User:Cf2022/sandbox/Christopher Robertson

Christopher Tarver Robertson is the N. Neal Pike Scholar in Health & Disability Law professor at Boston University School of Law. Robertson was previously Associate Dean of Research and Innovation and Professor of Law at the University of Arizona, where he was also the founder of its Regulatory Science Program. Robertson's work includes tort law, bioethics, conflicts of interest, informational limits, cognitive biases, the First Amendment, and corruption in healthcare and politics. His legal practice has focused on complex litigation involving medical and scientific disputes.

Biography
In 1997, Robertson attended Southeast Missouri State University on a Governor's scholarship where he graduated summa cum laude with a B.A. in Philosophy. He went on to earn a Ph.D. in Philosophy at Washington University in St. Louis and taught bioethics before going on to Harvard Law School earning his J.D., magna cum laude in 2007. In 2008, Robertson returned to Harvard Law School as an Academic Fellow & Lecturer On Law at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics. Robertson has received research support from the Edmond J. Safra Center for Ethics at Harvard, the Greenwall Foundation and the Robert Wood Johnson Foundation. He has also previously served on the clinical ethics committee for an academic medical center, and he has served as a peer review for leading presses and journals including Oxford University Press and the New England Journal of Medicine.

Upon completing his fellowship in 2010, Robertson became a tenure-track professor at the University of Arizona James E. Rogers College of Law and was tenured as a full professor in 2015. Robertson was also appointed Associate Dean for Research and Innovation at the James E. Rogers College of Law.   During this time period, Robertson also served as a visiting professor at Harvard Law School, New York University Law School, and the London School of Economics.  In 2020, Robertson was appointed the N. Neal Pike Scholar in Health & Disability Law at Boston University School of Law. '''Robertson's articles have have appeared in various legal and peer-reviewed journals, including the New England Journal of Medicine; California Law Review; Cornell Law Review; NYU Law Review;  and Yale Journal of Health Policy, Law, and Ethics; Journal of Empirical Legal Studies. Robertson has also previously been a reporter for the Health Law Monitoring Committee of the Uniform Law Commission.   Throughout his career, Robertson has also been quoted or featured in various national and local media outlets such as The Wall Street Journal, NBC News, NPR,  The Washington Post,  CNN, The Boston Globe,  The Hill,  Politico, STAT, The Brown Daily Herald, and Arizona Public Media. '''

'''Robertson remains actively engaged in various legal reform initiatives, including aiding the California State Bar in developing ways to reduce racial disparities in the attorney discipline system and reforming legal education.  In an effort to work toward legal education reform, Robertson is helping to develop JD-Next, which is a national program aimed at predicting student success and helping reduce racial disparities among pre-law students, among other initiatives.  During his time at the University of Arizona James E. Rogers College of Law, Robertson helped found the University of Arizona Regulatory Science Program, which works to "accelerate clinical and translational science and to train a new generation of regulators, lawyers and scientists."'''

Exposed: Why Our Health Insurance Is Incomplete and What Can Be Done about It.
In 2019, Harvard University Press published Robertson's monograph, Exposed: Why Our Health Insurance Is Incomplete and What Can Be Done about It. The book has been applauded for synthesizing complicated concepts in "medicine, public policy, law, philosophy, economics, political science, and ethics" to present non-partisan analyses to discuss American healthcare reform. Robertson notes how deficiencies in the Affordable Care Act have contributed to mass underinsurance, due to failures to address rising health care costs.  '''The text specifically focuses on  deficiencies in patient cost-sharing, as Robertson describes underinsurance as a cost-exposure that is disproportionate with patients' ability to pay. While prominent economic theories have supported the use of cost-sharing to reduce wasteful spending, there is significant evidence of its ineffectiveness, as cost-sharing largely aggravates access to care issues. For example, higher co-payments for prescription drugs can lead to increased emergency department visits and hospital stays, as lower-income patients will struggle with drug expenses.  Hence, even insured individuals can struggle significantly with healthcare costs, along with the uninsured.  Robertson argues that cost-sharing can be counterproductive, as cost exposures contribute to rising healthcare costs, reduce access to healthcare services, and contribute to financial crises by resulting in medical debt and financial fragility.'''

Robertson argues that cost-sharing only marginally contributes to healthcare cost containment, as high healthcare costs result from healthcare provider monopolies, insufficient information about treatment efficacy, and incentives for healthcare entities to value high-cost care over high-quality care. '''Rather than focusing on cost-sharing, which cannot address these major contributors to healthcare costs, Robertson advocates for legislation banning cost exposure for certain care, especially high-value preventative services (e.g. flu shots). Robertson also encourages the elimination of deductibles and co-pays for patients seeking established care that is "known to provide good value to patients." And, he also proposes implementing a reward system to encourage patients to choose lower-cost care when it is of equal or better quality than high-cost care. There are significant barriers that would prevent totally eliminating cost-sharing in the near future; therefore, Robertson favors improving cost-sharing by scaling it according to the patient's income and ability to pay. Similar policies that have been adopted in Canada and New Zealand are more successful than the current American model for cost-sharing. Robertson argues that scaling health insurance based on ability to pay would address access to care issues contributing to wasteful care and promote the use of high quality care among low-income families, especially.  As health insurance is generally provided by employers in the United States of America, Robertson notes that such reform could be easily implemented.'''

Other Health Law Scholarship
'''In his scholarship, Robertson has explored the "psychological costs" resulting from the "decisional burden" associated with health insurance. Psychological costs come from being forced to make decisions about health care and complicated medical expenses. ' The decisional burdens associated with these choices cause stress, "choice overload," "depletion of cognitive capacity," and "facilitation of regret," which can all lead to increased insurance costs as a result of poor decision-making. ' Robertson critiques mistakes in behavioral economics that influence medical insurance contracts, like optimism, salience, and projection bias'''. ''' These biases can all result in presumptions about the need for cost-sharing that can negatively affect the individual. For example, optimism about the future could lead individuals to underestimate the likelihood of experiencing illness and the need for health insurance. Salience, which often results in individuals only focusing on near-term consequences, can lead to exaggerated concerns about premiums, cost-sharing amounts, and network status, rather than other service-levels aspects of the insurance policy. Exaggerated focus on premiums or absolute cost-sharing limits, rather than cost-sharing aspects of insurance policies, can also be the result of projection bias, or the application of incorrect predictions of future mental states to present situations. The consequences of these influences on cost-sharing can be significant. Hence, Robertson has advocated for basing cost-sharing amounts on the insured's income, since income plays a large role in an insured's incentive to reject wasteful care, and their ability to pay for health care. '''

Robertson has explored issues with health care costs extensively. ' In fact, Robertson proposes that modifications to insurance reimbursement plans by public and private insurers should be based on the presumption against the use of expensive health care resources, for many reasons. ' Specifically, Robertson is concerned that health care benefits do not often exceed the costs of more expensive treatments for the following reasons: new health care technologies can be exorbitantly priced; FDA approval does not consider costs; medical care is not often based on sufficient evidence of effectiveness; empirical studies can be biased; empirical studies can be significantly affected by industry-interests; drug effectiveness might not relate to better overall health; benefits of expensive health care procedures might be insignificant; and the newest, most expensive treatment options often have the least support. ' Robertson suggests a presumption against expensive health care consumption could be implemented by: (1) scaling patient cost-sharing and (2) splitting health benefits. ' '''Scaling cost-sharing based on a percentage of income, rather than using the flat amounts for people of different socio-economic status, would minimize deterrence of the poor from seeking highly beneficial care, especially if the cost-sharing is clear and disclosed prior to consumption decisions being made.  Robertson's proposal to modify insurance policies to cover more expensive treatments with a split benefit would allow insurers to pay the patient a certain percentage of the treatment cost in cash. If the patient then spent the cash on the treatment, the insurer would cover the entire treatment cost. ' In this way, the health care system is spared from inefficient expenditures, while the patient can still receive the full cost of treatment if the patient believes the benefits of treatment are worth the health care costs.''' '

In his health law scholarship, Robertson has also criticized arguments in favor of off-label marketing by raising concerns that if broad off-labeling marketing is permitted, premarket approval of drugs is placed at risk. ' Robertson has repeatedly emphasized that FDA rules are important for regulating critical information in pharmaceutical marketing, because physicians often have concerns about industry-funded trials and marketing. ' Hence, off-label uses of pharmaceuticals should be entitled to fewer First Amendment protections. 

As part of his extensive scholarship on conflicts of interest, Robertson has argued that biased experts used in litigation should be chosen in a double-blind procedure, so that parties are truly soliciting neutral expert opinion on a case. ' Robertson believes that expert bias is inevitable given the current process of paying experts who have extensive contact with the party they are representing. ' To prevent parties from "cherry-picking favorable experts," Robertson argues in favor of utilizing a third-party intermediary to select a qualified expert based on a case's fact pattern. '  The intermediary would also interact with the expert, so that the party would not be aware of the expert's opinion, nor would the expert know which side he would be testifying for. ' Robertson proposes that a neutral intermediary without a financial motive, e.g. American Association for the Advancement of Science (AAAS), could impartially select a court-appointed expert from a representative sample of experts. ' Logistical and cost-associated issues with Robertson's proposal have been raised, but blind expertise has been viewed as being of great benefit for at least certain types of litigation, such as antitrust. ' As an expert in health law, institutional design, and decision-making, Robertson has also explored a wide range of topics in his scholarship, including '''torts, bioethics, professional responsibility, conflicts of interests, criminal justice, evidence, the First Amendment, racial disparities, and corruption. '''

Notable Publications
Robertson has co-edited three books: Nudging Health: Behavioral Economics and Health Law (2016, with Holly Fernandez Lynch and Glenn Cohen); Blinding as a Solution to Bias: Strengthening Biomedical Science, Forensic Science and Law (2016, with Aaron Kesselheim); and Innovation and Protection: The Future of Medical Device Regulation (forthcoming 2021). In 2019, Harvard University Press published Robertson's monograph, Exposed: Why Our Health Insurance Is Incomplete and What Can Be Done about It. In addition to his books, Robertson is a prolific writer with articles appearing in both legal and healthcare journals including the New England Journal of Medicine; Yale Journal of Health Policy, Law and Ethics, Journal of Legal Analysis, Journal of Law and Bioscience, Journal of Empirical Legal Studies, New York University Law Review, Cornell Law Review, and Journal of the American College of Radiology. Some notable journal articles published by Robertson include:

Christopher Robertson, K Aleks Schaefer, Daniel Scheitrum, Sergio Puig & Keith Joiner, Indemnifying Precaution: Economic Insights for Regulation of a Highly Infectious Disease, 7 Journal of Law and the Biosciences (2020).

Christopher Robertson & Tara Sklar, Telehealth for an Aging Population: How Can Law Influence Adoption Among Providers, Payors, and Patients?, 46 American Journal of Law & Medicine 311 (2020).

Christopher Robertson, The Ethics of Research That May Disadvantage Others, No. 20-14 Arizona Legal Studies Discussion Paper (2020).

Christopher Robertson, Andy Yuan, Wendan Zhang & Keith Joiner, Distinguishing Moral Hazard from Access for High-Cost Healthcare under Insurance, 15 PLOS ONEe0231768 (2020).

Christopher Robertson, Tara Sklar, Richard Carmona & Kathie Insel, Digital Health Privacy in Active-Aging Settings: Will the Law Let You Age Well?, 18 Journal on Active Aging 34 (2019).

Christopher Robertson & Tara Sklar, Affordability Boards: The States’ New Fix for Drug Pricing, 381 New England Journal of Medicine 1301 (2019).

Christopher Robertson, Shima Baradaran Baughman & Megan Wright, Race and Class: A Randomized Experiment with Prosecutors, No. 19-26 Arizona Legal Studies Discussion Paper (2019).

Christopher Robertson, Will Courts Allow States to Regulate Drug Prices?, 379 The New England Journal of Medicine 1000 (2018).

Christopher Robertson, Vaccines and Airline Travel: A Federal Role to Protect the Public Health, 42 American Journal of Law & Medicine 543 (2016).

Christopher Robertson & Aaron S. Kesselheim, Regulating Off-Label Promotion — A Critical Test, 375 The New England Journal of Medicine 2313 (2016).

Christopher Robertson, D. Alex Winkelman, Kelly Bergstrand & Darren Modzelewski, The Appearance and the Reality of Quid Pro Quo Corruption: An Empirical Investigation, 8 Journal of Legal Analysis 375 (2016).

Christopher Robertson, New DTCA Guidance — Enough to Empower Consumers?, 373 The New England Journal of Medicine 1085 (2015).

Christopher Robertson, Scaling Cost-Sharing to Wages: How Employers Can Reduce Health Spending and Provide Greater Economic Security, 14 Yale Journal of Health Policy, Law, and Ethics 239 (2015).

Christopher Robertson, Sunita Sah & Shima Baughman, Blinding Prosecutors to Defendants’ Race: A Policy Proposal to Reduce Unconscious Bias in the Criminal Justice System, 2 Behavioral Science & Policy 83 (2015).

Christopher Robertson, Athan Papailiou & David Yokum, The Novel New Jersey Eyewitness Instruction Induces Skepticism but Not Sensitivity, 10 PLOS ONE e0142695 (2015).