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Life, Liberty, [and the Pursuit of Happiness]: Medical Marijuana Regulation in Historical Context 生命,自由,[和幸福的追求]:历史背景下的大麻管制
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2018-12-11 DOI: 10.2139/SSRN.3299678
Lewis A Grossman
The struggle for access to medical marijuana differs from most other battles for therapeutic freedom in American history because marijuana also has a popular, though controversial, nontherapeutic use—delivery of a recreational high. After considering struggles over the medical use of alcohol during prohibition as a precedent, this chapter relates the history of medical marijuana use and regulation in the United States. The bulk of the chapter focuses on the medical marijuana movement from the 1970s to present. This campaign has been one of the prime examples of a successful extrajudicial social movement for freedom of therapeutic choice. With the exception of a single promising decision in 1975, courts have uniformly rejected arguments for medical marijuana access. But the 1996 passage of Proposition 215 in California triggered a tremendous wave of state measures legalizing medical cannabis, as well as a dramatic change in American attitudes about the issue. This chapter recounts this history in light of the special legal, political, and rhetorical challenges medical cannabis advocates have faced. First, many officials have opposed the legalization of medical marijuana, regardless of whether it offers therapeutic benefits, because of the public health harms and moral degradation they associate with the use of pot. Second, marijuana’s designation as a Schedule I substance under the Controlled Substances Act of 1970, and the DEA’s rejection of multiple citizen petitions to reclassify it, has placed extremely high obstacles in the way of researchers interested in scientifically assessing marijuana’s therapeutic efficacy. Third, federal government policies have lagged behind public preference and state law. Finally, medical marijuana supporters have had to negotiate an invaluable but fraught relationship with advocates for comprehensive marijuana legalization. The perspectives and goals of these two groups have overlapped and conflicted in fascinating and unexpected ways.
获得医用大麻的斗争与美国历史上大多数其他争取治疗自由的斗争不同,因为大麻也有一种流行但有争议的非治疗用途——提供娱乐性快感。在将禁酒期间因医疗使用酒精而引发的斗争视为先例后,本章讲述了美国医用大麻使用和监管的历史。本章的大部分内容集中在20世纪70年代至今的医用大麻运动上。这场运动是争取治疗选择自由的法外社会运动取得成功的主要例子之一。除了1975年的一项有希望的裁决外,法院一致驳回了获得医用大麻的论点。但1996年215号提案在加利福尼亚州的通过引发了一股将医用大麻合法化的州措施浪潮,也引发了美国人对这一问题的态度的戏剧性变化。本章根据医用大麻倡导者面临的特殊法律、政治和修辞挑战,讲述了这段历史。首先,许多官员反对医用大麻合法化,无论它是否有治疗益处,因为他们认为使用大麻会危害公众健康和道德败坏。其次,根据1970年《受控物质法》,大麻被列为附表一物质,缉毒局拒绝了多名公民对其进行重新分类的请愿,这给有兴趣科学评估大麻治疗效果的研究人员设置了极大的障碍。第三,联邦政府的政策落后于公众偏好和州法律。最后,医用大麻的支持者不得不与全面大麻合法化的倡导者谈判建立一种宝贵但令人担忧的关系。这两个群体的观点和目标以令人着迷和意想不到的方式重叠和冲突。
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引用次数: 0
Implementing a Public Health Perspective in FDA Drug Regulation 在FDA药品监管中实施公共卫生观点
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2018-06-08 DOI: 10.31228/osf.io/pc4b6
Patricia J. Zettler, M. Riley, A. Kesselheim
There is, without question, a public health crisis in the United States arising from both illicit and prescription opioid misuse, addiction, and overdose. The Food and Drug Administration (FDA) is one regulator with an important role to play in minimizing the harms associated with prescription opioids, while also ensuring that prescription opioids are available for the evidence-based management of pain. One question, however, is to what extent the agency can consider in its decisions to approve opioids and keep existing ones on the market the provider and patient behaviors contributing to the epidemic. This is, in part, because FDA’s approval of drugs is often understood as narrowly focused on weighing the benefits and risks of the products as defined in the preapproval clinical trials that are used to set the drug’s official FDA-approved indication. Such a limited focus would exclude important information about the real-world use and public-health impact of prescription opioids and other drugs with externalities. This Article argues that, to better regulate drugs like opioids that have such externalities, one step FDA should take is to use a “public health” perspective in its approval (and withdrawal) decisions. The Article describes how the federal Food, Drug, and Cosmetic Act authorizes FDA to take this broad approach in its drug approval and withdrawal decisions and offers some principles for implementing this approach systematically.Citation: Patricia J. Zettler, Margaret Foster Riley, and Aaron S. Kesselheim, Implementing a Public Health Perspective in FDA Drug Regulation, 73 Food & Drug L.J. 221 (2018).Posted with the permission of the Food and Drug Law Institute.
毫无疑问,美国的公共卫生危机是由非法和处方阿片类药物滥用、成瘾和过量引起的。美国食品和药物管理局(FDA)是一个监管机构,在最大限度地减少处方阿片类药物的危害方面发挥着重要作用,同时也确保处方阿片类药物可用于基于证据的疼痛管理。然而,有一个问题是,该机构在决定批准阿片类药物并使现有的阿片类药物继续在市场上销售时,在多大程度上可以考虑到导致这种流行病的提供者和患者行为。在某种程度上,这是因为FDA对药物的批准通常被理解为狭隘地关注于权衡产品的收益和风险,这些产品是在预先批准的临床试验中定义的,用于确定药物的官方FDA批准适应症。这种有限的关注将排除有关处方类阿片和其他具有外部性的药物的实际使用和公共卫生影响的重要信息。本文认为,为了更好地监管像阿片类药物这样具有外部性的药物,FDA应该采取的一个步骤是在批准(和撤回)决定时使用“公共卫生”的观点。本文描述了联邦食品、药品和化妆品法案如何授权FDA在其药物批准和撤回决定中采用这种广泛的方法,并提供了系统地实施这种方法的一些原则。引用本文:Patricia J. Zettler, Margaret Foster Riley, Aaron S. Kesselheim, FDA药品监管中公共卫生视角的实施,73 Food & Drug L.J. 221(2018)。经食品药品法律研究所许可发布。
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引用次数: 8
When the Alpha is the Omega: P-Values, "Substantial Evidence," and the 0.05 Standard at FDA. 当Alpha是Omega: p值,“实质性证据”和FDA的0.05标准。
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2017-01-01
Lee Kennedy-Shaffer

A prominent feature of statistical reasoning for nearly a century, the p-value plays an especially vital role in the clinical testing of new drugs. Over the last fifty years, the U.S. Food and Drug Administration (FDA) has relied on p-values and significance testing to demonstrate the efficacy of new drugs in the premarket approval process. This article seeks to illuminate the history of this statistic and explain how the statistical significance threshold of 0.05, commonly decried as an arbitrary cutoff, is a useful tool that came to be the cornerstone of FDA decision-making.

p值是近一个世纪以来统计推理的一个突出特征,在新药的临床试验中起着特别重要的作用。在过去的50年里,美国食品和药物管理局(FDA)一直依靠p值和显著性检验来证明新药在上市前批准过程中的有效性。本文试图阐明这一统计数据的历史,并解释0.05的统计显著性阈值是如何成为FDA决策基石的有用工具的,该阈值通常被谴责为任意截止。
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引用次数: 0
Commemorating the 40th Anniversary of the 1976 Medical Device Amendments. 纪念1976年医疗器械修正案颁布40周年。
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2017-01-01
Suzanne Junod
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引用次数: 0
An Analysis of “Natural” Food Litigation to Build a Sesame Allergy Consumer Class Action. 构建芝麻过敏消费者集体诉讼的“天然”食品诉讼分析。
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2017-01-01
Dana Shaker

In a world where food allergy is still an incurable disease, law and regulation stand as necessary mechanisms to provide food-allergic consumers with the information they need to protect their health. The Food Allergen Labeling and Consumer Protection Act of 2004 provided specific labeling requirements for the “Top Eight” allergens in the U.S.: milk, soy, gluten, egg, tree nut, peanut, fish, and Crustacean shellfish. Since then, sesame has become more prevalent as an allergen and remains just as dangerous, inducing anaphylactic shock in some sesame-allergic individuals. Yet sesame remains unregulated, despite advocates and congressional members arguing for its inclusion. This note entertains one solution to this problem by exploring the most strategic way to bring a sesame allergy class action against a private food company under California’s consumer protection statutes. Because this kind of class action does not have much, if any, precedent, this note analyzes the basic, preliminary issues that any litigant would have to navigate around to certify a class, including preemption, standing, and the claim itself, by focusing on how courts have examined these issues in the recent “natural” class action litigation. It also analyzes the legal, moral, and practical aspects of choosing a type of relief, as well as whom to include in the class. Finally, this note briefly considers how FDA itself can ensure sesame is regulated on the labels of food products, given that some of the legal issues may well be insurmountable for this particular class action. This note explores the potential solutions to difficult legal hurdles in constructing a sesame allergy class action, arguing that litigating a sesame allergy class action—even if it is not ultimately successful—could start a productive conversation that might lead Congress or FDA to provide greater public health and consumer protection for those with sesame allergy.

在食物过敏仍然是一种不治之症的世界上,法律和法规是向食物过敏消费者提供保护其健康所需信息的必要机制。2004年的《食品过敏原标签和消费者保护法》对美国的“八大”过敏原:牛奶、大豆、麸质、鸡蛋、树坚果、花生、鱼和甲壳类贝类提供了具体的标签要求。从那以后,芝麻作为过敏原变得越来越普遍,而且仍然很危险,在一些对芝麻过敏的人身上会引起过敏性休克。然而,尽管倡导者和国会议员主张将芝麻纳入监管范围,但芝麻仍未受到监管。本文通过探索最具战略意义的方法来解决这个问题,根据加州消费者保护法,对一家私营食品公司提起芝麻过敏集体诉讼。由于这类集体诉讼没有太多先例,因此本文通过关注法院在最近的“自然”集体诉讼中如何审查这些问题,分析了任何诉讼当事人在证明集体诉讼时必须解决的基本初步问题,包括优先购买权、诉讼资格和索赔本身。它还分析了选择一种救济类型的法律、道德和实践方面,以及将谁包括在该类中。最后,本文简要地考虑了FDA本身如何确保芝麻在食品标签上受到监管,因为在这个特殊的集体诉讼中,一些法律问题可能是无法克服的。本文探讨了在构建芝麻过敏集体诉讼中困难的法律障碍的潜在解决方案,认为提起芝麻过敏集体诉讼-即使最终不成功-也可以启动富有成效的对话,可能导致国会或FDA为芝麻过敏者提供更大的公共卫生和消费者保护。
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引用次数: 0
Communicating Tobacco Product Information to the Public. 向公众传播烟草产品信息。
IF 0.3 4区 医学 Q4 FOOD SCIENCE & TECHNOLOGY Pub Date : 2017-01-01
Micah L Berman, M Justin Byron, Natalie Hemmerich, Eric N Lindblom, Allison J Lazard, Ellen Peters, Noel T Brewer

The 2009 Family Smoking Prevention and Tobacco Control Act (TCA) requires tobacco companies to disclose information about the harmful chemicals in their products to the U.S. Food and Drug Administration (FDA). The law requires the FDA, in turn, to communicate this information to the public "in a format that is understandable and not misleading to a lay person." But how should the FDA comply with this requirement? What does it mean for information about complex chemicals to be "understandable and not misleading to a lay person"? These questions are not easy ones to answer. Disclosures about the amount of harmful chemicals (constituents) in different tobacco products may help to inform consumers, but may also conversely prompt consumers to reach incorrect or unsupported conclusions about products' relative health risks. This paper first analyzes the FDA's legal obligation to publish tobacco constituent information so that it is "understandable and not misleading to a layperson." Second, it discusses how that legal analysis has guided scientific research examining how members of the public interpret messages regarding tobacco constituents. Lastly, this paper concludes with policy recommendations for the FDA as it considers how to comply with the law's constituent disclosure requirement while still furthering its overall objective of promoting public health.

2009 年《家庭预防吸烟和烟草控制法》(TCA)要求烟草公司向美国食品药品管理局(FDA)披露其产品中有害化学物质的信息。法律要求 FDA "以外行人可以理解且不会误导的方式 "向公众传达这些信息。但 FDA 应如何遵守这一要求呢?关于复杂化学品的信息 "对外行人士来说可以理解且不具误导性 "意味着什么?这些问题并不容易回答。披露不同烟草制品中有害化学物质(成分)的含量可能有助于向消费者提供信息,但也可能反过来促使消费者对产品的相对健康风险得出不正确或无依据的结论。本文首先分析了 FDA 发布烟草成分信息的法律义务,即 "让外行人能够理解且不会产生误导"。其次,本文讨论了法律分析如何指导科学研究,研究公众如何解读烟草成分信息。最后,本文提出了一些政策建议,供食品及药物管理局在考虑如何遵守法律的成分披露要求的同时,进一步实现促进公众健康的总体目标。
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引用次数: 0
The “Natural” vs. “Natural Flavors” Conflict in Food Labeling: A Regulatory Viewpoint. 食品标签中“天然”与“天然香料”的冲突:一个监管观点。
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2017-01-01
Matthew J Goodman

Food branded with a Natural label can be found in any grocery store across the United States. Consumers consider this label to be an important attribute when making a purchasing decision and billions of dollars are spent annually on these products. While many consumers believe Natural foods are healthier, heavy reliance on that assumption is misguided as “Natural” has no formal legal definition—it’s merely defined pursuant to an FDA approved informal policy. Another important health attribute in a consumer’s purchasing decision is the presence of natural flavors in food. However, unlike the term Natural, FDA has promulgated legally binding regulations for natural flavors. These flavors are currently the fourth most common food ingredient listed on food labels. In reality, “natural flavors” are a far cry from what consumers might expect, as they can contain both artificial and synthetic chemicals (often used as processing aids). Nonetheless, without a legally binding Natural regulation, there has been little opportunity to contest the naturalness of natural flavors in the past. Recently, FDA has initiated a notification of request for comments on use of the term Natural, so an attempt to promulgate regulations may be underway. Thus, it is appropriate to consider where natural flavors will fall if binding regulations are set forth. This article looks at the Natural debate, its history, and model regulatory standards worth considering. Within that context, it also provides a critical discussion concerning a misunderstood, yet federally regulated, ingredient that our society so heavily consumes: natural flavors.

贴有天然标签的食品在美国任何一家杂货店都能找到。当消费者做出购买决定时,他们认为这个标签是一个重要的属性,每年在这些产品上花费数十亿美元。虽然许多消费者认为天然食品更健康,但严重依赖这种假设是错误的,因为“天然”没有正式的法律定义——它只是根据FDA批准的非正式政策来定义的。在消费者的购买决策中,另一个重要的健康因素是食品中是否含有天然香料。然而,与天然香料不同的是,FDA颁布了具有法律约束力的天然香料法规。这些香料目前是食品标签上列出的第四大最常见的食品成分。实际上,“天然香料”与消费者的期望相去甚远,因为它们可能含有人工和合成化学物质(通常用作加工助剂)。然而,由于没有具有法律约束力的自然法规,过去几乎没有机会质疑天然香料的天然性。最近,FDA发起了一项关于“天然”一词使用的征求意见通知,因此可能正在尝试颁布法规。因此,如果制定有约束力的法规,考虑天然香料将落在哪里是适当的。本文着眼于关于自然的争论,它的历史,以及值得考虑的模式监管标准。在这种背景下,它还提供了一种批判性的讨论,涉及一种被误解的、但受到联邦政府监管的、我们的社会如此大量消费的成分:天然香料。
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引用次数: 0
Making the Case for a National Food Strategy in the United States. 为美国的国家食品战略辩护。
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2017-01-01
Laurie J Beyranevand
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引用次数: 0
Assessing the Relative Influence and Efficacy of Public and Private Food Safety Regulation Regimes: Comparing Codex and Global G.A.P. Standards. 评估公共和私人食品安全监管制度的相对影响和效力:比较法典标准和全球G.A.P.标准。
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2017-01-01
Sam F Halabi, Ching-Fu Lin

An extensive global system of private food regulation is under construction, one that exceeds conventional regulation thought of as being driven by public authorities like FDA and USDA in the U.S. or the Food Standards Agency in the UK. Agrifood and grocer organizations, in concert with some farming groups, have been the primary designers of this new food regulatory regime. These groups have established alliances that compete with national regulators in complex ways. This article analyzes the relationship between public and private sources of food safety regulation by examining standards adopted by the Codex Alimentarius Commission, a food safety organization jointly run by the Food and Agricultural Organization and the World Health Organization and GlobalG.A.P., a farm assurance program created in the late 1990s by supermarket chains and their major suppliers which has now expanded into a global certifying coalition. While Codex standards are adopted, often as written, by national food safety regulators who are principal drivers of the standard setting process, customers for agricultural products in many countries now demand evidence of GlobalG.A.P. certification as a prerequisite for doing business This article tests not only the durability and strength of private sector standard setting in the food safety system, but also the desirability of that system as an alternative to formal, governmental processes embodied, for our purposes, in the standards adopted by Codex. In many cases, official standards and GlobalG.A.P. standards clash in ways that implicate not only food safety but the flow of agricultural products in the global trading system. The article analyzes current weaknesses in both regimes and possibilities for change that will better reconcile the two competing systems.

一个广泛的全球私人食品监管体系正在建设中,它超越了传统的由美国食品药品监督管理局和美国农业部或英国食品标准局等公共机构推动的监管。农业食品和杂货商组织与一些农业团体合作,一直是这种新的食品监管制度的主要设计者。这些集团建立了联盟,以复杂的方式与国家监管机构竞争。本文通过考察食品法典委员会(Codex Alimentarius Commission)采用的标准,分析了公共和私人来源的食品安全监管之间的关系。Codex Alimentarius委员会是由联合国粮食及农业组织(fao)、世界卫生组织(who)和globalg . a.p.共同管理的食品安全组织。这是一个由连锁超市及其主要供应商在20世纪90年代末创建的农场保证计划,现在已扩展为一个全球认证联盟。虽然食品法典标准通常由国家食品安全监管机构(标准制定过程的主要推动者)按书面形式采用,但许多国家的农产品客户现在要求提供globalg . a.p.的证据。这篇文章不仅测试了食品安全体系中私营部门标准制定的持久性和强度,而且还测试了该体系作为正式政府程序的替代方案的可取性,就我们的目的而言,这些程序体现在食品法典委员会采用的标准中。在许多情况下,官方标准和globalg . a.p.。标准的冲突不仅涉及食品安全,还涉及农产品在全球贸易体系中的流动。本文分析了两种制度目前的弱点,以及更好地调和这两种竞争制度的变革可能性。
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引用次数: 0
An International Model for Antibiotics Regulation. 国际抗生素监管模式。
IF 0.2 4区 医学 Q4 Social Sciences Pub Date : 2017-01-01
Emilie Aguirre

We face a global antibiotics resistance crisis. Antibiotic drugs are rapidly losing their effectiveness, potentially propelling us toward a post-antibiotic world. The largest use of antibiotics in the world is in food-producing animals. Food producers administer these drugs in routine, low doses—the types of doses that are incidentally the most conducive to breeding antibiotic resistance. In general, individual countries have been too slow to act in regulating misuse and overuse of antibiotics in foodproducing animals. This problem will only worsen with the significant projected growth in meat consumption and production expected in emerging economies in the near future. Although individual countries regulating antibiotics can have important effects, one country alone cannot insulate itself entirely from the effects of antibiotic resistance, nor can one country solve the crisis for itself or for the world. The global nature of the food system and the urgency of the problem require immediate global solutions. Adapting a democratic experimentalist approach at the international level can help achieve this goal. Using an international democratic experimentalist framework in conjunction with the World Organization for Animal Health (OIE) would provide for increased systematized data collection and lead to heightened, scientifically informed OIE standards, enforceable by the World Trade Organization (WTO), which could have a significant impact on the reduction of subtherapeutic use of antibiotics internationally. International democratic experimentalism addresses the global intricacy, time sensitivity, context- and culture-specificity, and knowledgeintensiveness of this problem. By encouraging more countries to experiment to solve this problem, the democratic experimentalist model would help develop a larger database of solutions to enable more meaningful cross-country comparisons across a wider range of contexts. This approach maintains democratic governance and legitimacy while maximizing data collection, efficiency, translatability, transparency, and information-sharing. Adapting democratic experimentalism internationally can enable the kind of concerted international effort required to address the pressing problem of antibiotic resistance.

我们面临着全球抗生素耐药性危机。抗生素药物正在迅速失去效力,可能将我们推向后抗生素世界。世界上使用抗生素最多的是食用动物。食品生产商以常规的低剂量使用这些药物,而这种剂量恰好是最有利于产生抗生素耐药性的。总的来说,个别国家在规范食用动物滥用和过度使用抗生素方面行动太慢。在不久的将来,新兴经济体的肉类消费和生产预计将大幅增长,这一问题只会恶化。虽然个别国家对抗生素的管制可以产生重要影响,但一个国家不能完全使自己免受抗生素耐药性的影响,一个国家也不能为自己或为世界解决危机。粮食系统的全球性和问题的紧迫性要求立即采取全球解决办法。在国际一级采用民主的实验主义方法可以帮助实现这一目标。与世界动物卫生组织(世界动物卫生组织)一起使用国际民主实验主义框架,将提供更多系统化的数据收集,并导致世界动物卫生组织(世界贸易组织)强制执行的更高的、科学的动物卫生组织标准,这可能对减少国际上抗生素的亚治疗性使用产生重大影响。国际民主实验主义解决了这个问题的全球复杂性、时间敏感性、背景和文化特殊性以及知识集约性。民主实验主义模式鼓励更多国家为解决这一问题进行试验,有助于建立一个更大的解决办法数据库,以便在更广泛的情况下进行更有意义的跨国比较。这种方法保持了民主治理和合法性,同时最大限度地提高了数据收集、效率、可翻译性、透明度和信息共享。在国际上采用民主实验主义可以使解决抗生素耐药性这一紧迫问题所需的国际协调努力成为可能。
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引用次数: 0
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Food and drug law journal
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