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• W4235173731 abstract "As I write this editorial note in the winter of 2016, the opioid epidemic is very much in the news. PBS's Frontline recently aired a one-hour special devoted to the topic. It is undeniably true that the United States has a problem afoot: drug overdose is the leading cause of accidental death in the nation. The occurrence of drug overdose has increased fourfold since 2009, and opioid addiction is the driving force behind this dramatic increase (ASAM 2016). But why so much attention to this drug epidemic? Surely substance addiction has long been a problem in the United States. Is this any different from the past scares? What many Americans already realize and what makes this drug epidemic different from those of the past is that opioid addiction is largely fueled by licit, not illicit, drugs. While just over half a million (586,000) are addicted due to heroin, nearly two million Americans have opioid addiction problems that started with prescription pain relievers. According to the American Society of Addiction Medicine (2016), “four in five new heroin users started out misusing prescription painkillers. As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013.” What this dramatic increase in opioid pain reliever addiction means is that the face of addiction has changed. Today, the victims of addiction look much more white and middle class than in previous epidemics; as a result, the stories told by advocates are much more likely to be received by sympathetic ears and their policy frames in response are much less punitive and more likely to take a helping, public health approach (Lopez 2015).The article in this issue titled “Effects of Competing Narratives on Public Perceptions of Opioid Pain Reliever Addiction during Pregnancy” by Alene Kennedy-Hendricks, Emma McGinty, and Colleen Barry, also finds that the socioeconomic status of woman with opioid pain reliever addiction during pregnancy also matters for how the public views the blaming of addicts and the appropriate policy response. In particular, they find through a series of experiments that by portraying a high socioeconomic status (SES), woman in the narrative lowered perceptions of blame for addiction and reduced public support for punitive policies. In light of yet another study exposing socioeconomic bias, amid numerous studies that expose racial bias, future research should really focus on what mechanisms will help the public and elected officials understand their biases and whether such an understanding would result in fairer policy responses.Indeed, Kennedy-Hendricks et al.’s finding of bias has important implications for all health problems and diseases with prevalence rates that vary by race and class. Take the next article in this issue, which considers the controversy over patients’ access to stem cell interventions. When grappling with this dilemma, Karen Maschke and Michael Gusmano rightly argue that one must first ask: What counts as evidence for a biomedical intervention? Who should define appropriate assessment, safety, and effectiveness, and how? To address these questions, they review several proposed initiatives to get stem cell and other new biomedical interventions into the clinic faster and consider the extent to which these policies can resolve the underlying conflicts about evidentiary standards for clinical use. They also consider whether efforts to expedite access to biomedical technologies may undermine countervailing efforts to increase the safety and effectiveness of stem cell interventions. Given the findings from the first article, it is important to consider whether the public's approach to these questions would change if those who wanted stem cell interventions were predominantly poor nonwhite minorities?Both of these articles get at the heart of health policy: Which services should government cover? How should they be distributed on the ground? And, what information about services is important to provide to the public? The third article, by Ae-Sook Kim, centers on this last question by considering how nursing-home performance data required by the federal government is important for consumers—there is evidence the public is using these data to make decisions—and for how nursing homes compete—they strive to reach a higher rating especially when operating in more competitive markets. This illustrates the crucially important role of government regulatory power—how government displays and frames information changes the public's perceptions of the deservingness of individuals, the value of health investments, and whether facilities are worthy of their business.Numerous public health regulations have been enormously successful at reducing harmful acts by corporations, such as the selling of toxic goods, and reducing individual behaviors that cause ill-health, such as smoking. However, writing sound regulations is complex, especially at the international level, and sometimes well-intended efforts can backfire. Benjamin Hawkins and Chris Holden's article, “A Corporate Veto on Health Policy? Global Constitutionalism and Investor–State Dispute Settlement,” makes this argument by showing how attempts to “constitutionalize” investment law through a proliferation of International Investment Agreements (IIAs) has created a series of new veto points at which corporations may seek to block new policies aimed at protecting or enhancing public health. Thus, ironically, while each IIA may be well-intentioned and designed to create positive public health behavior on the part of corporations, the additive effect of multiple IIAs may in fact give more power to corporations.Finally, we have two special section articles in this issue. A Report on Health Reform Implementation by Robin Flagg conducts a qualitative comparative case study to understand why two seemingly similar conservative states—Wisconsin and Ohio—took divergent paths on the Medicaid Expansion, and a Behind the Jargon essay by Sandy Tanenbaum examines the value of value-based purchasing.Enjoy." @default.
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• W4235173731 date "2016-09-12" @default.
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• W4235173731 title "Editor's Note" @default.
• W4235173731 doi "https://doi.org/10.1215/03616878-3632194" @default.
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