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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 department's efforts to protect the public's 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. [ABSTRACT FROM AUTHOR]

Background: Though social determinants are the primary drivers of health, few studies of people living with HIV focus on non-clinical correlates of insecure and/or fragmented connections with the care system. Our team uses linked clinical and multisector non-clinical data to study how residential mobility and connection to social services influence the HIV care continuum. We engage a diverse group of individuals living with HIV and other invested community members to guide and inform this research. Our objective is to generate consultant-informed, research-based interventions that are relevant to the community, and to share our engagement approach and findings so that other researchers can do the same., Methods: Our research team partnered with the Indiana Clinical and Translational Sciences Institute's Research Jam to develop and implement a human-centered design research plan to engage individuals with experience relevant to our research. We recruited a panel of consultants composed of people living with HIV and/or clinicians and individuals from agencies that provide medical and non-medical services to people living with HIV in Marion County, Indiana. To date, we have used a variety of human-centered design tools and activities to engage individuals during six sessions, with results informing our future engagement and research activities., Results: Since the inception of the project, 48 consultants have joined the panel. Thirty-five continue to be actively engaged and have participated in one or more of the six sessions conducted to date. Consultants have helped guide and prioritize analyses, aided in identification of data missing from our ecosystem, helped interpret results, provided feedback on future interventions, and co-presented with us at a local health equity conference., Conclusions: We utilize community engagement to expand the scope of our research and find that the process provides value to both consultants and the research team. Human-centered design enhances this partnership by keeping it person-centered, developing empathy and trust between consultants and researchers, increasing consultant retention, and empowering consultants to collaborate meaningfully with the research team. The use of these methods is essential to conduct relevant, impactful, and sustainable research. We anticipate that these methods will be important for academic and public health researchers wishing to engage with and integrate the ideas of community consultants., Competing Interests: Declarations. Ethics approval and consent to participate: This study received exempt review approval by the Indiana University Institutional Review Board, protocol 2007804959, entitled Getting to Zero People Living with HIV-Participant Engagement. We obtained informed consent from all consultants and contact each annually to ensure their continued interest in participating. Consent for publication: Written informed consent for publication was obtained from all consultants. That said, consultant images were rendered unidentifiable and there are no details about individuals reported within this manuscript. The only identifiable image (Fig. 7) in the manuscript is that of a co-investigator. Competing interests: Dr. Sarah Wiehe is a member of the United States Preventive Services Task Force (USPSTF). This article does not necessarily represent the views and policies of the USPSTF. There are no other competing interests to disclose., (© 2024. The Author(s).)

Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Jamie F. Chriqui serves as a Council on Education for Public Health site visitor.

Objective: The current study presents the legal epidemiological review of State Health Official (SHO) appointment laws, including the evolution of educational and experience requirements of SHOs over time. Findings can inform the discussion about state laws and the substantive, multidisciplinary qualifications essential to successfully leading state public health agencies in the 21st century., Methods: Standard policy surveillance methods were used to collect and assess the statutes governing SHO appointment and eligibility from all 50 states and the District of Columbia between 1995 and 2020., Results: SHOs are most frequently appointed by their jurisdiction's Health Secretary (n = 17), followed by Governor nominations with legislative approval (n = 15), and 13 states where the Governor is the sole SHO appointing authority. While a large majority of jurisdictions require certain professional and/or educational minimum qualifications to serve as an SHO, 11 states have no professional or experiential minimum qualifications. The most common minimum requirement found was possessing a medical degree, which is required in 22 jurisdictions (including Washington, District of Columbia). Twelve of these states require the physician to have additional education or experience, such as the possession of experience in public health (n = 5), experience in both public health and management (n = 3), or holding an additional health-related degree (n = 2). Four states added a medical degree as a requirement for SHOs over the last 25 years, while 5 states removed their medical degree requirement., Conclusions: States should reassess their eligibility requirements for SHO service in light of the advancement and demands of public health leadership in the 21st century, as many states continue to look to those with medical training as the primary source for such leadership., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Balancing on a tightrope twenty feet above the ground is outside the comfort zones of many health law professors. Being there forces you to consider in new ways yourself, your skills, and your surroundings. Fears arise, and yet you must still act. And you must trust that the person who offered you this opportunity cared about you and your well-being, and that they would ensure there was a way to get from where you began to the other side.

Given low rates of uptake of the COVID-19 vaccine for children 12-17 and 5-11 years old, research is needed to understand parental behaviors and behavioral intentions related to COVID-19 vaccination for their children. In the state of Indiana, we conducted a non-random, online survey of parents or caregivers (N = 10,266) about their COVID-19 vaccine intentions or behaviors, demographic characteristics, and potential motivating reasons for getting the vaccine. In terms of behaviors/intentions, 44.8% of participants indicated they were vaccine acceptors (i.e., had already had their children vaccinated or would as soon as it was possible), 13.0% indicated they were vaccine hesitators (i.e., wanted to wait and see), and 42.2% indicated they were vaccine rejecters (i.e., would not vaccinate or only would if mandated). Compared to vaccine rejecters, vaccine hesitators were more likely to be motivated by perceptions of vaccine safety and efficacy, normative influences such as close friends/family who had been vaccinated and a recommendation from a provider, as well as if they were vaccinated themselves. These findings have implications for the development of targeted vaccine promotion strategies, such as social norms messaging and a focus on vaccine safety, in order to increase COVID-19 vaccination for eligible children., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Policy surveillance is critical in examining the ways law functions as a structural and social determinant of health. To date, little policy surveillance research has focused on examining intrastate variations in the structure and health impact of laws. Intrastate policy surveillance poses unique methodological challenges because of the complex legal architecture within states and inefficient curation of local laws.We discuss our experience with these intrastate policy surveillance challenges in Indiana, a state with 92 counties and several populous cities, a complicated history of home rule, systemically underfunded local governments, and variations in demography, geography, and technology adoption. In our case study, we expended significant time and resources to obtain county and city ordinances through online code libraries, jurisdiction Web sites, and (most notably) visits to offices to scan documents ourselves.A concerted effort is needed to ensure that local laws of all kinds are stored online in organized, searchable, and open access systems. Such an effort is vital to achieve the aspirational goals of policy surveillance at the intrastate level.

We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes., Competing Interests: Competing interests: EK reports funding from the National Collegiate Athletic Association during the conduct of the study and research funding to institution in past 3 years from the Pac-12 Athletic Conference. KC reports grants from National Collegiate Athletic Association and US Department of Defense during the conduct of the study, book royalties from Springer, and membership on the NATA Foundation Board of Directors. JDS reports grants from National Collegiate Athletic Association and US Department of Defense during the conduct of the study. CD’L reports grants from the National Collegiate Athletic Association and US Department of Defense during the conduct of the study. JKR-M reports grants from the National Collegiate Athletic Association and US Department of Defense during the conduct of the study, research funding to institution in past 3 years from: National Football League, National Athletic Trainers Association Foundation, Centers for Disease Control, National Operating Committee on Standards for Athletic Equipment, and current membership on USA Football's Football Development Council. RS reports funding from the National Collegiate Athletic Association during conduct of the study., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly complex with variation in treatment by state. Evidence-based state-level regulation of OTPs can be a powerful tool and may help improve the unmet need for treatment. This study characterized the variability in state laws that regulate OTPs and examines how this variability is associated with state characteristics. Our data provides an opportunity for policymakers to consider regulations that increase access to care and retention in OTPs, which could improve population health., Materials and Methods: Utilizing policy mapping techniques, we identified all regulations governing OTPs in effect on January 1, 2017 and determined whether the most common regulations were consistent with best practices. We then examined how the number and type of regulations were associated with state characteristics. All policy mapping research was conducted between November 2017 and March 2019., Results: We identified 89 different regulations, the most common of which exists in fewer than half of all states; and most exist in <25% of states. Eighteen of the 30 most common regulations were inconsistent with best practice recommendations. Overall, variability in the number and type of OTP regulations was related to geographic location as opposed to state size., Conclusions: Wide-ranging variability exists in the regulations of OTPs across the U.S. Most state OTP regulations are not congruent with best practices., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction and Aims: People with opioid use disorder are prevalent in criminal problem-solving courts and dependency courts, which have rehabilitative aims. Medication for opioid use disorder (MOUD) is the standard of care. Court staff set treatment policies for court clients. They may receive training from MOUD manufacturers, but no studies have examined court staff receipt of such training., Design and Methods: To examine receipt of training from MOUD manufacturers, we designed a cross-sectional survey for court staff. We distributed it online to all Florida court staff in criminal problem-solving or dependency courts (n = 585). Outcome variables were receipt of training from one or more MOUD manufacturers and training source. Covariates included dichotomous measures of court type, staff role, gender and rurality. Logistic regression models estimated the relationship between receipt of training and covariates., Results: Twenty-one percent of Florida criminal problem-solving and dependency court staff completed the survey. The most common receipt of training was from the manufacturer of extended-release naltrexone (36%), followed by buprenorphine (24%) and methadone (11%). Fifty-seven percent of those who received training received it from more than one MOUD manufacturer. Criminal problem-solving court staff were more likely than dependency court staff to receive training from MOUD manufacturers. Court program co-ordinators were more likely than other staff roles to receive training from MOUD manufacturers., Discussion and Conclusions: A large minority of respondents received training from a MOUD manufacturer, primarily from extended-release naltrexone's manufacturer, raising concerns regarding information accuracy and conflicts of interest. Court staff should seek MOUD training from academic institutions and non-profit organisations instead., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)

Background: Despite its efficacy, medication-assisted treatment (MAT) is rarely available in the criminal justice system in the United States, including in problem-solving courts or diversionary settings. Previous studies have demonstrated criminal justice administrators' hostility towards MAT, especially in prisons and jails. Yet, few studies have examined attitudes among court personnel or compared beliefs among different types of personnel. Also, few studies have explored the relationship between MAT education/training and attitudes. Finally, few studies have directly compared attitudes towards methadone, oral buprenorphine, and extended-release naltrexone in the criminal justice system., Methods: We modified a survey by Matusow et al. (2013) to explore justice professionals' MAT attitudes, including associations with demographic variables, court role, and previous MAT education/training. After piloting the survey, we distributed it to a convenience sample of justice professionals registered for an educational summit held in Indiana in 2018. Data was analyzed using descriptive and inferential statistical methods., Results: 231 Indiana court employees who had registered for a state MAT educational summit completed the survey prior to the summit, including judges, probation officers, law enforcement personnel, attorneys, probation officers, program directors, counselors, and case managers. Overall, participants had significantly more positive attitudes towards extended-release naltrexone than towards other medications (p value <0.01). Court employee average attitudes towards methadone were significantly more negative than average attitudes towards oral buprenorphine; and average attitudes towards oral buprenorphine were significantly more negative than average attitudes towards extended-release naltrexone (p value <0.01). Employment as a prosecutor or law enforcement officer was associated with more negative attitudes towards oral buprenorphine and methadone (p value <0.05). Exposure to previous MAT training was associated with more positive attitudes for all medications (p value <0.05). Compared to participants with graduate degrees, participants with less education had significantly more negative attitudes towards extended-release naltrexone (p < 0.05). Gender, age, rurality, and personal/family recovery history were not associated with differences in attitudes., Conclusion: As expected, court employees' attitudes significantly differ by medication, with average attitudes towards agonist medications being more negative than attitudes towards extended-release naltrexone. Despite a larger evidence base for the efficacy of methadone and oral buprenorphine, justice personnel may have more positive attitudes towards extended-release naltrexone due to targeted marketing by the pharmaceutical manufacturer, fears about diversion or misuse of agonist medications, and historic criminal justice hostility towards agonist medications. Importantly, previous education/training regarding MAT is associated with more positive attitudes, suggesting that more awareness-raising or capacity building educational interventions are needed, especially for prosecutors and law enforcement personnel., (Published by Elsevier Inc.)

Vaccination is one of history's most successful public health interventions. Since 2000, vaccination campaigns against measles, which is highly contagious but preventable through the measles-mumps-rubella (MMR) vaccine, have reduced both the global incidence of the disease and measles deaths by 80 percent. However, progress toward measles elimination has slid backward in several previously well-protected global regions. With more communities below or at risk of falling below the 95 percent immunization rates required for herd immunity-due more and more to vaccine skepticism and declination rather than lack of access-many U.S. states and countries must reappraise their vaccination policies and programs., (© 2019 The Hastings Center.)

Background: In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature., Methods: We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy., Results: In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions., Conclusions: This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision-making and state-level health outcomes.

In psychology and the behavioral sciences generally, the use of the hierarchical linear model (HLM) and its extensions for discrete outcomes are popular methods for modeling clustered data. HLM and its discrete outcome extensions, however, are certainly not the only methods available to model clustered data. Although other methods exist and are widely implemented in other disciplines, it seems that psychologists have yet to consider these methods in substantive studies. This article compares and contrasts HLM with alternative methods including generalized estimating equations and cluster-robust standard errors. These alternative methods do not model random effects and thus make a smaller number of assumptions and are interpreted identically to single-level methods with the benefit that estimates are adjusted to reflect clustering of observations. Situations where these alternative methods may be advantageous are discussed including research questions where random effects are and are not required, when random effects can change the interpretation of regression coefficients, challenges of modeling with random effects with discrete outcomes, and examples of published psychology articles that use HLM that may have benefitted from using alternative methods. Illustrative examples are provided and discussed to demonstrate the advantages of the alternative methods and also when HLM would be the preferred method. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

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.

The longitudinal prediction of reading problems from fourth grade to sixth grade was investigated with a sample of 173 students. Reading problems at the end of sixth grade were defined by significantly below average performance (≤ 15th percentile) on reading factors defining word reading, fluency, and reading comprehension. Sixth grade poor reader status was predicted by fall of fourth grade passage reading fluency, spelling fluency, and the number of reading problems identified by teachers. Reading fluency and spelling fluency were significant predictors in logistic regression equation that combined to yield a screening battery with an area under the curve of .91. These results suggest that brief assessments of reading and spelling fluency in fourth grade may be able to identify students in middle childhood who have a reading problem or who are at risk for experiencing reading problems in sixth grade., (© Hammill Institute on Disabilities 2013.)

Mobile health (mHealth) technology has facilitated the transition of care beyond the traditional hospital setting to the homes of patients. Yet few studies have evaluated the legal implications of the expansion of mHealth applications, or "apps." Such apps are affected by a patchwork of policies related to medical licensure, privacy and security protection, and malpractice liability. For example, the privacy protections of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may apply to only some uses of the apps. Similarly, it is not clear what a doctor's malpractice liability would be if he or she injured a patient as the result of inaccurate information supplied by the patient's self-monitoring health app. This article examines the legal issues related to the oversight of health apps, discusses current federal regulations, and suggests strategies to improve the oversight of these apps.

This study investigated a Tier 2 intervention in the context of a Response to Intervention (RTI) model for 123 fourth grade students who were identified as having a high probability of reading failure. A randomized control trial was used to evaluate the effects of a 24 session multi-component supplemental intervention targeting fluency and expository comprehension of science texts. Intervention students performed significantly higher on comprehension strategy knowledge and use and science knowledge, but not on word reading, fluency, or other measures of reading comprehension. Moderators of intervention effects were also examined; children at higher risk in the intervention condition appeared to benefit more in comparison to lower probability children in intervention and compared to higher probability children in the control condition.

A conditionally linear mixed effects model is an appropriate framework for investigating nonlinear change in a continuous latent variable that is repeatedly measured over time. The efficacy of the model is that it allows parameters that enter the specified nonlinear time-response function to be stochastic, whereas those parameters that enter in a nonlinear manner are common to all subjects. In this article we describe how a variant of the Michaelis-Menten (M-M) function can be fit within this modeling framework using Mplus 6.0. We demonstrate how observed and latent covariates can be incorporated to help explain individual differences in growth characteristics. Features of the model including an explication of key analytic decision points are illustrated using longitudinal reading data. To aid in making this class of models accessible, annotated Mplus code is provided.

The authority of government to require participation in mandatory childhood vaccination programs may not target specific groups for either participation or exemption on a discriminatory basis. This poses difficulties when allowing religious or philosophical exemptions to mandatory vaccination, because certain groups are more likely to appeal for exemption. Avoiding loss of herd immunity, then, may require either discrimination against these groups by disallowing an exemption option that is available to others, or by denying the good of an exemption option to the entire population because of the action of certain groups. To avoid this unacceptable choice, steps must be taken now to more stringently enforce exemption requirements.

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 state's 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 even of a terror-related outbreak of smallpox, the general public's access to voluntary vaccination would become justified, even in areas beyond where the outbreak has occurred.

Professor Silverman's article examines the complex challenges faced by U.S. policymakers attempting to balance the public health protections of mandatory childhood immunization programs with the legal, religious, philosophical, and practical concerns raised by permitting non-medical exemptions under the programs. The article begins with a discussion of the history of childhood immunization programs, and continues by describing the inconsistency of enforcement of state immunization laws and exemptions. The author analyzes recent cases from New York, Wyoming, and Arkansas, and discusses how these decisions both pose threats to these programs' public health protections, while also offering insight into potential problems for other state vaccination programs. Professor Silverman concludes by advocating that states adopt an "informed refusal" approach to vaccination exemption as a way of improving immunity protections, while respecting the autonomy rights of those who wish to opt out of the program.

In response to the threat of a smallpox attack on the United States, the Centers for Disease Control and Prevention ("CDC") recommended the establishment of smallpox clinics designed to distribute a vaccine to the entire U.S. population in a ten day period. However, a number of potential obstacles raise questions about the feasibility of this plan. What is needed is a plan that applies principles of triage to smallpox vaccine distribution following a bioterrorism attack. Only in this way can those most vulnerable--the previously unvaccinated--be protected from a significantly increased risk due to delays that might arise in executing the CDC plan.

In this paper, we examine the phenomenon of 'clustering of exemptions' to childhood vaccination, and the dangers this poses both to those exempted as well as the general population. We examine how clusters of exemptions might form through collective action as described by Thomas Schelling, and how religious groups who live in close proximity to one another can "self-select" in a way that exacerbates this phenomenon. Given the growing number of exemptions and the increasing visibility of the anti-vaccine movement, policy makers must be vigilant for dangerous clustering in order to avoid loss of herd immunity., (Copyright 2002 Published by Elsevier Science Ltd.)

Telemedicine and e-medicine have the potential to transform medical practice. However, while the benefits have long been known, many physicians and health systems have been reluctant to engage in such practices due to unresolved legal and ethical concerns. I conducted a systematic examination of US and European statutes, regulations and civil, criminal and administrative decisions pertaining to telemedicine and e-medicine, as well as a review of the ethical, legal and medical literature pertaining to the practice of telemedicine and e-medicine in the US and Europe. There appear to be four main areas of concern: the doctor-patient relationship; malpractice and cross-border licensure; standards; and reimbursement. The lack of generally agreed interstate and international standards of law and ethics means that telemedicine and e-medicine will continue to struggle to gain widespread support from providers, patients and regulatory bodies as an acceptable means of health service delivery. Progress may depend on federal and international leadership.

The world of e-health and e-medicine offer hematologists and oncologists wonderful opportunities to enhance and expand their practices and to offer patients the opportunity to gain access to information and specialty care never before available. Legal and political challenges abound, however, concerning the practice and financing of e-health and e-medicine. Financing and reimbursement for e-medicine are limited, licensure laws are structured in a way that inhibits telemedicine's widespread growth, public protection efforts are sluggish and spotty at best, and there are tremendous areas of uncertainty about such issues as malpractice exposure, patients' rights, and proper practices concerning physician-patient e-mail. It is impossible to predict what health care delivery will look like even a decade from now (and some would argue it would be a fool's errand to attempt to do so) [56]; however, despite all of these obstacles, physicians should continue to explore innovative ways to integrate computer technology and the Internet into medical practice.