On November 2, 2010, the US Supreme Court heard arguments in the case of Schwarzenegger v Entertainment Merchants Association, with a ruling expected in 2011. This case addressed whether states have the right to restrict freedom of speech by limiting the sale of violent video games to minors. To date, 8 states have tried to pass legislation to this effect, with all attempts being found unconstitutional by lower courts. In large part, the Supreme Court's decision will be determined by its review and interpretation of the medical and social science literature addressing the effects of violent video games on children. Those on both sides of the violent video game debate claim that the scientific literature supports their opinions. Some involved in the debate have proclaimed that the debate is scientifically settled and that only people holding personal interests and biases oppose these "established truths." We review the historical similarities found in the 1950s comic book debate and studies identified from a PubMed search of the term violent video games showing both the harmful and beneficial effects of these video games. We define factors that physicians need to consider when reading and stating opinions about this literature. Opinions from past court rulings are discussed to provide insight into how judges may approach the application of these social science studies to the current legal issue. Although on the surface the case of Schwarzenegger v Entertainment Merchants Association pertains only to the restriction of violent video games, it may establish principles about how medical and public health testimony can affect fundamental constitutional rights and how much and on what basis the courts will defer to legislators' reliance on unsettled science.

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