The Skinny-Label Case: A Unanimous Supreme Court Sides with the Generic

Supreme CourtJust this morning, the Supreme Court issued its slip opinion on Hikma v. Amarin, the most recent “skinny-label” case, and it did so unanimously. Justice Jackson, writing for all nine, reversed the Federal Circuit and held that Amarin’s lawsuit against the generic manufacturer Hikma cannot survive a motion to dismiss. I had planned to spread this story across a short series (with the first one going live today — the life of an academic!), yet the Court’s timing collapsed it into one post. So let me take it from the top: how the generic-drug bargain works, how a fish-oil pill turned into a Supreme Court case, what the Justices made of it, and why this quiet dispute is one of the more consequential drug-pricing rulings in years.

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Interrupting the Intergenerational Trauma of Family Violence

Shadows of child and adult holding handsIn recent years, lawyers and judges have increasingly recognized the role that exposure to trauma plays in the lives of persons who are involved with the legal system. While trauma can come in many forms,  providers of mental health or legal services need to be especially aware of trauma that is ongoing and has intergenerational consequences. The term “intergenerational trauma” has most often been associated with societal trauma that has been inflicted on certain racial or ethnic groups, who live with the effects and pass them along to succeeding generations. Frequently discussed examples of this are African American slavery, Native American forced attendance at boarding schools, and the Holocaust of World War II. All of these horrors affected survivors in a myriad of ways, and the economic, social, and emotional impact can be felt many generations later.

Here, though, I want to focus on a more mundane and equal-opportunity form of intergenerational trauma: family violence, which is defined here as physical, sexual, or emotional abuse or aggression directed against an intimate partner or child in the family. These are sadly common behaviors that occur across race, gender, and socio-economic status lines. The Centers for Disease Control and Prevention (CDC) estimates that over their lifetimes, approximately 1 in 4 women and 1 in 10 men experience physical or sexual violence or stalking, and more than 43 million women and 38 million men experience psychological aggression. The U.S. Department of Health & Human Services reports that in 2019 there were approximately 656,000 victims of child abuse and neglect in the U.S., which is a rate of 8.9 victims per 1,000 children Certain ethnic groups such as American Indians and African Americans had even higher rates, and children under 1 year of age had a rate of victimization equal to 25.7 per 1,000 children. Evidence suggests that the incidents of family violence have increased during the isolation, stress, and lock-downs of the Covid-19 pandemic.

While conventional wisdom has long suggested that children living in violent homes may learn to be abusers or victims when they grow up, research on the biopsychosocial nature of family violence gives us insight into why this is the case.

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The Worst Places in America

person sitting in wheelchair in empty nursing home hallwayNumerous social commentators have noted how the pandemic has hit the least powerful and prosperous parts of the population the hardest.  Infections, hospitalizations, and deaths have been disproportionally high among the poor, people of color, recent immigrants, Native Americans, and the elderly.

The pandemic has also underscored the worst places to work and live, with the pejorative “worst” referring to the way certain places weigh heavily on the body, mind, and spirit.  These places are not only individualized but also organized into types and categories.  I nominate three types of places as the worst in the United States:  prisons, nursing homes, and food processing plants.

Media accounts have reported at length on how COVID-19 has ravaged prison populations, but prisons were undesirable places long before the virus arrived.  The nation has in general abandoned any commitment to rehabilitate inmates, and prisons have deteriorated into demeaning, dangerous warehouses.  Diseases and medical problems are four to ten times as common as they are in the general population, and the Prison Policy Initiative and Wisconsin Department of Corrections estimate that 42% of the state’s inmates suffer from one or more mental illnesses.   According to the prominent sociologist Jonathan Simon, most of the nation considers prison inmates to be “toxic waste” of a human variety and thinks of the people who run the prisons as engaged in “waste management.”

Nursing homes have been the places in which 40% of COVID-19 fatalities have occurred, and some of the most excruciating pandemic scenes have involved distraught friends and relatives saying goodbye to confused and dying residents through tightly-sealed windows.

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