Springer Science and Business Media LLC

It is estimated that 42% of the American public is using some form of alternative medicine, which reflects the changing needs and values in our society. Unfortunately, Western medicine has failed to see alternative medicine as complementary and integrative with conventional medicine. This is due to the fact that there is very little scientific data available regarding the safety, efficacy, optimal dosage and side-effects or interactions of these alternative medicine therapies. Many physicians dismiss a patient's questions concerning alternative medicine because the physician believes it is “quackery,” without any proof to support this claim. This violates the patient's right to full disclosure of all possible treatment options and encourages patients to use these therapies without their physician's knowledge. As a result, it is estimated that 46% of those using alternative medicine do so without the supervision of their primary care physicians or alternative medicine practitioners. At the present time there is no regulatory process to ensure the safety and efficacy of these alternative medicine therapies. Manufacturers do not have to prove that their product works, but they must ensure that their product is not harmful. The combination of failure to inform physicians of usage and the possibility of adverse reactions with prescription drugs is placing the lives of many Americans in jeopardy. Ethically, consumers have the right to use alternative medicine therapies as a matter of autonomy, but they also have the duty not to harm themselves. To ensure their safety, alternative medicine therapies must be evaluated in regards to safety and efficacy so that they can be integrated into conventional medicine. The Federal Drug Administration has the ethical responsibility to take the lead in this area. To protect the common good, there is a need to know not only what alternative medicine can do for us but what it can do to us.

Public assistance is one option for providing a safety net to protect the health of children, but assistance may also generate feelings of shame that impact self-esteem. This study aims to elucidate the impact of public assistance on child mental health. We used cross-sectional data on 6920 first graders from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. We found children living in relative poverty had more behavioral problems, low resilience, and were likely to refuse to go to school. After propensity-score matching among low-income households, the likelihood of children refusing to go to school was larger in the families receiving assistance as compared to non-recipients (OR 4.00, 95% CI 0.85–18.84) although there were no significant differences between recipients and non-recipients in low-income households. Our study produced insufficient evidence to indicate that social assistance is associated with child mental health, resilience, or school refusal.

Massive volumes of solid waste are produced in the United States. Options for disposal are limited. Incineration and recycling are frequently proposed solutions. However, incinerators and waste recovery facilities, such as scrap smelters, generate hazardous air pollutants and toxic ash. Their potential hazards to health have not been adequately assessed. To illustrate the policy issues surrounding waste incineration and resource recycling, we examine the case of U.S. Metals, a scrap metals recovery plant in Carteret, New Jersey. This plant emitted 20 kilograms of dioxin in its 25 years of operation. It also released 86 tons of lead annually; nearby air lead levels were repeatedly in violation of standards. Construction of a tall stack caused export of toxic emissions from the plant to Staten Island, New York; high concentra- tions of lead were documented in surface soil on Staten Island. Because neither the State of New Jersey nor the U.S. Enviromental Protection Agency were willing to regulate emissions from the plant, New York, the downwind state, was forced to sue U.S. Metals in federal court. The suit resulted ultimately in closing the plant. The case illustrates the difficulties in regulating pollution across state lines, a difficulty compounded by the abdication of responsibility by state and federal agencies. Further, the episode appears paradigmatic of a disturbing trend by state and local governments to locate waste combustion facilities at sites which will resolve problems of solid waste by encouraging export of airborne pollutants across regulatory boundaries.

In order to effectively control spread of coronavirus 2019 (COVID-19), it is essential that jurisdictions have the capacity to rapidly trace close contacts of each and every case. Best practice guidance on how to implement such programs is urgently needed. We describe the early experience in the City and County of San Francisco (CCSF), where the City’s Department of Health expanded contact tracing capability in anticipation of changes in San Francisco’s ‘shelter in place’ order between April and June 2020. Important prerequisites to successful scale-up included a rapid expansion of the COVID-19 response workforce, expansion of testing capability, and other containment resources. San Francisco’s scale-up offers a model for how other jurisdictions can rapidly mobilize a workforce. We underscore the importance of an efficient digital case management system, effective training, and expansion of supportive service programs for those in quarantine or isolation, and metrics to ensure continuous performance improvement.