Certain Age Groups May Encounter More Ethics Risk, Says New Report from the Ethics Resource Center

Ethics Resource Center
Press Release
Originally presented on June 24, 2013

Younger workers are more susceptible to experiencing ethical dilemmas on the job, the Ethics Resource Center (ERC) said today in “Generational Differences in Workplace Ethics,” a supplemental research report to their 2011 National Business Ethics Survey®.  The new report takes an in-depth look at how employees of different generational cohorts are shaping today’s workplace.

The report delves into trends among four specific generational groups- Millenials, Generation X (Gen X’ers), Boomers, and Traditionalists. Each generation, shaped by significant world events and cultural trends, exhibits distinct differences when it comes to ethics.  According to the study, certain age groups are more “at risk” than others when it comes to the four key measures of ethical performance- pressure to compromise standards, misconduct, reporting, and retaliation.  For instance, the report reveals that the younger the worker, the more likely they are to feel pressure, observe misconduct, and experience retaliation for reporting.

Major findings from the survey include:

• Almost half of Millenials (49 percent) observed workplace misconduct
• The youngest workers (29 percent) were significantly more likely to experience retaliation than Gen X’ers (21 percent) and Baby Boomers (18 percent)
• After witnessing misconduct, over half of employees in every age group reported it to their supervisor first

“It is important for companies to realize that each generation perceives ethics and culture differently from the others,” said ERC’s President, Dr. Patricia J. Harned.  “However, business leaders should know they do not have to completely redesign their ethics and compliance programs.  Implementing an effective ethics and compliance program and building a strong ethics culture will continue to make a difference for all employees. The key is communicating their commitment to ethics differently for different generations.”

This study is the most recent in a series of surveys conducted by the ERC. The ERC has fielded a biennial National Business Ethics Survey (NBES®) since 1994, providing business leaders a snapshot of workplace ethics trends.  Throughout the years the NBES has been expanded into a series, making it possible to focus on specific areas of interest.

“Generational Differences” allows ERC to address challenges facing a workforce spanning multiple generations, and offers suggestions for business leaders on how to reach each generation.  This newest report was made possible in part by a generous contribution from Raytheon Company.

Download the entire supplemental report here.

SUPPORT Update: OHRP’s Compliance Actions on Hold

By John B. Lantos
The Hastings Center Bioethics Forum
Originally posted June 5, 2013

In a thoughtful, nuanced letter to the University of Alabama (the home of the Principal Investigator of the SUPPORT study), the Office for Human Research Protection announced that it has “put on hold all compliance actions against UAB relating to the SUPPORT case.”  Further, OHRP promises not to initiate compliance actions “in studies involving similar designs” until it clarifies the guidelines for such studies. In doing so, it acknowledges “widespread misunderstanding about the risks that are required to be disclosed in obtaining informed consent for certain types of studies.”  (Previous posts on the SUPPORT controversy are here, here, here, and here.)

OHRP promises that the process of drafting new guidelines will be “as open as possible, with input from all interested parties.”  To achieve this, it will “engage in the usual notice and comment process with regard to draft guidance” and “will also conduct an open public meeting on this topic.” This is a welcome development.

The letter also suggests the positions that OHRP will take in these discussions. It focuses on three main points.

First, the letter acknowledges that these discussions will focus on situations where the standard of care includes known and widespread practice variation with no reliable evidence on which practices are associated with which risks or benefits. “When the SUPPORT study was initiated,” it states, “there was no clear recent evidence indicating that different oxygenation levels with the then-current standard of care (85%- 95%) would produce differences in neurological damage or survival.”

The entire blog post is here.

Drug Executive Faces Manslaughter Charges

By SCOTT SAYARE
The New York Times
Published: December 11, 2012

A French court brought manslaughter and injury charges on Tuesday against a drug executive and six companies in a case involving a diabetes and weight-loss drug that caused cardiovascular damage, the Paris public prosecutor’s office said.

The executive, Jacques Servier, 90, and six companies of the Servier group are accused of having known the risks associated with the drug, Mediator, which they produced and marketed until French authorities ordered it withdrawn in 2009, the spokeswoman, Agnès Thibault-Lecuivre, said.

The entire article is here.

Do Post-Market Drug Trials Need a Higher Dose of Ethics?

Patients who sign up for trials testing more than one already approved intervention do not always know if one is being tested for harmful side effects

By Katherine Harmon
Scientific American
Originally published August 23, 2012

Here is an excerpt:

What you might not know—even after you sign up for the trial and have inked the informed-consent form—is that scattered reports are starting to suggest that the new medication might occasionally cause severe side effects. And the real reason the trial is being conducted with these previously released drugs is to test whether the new medication really is a lot riskier to everyone or just to a subset of patients.

If you found that out, would you still sign up for the trial? The problem is that many patients—and often even the institutional review boards that approve the trials—are never informed of these lingering questions.

This is one of the big ethical holes often left open in post-market trials, says Ruth Faden, director of the Johns Hopkins Berman Institute of Bioethics, who co-authored a new essay on this topic in The New England Journal of Medicine, which was published online August 22. She and a team of co-authors released a formal Institute of Medicine (IOM) report earlier this year recommending that the FDA improve this and other ethical aspects of post-market trials—especially those it requires.

Click here for the entire story.

Chronic Pain Fuels Boom in Opioids

By John Fauber

Milwaukee Journal Sentinel/MedPage Today

Originally published on February 19, 2012

Prescriptions for narcotic painkillers soared so much over the last decade that by 2010 enough were being dispensed to medicate every adult in the U.S. around-the-clock for a month.

Fueling that surge was a network of pain organizations, doctors, and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the very companies that made them, a Journal Sentinel/MedPage Today investigation found.

Last year, the Journal Sentinel/MedPage Today found that a University of Wisconsin-Madison-based organization had been a national force in helping liberalize the way opioids are prescribed and viewed. During a decade-long campaign that promoted expanded use of opioids -- an agenda that critics say was not supported by rigorous science -- the UW Pain & Policy Studies Group received $2.5 million from makers of opioid analgesics.

After that article was published last April, the UW Pain group said it had decided to stop taking money from the drug industry.

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The Pendulum Swings Back

Several of the pain industry's core beliefs about chronic pain and opioids are not supported by good science and contributed to the growing use of the drugs, a Journal Sentinel/MedPage Today review of records and interviews found.

Among the misconceptions:

• The risk of addiction is low in patients who obtain their narcotic painkillers legitimately.
• There is no maximum dose of the drugs that can't be safely prescribed.
• People who seek more frequent prescriptions or higher doses of the drugs aren't addicts, they are "pseudoaddicts" who just need more pain relief and more opioids.

Underlying those fallacies, critics say, is an even larger one: That the use of narcotic painkillers to treat non-cancer pain lasting many months or years is supported by rigorous science.

Even doctors who have financial relationships with companies that make narcotic painkillers concede that the practice of pain medicine got ahead of the science.

Lynn Webster, MD, a Utah pain specialist who has worked as a consultant and adviser to most of the companies in the opioid analgesic market, said the pain community got some of it wrong.

"We overshot our mark, all well-intended, I believe," Webster, an officer of the American Academy of Pain Medicine, said in an interview. "We certainly have a lot of reverse education that needs to occur."

Some chronic pain sufferers do benefit from the drugs, Webster said.

"The problem is pain is complex," he said. "There is a whole family of opioids and we have not figured out how to best identify the individuals who can benefit long term.

"I don't think industry was trying to harm anyone. I think industry was trying to fill a need that we as physicians saw."

Others say that Webster is too forgiving in his analysis: they claim that the pharmaceutical industry chose profits over patient safety.

The entire story is here.

Antipsychotic drugs tied to diabetes risk in kids

By Amy Norton
Reuters/Yahoo! News

The antipsychotic drugs that are increasingly being used to treat bipolar disorder, autism and other mental disorders in children may come with an increased risk of diabetes, a new study suggests.

Previous research has linked the so-called second-generation antipsychotics to an increased risk of diabetes in adults. And there's been some evidence that the drugs can cause weight gain in children.

The new findings, published in the journal Pediatrics, add to concerns that the medications may ultimately lead to diabetes in some kids.

Using records from three U.S. health plans, researchers found that children and teens who started on an antipsychotic had four times the risk of being diagnosed with diabetes, versus kids not using any psychiatric medication.

They developed diabetes at a rate of just over three cases per 1,000 children per year. That compared with just under 0.8 cases per 1,000 among medication-free kids.

Second-generation antipsychotics include drugs such as Risperdal, known generically as risperidone, Zyprexa (olanzapine), Seroquel (quetiapine) and Abilify (aripiprazole).

The drugs are used to treat conditions like bipolar disorder, schizophrenia and irritability and aggression in children with autism. They are also sometimes given to children with attention-deficit hyperactivity disorder (ADHD), even though there's no research evidence to support that.

The entire story is here.

New data spill shows risk of online health records

By Jordan Robertson

AP Technology Writer

Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see.

There were insurance forms, Social Security numbers and doctors' notes. Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction.

At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized.

Electronic records can lower costs, cut bureaucracy and ultimately save lives. The government is offering bonuses to early adopters and threatening penalties and cuts in payments to medical providers who refuse to change.

But there are not-so-hidden costs with modernization.

"When things go wrong, they can really go wrong," says Beth Givens, director of the nonprofit Privacy Rights Clearinghouse, which tracks data breaches. "Even the most well-designed systems are not safe. ... This case is a good example of how the human element is the weakest link."

Southern California Medical-Legal Consultants, which represents doctors and hospitals seeking payment from patients receiving workers' compensation, put the records on a website that it believed only employees could use, owner Joel Hecht says.

The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.

The data were "available to anyone in the world with half a brain and access to Google," Titus says.

Titus says Hecht's company failed to use two basic techniques that could have protected the data — requiring a password and instructing search engines not to index the pages. He called the breach "likely a case of felony stupidity."

One of the patients affected was Paul Thompson, who learned of the breach from Titus.

The Sugarloaf, Calif., electrician blew out his shoulder four years ago on a job wiring up a multiplex movie theater. His insurance company denied his claim, which led to a protracted dispute. He eventually settled.

Thompson says his injury has been a "long, painful road."

Unable to afford surgery in the U.S. to fix his torn rotator cuff, he paid a medical tourism company that was supposed to schedule a cheaper procedure in Costa Rica. The company went bankrupt, however, and Thompson said he lost nearly $7,300.

To have his personal information exposed on top of that was a final indignity.

"I'm totally disgusted about everything," he said, calling the breach "another kick in the stomach."

Thomson is worried that hackers may have spotted his information online and tagged him for future financial scams. He contacted his bank and set up a fraud alert with the credit reporting agencies.

He says the prospect of all health records going electronic — which federal law mandates should happen by 2014 — "scares the living hell out of me."

When mistakes occur, the fallout can be more severe than the typical breach of email addresses or credit card numbers.

The rest of the story can be read here.

Upcoming Article: Is Coming Out Always a 'Good Thing'?

*Social Psychological and Personality Science* has scheduled an article for publication in a future issue of the journal: "Is Coming Out Always a 'Good Thing'? Exploring the Relations of Autonomy Support, Outness, and Wellness for Lesbian, Gay, and Bisexual Individuals."

The authors are Nicole Legate, Richard M. Ryan, and Netta Weinstein.

Disclosing a lesbian, gay, and bisexual (LGB) identity to others, or ''coming out,'' has been shown in past research to be associated with mental health benefits (e.g., Ragins, 2004).

Yet, in a world that can be unaccepting of nonheterosexual orientations, coming out also involves risk. LGB individuals may anticipate stigmatization, negative judgments, or rejection feelings that deter them from self-disclosing their sexual identity.

Recent legislation like Don't Ask Don't Tell provides a clear example of this risk: those who came out as LGB in the military were discharged from service. Indeed, some research suggests that coming out can result in other negative consequences such as costs to well-being (D'Augelli, 2006).

It is thus the case that many LGB individuals are selective, varying from context to context in how much they disclose their sexual identity to others.

In the present article, we explore this within-person variability in disclosure using a self-determination theory framework (SDT; Deci & Ryan, 1985, 2000; Ryan & Deci, 2000). SDT (Ryan & Deci, 2000) is a theory of personality and motivation that concerns how social contexts impact motivation and well-being.

According to SDT, social contexts vary in their levels of autonomy support, defined as interpersonal acceptance and support for authentic self-expression (Lynch, La Guardia, & Ryan, 2009; Ryan, La Guardia, Solky-Butzel, Chirkov, & Kim, 2005).

In environments high in autonomy support, people feel accepted for who they are, are free to act and express themselves, and are more open to rely on others. In contrast, in controlling environments, people feel pressured to appear, behave, or perform a certain way (Deci & Ryan, 1985), and they exhibit less openness and more defensiveness (Hodgins et al., 2010).

It is thus likely that autonomy supportive environments reduce perceived risks for coming out, whereas in environments perceived as controlling individuals may be less likely to express a potentially stigmatized part of themselves that could incur censure.

In addition, we argue that the autonomy supportiveness of an environment influences the well-being experienced in that environment as a result of disclosure. Specifically, we expect that LGB individuals who disclose in environments low in autonomy support will not experience the typical boost to wellness from coming out reported in the literature.

Here's how the article ends:

"This research has implications for practitioners providing treatment to LGB individuals because it suggests that people experience greater wellness when they come out in certain contexts, but certainly not all contexts. This research also has implications for workplaces. Providing autonomy support is beneficial for all employees (Baard et al., 2004), but may be especially important for LGB employees' wellness and productivity. Future research should look at disclosing in workplaces that foster self-expression versus controlling work environments and compare wellness and productivity of employees of different sexual orientations. More generally the findings may speak to factors that can facilitate greater openness and wellness in individuals who face stigma, as well as to the costs of controlling social contexts and the self-concealment they often foster."

Thanks to Ken Pope for this information.