Almost as soon as it was signed into law in 2010, the Patient Protection Affordable Care Act (PPACA), also known as Obamacare, landed in court. Led by Florida, 26 states challenged the health reform law, claiming that its individual mandate to purchase health insurance and its expansion of Medicaid were unconstitutional. The following year, the Supreme Court took up a combined case that considered claims by those states and the National Federation of Independent Business, and in June affirmed the constitutionality of the individual mandate while limiting the law’s Medicaid provisions. Meanwhile, the PPACA has extended insurance coverage for young adults who can now stay on their parents’ plans to age 26 and eliminated insurers’ pre-existing condition exclusions for children. It has also assembled providers into accountable care organizations that meet to share how they achieve quality thresholds while saving costs for the Medicare program. The law promises many more alterations to the health care system. With President Obama’s reelection making the PPACA the law of the land, we can expect major expansions in Medicaid coverage and new cost-saving mechanisms in the Medicare and Medicaid programs. —Arti Virkud
In September, the New York City Board of Health approved Mayor Michael Bloomberg’s proposal for citywide restrictions on the sale of sugar-sweetened drinks. The controversial restrictions proposed by the public health-oriented Bloomberg administration have gained more traction politically than previous efforts to limit the soda intake of New Yorkers in order to curb obesity. The American beverage industry and a handful of New York restaurants filed suit in October, claiming the Board of Health did not have the right to ratify unilaterally these proposed restrictions, which are scheduled to take effect in March.
Indeed, the science underlying the connection between soda intake and obesity, leveraged selectively by the Bloomberg proposal, is contested. Despite the controversy, other American cities are considering similar restrictions, further emphasizing New York City’s leading edge in what may amount eventually to yet another wave of progressive public health reform around the country, much like public smoking bans and menu calorie counts. —Dana March
A tainted steroid medication for spinal injection has left 620 individuals infected with meningitis and 39 people dead, as of November 17, 2012. Another 14,000 people are at risk of developing the infection because this type of meningitis has an incubation period that could last months. The source of the tainted injections has been traced to three lots of preservative-free methylprednisolone acetate (MPA) injection from the New England Compounding Center (NECC). The U.S. Food and Drug Administration (FDA) found poor sanitation conditions at the compounding center, including greenish-yellow residue on sanitation equipment and high levels of mold and bacteria. NECC has closed, surrendered its license, and recalled all of its products—not just the MPA injections. The regulatory failure has called into question whether the FDA has enough jurisdiction to prevent future oversights. Legislation has been proposed to include compounding facilities under the oversight of the FDA and to include labels that indicate if the compound hasn’t been tested by the FDA. —Lauren Weisenfluh
In November’s election, Washington and Colorado became the first states to legalize marijuana for recreational use since the drug was banned by the federal government in 1937. The passage of these ballot initiatives is the latest indication of growing favor toward a plant that was once vilified as the “devil weed.” Marijuana has, since 1996, been legalized for medical use in 18 states and the District of Columbia, a measure that is supported by a growing number of Americans. The votes come too at a time of rising antipathy toward putting people in prison for marijuana use, a practice that public health and legal experts have accused of contributing to America’s “epidemic” of mass incarceration.
None of which is to say that Americans will be able to smoke a joint in the streets anytime soon. The federal government still considers marijuana illegal and is looking at taking action against Colorado and Washington, although President Barack Obama recently indicated it will not be a top priority. There are concerns that relaxed attitudes toward marijuana have propelled a rise in teen use of the drug, which in 2011 hit a 30-year high, as well as questions around the drug’s medical efficacy.
If the federal government does choose to go after legalized marijuana, President Obama will face the wrath of many of his liberal supporters, as well as senior citizens who are increasingly turning to the drug to soothe their ailments. Expect in 2013 to see several more states considering laws similar to those passed in Washington and Colorado. —Elaine Meyer
Hurricane Sandy battered the mid-Atlantic region at the end of October, leaving in its wake death, tens of billions of dollars’ worth of damage, enduring darkness, and devastated communities struggling to recover. From unprotected coastlines to fragile mental health care systems in New York City, Sandy was a unique storm that lay bare the region’s myriad vulnerabilities to disasters—and the public health contours of such a disaster.
Evacuation orders brought to a head tensions between individuals’ decisions to weather the storm and officials’ paternalistic, preventive measures. Vulnerable populations, such as the elderly and the disabled, were hit especially hard. And years of important medical research addressing diseases like cancer and heart disease were wiped out at New York University. Indeed, Sandy’s long arms continue to reach into public health, with total costs that may be incalculable. —Dana March
In an apparently well-meaning attempt to answer a question their patients often asked them, the authors of the Stanford organic study managed to publish one of the most controversial research papers of the year. When the group’s meta-analysis found organic food was not significantly more nutritious than conventionally grown foods, organic proponents cried foul, protesting that coverage of the study largely overlooked the finding that organic food exposed consumers to fewer pesticides and antibiotic-resistant bacteria. In one breath, the paper called into question the source of epidemiological data, the issue of conflict of interest, and the true meaning of “organic.”
The uproar made us wonder whether organic proponents could better achieve their desired foodscape, too. By promoting increased access to healthier food amongst low-income groups, rather than arguing organic foods’ nutritional benefits for the select few who can afford them, just maybe they could exhibit their benefits to all—no matter the Stanford study’s findings. —Joshua Brooks
Fears of bioterrorism sparked an uproar when scientists from the Netherlands and the University of Wisconsin submitted their findings on H5N1 bird flu genetic mutations to an academic journal. The mutations allow ferret-to-ferret transmission in respiratory droplets, and researchers hoped the new information would help anticipate how H5N1 might evolve into a human-to-human infection. But because ferrets catch the same flu as humans, some experts feared that the findings could be used for both good and bad purposes, referred to as “dual-use” research, for the creation of a biological weapon. In fact, the U.S. National Science Advisory Board for Biosecurity (NSABB) initially voted to withhold the research’s methods—including its genetic code—from publication. Proponents of the research questioned the role and boundaries of government regulation in science, arguing that scientific transparency allows discoveries to occur. While both papers were eventually published (Imai et al., 2012 and Herfst et al., 2012) after a new NSABB vote in favor of releasing revised manuscripts, the controversy brought up many challenging questions for future research, including how discoveries should be evaluated for their dual-use research potential. —Lauren Weisenfluh
The release of documents reporting a total of 18 deaths and multiple health complications allegedly linked to the energy drinks 5-Hour Energy, Monster and Rockstar created cause for concern this year. The F.D.A., long removed from a regulatory role over these dietary supplements, announced an ongoing investigation into the issue, while the reports of alleged health complications from excessively caffeinated supplements prompted senators to question the effects of the energy drinks and their extreme marketing.
In the constant tension between individual freedom and consumer safety, politicians and regulators may have taken the first step to overhaul lax regulations on supplements or, in the very least, given consumers the ability to know the contents and potential risks of what they’re drinking. When compared to the influence that exclamation-marked and block-lettered promises of “guarana,” “taurine” and “electrolytes,” have on consumers, it may be the least the F.D.A. can do. —Joshua Brooks
Early in 2012, the FBI made the decision to include men as possible victims of rape, the first time males have been included in the agency’s definition since it was first established 85 years ago. The crime has a staggering estimated 300,000 female victims each year, notably greater than the 248,300 rape reports actually filed. While the FBI’s Uniform Crime Reports, which compiles statistics for all crimes around the country, says zero men are raped each year, the Justice Department estimates that there are more than 90,000 male victims. After persistent reports of assault from men and lobbying by advocates, the FBI changed the terms, adding penetration with objects, which had been left out of the old definition. Most visible in the news in the past few years was the case of Jerry Sandusky, the former Penn State football coach who was convicted of sexually assaulting and raping at least 10 young boys. These victims would not fall under the FBI’s previous definition of rape; the change now includes the crimes the victims suffered. —Larkin Callaghan
When the breast cancer advocacy group the Susan G. Komen Foundation halted its funding of Planned Parenthood clinics, it found itself in the kind of controversy it hoped to avoid by pulling the grants to begin with. Komen claimed that ceasing its funding of breast cancer screenings at the clinics was based on a new policy of the foundation to bar financial support of organizations under government investigation. A Republican congressman had opened an investigation into Planned Parenthood’s funding of abortion services, speculating that it was illegally using federal monies, despite Planned Parenthood’s regular and consistent compliance with legislation. It was widely speculated that Komen’s decision to defund was based on the organization bowing to anti-abortion activists and employees. There was significant backlash from Komen’s decision. Supporters of Planned Parenthood raised over $650,000 in 24 hours, almost equal to the amount that Komen gave to Planned Parenthood the previous year. After uproars in the media and among Komen supporters, the foundation reversed its decision, and a senior level official in the organization involved in the defunding plan resigned. —Larkin Callaghan
Edited by Jordan Lite. Additional research by Joshua Brooks, Arti Virkud and Lauren Weisenfluh.