Double Duty

Welcome back to Contemplative Being!

To be perfectly honest I was not entirely sure what to write about this week, this in no way indicates that there is a lack of ethical concerns going on in the country that would be wishful thinking. In order to get some ideas flowing I did what I imagine most other people do these days to get ideas, ask Google of course. I typed “ethics in the news” and clicked search and was instantly bombarded no less than 160,000,000 results all in just .43 seconds. YAY GOOGLE! It would be easy to get completely overwhelmed with all those results so I decided to click on the first one which happens to be a great example of conflict of interest.

The story takes place in beautiful Hawaii where the state Ethics Commission is looking into potential conflicts of interest at the Department of Land and Natural Resources’ enforcement division. A complaint has been filed alleging potential misconduct by some department staff that do part-time work for Sodexo. The complaint centers on an acting chief, one of his deputies and the deputies’ secretary. The division in which they all work is the one responsible for policing the state’s costal waterways to ensure that their ecological resources are safeguarded. Now, the problem is not having a part-time job, nor is it that all three of them have part-time jobs working with Sodexo. Although I could see how that could raise concern. The problem is in fact two fold. The primary issue is that between the chief and deputy the roles are reversed at the part-time job. To explain that in other terms at the state job the chief, Jason Redulla supervises the deputy, Kirk Smythe however, at the Sodexo job Kirk supervises Jason. It does not take an ethics expert to see how this could be a conflict of interest. The second problem is regarding Smythe’s secretary whom as stated earlier also works for Sodexo part-time. The complaint alleges that she has been using state resources such as her work computer and cellphone while on the clock with state’s time to do work for her part-time gig. Again, not hard to see how this is violates ethical standards.

A conflict of interest is defined as a situation in which a person or organization is involved in multiple interests financial, emotional or otherwise, where one of which could possibly corrupt the motivation of the individual or organization. To put this in context of the situation Jason the chief may be inclined to give special treatment to Kirk in hopes that Kirk will give Jason special treatment at the part-time job. When it comes to perceived ethical misconduct whether or not any misconduct actually took place is irrelevant. The damage is done simply by the fact that something unethical could have taken place. This creates a sense of mistrust by the public regardless of there being any merit to the claim and for that reason it is essential to avoid a situation that could be perceived as unethical. With regards to the secretary it appears that the problem is misconduct rather than conflict of interest. There is still potential conflict of interest in this situation on behalf of Kirk because he may know his secretary is using state resources and time to do work for Sodexo and he may be looking the other way since he works for them too.

Getting involved in potential conflicts of interest and straight out misconduct is of course unethical. Sometimes it is difficult to know that the ethical decision is and in such cases a useful tool to figure it out is the ethics triad. The ethics triad consists of analyzing a situation by results, rules and virtue. When analyzing the results one must ask the question of what outcome is in the interest of the greater good and would you be ok with reading the result of your decision on the front page of the paper. In rules analysis one must think about rules or laws governing the decision at hand. What do the rules say is the right thing to do? Lastly using the virtue analysis one must ask oneself what kind of person are you. Based on one’s own morals is the outcome of the decision acceptable. This tool does a good job of evaluating decisions and perhaps if the people in this story would have used this approach to evaluate their decision they would have reconsidered it. Many states have ethics commissions that monitor the activities of state employees and others that do dealings with the state so it may take a while but sooner or later the unethical behavior will be caught.

Thanks for reading!   

Related Links

EXCLUSIVE: Commission investigates DLNR ethics complaint. (2015, February 25). Retrieved February 25, 2015, from http://www.hawaiinewsnow.com/story/28194403/exclusive-commission-investigates-dlnr-ethics-complaint     

Take one twice daily

Welcome back to Contemplative Being!

Today I would like to talk about something I suspected but did not really know much about prior to last night when I decided to watch Last Week Tonight with John Oliver for the first time. I’m not saying the show is like an encyclopedia but it got me thinking about the issue so I did a bit more digging although I would still not consider myself an expert on the matter by any means. The topic covered in the season two premier episode was that of pharmaceutical sales and payments that pharma makes to doctors.

I imagine that most people know that medical sales are a well-established career. I admit that I do not know anyone that works in the field but from my understanding the job is about traveling around to different doctors’ offices and telling the doctors what new medication and medical equipment/supplies their company has recently developed and leaves the doctor with samples of the medication. Given my assumption of how the job works I was surprised to hear from the show that most people that work in medical sales have no medical or scientific background at all. This is not necessarily a problem because people of course can learn about what they are being made to sell. What really caught me off guard is that the sales representatives often use other means to encourage doctors to prescribe their company’s products. The range of techniques used to encourage doctors to prescribe their products goes from bringing free lunches to the office sometimes on a regular basis to luxurious hotel and travel and even direct payment of cash. Pharma has realized that not all doctors are easily motivated by the allure of more money so they have gone as far as recruiting some doctors and refers to them as “thought leaders”. It is an appealing title to say the least. The role of a “thought leader” is to talk and present to other doctors using a script and presentation materials that the pharmaceutical company has provided to them in an effort to persuade other doctors to prescribe their products. The idea here is to fool other doctors to prescribe particular drugs based on an unbiased recommendation from a doctor when in reality it is just another sales pitch.

At this point I started to wonder how the pharmaceutical company knows who prescribes what. It makes perfect sense but I never really thought about it, the data from those computers that your pharmacy uses to log your prescription is sold to the pharmaceutical companies. This means that whenever you fill a prescription the pharmaceutical companies know what the prescription is for and who prescribed it. This allows pharma to track the prescription history of every doctor. With this information in hand the company is able to pick up the phone and place a call to a doctor that may have agreed to prescribe a drug but ended up prescribing a competitor’s offering to remind them of whatever agreement they had paid for.

When Obama first unveiled his health care reform plan the first thing the opposition said is that the government should not get to decide on the treatment plans of patients. It appears that it is pharma that gets to decide in reality. Is it ethical for pharma to be able to bribe doctors into pushing the products of whoever paid them the most? I am not sure what you think but I do not want my doctor prescribing something to me because the manufacturer paid him to. I think doctors should prescribe based on what their knowledge and experience has taught them would be best for my particular situation. I think this ties back to my earlier post titled Free Stuff about governor Chris Christie receiving gifts in exchange for encouraging the Port Authority to accept a proposal from his friend.

As public administrators it is our responsibility to ensure that the people we serve are given the information they need to be able to make informed decisions. There are laws in place prohibiting some of the strategies that pharma uses such as paying kickbacks to doctors who prescribe their drugs. Pharmaceutical companies have paid billions to the federal government to settle cases over the past few years but that does not seem to faze them. According to the show pharmaceutical companies spend significantly more on marketing than they do on research. There is nothing wrong about a company wanting to make a profit but when it crosses the line to kickbacks and bribery it is unacceptable. One of the outcomes of Obama’s health care reform was the creation of the Open Payment website where people can search for their doctors and find out how much money they have received from pharma. One of the ethical principles at play here is that of motivated reasoning. Pharma like most corporations in the U.S want to make as much money as possible and the way to do that is by selling their products. They are so motivated that they have lost sight of what is right and wrong and without further reform they are likely to continue going down this path. Ethical fading has taken hold because they continue going down the path and gradually go deeper losing sight of what is right. Because of this more settlements are likely to come as paying fines is seen as a cost of business because the amount they make by breaking the law is worth the price. It seems like we have a long road to travel still before doctors are truly able to make decisions about our health without external forces working to manipulate them. Don't get me wrong I think pharmaceutical companies are increadibly important and have helped the overall health and longevity of us all. I just think they need to get back on the right path. 

Thanks for reading, come back next week.   

References and Related Links

Oliver, J. (2015, February 8). Last Week Tonight with John Oliver: Marketing to Doctors (HBO). Retrieved HBO. February 19, 2015, from https://www.youtube.com/watch?v=YQZ2UeOTO3I

Silverman, E. (2015, February 9). Does Pharma Money Mix With Cash Receptors in Your Doctor’s 

Wallet? The Wall Street Journal. Retrieved February 19, 2015, from http://blogs.wsj.com/pharmalot/2015/02/09/does-pharma-money-mix-with-cash-receptors-in-your-doctors-wallet/

Open Payment Website - http://www.cms.gov/openpayments/

News in the News

Hi, welcome back to Contemplative Being.

Today I would like to talk about news in the news. By now everyone has heard that the anchor of NBC Nightly News Brian Williams has been suspended without pay for six months. The question is why? What could a news anchor do to potentially result in being fired, other than getting bad ratings which is not a problem for Nightly News.

What has Brian done to cause him to be suspended and potentially fired as the anchor from one of TV’s most watch news shows? The answer to this question is that he has become the news. The job of a news anchor is to sit or at times stand in front of a camera and read what is on the teleprompter. The question then becomes who writes the stories that the anchor reads? The answer to this question likely depends on the size of the program. If the program is somebody on a YouTube channel odds are they right their own material but if it’s a large network TV program there are writers to do that job. It seems unlikely that Brian Williams writes his own script but he probably does have some say in it and he probably reads through it prior to going on air although this we do not know for sure. I know whenever I have to give a presentation I like rehearsing but then again I have to write my own material so I already know what I am going to say.

For Brian it all unraveled on Friday, January 30, 2015 when he misrepresented events that occurred 12 years ago when he and his NBC team were embedded in Iraq. You might be wondering why Brian decided to talk about something that happened over a decade ago and the reason was because he wanted to thank a soldier, Command Sergeant Major Tim Terpak for protecting him and his team. The two had kept in contact all this time and the Terpak was visiting New York City after recently retiring from the army so Brian invited him to a Rangers game. On the air Brian said that Command Sergeant Major Terpak protected him and his team when the helicopter they were traveling in was forced to land because it was hit by a rocket propelled grenade (RPG). At the rangers game the stadium announcer took it further by saying that the helicopter he was traveling in was forced to land after being crippled from a hit by a RPG. The problem is that the helicopter they were traveling was not hit by the RPG instead it was another helicopter in the convoy that was hit by the RPG.

The question is did Brian Williams lie or misremember? At this point the inaccurate story has been told twice in the span of a couple days albeit just once by Brian and the first telling was by the Rangers announcer on the 29^th. On Monday during Brian’s news program he apologized for the error claiming that he misremembered the facts of the event that occurred so long ago. On two separate occasions years ago Brian told the story but never explicitly stated that his helicopter was the one that was hit.

So who messed up here and was it intentional? It was either Brian or some NBC writer that provided the information to the Rangers and also put it in Brian’s script for Friday’s show? If it was Brian it calls into question his integrity as a newsman however, if it was a writer it casts doubt on the integrity of the NBC Nightly News program. If it was Brian the solution is easy suspend or fire him and put someone else in the anchor chair. If it was a writer NBC could call him/her out or cancel the program. The Nightly News program makes NBC millions of dollars so cancelling is unlikely. For the network the easiest and most beneficial thing to do is let Brian take the fall regardless of whether or not it is his fault.

What I find of particular interest is that news shows manipulate the facts to push their agendas all the time. Fox News for example has a well-documented track record of inaccurate reporting. According to an analysis done by the Pew Research Center Project for Excellence in Journalism 68% of Fox News programming contains personal opinions rather than facts. This is compared to 27% for MSNBC and 4% for CNN
.

The ethical question here is whether or not it is right for an employer to let an employee take the fall for a mistake that may not have been his fault? In my opinion the answer is no, an employer should support their employees and stand up for them in cases such as this when the employee has not done anything wrong intentionally. Unfortunately, money rules both in corporate America and government so it is not is easy to figure out how decisions are made. In my opinion Brian made an honest mistake and misremembered the facts of the event. People have really bad memories of stressful situations; add 12 years to the mix and stories always evolve. I think that a writer supplies the Rangers with the announcement made at the game and this likely influenced Brian’s memory so when reporting the story the next day he failed to accurately remember the events that took place.

Every news outlet be it television, radio, print and online has an agenda, this is no secret and hopefully everyone realizes it. You should never believe what you read or hear from any single source. In order to get a good picture of reality it is essential for people to get news from multiple sources and create thoughts and opinions based on the collection of data. This does not have anything to do with the story at hand but I think it’s important so I wanted to share it.

Thanks for reading, stop back again next week!

Related Links

Brian Williams and the Smoking Gun That Isn't. (2015, February 14). Rolling Stone. Retrieved February 15, 2015, from http://www.rollingstone.com/tv/features/brian-williams-and-the-smoking-gun-that-isnt-20150214?page=5

Stelter, B. (n.d.). What else has NBC News dug up on Brian Williams? CNN Money. Retrieved February 15, 2015, from http://money.cnn.com/2015/02/12/media/brian-williams-investigation-questions/

Investigative Journalists and Digital Security. (n.d.). Pew Research Center. Retrieved February 15, 2015, from http://www.journalism.org/

Doctor's Orders

Welcome back to Contemplative Being! 

This week I wanted to address something that has been in the news every day for the past month or so, yes, you guess it, the measles.  If you are wondering how this relates to ethics you’ll see just keep reading. If you are anything like me you may be wondering why the U.S. is dealing with a measles outbreak especially considering the fact that in 2000 the CDC officially declared that the measles was eliminated in this country. Keep in mind that this does not mean that the virus was whipped off the planet; it has been and continues to be present all over the world infecting millions of people. The reason the U.S. was able to banish the virus was thanks to a vaccine first introduced in 1963. A few years later in 1968 the vaccine was improved to make it the highly effective vaccine we have today. In 1967 and 1969 vaccines were developed for mumps and rubella respectively and in 1971 all three vaccines were combined into one known as MMR.

CDC - Thin-section transmission electron micrograph (TEM)
image of a single measles virus particle

The measles is highly contagious. There is a 90% chance that an unvaccinated individual will contract the disease if they come in contact with the virus which is spread through the air and can remain alive for up to two hour. Having lived in this country my entire life in a time when vaccination for the virus was normal I must say that I do not really know much about the disease and for some reason the name “measles” does not really sound scary but I have learned that it should be. According to the World Health Organization measles is one of the leading causes of death particularly of children around the world. From 2000-2013 thanks to the vaccine there was a 75% drop in measles deaths worldwide. According to the CDC in the U.S. there were fewer than 200 reported cases of the disease since it was declared effectively eliminated in the country in 2000 through 2013 and fewer than 100 cases in nine of those years. Last year that number spiked to nearly 700 cases and we are on track to go even higher this year, in the first month of 2015 over 100 cases have already been reported.  By now you probably have a few questions. First how could the U.S have declared the disease eliminated in 2000 if people have still been getting infected? And what happened to make the number of cases skyrocket last year and likely again this year? The answer to the first question is that since the virus has remained highly active in the rest of the world infected travelers bring it with them but thanks to the high level of vaccination here it did not spread. The answer to the second question is a bit more involved but it boils down to fewer people in this country being vaccinated which leads to another question which is why are fewer people being vaccinated?

Photo of Andrew Wakefield

Back in 1998 a British doctor by the name of Andrew Wakefield submitted a paper to The Lancet a medical journal that reported a link between the MMR vaccine and autism. As you might expect the media took this information and ran with it. What the media failed to report on was that in 2004 the article partially retracted and fully retraced in 2010 because the research was found to have been fraudulent and the doctor was barred from practicing medicine as a result. So why would Andrew Wakefield do this? You guessed it, money. Prior to publishing his report he filed for a patent for a single measles (non-combined) vaccine that his report claimed would be safer. Not only that, he was actually being paid big bucks by trial lawyers that wanted to sue vaccine manufacturers for “vaccine injury”, Wakefield seemingly forgot to disclose these facts in his study. Immediately following the publication of the article in 1998 numerous research groups have attempted to replicate the findings of Wakefield with no success. The CDC along with the UK National Health Service and several other organizations have stated conclusively that there is no link between the MMR vaccine and autism.

The damage was done; frightened parents did not want to put their kids at risk of developing autism so they have opted out of the vaccine which is typically administered to children when they turn one with a booster before starting school. No there are large numbers of unvaccinated children and young adults all over the country so when one of those people comes in proximity to an infected person that may have contracted the virus while traveling elsewhere the virus spreads and continues to do so like a wildfire. Although the research has been discredited there is still a large anti-vaccine movement that continues to believe in this link. According to the World Health Organization in 2013, 16 people die every hour from the measles and from 2000-2013 the vaccine has prevented an estimated 15.6 million deaths and yet the rate of vaccination in the U.S. has dropped in that timeframe.  

It’s hard to believe that one man could do so much damage just to make a buck. This serves as an example of what can happen when ethical considerations are ignored. Andrew Wakefield failed every ethical test and only time will tell how many will die needlessly as a result of his actions.

Thanks for reading, see you next week.

References and Links

Measles. (2014, November 3). Centers for Disease Control and Prevention. Retrieved February 7, 2015, from http://www.cdc.gov/measles/about/index.html

Measles Cases and Outbreaks. (2015, February 2). Centers for Disease Control and Prevention. Retrieved February 7, 2015, from http://www.cdc.gov/measles/cases-outbreaks.html

Measles. (n.d.). World Health Organization. Retrieved February 7, 2015, from http://www.who.int/mediacentre/factsheets/fs286/en/

Gorski, D. (2009). Antivaccine hero Andrew Wakefield: Scientific fraud?. Science-Based Medicine. Retrieved February 7, 2015, from http://www.sciencebasedmedicine.org/antivaccine-hero-andrew-wakefield-scientific-fraud/

Beaubien, J. (2015). Measles Vaccination Rates: Tanzania Does Better Than U.S. NPR. Retrieved February 7, 2015, from http://www.npr.org/blogs/goatsandsoda/2015/02/06/384068229/measles-vaccination-rates-tanzania-does-better-than-u-s