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Multidrug resistant organisms (MDROs) are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs (ASPs) have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant (FMT) has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs for reasons other than severe recurrent or refractoryClostridioides(formerlyClostridium)difficileinfection.

A heated debate surrounds pharmaceutical companies’ proactive dissemination of information about uses of their drugs beyond those approved by the US Food and Drug Administration (FDA), a practice commonly referred to as “off-label promotion”. At the core of this debate is an underlying assumption that pharmaceutical company speech about off-label uses is inherently false and misleading and not in the best interests of patients. If, however, the companies’ off-label speech is truthful and not misleading, the speech may be protected by the First Amendment, making the FDA’s prohibition of off-label promotion unconstitutional. This study is the first to link alleged pharmaceutical company speech with published clinical evidence bringing data to inform the debate. To evaluate whether pharmaceutical company speech alleged in False Claim Act (FCA) complaints is supported by published clinical evidence. Reviewed were 66 FCA complaints alleging off-label promotion of branded prescription drugs. Indications in these complaints were matched to published clinical evidence using a nationally recognized compendium, Micromedex® 2.0. Of the uses alleged in FCA complaints, 51.6% (at least 22.1% of which were off-label) were supported by at least some published clinical evidence and, therefore, not inherently false or misleading. Given this evidence, the current government policy of prohibiting proactive dissemination of off-label information by manufacturers may not be consistent with the First Amendment. Some of the off-label uses alleged in FCA complaints investigated and settled by the federal government were supported by published clinical evidence; however, many of the alleged uses were unsupported by any clinical evidence and, thus, false and misleading. These results suggest that government regulation of pharmaceutical company speech remains warranted because company speech is not consistently evidence-based. Even so, evidence-based pharmaceutical company speech is protected by the First Amendment. As a result, the federal government’s historic practice of prohibiting all off-label promotion may be unconstitutional.

Lawyers are most often portrayed and understood to be zealous advocates for individual clients in adversarial litigation or zero-sum transactions. Law schools provide excellent preparation for this type of lawyer role, but lawyers' unique understanding of the law is also needed for systemic advocacy, policymaking, and legal education to solve the most difficult societal problems. An interdisciplinary public health law class is one way for law schools to provide students an opportunity to explore and develop these other professional identities.

This article reviews recently promulgated Internal Revenue Service regulations for nonprofit hospitals seeking tax exemption and a new estimate of national hospital community benefit spending, and analyzes how they point to the value of hospitals working with community partners to address the social determinants of health. It then explains how unmet legal needs function as health determinants, and suggests how hospitals' participation in medical-legal partnerships can address those needs. This article was published on December 7, 2015, at www.publichealthreports.org

Background Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. Main body Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. Conclusion Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system.

Not all hospital inpatients need the level of care (including staffing, testing, monitoring, and treatment) uniquely available in the acute-care setting. In the United States, these longer-term, nonacute inpatients tend to be some combination of chronically ill, poor, homeless, undocumented, uninsured, and disabled-all groups who have struggled for health equity, political recognition, and voice. Even so, these "permanent patients" continue to receive care in one of the most expensive settings. This phenomenon is the result of federal legislation that creates an affirmative duty to care for all able to access our emergency departments without also making safe housing available to all. A handful of federal laws and policies as well as a potpourri of state laws and policies are involved.