Amid growing interest in the integration of health and social care to improve outcomes, communities across the United States have explored development of Community Information Exchanges (CIEs). A CIE is a community governed infrastructure that enables critical health and social information to be responsibly shared among partner organizations in support of holistic coordination of care. The development and use of a CIE give rise to a host of legal and policy challenges. Use and disclosure of data through a CIE are governed by a patchwork of different legal requirements, at times distinct and at times overlapping. Development of a legal framework for a CIE requires attention to clearly articulated data flows, detailed use cases, strong legal agreements and policy considerations. CIEs typically rely on an individual’s express consent to share their information, requiring careful evaluation of applicable laws and regulations and promotion of community trust and equity. And because many participants in a CIE are HIPAA covered entities, functions of the CIE must fit within HIPAA’s regulatory framework. This article examines in depth two components of a sound legal framework—consent models and HIPAA compliance—identifying considerations and lessons learned to support lawful and ethical information sharing through a CIE.

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.

This commentary suggests that the meaning and content of dignity is bound to the broader question of who is said to have personhood and sovereignty, and thus protection and rights under the law, and who is excluded from our legal community.

Recent academic debate has questioned whether equitable interests should continue to be classified as proprietary, proposing instead analyses based on “rights against rights”, “modified” proprietary rights or the erosion of the proprietary/personal divide. This article, based on the text of the XXIV Old Buildings Lecture 2025, argues that these alternative frameworks, while illuminating, do not displace the enduring value of the traditional proprietary analysis. It shows that equity has long functioned as the principal means by which the law recognises ownership beyond traditional common-law categories. The proprietary characterisation of equitable interests accords with established principle, is often the simplest workable solution to the problem in hand, and corresponds to the ordinary understanding of ownership.

Tribal nations possess the inherent sovereign authority to protect the health and welfare of their people. Without equitable access to public health data, Tribal nations cannot fulfill this essential governmental duty. Federal, state, and local public health agencies must implement Tribal data sovereignty principles to support the exchange and protection of Tribal public health data. The adoption of Tribal data-sharing agreements can provide a framework for strengthening Tribal data sovereignty and recognizing a Tribe’s inherent right to collect and manage their data.

The high cost of medication is a common challenge for many Americans. This is particularly true for patients served by Federally Qualified Health Centers (FQHCs) that often have low income and are medically vulnerable. In this article I discuss the history and purpose behind the creation of the 340B drug pricing program, legislation enacted to limit the cost of drugs used by patients covered by Medicaid that requires drug manufacturers to enter into discount agreements with the Health Resources and Services Administration (HRSA), and how for years this program has been used to finance health care provision for communities that use FQHCs as their source of primary care. Additionally, I will discuss the history behind the creation of FQHCs and how that mission is affected by litigation and proposed reforms that would limit the ability of FQHCs to leverage savings and revenue from the program to fund health services for their patient populations. I argue that reinforcement of existing discounting practices, along with limited reforms of the 340B program are necessary to avoid disruption of health care provision for patients of FQHCs and to ensure that the 340B program continues to perform as intended.

This article reports new legal data on state syringe services program (SSP) and drug paraphernalia laws in the United States. Scientific legal mapping methods were used to develop a longitudinal legal dataset capturing state-level SSP and drug paraphernalia laws in effect from January 1, 2010, through June 1, 2024. During that period, the number of states with a legal mechanism allowing for syringe distribution from SSPs nearly doubled. However, legal barriers to SSP operations remain in many states.

Cryptoassets, while viewed by many as a significant innovation in the banking and investment industry, present exigent risks to investors, markets and possibly the financial system itself. Can these risks be managed appropriately using securities regulation? This article argues that securities regulation is appropriate to regulate a popular kind of cryptoasset, utility tokens, given the similarities between utility token risks and those found in traditional securities markets. This analysis begins to point to a consistent global regulatory response to cryptoasset regulation and has implications for future cryptoassets and financial innovation more generally.

Prevailing wisdom suggests that sentencing guidelines may constrain judicial discretion and hinder individualised justice; however, our cross-jurisdictional analysis indicates that they might actually better protect these principles than unrestricted discretion. Utilising two large-scale datasets from England and Wales, and Hong Kong, we examine sentences for burglary, assault, and drug trafficking. The results reveal a paradox: guidelines in England and Wales contributed to greater consistency in retributive proportionality and enhanced consideration of personal mitigating factors. Conversely, Hong Kong’s discretionary approach resulted in inconsistent application of sentencing considerations and personal mitigating factors. Both systems prioritised procedural efficiency, with guilty pleas markedly reducing sentences across various offences. These findings challenge the ‘bias effect’ critique by demonstrating that well-structured guidelines can safeguard individualised justice better than unfettered discretion can. The study offers robust empirical evidence for institutional design in criminal justice systems.

In response to the article So You Think You Know Who’s the “Legally Authorized Representative”: Clinical Research Hits a Snag, this invited commentary draws attention to the practical realities that are overlooked in the paper’s examination of enrolling research participants without decisional capacity to provide their own consent. In such scenarios, the participant’s Legally Authorized Representative (LAR) is co-enrolled to consent on the participant’s behalf. Implementation of a research-based LAR is a two-part process that involves identifying the LAR according to legal hierarchy and performing a capacity assessment to determine whether the prospective participant requires an LAR. The paper makes several comparisons between standard care and research approaches to these decisions, most of which the author deems inadequate for clinical research contexts, and suggests that navigating this process may pose “unexpected legal and ethical hazards” for researchers. By offering a practitioner’s perspective in this commentary, I hope to bring clarity to this argument by explaining from direct experience how LAR implementation includes much greater collaboration and thought partnership between researchers and IRBs than the author gives credit for.