Category: NEJM

Beyond Legalization — Dilemmas Physicians Confront Regarding Aid in Dying

“What do you think about physician aid in dying?” Because 18.2% of the U.S. population lives in jurisdictions where physician aid in dying (PAD) is now legal, physicians need to anticipate that patients may inquire about or request it. Two decades ago,…

Preserving Access for People with Disabilities

Title III of the Americans with Disabilities Act (ADA) prohibits discrimination against persons with disabilities in “places of public accommodation” — those that are generally open to the public, including such categories as schools, restaurants, and …

The FDA and the Next Wave of Drug Abuse — Proactive Pharmacovigilance

In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more ap…

Rationale, Opportunities, and Reality of Biosimilar Medications

Biologic therapies for cancer and other disorders contribute to improved outcomes for many patients but also account for a large proportion of health care expenditures. Opportunities for cost containment may emerge as the patents on originator products…

Subscribing to Your Patients — Reimagining the Future of Electronic Health Records

Nearly all U.S. health care systems and many physician practices have by now migrated from paper charts to electronic health records (EHRs). But though this shift could have been a transformative change, current EHRs are largely digital remakes of trad…

Doughnuts and Discounts — Changes to Medicare Part D under the Bipartisan Budget Act of 2018

The Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 created a new Medicare benefit (Part D), a new insurance product (prescription-drug–only plans), and a new market. Fifteen years later, Part D is widely regarded as a succes…

A Randomized Trial of a Family-Support Intervention in Intensive Care Units

Approximately one in five persons in the United States dies in or shortly after discharge from an intensive care unit (ICU), typically after a decision has been made by the patient’s surrogate decision maker to forgo life-prolonging therapies. Problems…

The Calorie-Labeling Saga — Federal Preemption and Delayed Implementation of Public Health Law

Passing the 2010 Affordable Care Act (ACA) was a landmark event in health care policy. The ACA’s scope also went beyond health care. Included among myriad health insurance reforms and coverage expansions was Section 4205, a federal requirement for food…

Addressing Generic-Drug Market Failures — The Case for Establishing a Nonprofit Manufacturer

Robust competition usually keeps the price of generic drugs well below that of brand-name drugs. When there is little or no competition, however, generic-drug manufacturers can substantially increase prices, and drug shortages may occur. Such market fa…