Prisons and the Mentally Ill

Religion and Ethics Newsweekly
Originally published June 21, 2013

It doesn’t make moral, ethical, or fiscal sense, according to Cook County sheriff Tom Dart, to house people who are mentally ill in jails and prisons.

Watch Prisons and the Mentally Ill on PBS. See more from Religion & Ethics NewsWeekly.

Moral Luck

By Thomas Nagel

Here is an excerpt:

Where a significant aspect of what someone does depends on factors beyond his control, yet we continue to treat him in that respect as an object of moral judgment, it can be called moral luck. Such luck can be good or bad. And the problem posed by this phenomenon, which led Kant to deny its possibility, is that the broad range of external influences here identified seems on close examination to undermine moral assessment as surely as does the narrower range of familiar excusing conditions. If the condition of control is consistently applied, it threatens to erode most of the moral assessments we find it natural to make. The things for which people are morally judged are determined in more ways than we at first realize by what is beyond their control. And when the seemingly natural requirement of fault or responsibility is applied in light of these facts, it leaves few pre-reflective moral judgments intact.  Ultimately, nothing or almost nothing about what a person does seem to be under his control.

Why not conclude, then, that the condition of control is false--that it is an initially plausible hypothesis refuted by clear counter-examples? One could in that case look instead for a more refined condition which picked out the kinds of lack of control that really undermine certain moral judgments, without yielding the unacceptable conclusion derived from the broader condition, that most or all ordinary moral judgments are illegitimate.

What rules out this escape is that we are dealing not with a theoretical conjecture but with a philosophical problem. The condition of control does not suggest itself merely as a generalization from certain clear cases. It seems correct in the further cases to which it is extended beyond the original set.  When we undermine moral assessment by considering new ways in which control is absent, we are not just discovering what would follow given the general hypothesis, but are actually being persuaded that in itself the absence of control is relevant in these cases too. The erosion of moral judgment emerges not as the absurd consequence of an over-simple theory, but as a natural consequence of the ordinary idea of moral assessment, when it is applied in view of a more complete and precise account of the facts. It would therefore be a mistake to argue from the unacceptability of the conclusions to the need for a different account of the conditions of moral responsibility. The view that moral luck is paradoxical is not a mistake, ethical or logical, but a perception of one of the ways in which the intuitively acceptable conditions of moral judgment threaten to undermine it all.

The entire article is here.

The Half-Trillion-Dollar Depression

By CATHERINE RAMPELL
The New York Times
Published: July 2, 2013

Mental illness has been an increasingly significant health concern over the past several decades, but it’s now becoming an economic one too. The number of Americans who receive Social Security Disability Insurance for mental disorders has doubled during the past 15 years. Eliza is now one of an estimated 11.5 million American adults with a debilitating mental illness, on whom the country spends about $150 billion annually on direct medical costs — therapy, drugs, hospitalizations and so forth. But the biggest blow to the overall economy are the many hidden, indirect costs. People with serious mental illness earn, on average, $16,000 less than their mentally well counterparts, totaling about $193 billion annually in lost earnings, according to a 2008 study published in The American Journal of Psychiatry. And many mentally ill workers, who are more likely to miss work, also suffer from what social scientists call presenteeism — the opposite of absenteeism — in which they are very likely to be less productive on the job when they show up.

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Even though tens of millions of people will get more coverage, estimates suggest that only 1.15 million new users will take advantage of mental-health services. A lot of people who will be extended coverage don’t need care; others, fearful of the stigma around mental health, may not take it. What’s more distressing, from both an economic and a social perspective, is that a lot of people who do muster the courage still won’t get the right kind of treatment. About half of Americans who seek care for serious mental illnesses get treatment that does not help them or is not even recommended for their condition.

The entire article is here.

Corruption in Business and the Importance of Ethics

By Vivek Wadhwa
The Wall Street Journal Blog - The Accelerators
Originally published June 28, 2013

Here is an excerpt:

How can companies do better? Corporate executives and business owners need to realize that there can be no compromise when it comes to ethics and there are no easy shortcuts to success. Ethics need to be carefully sown into the fabric of their companies.

Business executives need to start by spelling out and communicating their values. Then they need to lead by example. This means getting rid of the bad apples and declining opportunities that bring instant wealth at the cost of selling one’s soul.

Corporate culture is built from the top down. Employees embrace the ethics and values of their leaders. You simply can’t have one set of standards for management and another for staff. Every executive and employee needs to be held accountable.

Employees need to be encouraged to speak up when they see wrongdoing — to “speak truth to power.” And when a mistake is made, it is better to deal with the immediate fallout rather than allow it to build its own momentum. A corporate culture that doesn’t allow for mistakes is destined for disaster. The best strategy is to encourage employees to come clean and learn from their errors.

The worst is when employees are pressured to hide information. A company can usually survive short term snags. But covering up a problem is likely to create even bigger problems later on.  No truth remains hidden forever.

The entire article is here.

New whistleblower protections take effect for federal contractors

By Jared Serbu
Federal News Radio
Originally published July 1, 2013

Effective Monday, whistleblower protections for federal contractors are being expanded to fill gaps that whistleblower advocates say have, until now, left tens of thousands of potential witnesses to wrongdoing vulnerable to retaliation by their employers.

Under any federal contract that's signed on or after July 1, reprisal protections will be extended for the first time to subcontractors who report waste, fraud or abuse.

The revision to federal statutes also entitles contractor employees to whistleblower protection when they report wrongdoing on a federal contract to supervisors within their own companies. Previous laws required them to take their complaints to a government office such as an inspector general, a government contract manager or a member of Congress in order to receive protection.

The entire article is here.

Avoiding the digital ‘flock’

By Chuck Leddy,
Harvard Gazette
Originally published June 27, 2013

Here are two excerpts:

Digital tools actually encourage flocking (called “homophily” by social scientists), Zuckerman said. For instance, “Facebook is very good at connecting us with people we’re already connected with.”  Zuckerman also mentioned Facebook’s search function, which personalizes results based on your “likes” and the preferences of your friends. “It’s kind of creepy,” said Zuckerman. “I’m not sure I want my friends pre-filtering for me.”

Whether in the real or virtual worlds, said Zuckerman, “We have a talent for finding people with the same socioeconomic background or racial background. But this tendency to flock may be keeping us from finding the information we need,” and the tools we’ve built for the Internet only enhance our flocking bias.

“My fear is that our tools are not promoting diversity,” said Zuckerman, whose appearance served as a launch party for his book “Rewire.” Personalization tools “want to give you precisely what you want, to make you comfortable” and ready to buy things, he said. “The danger is that we may be driven into small circles of the same content,” a sort of digital self-segregation into echo chambers where none of our assumptions get scrutinized.

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How then should people manage their tendency to seek out like-minded folk? First, they need to track their behavior for the presence of flocking bias. Zuckerman showed a graph exposing his own Twitter “follow bias”: Only 27 percent of the people he follows are women. “This is an embarrassing slide,” Zuckerman said, “but now when I follow someone, I think about” the follow bias. He said people need to be self-reflective about their media-consumption preferences, and push back against them. “I know that left on my own, I’d spend all my time reading cute cat macros on Reddit” or constantly consuming news about his beloved Green Bay Packers.

The entire story is here.

Breaking the Seal on Drug Research

By KATIE THOMAS
The New York Times
Published: June 29, 2013

Here are som excerpts:

For years, researchers have talked about the problem of publication bias, or selectively publishing results of trials. Concern about such bias gathered force in the 1990s and early 2000s, when researchers documented how, time and again, positive results were published while negative ones were not. Taken together, studies have shown that results of only about half of clinical trials make their way into medical journals.

Problems with data about high-profile drugs have led to scandals over the past decade, like one involving contentions that the number of heart attacks was underreported in research about the painkiller Vioxx. Another involved accusations of misleading data about links between the antidepressant Paxil and the risk of suicide among teenagers.

To those who have followed this issue for years, the moves toward openness are unfolding with surprising speed.

“This problem has been very well documented for at least three decades now in medicine, with no substantive fix,” said Dr. Ben Goldacre, a British author and an ally of Dr. Doshi. “Things have changed almost unimaginably fast over the past six months.”

Much of that change is happening because of what Dr. Goldacre calls an “accident of history.” In 2009, Dr. Doshi and his colleagues set out to answer a simple question about the anti-flu drug Tamiflu: Does it work? Resolving that question has been far harder than they ever envisioned, and, four years later, there is still no definitive answer. But the quest to determine Tamiflu’s efficacy transformed Dr. Doshi and others into activists for transparency — and turned the tables on drug makers. Until recently, the idea that companies should routinely hand over detailed data about their clinical trials might have sounded far-fetched. Now, the onus is on the industry to explain why it shouldn’t.

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Earlier this month, Dr. Doshi opened what he hopes will be a new chapter in his quest for greater understanding of clinical trials. He and several other researchers published what amounted to an ultimatum to drug companies: publish your data, or we’ll do it for you.

The entire story is here.

ATA Responds to CMS Proposal for Expanded Telemedicine Coverage

Press Release
The American Telemedicine Association
Originally published July 10, 2013

The American Telemedicine Association voices its cautious support for new proposals by the Centers for Medicare and Medicaid Services (CMS) that would expand Medicare’s telehealth footprint.  CMS proposes to increase the number of beneficiaries eligible for telemedicine by modifying their urban/rural definitions and proposes several new reimbursable telemedicine services.

“Overall, the proposed rules are good news for Medicare patients and forward-thinking healthcare providers. We applaud CMS for taking steps to help these patients benefit from proven telemedicine technologies,” said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association. "But many potential beneficiaries are still left behind.  For example, we hope that either CMS or Congress take additional steps to restore telehealth benefits to the one million beneficiaries in 104 counties that lost coverage last year due to reclassification to metropolitan areas.”

The entire story is here.

Thanks to Alex Siegel for this information

Diagnosis: Insufficient Outrage

By H. GILBERT WELCH
The New York Times - Op Ed
Published: July 4, 2013

RECENT revelations should lead those of us involved in America’s health care system to ask a hard question about our business: At what point does it become a crime?

I’m not talking about a violation of federal or state statutes, like Medicare or Medicaid fraud, although crime in that sense definitely exists. I’m talking instead about the violation of an ethical standard, of the very “calling” of medicine.

Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting.

A number of publications — including this one — have recently published big reports on the exorbitant cost of American health care. In March, Time magazine ran a cover story exposing outrageous hospital prices, from $108 for a tube of bacitracin — the ointment my mother put on the scrapes I got as a kid and that costs $5 at CVS — to $21,000 for a three-hour emergency room evaluation for chest pain caused by indigestion.

The entire story is here.