Building a Home for Health Law

In 2005, Petrie Professor of Law Einer Elhauge founded the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics as “as a research program dedicated to legal analysis and interdisciplinary scholarship on the questions facing health policymakers, medical professionals, industry leaders, patients, and families.” In the 20 years since, the Center has established a robust community of scholars and practitioners working at the intersection of law and health. To mark this occasion, three scholars central to the Center look back at where Petrie-Flom started, how it’s evolved, and where it’s going. We are joined by:

• I. Glenn Cohen, the James A. Attwood and Leslie Williams Professor of Law, deputy dean, and faculty director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School
• Carmel Shachar, assistant clinical professor of law and faculty director of the Health Law and Policy Clinic at Harvard Law School; former executive director of the Petrie-Flom Center from 2017 to 2023 
• Susannah Baruch, executive director of the Petrie-Flom Center 

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The Practice: Glenn, you were an inaugural fellow soon after Professor Elhauge founded the Center, before becoming faculty codirector in 2009 and later director. What was the original vision for Petrie-Flom?

I. Glenn Cohen: We received an amazing gift from Joe Flom and the Petrie Foundation, and the idea was that health care is a huge part of the economy, a huge part of our lives—but not a huge part of legal academia. It was kind of a backwater. In founding the Center, we asked: Could we establish a center that would not only inspire Harvard students and Harvard faculty but faculty across America to take health law seriously and to establish it as a field of real inquiry.

There were a lot of law schools that are great law schools that I didn’t even apply to because they didn’t have anyone on faculty who focused on health law.

Carmel Shachar, assistant clinical professor of law, Harvard Law School

The Practice: Carmel, you were affiliated with the Center as a student at HLS and returned in 2017 to teach and lead Petrie-Flom as executive director. What drew you to Petrie-Flom as a student, and then later to help lead it?

Carmel Shachar: I went to law school knowing I wanted to work on health law in my career. At the time, as Glenn said, health law was a niche field. There were a lot of law schools that are great law schools that I didn’t even apply to because they didn’t have anyone on faculty who focused on health law. From day one, I was marked for the Petrie-Flom Center. When I got into HLS, the dean of admissions hand-wrote a note on my admissions letter, “The Petrie-Flom Center will be so happy to have you.” I hope I’ve lived up to that prediction.

Cohen: One hundred percent.

Shachar: It was an amazing experience for a student who had this passionate interest in a field that was being increasingly recognized but wasn’t yet considered a major part of legal academia. I was able to do research as a student fellow, to work with Glenn, to work with the broader Petrie-Flom community, and to take classes from notable scholars such as Francis Kamm, a philosopher who was a senior fellow at the time. When I graduated, I hit the ground running at a firm with a marquee health law practice—in large part due to the foundation the Center provided.

It was also special to come back after graduation. Petrie-Flom is one of the oldest health law centers in the United States, if not the oldest, and has set the agenda for much of the conversation of where health law needs to go, where it needs to focus, what the important ideas are. To help figure out “What should we as a field be working on right now?” was so exciting.

The Practice: Susannah, you became executive director just two years ago. What were your first impressions of Petrie-Flom? What drew you to the role?

Susannah Baruch: When Petrie-Flom started, I was working in genetics policy and was intrigued by this new entity that had come into the world. My first impression was this was a center that managed to cover an extraordinary amount of territory. That’s reflected in its very long name—health law policy, biotechnology, and bioethics—and as executive director I’ve come to appreciate that we have active research happening related to all of those words.

When I arrived in mid-2023, COVID-19 had highlighted the many connections among health, law, and policy. And at the time, the Center was leading the way on two cutting-edge topics: AI, health care, and medicine; and the legal and ethical issues surrounding psychedelics, particularly for therapeutic or medical use. I’m thrilled that my job is to support these innovative and productive conversations and areas of scholarship.

The Practice: Glenn, you said that when Petrie-Flom was founded, health law wasn’t really a field, and today the Center is at the epicenter of a substantial area of study. Can you talk about the evolution of this field in the past two decades?

Cohen: While there definitely was a field in the years before our Center, and some great luminaries, it has really taken off since. To illustrate, let me do this by sector. Looking at the academy, we now have a large number of new centers that have come online, some of them inspired by Petrie-Flom. Today I’m at UT Austin speaking at a workshop inspired by the original workshop Einer Elhauge started. The workshop brings in a scholar to present a paper in health law, bioethics, and biotechnology for students. We have workshops like that at Texas, a clinical workshop at Stanford, and many other places. We love Harvard, but we love the work and we think it’s important to empower people—not just in the U.S., but across the world—to engage with it.

That brings me to the second theme, which is the global spread of this field: the health law community today is much more connected to peers outside the United States. For example, I coedited a book a couple years ago focused on comparative artificial intelligence in medicine regulation. We had representation in Europe, East Asia, the Gulf countries, and the U.S. It’s a much more globalized field, even as the U.S. itself in the last couple of years has retreated a little bit from global health.

When we started, [health law academia] felt a little bit lonely. I’m delighted that now it feels like a crowded field, but crowded in the best way, like a party of your friends, not crowded like being stuck in the subway.

I. Glenn Cohen, James A. Attwood and Leslie Williams Professor of Law, Harvard Law School

Third, the explosion of biotechnology, pharma, and biotech has meant new avenues of research—it’s helped contribute to improvements in our health but also been a productive force for the economy, especially in Boston. When you look at what sectors are growing economically, it’s always health care that leads the way. We’ve had a real realization that these issues are not just interesting from a legal matter but also engines for our financial growth as a country. And in that growth, there are lots of difficult legal and ethical questions, whether it’s biosimilars and how to think about them compared to generic drugs for biologics, for example, or whether it’s about alternative innovation structures beyond patent law or the deployment of new technologies in medicine.

We all saw the debates about COVID and vaccinations and how it relates to public health. That’s another change that’s happened in the last 20 years. For me, the best change is just the number of colleagues I now have. I will toot our horn: the Petrie-Flom Center has produced many of these amazing people across the country now doing this work at top institutions and developed a deep connection to the profession.

When we started, it felt a little bit lonely. I’m delighted that now it feels like a crowded field, but crowded in the best way, like a party of your friends, not crowded like being stuck in the subway.

It was very interesting to be in a health law and bioethics center at a time [the pandemic] when our health care system was being so heavily tested.

Carmel Shachar

The Practice: Carmel, you were executive director through the pandemic, which was a time when a lot of people became attuned to the ways that public health and the law were connected. What stands out to you from your tenure as executive director?

Shachar: It was very interesting to be in a health law and bioethics center at a time when our health care system was being so heavily tested. Of course, there were ethical issues that came up, for example, with rationing ventilators, how to talk about masking, and certainly with the rollout of vaccines.

We did a lot of convening during that time in which we brought together really smart people to talk about the issues in ways that were very accessible. We received feedback that there were a lot of people, for example, working in state government who were trying to figure out, “OK, what should my state’s response be?” who thought those materials were very helpful. The Dobbs decision was also very impactful to the Center’s agenda and programming.

But then, one thing the Center has always done very well is think about not just what the issue facing all of us in the moment is, but what the issue will be several years from now. For example, when I came in, we were just about to launch our project on precision medicine and AI, which was one of the first legal scholarly explorations of the implementation of AI in health care. That became a huge topic, and Petrie-Flom was a year or two ahead of everybody else in talking about it.

The same thing happened with our work on the regulation of psychedelics. And that’s one thing that has been, I think, consistently exciting about Petrie-Flom is that the team is focused not just on the present but also on what conversations need to happen in a year or two or five years down the line.

The Practice: You’ve mentioned some of the big projects, especially psychedelics and AI, but are there other research areas in which you’ve seen real-world impact?

Cohen: Two jumped out to me. First, I did some work many years ago on the FDA’s ban on gay men donating blood, essentially an outright ban on men who have sex with men (MSM). It resulted in an academic article, an op-ed in the New York Times, and other media attention. Over time, during the Obama era, the administration changed its position on this in part because of these kinds of interventions.

The other thing that comes to mind is work we did at the Center regarding football players’ health. This one, I think, got a little bit under the skin of the NFL. There’s a back-and-forth between us and the NFL because we invited them to comment on our report and they said all the things they disagreed with and we said why we disagreed with their disagreement.

At a time when the national conversation was really focused on traumatic brain injuries related to football, we were an essential voice in looking at some of the more subtle issues related to that: how team doctors are employed and who they answer to in conflicts of interest, whether there are lessons to be learned from other leagues, financial issues involving the ways in which players are paid and how that creates certain kinds of incentives that might be injurious to people’s health.

Shachar: Another place where Petrie-Flom really shines is how collaborative it is. The Center’s always positioned itself with intellectual generosity—there’s more than enough work to go around. For example, we worked with the Center for Law, Brain, and Behavior, trying to take cutting-edge research on neuroscience and asking how the juvenile brain evolves and the aging brain adapts. Our work with the Coalition to Transform Advanced Care has also been very important: thinking through that really challenging, very critical last year of life that is difficult on the patient, difficult on the caregivers, but also is very difficult on the health system and how we meet these patients’ needs.

There is a potential and a hope that comes from new technologies like AI or even the renewed interest in psychedelics.

Susannah Baruch, executive director, Petrie-Flom Center

The Practice: You’ve also highlighted the importance of keeping this work interdisciplinary and working with scholars across the field. Susannah, as you’re thinking about what’s next: Are there any pressing research questions you’re excited to tackle under Petrie-Flom’s umbrella?

Baruch: Our annual conference last year was on aging and the end of life and health, and for this upcoming year, we are focusing specifically on embryos and the legal and ethical issues surrounding them. Again, the breadth of what we do can be sort of mind-blowing.

Also, in the reproductive health space, a current piece of work is to understand the impact on clinicians in reproductive health care and the lawyers who work with clinicians who are trying to sort this all out. For instance, we’re doing a joint spring convening with our colleagues at the Center for Bioethics over at Harvard Medical School to consider conscience, courage, and moral leadership around health care, and how law and policy folks are trying to sort through that post-Dobbs.

When I arrived at Petrie-Flom, we were working on a conference book on health law as private law, which explores the ways that private understandings of legal obligation can help shape issues that may also be dealt with in the public sphere.

There is a potential and a hope that comes from new technologies like AI or even the renewed interest in psychedelics. Legal experts can use different tools to make sure there’s hope, but not too much hype, and we can modulate the way that the world might be talking about new ideas; for example, the deployment of AI in medical care and how the FDA could or should be involved in regulating AI as a tool in health. Physicians and hospitals should understand the risks and should know that the products being offered to them are safe and effective. There’s also a growing sense that AI is an incredible tool for underserved areas, for example, where there may not be adequate expert medical personnel available to read radiology reports.

The Practice: Turning to how Petrie-Flom has widened the field, how has the Center helped mentor and guide young people? Are there more careers in health law than there were 20 years ago?

Cohen: One of the fun things at the 20th anniversary is we got to track down all of our academic fellows, visiting fellows, and student fellows over the years—and it’s kind of an amazing list of where they are now. Among the student fellows, we’ve got a ton of law professors, a MacArthur Genius Award winner. We have neurosurgeons and many doctors. We’ve got people who are product counsel at places like Google and Palantir. We’ve got somebody who’s running the Center for Medicare and Medicaid Innovation at Health and Human Services right now, tons of people at the FDA, people in the White House Counsel’s Office.

In terms of how it’s changed in the long view of 20 years, the Center always had a big tent philosophy that we really do want people who do all of those things and we want people who go into practice or who go into academia or who touch on all of those things over the course of their career. We’ve been able, I think, to maintain that kind of wide tent while being very purposeful and meeting students where they are. For instance, we have always had a competitive robust student fellowship program, but now we also give them an industry mentor, someone who can guide them to make sure there’s real-world impact for the work they’re doing, but also possibly build bridges and help them think through what they might do after.

For a lot of student fellows, it’s [the Petrie-Flom student fellowship is] their first stab at doing independent research that isn’t structured in a class.

Carmel Shachar

Baruch: When I was in law school, there was no such thing as health law. Even as I moved more toward my particular areas of interest on reproductive health and genetics policy, people were like, “Oh, you’re leaving the law. You’re moving into this very different field.” Having the Petrie-Flom Center means that students coming to us know that all of the possibilities are open to them and they can really follow what their interests are.

Shachar: For a lot of student fellows, it’s their first stab at doing independent research that isn’t structured in a class. We’ve had students who have done survey work or classic legal analysis or more health policy pieces. It’s amazingly tailored to what the student wants to work on. We’ve also encouraged the students to do more public-facing writing on our blog in that a lot of making a name for yourself now is having that public thought leadership out there, whether it’s op-eds, client alerts at a law firm, or even social media.

The Practice: Carmel, you now run the health law and policy clinic. Drawing on that as well as your experience at Petrie-Flom, what does it take to be successful as a lawyer at the intersection of law and health?

Shachar: Working in health law, because it’s a field that’s devoted to an industry as opposed to a particular legal methodology, often means being very creative and open to falling down new rabbit holes and to continually learning new areas of law. In my own career, I have now constantly found areas that I need to master where I’m like, “Oh, I’m a health care data privacy person, but now I need to learn constitutional law to understand the privacy dimensions there,” for example. What Petrie-Flom and what health law really gives students is that sense of “OK, I don’t need to walk into a job or a project or work with a particular client and already know the answer. I need to have the confidence that I can hear what my client wants and I can get to that answer.”

That’s increasingly true in the legal profession overall. You see the rise of very large office of general counsels in various health care entities. Most hospitals now essentially have a small law firm embedded in them, and these lawyers are asked to be creative and to roll up their sleeves and master whatever their hospital system needs doing. Flexibility is so important for lawyers in modern practice.

The Practice: Susannah, as someone who also spent time in practice, what else would you add?

Baruch: In terms of new careers opening up in the field, there are a lot of policy lawyers that exist in the world working at the federal and state and local level. While health policy is sometimes thought of as less legally oriented, we need people who are really well-grounded in the law in the policymaking space.

It’s also critical to be open to learning new buckets of information. Being willing to understand a new technological development or medical development or scientific development, and to get to be at least conversant with the experts and ask the right questions in thinking about what legal and other issues are going to come up. Legal training is key even if it doesn’t look and feel exactly like practice in a law firm. The broadening of the general counsel office in hospitals is another great example of that, as Carmel said.

I’ve been in very adversarial positions as a litigator, and what I loved about health law was that it was incredibly collaborative.

I. Glenn Cohen

The Practice: We have a lot of readers who are practicing lawyers at law firms, and many firms have health care practices, as the one, Carmel, you worked for. Susannah, how does Petrie-Flom’s work relate to the expansion of these practices and lawyers working in firms?

Baruch: Like Carmel, many of our student fellows spend time in a law firm setting as part of their early career. Some stay for a long time and shape and lead these growing practices; others may move into government service or academic roles. We also see our scholarship in cutting-edge areas of law, our panel discussions, and the work we publish in our blog, Bill of Health, as important resources for practicing lawyers.

The Practice: What is the hardest part of working at the intersection of law, policy, medicine, and bioscience today?

Cohen: I’ve been in very adversarial positions as a litigator, and what I loved about health law was that it was incredibly collaborative. We had a shared idea, “Our enemy is disease and it’s a common enemy and our enemy is death.” There were political fights to be sure, especially in the more bioethics sides. But overall it was an area where the public had a lot of alignment about what the goals were, even if we sometimes disagreed about methods.

I think the current political moment is much more challenging in that things that I would’ve thought of as a given are suddenly controversial. And this really happened, I think, starting with the Affordable Care Act, but has snowballed, especially in the current moment relating to vaccines and public health and COVID. It was a fundamental resetting of people’s relationships to public health as an idea. I view this as a very big challenge for the country.

This challenge has also mirrored itself on the global stage where the U.S. has retrenched itself from a leadership position on global and public health compared to where we were eight or nine years ago.

Don’t think that because you don’t have a doctoral degree in microbiology that you can’t be part of the most important, interesting conversations that lawyers and ethicists are having.

I. Glenn Cohen

Baruch: Lawyers pride themselves on understanding the intricate details of what they’re contending with, but that can be difficult when thinking about the global picture. What does the legal environment mean given so many different regions and countries in the world? What are the different marketplaces emerging in different states or regions? The complexity of thinking about the legal environment and the regulatory environment at a global level is a challenge that someone going into this field has to want to engage with and welcome.

The Practice: That’s a good place to ask, if you could offer one piece of advice to someone emerging into this field, what would it be?

Cohen: Stay curious. Don’t think that because you don’t have a doctoral degree in microbiology that you can’t be part of the most important, interesting conversations that lawyers and ethicists are having. It turns out the skills we bring are in incredibly high demand. As fields go, this is a nice one in that the supply of people doing this work is much below the demand for it. It’s nice to be wanted and to realize that you could be somebody who’s extremely influential, even if you’ve never held a scalpel or never looked through a microscope.

Shachar: For somebody starting out, I would remind them that careers are marathons, not sprints. Sometimes people who are starting out in their careers can put a lot of pressure on themselves to solve what it is that they want to do with their whole life. But thinking about careers as different stages where you’re learning and training and continually refining what it is that you do, and maybe sometimes pivoting, hopefully takes the pressure off the idea that “I need to graduate law school and come up with the one perfect job that I will want to have for the rest of my life.”

Baruch: In my experience you don’t know your path really until you’re looking back at it. But you can choose each stepping stone along the way. It’s great to have a goal or a direction or an area of interest, but so much can change even in five years of your career, so try to be open to the next stepping stone maybe being a little bit to one side or different than you thought, and have some faith in that process working out.

The Practice: As we just finished the first 20 years, when you look back in another 20 years, Glenn, what do you hope to see when you look at Petrie-Flom at 40?

Cohen: Continuous excellence, continuous engagement with both the academy and practice. And I expect that whoever succeeds me as a faculty director will do an even better job than I have. I’d be delighted to be surpassed by whoever succeeds me.

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I. Glenn Cohen is the James A. Attwood and Leslie Williams Professor of Law, deputy dean, and faculty director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

Carmel Shachar is an assistant clinical professor of law and the faculty director of the Health Law and Policy Clinic at Harvard Law School. She was the executive director of the Petrie-Flom Center from 2017 to 2023.

Susannah Baruch is the executive director of the Petrie-Flom Center. Previously, she led projects in genetics law and reproductive health in Washington, D.C.