment. This existing relationship is key to an effective system of biodefense for the nation, because the use of biological weapons through every environmental pathway poses a potential threat. Contaminations of water, growing crops, grazing cattle, air through inhalation, dermal absorption, or consumption of food or water in the human environment are potential delivery methods. For these risks of bioterrorism in the environment, there is an existing federal regulatory and statutory framework upon which the relationship between the environment and public health can be strengthened and shaped.

Obesity is the number one health problem facing America today. The connection to physical inactivity and a sedentary lifestyle has long been recognized, but only recently has it become a focal point for physicians worldwide. Surprisingly, the answer may be as close as America's backyardthe public lands and waters under the management of the U.S. Department of the Interior (Interior), as well as other federal, state, and local agencies. While traditional efforts to increase physical activity among Americans have focused on exercise-related activities such as calisthenics, treadmills, or stair machines, more recently leisuretime activities like gardening and housework have emerged as additions to the physical activity arsenal. These activities in turn have shifted attention away from individual obstacles and toward barriers to human movement in the built environment.

Mercury is a persistent, bioaccumulative toxin that adversely affects human beings and wildlife. Mercury, like many such toxins, is a multimedia pollutant that can readily transfer among air, water, and soils, and thus crosses the boundaries of traditional regulatory programs. Mercury can also be transported long distances in the atmosphere, creating transboundary issues that are regional and global in scope. Human exposure to mercury is largely attributable to the consumption of contaminated fish, with women of childbearing age, infants, and children at greatest risk. Because mercury persists in the environment, the risk of neurological or other impairments can span generations. Mercury, largely from anthropogenic sources, enters aquatic systems through a variety of pathways including direct deposition from the atmosphere, runoff, and wastewater discharges.

For several decades now we have been acutely aware of the increasingly intensifying effect that environmental degradation has on human health. While many of these effects are localized, given the increasingly global nature of environmental problems their impact on human health has also become global in dimension. Health experts are becoming more and more concerned about the potential impact on public health if no precautionary measures are taken to deal with these global environmental problems.

Of course, environmental problems have consequences beyond their public health impact. The emphasis in this Article on public health should not be taken as advocating an anthropocentric approach to environmental problems. This Article focuses on public health as a way of drawing attention to the enormity of the problem.

The people have a right to clean air, pure water, and to the preservation of the natural, scenic, historic and esthetic values of the environment.

There is a long history of attacks on scientists. During the Inquisition, the Roman Catholic Church charged Galileo with heresy and, after imprisonment and threats of torture, forced him to renounce his theory that the sun, not the earth, was the center of the universe. In the 1950s, politicians sought to silence scientists that allegedly held political views sympathetic to Communists.

In recent years, research results, rather than the scientist's religion or politics, have motivated attacks on scientists. As environmental issues grow in economic significance and as science takes on increasing importance in influencing public opinion and resolving environmental policy debates, suppression of environmental science has become increasingly common. As one author observed, the power of science to legitimate environmental positions by claiming exclusive truth makes ownership of science one of the most contested issues in modern environmentalism.