Bribery by the pharmaceutical industry is one common manifestation of corruption that can be found in a pharmaceutical system. This study analyzes patterns of bribery in the global pharmaceutical industry through a systematic review of Organisation for Economic Co-operation and Development (OECD) Working Group on Bribery Phase Reports published between 1999 and February 2025. These reports document investigations and enforcement actions related to bribery across jurisdictions. An inductive thematic analysis was used to identify key patterns in cases implicating pharmaceutical firms. We found patterns across many of the cases we studied. For example, bribery was often approved by high-ranking managers. Also, the use of intermediaries and complicated corporate structures to obscure bribes. Multiple cases revealed the involvement of subsidiaries, third-party vendors, or shell companies that processed payments disguised as legitimate transaction. Reported bribes amounted to about US$12.6 million, with sanctions exceeding US$1.1 billion. Government officials, regulatory authorities, and healthcare providers were bribed through cash, gifts, luxury travel, and fraudulent research to gain market access, increase sales, or influence prescribing. These findings underscore the systemic nature of bribery in the pharmaceutical sector and call for stronger oversight and accountability to protect public trust and equitable medicine access.

This memorial essay introduces the Journal of Law, Medicine, and Ethics special issue on supported decision-making in research by honoring David T. Wasserman (1953–2025), a major organizer of the NIH workshop from which the issue emerged and a coauthor of two papers in the volume. It situates supported decision-making in research as an emerging approach that aims to make participation by people with cognitive disabilities possible without displacing their agency through default reliance on legally authorized representatives. The essay highlights Wasserman’s distinctive contribution to this developing area. He sought a position that is respectful while remaining clear eyed about exploitation risks and about well-intentioned practices that can undermine a participant’s interests, especially in hard cases where meaningful authorization is fragile. Drawing on the two coauthored papers in the issue and on colleagues’ recollections, the essay emphasizes Wasserman’s commitment to conceptual clarity, workable institutional design, and mentorship through collaboration. It closes by reflecting on his intellectual virtues, humor, and lasting influence on disability bioethics and research ethics.

Tort law has traditionally prioritized physical over emotional injury claims, due in part to insufficient methods of quantifying the latter. But advances in neuroimaging now make it possible to measure the distinct (and often chronic) neurological damage caused by PTSD, suggesting that it should be treated as both a physical and emotional harm. I argue that this recategorization may help PTSD victims win just restitution, especially for those from marginalized groups whose suffering has traditionally been overlooked and underappreciated by the legal system. Lingering probative and prejudicial flaws will likely limit current judicial applications of PTSD neuroimaging to citations of aggregate research. Until the technology improves in accuracy and sensitivity, individual PTSD neuroimaging on tort plaintiffs will fail to meet most state and federal evidentiary standards. When it does achieve sufficient reliability, neuroimaging precedent for traumatic brain injury may offer guidance on how to incorporate the technology without creating a “CSI effect” that harms plaintiffs unable to access or afford brain scans. PTSD neuroimaging may ultimately foster a greater appreciation for the physical toll of psychological illnesses, catalyzing the movement to dismantle the mind-body divide in tort jurisprudence.

In recent years, we have seen an immense expansion in recombinant DNA, especially in its use in gene therapy applications. Throughout its history, the United States set up several mechanisms of national safety and ethical oversight for rDNA to ensure that we proceeded with its use appropriately. As our knowledge and experience with it grew, there has been increasing pressure to decrease the oversight and monitoring requirements for its use. In 2019, the National Institutes of Health amended the NIH Guidelines for Research Involving Recombinant DNA Molecules eliminated three national mechanisms for guidance, monitoring, and review of this biotechnology. Four years later, we revisit these changes and their implications for a current emerging biotechnology: xenotransplantation. By better understanding the motivations for these mechanisms and analyzing the test case, we argue that these changes have worrisome implications for our ethical oversight of emerging biotechnologies both in the realm of gene transfer technologies and beyond.

The 2025 Public Health Law Conference theme — Connection. Collaboration. Community. — acknowledges this critical time in public health — a time when survival and progress both require working together to best leverage laws and policies. This symposium issue of the Journal of Law, Medicine & Ethics is dedicated to an examination of some of the critical topics discussed at this conference.

In “Body and Soul: How Neuroimaging Should Revise Tort Perspectives on PTSD,” author Alexandra Midler addresses head-on the old distinction in law between physical and emotional injury. Midler correctly notes that tort law has traditionally prioritized physical over emotional injury. Midler uses Post Traumatic Stress Disorder (PTSD) as an example of a disease that can span both physical and emotional injury. Midler’s article is an important and much needed addition to the emotional versus physical injury debate. The focus on PTSD is particularly telling considering the number of people suffering from the disease worldwide. I argue that neuroscience and related disciplines continue to advance, breaking down some of the traditional barriers between physical and emotional harm. It is about time that tort law caught up with these advances.

This article reviews the history and current evidence of systematic pharmaceutical industry corruption. It draws on studies by the OECD on international corruption; reports of the Securities and Exchange Commission; studies of the Public Citizen health Research Group of settlement agreements between federal and state authorities and pharmaceutical firm; the history of the Medicare and Medicaid Anti-Kickback Act; professional and industry codes of ethics; the literature on institutional corruption; and studies of conflicts of interest. These sources support findings of systemic corruption since the mid-20th century. The paper also explores the relationship between classic corruption, institutional corruption and conflicts of interest in medicine and pharmaceutical policy.

Supported decision-making is rapidly gaining attention as an alternative to guardianship and other forms of surrogate decision-making for people with cognitive disabilities. This article provides an overview of the legal status of supported decision-making in the United States, with particular attention to how states are recognizing supported decision-making in different legal contexts. It then explores how the law of supported decision-making applies to clinical research. It explains that although federal research regulations and guidance do not explicitly address formal supported decision-making, individuals may use supported decision-making to make decisions about participating in clinical research and researchers may be required to allow such use under federal laws that protect against disability discrimination. It then concludes by considering legal barriers to greater use of supported decision-making and how these barriers might be overcome.

Commenting on Cargill’s article, this Commentary examines how gene therapy research is regulated in the United States and how oversight of the field has developed. It discusses recent applications of gene therapy technologies and their implications for oversight, and of the impact of ordered cuts to NIH-funded research on gene therapy developments more broadly. Ultimately, it underscores the need for adaptive oversight frameworks for research involving emerging biotechnologies that balance scientific innovation, safety, and ethical considerations, and for effective public engagement on the acceptable use of these technologies, notwithstanding the discontinuation of NIH’s advisory mechanism established for this purpose.

This article explores the connection between health and democracy, positing that public health is rooted in political decisions and that improving health outcomes and advancing health equity requires strengthening inclusive, representative democracy. It describes the relationship between civic health, civic and voter participation, power, and health outcomes, and demonstrates that communities with higher rates of civic and voter participation are linked to better population health outcomes. The authors assert that public health practitioners have the opportunity and the responsibility to improve health by democratizing their practice and supporting policies and approaches which strengthen civic health and promote civic and voter participation. The authors also provide detailed stories from two health agencies — Wisconsin and Minnesota — illustrating these efforts in action and offer several strategies for how practitioners can incorporate this work into their scope of practice.

We conducted an exploratory cross-sectional analysis of ethical principles and practices in forty-one published research papers with empirical data on HIV prevalence, incidence, or risk factors in humanitarian settings. We identified ten key concepts pertinent to ethical principles and applications, and presented recommendations to inform future HIV prevention research.

Public health data modernization in the United States has accelerated since COVID-19 exposed systemic weaknesses in fragmented data infrastructure and governance. Technical solutions have advanced, but legal and relational barriers still complicate data sharing across jurisdictions. Traditionally, interjurisdictional data sharing has relied on individually negotiated Data Use Agreements (DUAs), a process that is both resource-heavy and often opaque. To address this, the Centers for Disease Control and Prevention have proposed a Core DUA to standardize terms and reduce administrative burden. However, its success depends on trust — a fragile foundation increasingly strained by politicization, perceived lack of transparency, and controversial federal actions involving sensitive data. Jurisdictional concerns about compliance, security, and misuse underscore the need for governance frameworks that prioritize clarity, reciprocity, and accountability. Coercive approaches risk deepening fragmentation and undermining collaborative governance. Ultimately, modernization efforts will fail without supporting trust as the cornerstone of public health data governance. This article examines legal variation, transactional friction, and evolving jurisdictional perspectives to illuminate the critical role of trust in shaping the future of public health data systems.

People with intellectual and other cognitive disabilities often face barriers to participating in clinical research, particularly related to the informed consent process. Recent federal policy and legal efforts have advanced strategies to address these challenges, including using supported decision-making. This article discusses this recent progress and the risks and potential opportunities to continuing it in a shifting federal landscape.

Patients living with nociplastic pain are at particular risk of being unfairly judged because their symptoms are subjective and occur without measurable abnormalities. Nociplastic pain, now recognized as a third category of pain alongside nociceptive and neuropathic pain, arises in the absence of tissue damage sufficient to explain the clinical presentation. This “unseen” pain affects at least ten percent of the population, commonly involves the musculoskeletal or visceral systems, and leads to substantial suffering and functional impairment. Validation of these chronic symptoms is often contentious because no objective biomarker or physical sign can reliably confirm their presence or severity. The concept of illness without measurable parameters challenges clinicians and conflicts with legal systems that rely heavily on objective evidence in adjudicating health-related questions. Most clinicians have limited training in medicolegal principles, standards of impartiality, or the ethical distinctions between patient advocacy and objective reporting. These challenges are amplified in cases involving chronic nociplastic pain, where the lack of observable findings complicates clinical interpretation and may conflict with traditional expectations for legal evidence. Bias, whether conscious or unconscious, may occur at multiple stages of the medicolegal process. Inaccurate, incomplete, or biased information from patients, treating clinicians, independent medical experts, insurers, or legal representatives can influence fairness, credibility, and decisional outcomes. This review summarizes key considerations in the adjudication of chronic nociplastic pain and examines how various sources of bias may shape medicolegal decision-making. Improving awareness of these risks and implementing strategies to reduce bias may promote a more reliable and equitable interface between clinical assessment and legal adjudication.

Employers purchase health benefits for more than 60% of the nonelderly population, making employers both important custodians of employee well-being and important actors in the health care ecosystem. Because employers typically have unilateral control over health and retirement benefits, the federal Employee Retirement Income Security Act (ERISA), enacted in 1974, imposes fiduciary obligations on employers when they manage or administer benefits. We provide evidence, from a novel survey of respondents who administer or oversee health benefits for their companies, that many employers appear to neglect even the most basic of their fiduciary obligations to their employees. This neglect may help explain the poor performance of employer plans in controlling costs and providing access to health care, and it suggests that many employers may be vulnerable to liability from ERISA lawsuits.

Supported decision-making presents a promising avenue to address tensions between the benefits of clinical research for persons with intellectual disability (PWIDs) and the potential exploitation of PWIDs in research. However, while much has been written about supported decision-making with PWIDs in clinical practice, there has been little attention to its possible use in clinical research, especially for PWIDs whose capacity to benefit from support may be uncertain or disputed. In this article, we will interrogate three challenges that arise in this context: communication, influence, and speculation and displacement. Through examples adapted from ethics consultations and cases in the literature, we aim to provide guidance on how to address these challenges.

The knowledge of the Social Determinants of Health (SDH) approach implies Health in All Policies and thorough cultural and social transformations, as well as whole-of-government, whole-of-society policies and governance to address health inequities. Nonetheless, this article argues that in the currently dominant rational decision-making model in health policymaking, these policy implications from the knowledge of the SDH approach would lead to an intrinsic contradiction with the logic of modern bureaucracy based on the legal authority as suggested by Max Weber. Using two examples of social determinants of health — universal health coverage and housing issues — this article demonstrates the potential of the polis model proposed by Deborah Stone to take advantage of the knowledge of the SDH approach to pursue structural policy interventions.

Every US state requires drivers to pass a knowledge and skills examination before obtaining their driver’s license. Surprisingly little is known about the progression of people through the examination process. To date, no research has been conducted on the proportion of individuals who pass from one stage of the driver examination process to the next compared to those who fail and are required to be reexamined. The purpose of this study was to follow the progression of a cohort of new drivers in Washington State as they advanced through the driver examination process. We reviewed driving records for 2,604 teens who started a driver education course in 2024. Of those who attempted the knowledge test at least once, 96 percent passed their knowledge test and 85 percent passed their skills exam. There were significant differences in pass and fail rates by sex, race, and household income. The overwhelming majority of new drivers passed both the knowledge and skills exams after two attempts. The fact that teenagers have a high risk of crashing in the first year of licensure suggests that the full safety potential of the knowledge and skills exams are not being realized.

Providing physiologic support to a brain-dead pregnant decedent poses complex ethical, legal, and clinical challenges. Understanding these considerations is necessary to navigate complex discussion and provide appropriate medical care. We use a theoretical case to examine these considerations and outline a path forward.

Commentary on “ERISA and the Failure of Emplloyers to Perform Their Fiduciary Duties: Evidence from a Survey of Health Plan Administrators.”