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Perspective

Biomarkers Unbound — The Supreme Court's Ruling on Diagnostic-Test Patents
In recent decades, biomarkers have become essential in diagnosing disease and assessing patients' responses to therapy. The increasing quantitative rigor and efficiency of these tests have led to the possibility of "personalized medicine." Despite such progress, the way in which a physician uses…
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Perspective

Lost in Translation — ¿Cómo se dice, “Patient Protection and Affordable Care Act”?
The political seas roiled by the Affordable Care Act (ACA) have grown more volatile in the 2 years since its passage. Whether it is the constitutionality of the insurance mandate, the economic feasibility of the Medicaid expansion, or controversy over the conscience clauses, much has been said and…
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Perspective
Is Medicaid Constitutional?
Although the media and the U.S. public focused primarily on the minimum-coverage requirement, or individual mandate, during the recent oral arguments in the challenges to the Affordable Care Act (ACA) before the Supreme Court, the most important issue before the Court may well be the…
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Perspective
Supreme Court Arguments on the ACA — A Clash of Two World Views
During the last week in March, much of the country was riveted by 3 days of Supreme Court arguments in the constitutional challenge to the Patient Protection and Affordable Care Act (ACA). The Court devoted more than six times the normal amount of time to oral arguments — a ratio not seen since…
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Perspective
Suing States over Threatened Access to Care — The Douglas Decision
What began, in Douglas v. Independent Living Center of Southern California, as a challenge to a series of California laws aimed at reducing Medicaid payments to health care providers grew into a profoundinquiry — not into the merits of state versus federal law, but into the appropriateness of the…
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Correspondence
Defense Costs of Medical Malpractice Claims
To the Editor: Despite research on the overall costs of the U.S. medical liability system, national data are limited on the costs associated with resolving medical malpractice claims — defense costs — and how they vary according to physician specialty. The frequency of malpractice claims and…
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Perspective
Removing Legal Barriers to High-Quality Care for HIV-Infected Patients
When AIDS emerged in the 1980s, fear and misunderstanding about the disease prevailed. Patients with AIDS faced a grim prognosis, with no effective treatments. They confronted discrimination in the workplace and throughout society and had little legal recourse for combating it. Simply getting…
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Perspective
The Severability of the Individual Mandate
The Supreme Court is now reviewing a federal appeals court decision that the individual mandate in the Affordable Care Act (ACA), which requires that individuals either purchase health insurance or pay a penalty, is unconstitutional. If the Court agrees, it will then consider whether to invalidate…
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Perspective
Supreme Court Review of the Health Care Reform Law
Later this month, the U.S. Supreme Court will examine the constitutionality of the Affordable Care Act (ACA), potentially producing a landmark decision. For most cases, the Supreme Court allocates 1 hour for oral argument — 30 minutes for each side. For the health care reform case, the Court has…
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Correspondence
Percutaneous Injuries before and after the Needlestick Safety and Prevention Act
To the Editor: The Needlestick Safety and Prevention Act (NSPA) (HR.5178) was signed into law on November 6, 2000. It required employers to provide safety-engineered devices to employees who are at risk for exposure to bloodborne pathogens, to include frontline workers in selecting these devices,…
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Perspective
What We Talk about When We Talk about Health Care Costs
Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help…
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Perspective
Penny Wise, Pound Foolish? Coverage Limits on Immunosuppression after Kidney Transplantation
As a treatment for end-stage renal disease (ESRD), kidney transplantation is superior to dialysis for improving patient survival rates and quality of life. Its long-term success, however, requires ongoing treatment with immunosuppressive drugs. Ironically, although many of the pivotal discoveries…
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Perspective
200th Anniversary Article: Patients and Doctors — The Evolution of a Relationship
The relationship between patients and doctors is at the core of medical ethics, serving as an anchor for many of the most important debates in the field. Over the past several decades, this relationship has evolved along three interrelated axes — as it is defined in clinical care, research, and…
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Perspective
All Heat, No Light — The States' Medicaid Claims before the Supreme Court
It has been clear for some time that the political fight over the minimum-insurance-coverage requirement in the Affordable Care Act (ACA) would eventually reach the U.S. Supreme Court. What few would have predicted was that the question of the constitutionality of the latest in a long line of…
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Perspective
The Fate of Health Care Reform — What to Expect in 2012
The Patient Protection and Affordable Care Act of 2010 (ACA) is arguably the most significant health legislation enacted in generations. As remarkable a political and policy achievement as it was, what the reform will actually accomplish is largely yet to be determined. Whether it slows the growth…
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Perspective
Selling Bone Marrow — Flynn v. Holder
On December 1, 2011, in Flynn v. Holder, the U.S. Court of Appeals for the Ninth Circuit held that the ban on selling "bone marrow" that is part of the National Organ Transplant Act (NOTA) of 1984 does not encompass "peripheral blood stem cells" obtained through apheresis. This ruling means that…
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Perspective
The Constitutionality of the ACA's Medicaid-Expansion Mandate
Nearly all media and scholarly discussion of the constitutionality of the Affordable Care Act (ACA), has focused on the individual mandate to obtain health insurance. The Supreme Court has now promised to review not only that issue but also the issue of whether the ACA's Medicaid expansion violates…
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Perspective
The Irrelevance of the Broccoli Argument against the Insurance Mandate
The parties who have brought legal challenges to the Affordable Care Act's (ACA's) individual mandate to obtain health insurance claim that the Constitution's Commerce Clause authorizes the regulation of only commercial activity, not inactivity, and thus gives Congress no power to force individuals…
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Perspective
Copyright and Open Access at the Bedside
For three decades after its publication, in 1975, the Mini–Mental State Examination (MMSE) was widely distributed in textbooks, pocket guides, and Web sites and memorized by countless residents and medical students. The simplicity and ubiquity of this 30-item screening test — covering such…
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Special Report
Implementation of the Federal Health Information Technology Initiative
PART TWO OF TWO Presented as the 36th annual Joseph Garland Lecture of the Boston Medical Library on October 25, 2011. Dr. Garland was editor-in-chief of the Journal from 1947 through 1967. In the spring of 2009, the Department of Health and Human Services (DHHS) faced a daunting project: to lead…
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