Norfolk Southern, the American railway giant, has found itself in the midst of a train derailment crisis. With two noteworthy derailments in the past two months, Norfolk Southern has vehemently denied that its derailment in East Palestine, Ohio will cause lingering health problems to the citizens of the town.

President Biden said Norfolk will be responsible for air testing and clean up after almost 120,000 gallons of vinyl chloride spilled during the 38-car derailment on February 3^rd, 2023. The company has deployed air quality test squads in conjunction with the Environmental Protection Agency to assure residents of the town that they are safe to return to their homes. While there is obvious distrust between Norfolk Southern and the residents of East Palestine, an unexpected group has found themselves in the midst of this controversy: the workers themselves.

In an open letter to U.S. Department of Transportation Secretary Pete Buttigieg sent on March 1^st, 2023, an American Rail System Federation official detailed how workers sent to help clean-up the contamination in East Palestine were becoming ill. Workers “inquired about the appropriateness of their personal protective equipment and the safety of their working conditions” and were met with little to no response from Norfolk Southern. J.B. Long, the General Chairman of the ARSF and author of the letter, alerts Secretary Buttigieg that Norfolk Southern is “Dangerous to America.”

Remediation workers and East Palestine residents have a right to be concerned. According to the Center for Disease Control, vinyl chloride is a toxic chemical readily absorbed into the lungs and can cause health issues, including damage to the central nervous system and death. Residents have expressed to multiple news outlets, that they have experienced nausea, headaches, and skin rashes due to chemical exposure.

Although air-quality testers and politicians have vocally reassured residents their homes are safe to enter, the optics hardly fit the narrative. “Right now they’re saying, ‘Oh, our team said they didn’t test anything in the air.’ Well, let’s talk about the soil, let’s talk about the residue, why are people getting sick if it’s… safe,” East Palestine resident Zsuzsa Gyenes told Vice News.

Now, almost three months after the devastating spill, independent testing conducted by a team from Purdue University has found carcinogenic chemicals in the air and water surrounding East Palestine. Andrew Whelton, an engineering professor at Purdue and a member of the testing team, told FOX Business, “Many statements by government agencies were being made about safety. ‘The air is safe, the water safe, your homes are safe.’ But they weren’t actually sharing a lot of the data. And that raised a red flag for us.” Whelton recently wrote a letter to the EPA asking for additional oversight on water testing in East Palestine.

The train derailment in East Palestine, while devastating, is just one of thousands of chemical spills that happen in the U.S. annually. Analysis of EPA data regarding chemical spills conducted by The Guardian found that the U.S. averages two chemical spills a day, causing environmental, health, and economic problems across the country. Even though Norfolk Southern is being held accountable, only time will tell how and when the site is fully cleaned up, and the long-term health implications of the spill. “I definitely don’t trust Norfolk or the team that they hired. I don’t think they should have been given the ability to hold the reins on the narrative,” said Gyenes.

Last summer, I wrote about the Medical Question Doctrine, the theory that federal courts should defer to physicians on medical-legal questions. The relevance of my piece has resurfaced, now that Texas district court Judge Matthew Kacsmaryk issued a nationwide injunction prohibiting the FDA’s mifepristone approval.

Mifepristone is a one of two medications used for medical abortions. Mifepristone “blocks a hormone called progesterone that is needed for a pregnancy to continue.” The drug itself was first approved in 2000, and its approval was audited and validated in 2008. Mifepristone is effective and safe: the drug is 80% successful and sends fewer people to the ER than Tylenol and Viagra. In fact, only 24 out of nearly 3.7 million individuals who took mifepristone experienced a fatal side effect – and 6 of those cases coincided with alcohol and drug use. This puts the fatality rate of mifepristone at .00065%. Even compared to surgical abortion, medical abortion is indistinguishable with regards to safety and effectiveness.

On a tenuous legal theory and even more strained medical analysis, Judge Kacsmaryk stayed the initial and subsequent mifepristone approvals by the FDA. In essence, Judge Kacsmaryk paused legal distribution and prescription of mifepristone (with a seven-day grace period). Judge Kacsmaryk’s decision rested on the administrative complaint that the FDA had improperly approved the drug and that patients and doctors may experience injuries from using mifepristone.

In response to this decision, legal scholars, newspapers, and the United States President have criticized the decision for adopting radical, conspiracy-like reasoning that badly misconstrues reproductive medicine (and administrative law). In making his decision, Judge Kacsmaryk relies on a new theory of standing, a dormant 1873 statute, and an unprecedented remedy.

Last year, I suggested that the Medical Question Doctrine ought to consider “[1] the breadth of science on the policy, [2] the good faith justification by the physician, [3] the interest convergence of industry in pushing the treatment, [4] the effectiveness of the treatment in past experimentation, and [5] the interests of the state in regulating the treatment.” While none of these factors are dispositive, the Medical Question Doctrine prioritizes dereference to the individual physician rather than substitute the physician’s expertise for the Court’s.

In contrast to these careful considerations, Judge Kacsmaryk’s nationwide remedy contravenes the particularized, case-specific reasoning that physicians use when prescribing treatment. Of course, subsequent FDA regulations had gone further, permitting a prescription without a doctor’s visit. However, Judge Kacsmaryk’s remedy prevented a prescription, even with informed consent (as the initial approval permitted). More than just a contempt for abortion, this decision joins a series of nationwide remedies that demonstrate serious misgivings about expertise and agency judgement. Broadly, this means that a court without medical training can override the best medical judgement of physicians, even when that physician believes that such a treatment may be the most effective medication.

This is especially troubling when the American Medicine Association Code of Medical Ethics requires that physicians “[k]eep[] current with best care practices.” What happens when Federal Judges prohibit the use of best medical treatments? How can doctors conform with their ethical duties when judges intervene into the medical practice? Even for a Court skeptical of the administrative state, the local and particular nature of medical practice should warrant greater deference to physicians who have the most amount of information and knowledge on a particular topic. As I’ve noted before, the US Congress has only had 27 physicians elected to office since 2005, so it is difficult to understand why politicians or judges without medical training should be left to unquestionably dictate best care practices.

While this article does not advocate “Chevron for Doctors,” it does require that a court consider its own expertise on the difficult decisions doctors are forced to make and defer to their on-the-ground training (much in the same way courts will defer to police officers when evaluating qualified immunity claims). Once again, the Supreme Court will be presented with an opportunity to recognize its limits. Rather than succumb to conspiracies about the “Clinton Administration,” the Supreme Court should commit to local decision making; not by politicians and judges who do not understand complex medical procedures, but by doctors who are on the ground making these decisions.

“Medicalization” generally refers to a process in which previously nonmedical conditions come to be understood under the notions of disease and illness. Homelessness is not researched as a disease itself, yet situations for homelessness can be defined as a medical problem. Although medicalization has assisted the healthcare community in gaining awareness of the matter in question, the medicalization of homelessness focuses on cultural and circumstantial understandings rather than professional domain. The medical community reactively spends excessive amounts of money, services and resources on addressing the healthcare needs brought on by homelessness, rather than proactively providing for the tangible needs of the poverty-stricken areas before homelessness occurs. Although access to treatment and medication services is a step in the right direction, it reveals a problem with the medical model: it places homelessness as a potential consequence to disease, addiction or mental illness instead of understanding its contributing nature in creating disease, addition or mental illness.

Politicians and the press tend to link homelessness to mental illness, thus medicalizing a socioeconomic problem. While mental illness can contribute to homelessness, it is not the sole cause. Persisting from the beginning, poverty-stricken communities lacked supportive housing services for individuals experiencing homelessness with acute needs to physical or mental health issues. There was, and currently is, a desperate need for more than just housing. These individuals require additional help to become housed and stay securely housed, in order to maintain mitigate conditions such as a physical ailment or mental ailment exacerbated by homelessness.

Currently, the political and medical sectors focus on prevention and control for disease as well as substance abuse and mental health, which all thrive in poorly maintained areas where more than half the population is prone to experience a form of homelessness. Even with such data and research confirmation, policies continue to stray away from the problem: homelessness itself. The medicalized framework in the US is designed to treat symptoms rather than root causes of homelessness. As a result, legal and policy solutions focus on critiquing this medical framework from an outcome perspective, rather than implementing policies aimed at addressing those root causes. It is important to take a more holistic and systemic approach to address homelessness, one that recognizes the multiple factors that may be contributing to the cause of such debilitating conditions. Shifting the perspective to view homelessness as one of the factors that can create disease, addiction or mental illness may help policymakers create better homeless prevention laws at a federal level, rather than adequately address the notion that treating physical and mental conditions will decrease homelessness.