justice

Gender Disparity: Paycheck Fairness Act is not enough

R. Horton

Before I start, let me say that I support any effort to address wage inequality and I believe strongly in the right to equal pay for equal work. If the Paycheck Fairness Act helps to bring more equity to the workplace, I’m all for it, but it will not eliminate wage disparities between men and women on its own.

Republicans are wont to point out that women make less than men not because of discrimination but because of lifestyle choices. (Read a fuller discussion of this in The Guardian.) Their argument centers on the fact that it is possible to pay every woman in any given job the same wage as every man in a similar job and still end up with wage disparity because more women are in lower-paying jobs. To Republicans, this means sexual discrimination is not a problem (everyone should just choose to be a petroleum engineer or investment banker, right?), but for the rest of us it means that sexism is a pernicious problem that will not easily be solved with a piece of legislation.

First, we might ask why the jobs more women choose pay less than the jobs more men choose. One proposed answer is that men choose jobs that are riskier and require a more “masculine” personality. Women, it is assumed, will choose safer and less demanding jobs. Another answer is that women gravitate toward jobs that require fewer hours (they need to get home to the kids, you know?). And another is that women choose jobs that require less training.

According to the 2013 Physician Compensation Report, male doctors earn 30 percent more than female doctors. The report explains the disparity thus: “There are fewer women in some of the higher-paying specialties. For example, in orthopedics, only 9 percent of the survey respondents were women, whereas in pediatrics, 53 percent of survey respondents were women.”

Interestingly, the lowest paid specialty in medicine is now HIV/Infectious Diseases, which also happens to be the specialty with the second highest rate of overall satisfaction (just behind dermatology). The other low-paying specialties are family medicine, diabetes/endocrinology, and internal medicine. Other high-paying specialties, after orthopedics, are cardiology, radiology, gastroenterology, and urology.

While I can’t see that the risk of treating infectious diseases is lower than the risk of practicing urology, I do see that the lower-paid specialties focus more on care and concern and require human interaction. (It still may be true that women are more risk-averse, which may be why they are safer doctors.) It seems to me that we value technical expertise over human and care and concern in most fields. At least we are more willing to pay for technical expertise and less willing to pay for the care and concern that we will all need.

Teachers work hard and take many risks but will never earn as much as petroleum engineers. Ah, but petroleum engineers fatten the bottom line for their employers, you say. Let them try to survive without teachers to get them there. Let all the hard-working risk takers make it through life without the people who cared for them and helped them become successful. And men have always said this, haven’t they? We have clichés such as “Behind every successful man is a woman.” And women have done their work, largely, for free—because they had no other choice. So the work women have done is devalued (though prized in way) and undercompensated. If fewer people were willing to do “women’s work,” the price of such work may indeed rise, but I don’t see this happening any time soon.

And men sometimes choose work that may be seen as “feminized.” When they do, men also earn less because their work is undervalued, too. If the work were not undervalued, I aver that more men would choose different careers. After successful careers in industry, some men choose to leave their jobs for more “meaningful” work after middle age. The work people describe as “meaningful” or “rewarding” is almost always related to either caring relationships or creative enterprises; these are the activities that make life seem worthwhile.

Because these activities bring so much personal satisfaction, people are willing to do them for less pay. If petroleum engineering did not pay so well, I’m sure some people would still choose it as a profession, but many people choose it now only because it pays well and not because it enriches their lives in any other way. Many men are starting to reject the idea that they must choose careers based on how well they pay. Some men in the men’s movement reject being treated as “success objects.” Nonetheless, I think women are more likely than men to feel free to choose careers based on satisfaction rather than remuneration, and men are more likely than women to feel they must choose a career that pays well. There are many, many exceptions, of course, but not enough to close the pay gap between men and women.

So, what should we do to address the problem of wage disparity? First, stop devaluing “feminine” work. Recognize the true value of education and care. Second,  stop treating men as “success objects.” Remove the stigma from rejecting a high-powered career for a more rewarding and meaningful life. Finally, make it possible to find a balance between a career that pays well and a meaningful life. Some women may pass up high-paying professions because they do not want to neglect their family relationships or similar concerns. At the same time, some men neglect relationships and personally rewarding work because they feel obligated to earn as much as possible. Men and women would both behave differently if it were possible to enter any career without having to sacrifice family relationships, volunteer opportunities, and creative outlets. Another world truly is possible.

What Obamacare has done for me

R. Horton2 Comments

When I first met my wife in 2007, she told me she was about to quit her job of 27 years in the oil and gas industry to pursue a career in family therapy. Quitting her job meant giving up her employer-provided insurance, so she went on COBRA for 18 months. By that time, she was in graduate school and was able to get student insurance. When she graduated, however, she was unable to get insurance on her own as she had pre-existing conditions that precluded purchasing insurance on the open market.

I was following a similar path. When we first met, I was working on my PhD while also teaching full time. In 2011, I was beginning my dissertation and my college, facing budget cuts, was offering a payoff to anyone willing to resign. By this time, my wife was on my insurance, and I hesitated to give up my benefits, but we eventually decided I would resign and take student insurance for both of us.

From there, I was playing a delicate balancing act. I knew the healthcare exchanges mandated by the Affordable Care Act (Obamacare) were supposed to become available in January 2014. I pressed forward with my dissertation without wanting to graduate before the exchanges were available. I found that I could stay on the student insurance for six months past my graduation date. I defended my dissertation in March 2013, but did not turn in final paperwork in time for spring graduation, meaning that I would have to enroll in the summer. I graduated in August and was able to keep the student insurance for my wife and myself until February 2014.

Thankfully, the exchanges did go into effect by the beginning of 2014, and we were both able to purchase insurance for ourselves. The cost of the insurance was about the same as the price for the student insurance, but it is a much better insurance plan. I am extremely grateful for the Affordable Care Act (ACA), which made this possible.

But the ACA is even better than I realized. I now teach part time for two colleges. Under the ACA, I can join rejoin the Teacher Retirement System of Texas and purchase health insurance along with disability insurance, accidental death and dismemberment insurance, and life insurance for myself and my wife. Further, the teaching I am now doing applies to my years of service in the Teacher Retirement Service, which means my retirement account is growing and will become available to me sooner.

I am not happy with all of President Obama’s policies by any means, and ultimately I would like to see the US adopt a single-payer model for healthcare, but Obamacare is a step in the right direction. Without Obamacare, my wife and I would have joined the millions of working Americans who have no health insurance or access to affordable healthcare.

So, thanks, Obama.

Will industry-funded research kill you?

R. Horton

Last week, I wrote a blog about the effects of financial conflicts of interest (FCOI) on treatment decisions of doctors and whether disclosure alone will have any effect on eliminating bias and corruption. As a result, I received some comments and information on FCOI in published research.

Before I say more, I would like to clarify that someone who is conducting research funded by industry is not technically, in my studied opinion, involved in a FCOI, because such a person has the single interest of generating products that will result in profit for industry. It is possible that research undertaken with the aim of commercial success will benefit humanity, but if profit is not possible, humanity be damned. (I am making an assumption, which may be naive, that most of us think medical research should be aimed at making life better for humanity.)

To help combat the problem of bias in research, John Henry Noble suggests prison time for those found guilty of scientific fraud. In my opinion, he makes two strong claims: 1. “The false claims of the perpetrators rise to the status of crime against society, insofar as they endanger public health by sullying and misdirecting the physician’s ‘standard of care.’” 2. “The due process of law is likely to uncover and judge the evidence of guilt or innocence more reliably and fairly than will the institutions of science and the professions that historically have resisted taking decisive action against the perpetrators.”

I agree that jail time is appropriate for egregious cases of scientific fraud, but I’m not sure it eliminates the problem of industry-driven research. Another person told me industry-funded research should be published for two reasons: 1. Some people are biased without the benefit of industry funding. 2. Some industry-funded research proves to be quite beneficial. Perhaps surprisingly, I agree with both of these statements as well–as far as they go. Certainly, many people carry any number of biases that do not result from corporate funding, and the history of scientific fraud is littered with examples. Further, corporate labs frequently create products I enjoy immensely.

Oddly enough, the person defending industry-funded research sent me a link to a paper to support the contention that FCOIs are not a strong predictor of bias. I say it is odd because the paper didn’t seem to support that position. The paper analyzed the associate between industry funding and the likelihood that the researchers would find an association between sweetened beverages and obesity. The authors of the paper found that “Those reviews with conflicts of interest were five times more likely to present a conclusion of no positive association than those without them.” It is perhaps the conclusion of the paper that gives hope to those advocating for industry funding:

They [results of the study] do not imply that industry sponsorship of nutrition research should be avoided entirely. Rather, as in other research areas, clear guidelines and principles (for example, sponsors should sign contracts that state that they will not be involved in the interpretation of results) need to be established to avoid dangerous conflicts of interest.

In other words, it would reduce bias if sponsored researchers were limited to collecting data without analyzing it. This is hardly a ringing endorsement of industry-funded research, but so be it.

So, I do not think all industry-funded research should be banned. Rather, I think we (as a society) need to ensure that we have ample researchers who are free of FCOIs. In other words, we need substantial funding for independent research centers where researchers can work for the advancement of knowledge without a constant concern for the production of profit. Forcing our public universities and research labs to turn to corporations for funding corrupts our pursuit of knowledge and the advancement of society. We must restore public funding to education and research.

For more on the possible risks of funded research, read about Dan Markingson here. Or read about Jesse Gelsinger here.

Sunshine disinfects nothing

R. Horton5 Comments

I seem to remember Jon Stewart once playing a clip of a politician declaring that sunshine is the best disinfectant. After the clip, Stewart warned viewers that using sunshine as a disinfectant could lead to a nasty infection. In response to the Sunshine (Open Payments) Act, bioethicist Mark Wilson sounds a similar alarm in a recent paper.

For years, many people, including myself, have argued that industry payments to physicians should be disclosed to the public, so that we will all be aware of possible financial conflicts of interest (FCOI). My hope was that disclosing conflicts of interest might help actually reduce corruption or even simple bias in medical practice, but Wilson points to our experience of Wall Street before and after the 2008 financial collapse to show that knowledge of conflicts of interest does not prevent them. Rather, disclosure only shifts the burden for reducing FCOI to patients, who are least empowered to eliminate them. Rather than fixing the problem, Wilson claims the Sunshine Act only “mythologizes transparency.”

Wilson pointed me to a paper (“Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5”) in Psychotherapy and Psychosomatics that illustrates the problem. If you want the details, you can read the paper yourself, but I will skip right to the conclusion, which I admit is how I read most papers anyway:

[I]t is critical that the APA recognize that transparency alone is an insufficient response for mitigating implicit bias in diagnostic and treatment decision-making. Specifically, and in keeping with the Institute of Medicine’s most recent standards, we recommend that DSM panel members be free of FCOI.

Telling people about FCOI does not reduce bias and corruption; it only offers an opportunity for people to be aware that bias and corruption exist. I think it is valuable that the Sunshine Act is making people aware of FCOI. In response, though, I hope we will take steps to reduce FCOI. Unfortunately, the burden is indeed shifted to voters and consumers. The most disturbing and obviously true statement Wilson makes in his paper is this: “Until politicians end their own commercial COIs, the Sunshine Act will likely remain the governance order of the day.”

We can’t hope the experts will solve this problem. We must demand that FCOI are eliminated.

You shouldn’t have to go to jail for mental health treatment

R. Horton

Last week I tweeted a link to a Texas Observer article by Emily DePrang about sexual assaults in Harris County jails. DePrang had written about two Bureau of Justice Statistics studies that showed the Harris County Jail on Baker Street had sexual assaults that are higher than national averages.

One survey reported rates of sexual victimization as reported by inmates, and found that inmates reported higher than average rates of victimization from other inmates. The other survey was based on official reports of sexual violence in jails and also reported higher than average rates for the Baker Street jail. DePrang did not discuss, in her short post, all the statistical and methodological limitations of the studies in question.

To my surprise, Alan Bernstein, the director for public affairs at the sheriff’s office tweeted me, saying he hoped someone would fact-check DePrang’s article as it had many mistakes, so I asked him what the mistakes were, and he sent me a list of items he felt were misleading. Later, the Texas Observer agreed to publish his response to the article (his published response was slightly different from what he sent me).

For the most part, his response pointed out the limitations of the study. Also, he noted that only one of four jails in Harris County had a higher incidence of sexual assault, and he also noted that jail had a high percentage of inmates who are under treatment for mental illness. In his note to me, Bernstein asked, “Is touching a clothed inmate’s thigh sexual violence? Maybe so. But this is one of the actions considered sexual victimization in the study.” I will just say that I consider any unwanted touching of my upper thigh over or under clothing to be sexual assault, even if the “violence” seems minor.

In trying to separate the signal from noise, though, what interested me most was not the definition of sexual violence or even the limitations of the study but the fact that the jail had so many inmates on medications. The Houston Chronicle quoted Sheriff Adrian Garcia saying, “The Harris County Jail has been referred to as the largest psychiatric facility in the state of Texas” and “More than 2,000 inmates … are on psychotropic medications on a daily basis.” And in Bernstein’s response, posted on the Texas Observer site, he said:

That building houses the jail system’s inmates with acute mental illness. In fact the statistician who worked on the 2011 study tells us that two-thirds of the surveyed inmates in the so-called “high” rate building had “psychological stress disorders.” We don’t know how that was determined, and we would never allege that people with mental illness fabricate allegations more often than anyone else.

I’m not sure what “acute” means in this context, but I suspect anyone on medication is assumed to have an acute mental illness. Given the number of prescriptions written for antidepressants and anti-anxiety medications these days, I suspect a fairly high percentage of the general population is acutely mentally ill, according to these assumptions. Even someone being treated for mild depression, though, will experience unpleasant side-effects if doses are missed, as they are likely to be missed inside a jail. We should be concerned both about lack of treatment for mental health and the over-prescription of  drugs for depression and anxiety. Withdrawal sometimes leads to aggressive behavior and could account for some problems. On the other hand, mental illness is also stigmatized, and those receiving treatment may become targets for abuse at the hands of other inmates.

Fortunately, I found more information on treatment of the mentally ill in Harris Country jails in excellent article by DePrang titled “Barred Care.” According to the article, the jail “treats more psychiatric patients than all 10 of Texas’ state-run public mental hospitals combined.” And why is that? Because no one else is treating those patients. Again from the article: “Harris County has one of the most underfunded public mental health systems in a state that consistently ranks last, or almost last, in per capita mental health spending.” Some people get so desperate for relief, that they break the law just so they can go to jail and get treatment.

The program in the jail is commendable. The funding priorities of our state government are not. In 2003, the Texas legislature slashed funding for mental health services in Texas. According to DePrang’s article, “In Harris County, the number of law enforcement calls about people in psychiatric crisis jumped from fewer than 11,000 in 2003 to more than 27,000 in 2012.” So, the Harris County jail has a high number of mentally ill as a result of deliberate action of our state’s lawmakers. This should make us all angry. Cutting funding for mental health services only to force the mentally ill into jails is cruel and expensive. No matter what sends people to jail, many will never really recover from the stigma and the trauma of the experience.

What should be done? We should lobby our lawmakers to restore funding for mental health services in Texas. We should stop blaming the mentally ill for their problems. We should resist the temptation to treat even minor difficulties with powerful and addicting drugs. We should insist that Texas expand Medicaid as part of the Affordable Care Act (this would cost the state nothing) so that people can receive basic medical care and avoid crisis.

In short, we should learn to heal each other. The person with a mental health crisis tomorrow could be you.

Montaigne: We’re all animals

R. Horton3 Comments

I have a bad habit of speculating about what animals, usually my dog or someone else’s pet, are thinking. This leads people close to me to accuse me of anthropomorphism. They say I assume animals experience the world in the same way I do without any real evidence to tell me what kinds of  “thoughts” animals might have.

And it is true; I have no way to verify what animals are actually thinking, but I don’t have any reliable way to know what anyone is thinking, so I go about my day assuming animals, especially mammals, experience life more or less as I do, even if they can’t express it with language. I happen to think those of us who make this assumption are kinder than those who don’t. And if we must make assumptions, anyway, we might as well make assumptions that increase kindness in the world.

In Political Emotions, Martha Nussbaum turns the tables on the critics of anthropomorphism. Rather than accusing people of projecting human emotions onto animals, she questions why humans are so insistent on denying that human and nonhuman animals share some emotional experiences. Rather than anthropomorphism, she says, we are guilty of anthropodenial.

Humans have a long history of placing themselves closer to angels than to other mammals. In fact, many humans see themselves as a sort of angel in waiting. We separate ourselves from other animals by drawing a supposed bright line between ourselves and animals. What’s more, humans have a tendency to separate themselves from other humans by projecting animal qualities on others. Humans in despised and marginalized groups are said to be vicious, savage, smelly, dirty, shameless, and stupid. Being no better than animals, members of such groups are often treated much worse than “angels in waiting.”

Nussbaum’s description seems radical in some ways, but the distinction between writers and thinkers who deny the shared experience of human and nonhuman animals and those who embrace the similarities is ancient. Writing in the 16th century, Michel de Montaigne

Michel de Montaigne wrote of his condition tha...
Michel de Montaigne wrote of his condition that, “I am at grips with the worst of all maladies, the most sudden, the most painful, the most mortal and the most irremediable. I have already experienced five or six very long and painful bouts of it.” (Photo credit: Wikipedia)

made many of the same points as Nussbaum. He notes, first, that the humans are the “most wretched and frail” of species yet also the proudest.

He says the human animal “attributes to himself divine qualities, withdraws and separates himself from the crowd of other creatures, cuts out the shares of the animals, his fellows and companions.” And he challenges the assumption, asking, “From what comparison betwixt them and us does he conclude the stupidity he attributes to them?” He points out that we eat, reproduce, protect our young, and generally try to survive right along with all the other animals. Of course, one of the most important similarities is the way we deal with pain, both physical and emotional. He says, “Our crying is common with the greatest part of other animals, and there are but few creatures that are not observed to groan, and bemoan themselves a long time after they come into the world.”

We suffer and bemoan our fate right alongside our animal companions on the earth. While we may wish to bring the heavens under our feet, as he says, we are lowly animals seeking comfort and refuge from fear, hunger, and loneliness. And if humans are wont to declare themselves superior to animals based on an alleged superiority and favor from God, humans are just as likely to attempt to declare themselves superior to other humans—largely by comparing those humans to animals in an effort to degrade them.

Thus, members of other cultures, skin colors, or practices are seen as being savage or beastlike. Their animalism is evident by their alleged smells, filth, aggression, or unchecked sexuality. Not one to shirk from the most extreme cases, Montaigne examines cultural views of cannibals. He describes in gruesome detail the methods of war, capture, and torture reputed to some classes of cannibalistic humans. After Montaigne has thoroughly disgusted his reader, he declares, “I am not sorry that we should here take notice of the barbarous horror of so cruel an action, but that, seeing so clearly into their faults, we should be so blind to our own.”

Without shirking from the most horrifying practices of cannibalistic cultures, Montaigne then turns to examine his own culture. He says, “I conceive there is more barbarity in eating a man alive, than when he is dead; in tearing a body limb from limb by racks and torments, that is yet in perfect sense; in roasting it by degrees; in causing it to be bitten and worried by dogs and swine . . . than to roast and eat him after he is dead.”

He then tells us of a case where cannibals are brought into “civilized” society and shown the pinnacle of human achievement. After they have seen all the finery, the king asked them what they most admired. They said “that they had observed, that there were among us men full and crammed with all manner of commodities, while, in the meantime, their halves were begging at their doors, lean, and half-starved with hunger and poverty; and they thought it strange that these necessitous halves were able to suffer so great an inequality and injustice, and that they did not take the others by the throats, or set fire to their houses.”

Be kind to animals. Even human ones.

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Tea Party and the “Mask of Anarchy”

R. Horton1 Comment
Percy Bysshe Shelley, by Alfred Clint (died 18...
Percy Bysshe Shelley, by Alfred Clint (died 1883). See source website for additional information. This set of images was gathered by User:Dcoetzee from the National Portrait Gallery, London website using a special tool. All images in this batch have been confirmed as author died before 1939 according to the official death date listed by the NPG. (Photo credit: Wikipedia)

I don’t think I’m the only one to notice that Percy Bysshe Shelley‘s “Mask of Anarchy” seems amazingly relevant to current efforts to suppress the voices and will of workers around the world. So, I’ve taken the poem almost verbatim, made a few textual changes, and changed the names of the politicians to the names of Tea Party members and others in the Republican party. For more info on the poem, see The Guardian‘s partial explication.

Here is my take:

As I lay asleep in Houston, Texas
I heard a voice declare war on us,
And with great power it led me
To walk in visions of Poetry.
I met Murder as the widows began crying—

He had a mask like Paul Ryan—
Very smooth he looked, yet grim;
Seven blood-hounds followed him:
All were fat in the savage crew,

For one by one, and two by two,
He tossed them human hearts to chew
Which from his wide cloak he drew.
Next came Fraud, and he had on,

Like John Boehner, an ermined gown;

Official portrait of United States House Speak...
Official portrait of United States House Speaker (R-Ohio). (Photo credit: Wikipedia)

His big tears, for he wept well,
Turned to mill-stones as they fell.
And the little children, who

Believed him to be true,
Thinking every tear a gem,
Had their brains knocked out by them.
Clothed with the Bible, as with light,
And the shadows of the night.

Like Perry, next, Hypocrisy
On a crocodile rode by.
And many more Destructions played
In this ghastly masquerade,
All disguised, even to the eyes,

Like Bishops, lawyers, peers, and spies.
Last came Anarchy : he rode
On a white horse, splashed with blood;
He was pale even to the lips,
Like Death in the Apocalypse.

And he wore a kingly crown;
And in his grasp a sceptre shone;
On his brow this mark I saw—
‘I AM CRUZ, GOD, KING, AND LAW!’

With a pace stately and fast,
Over Texas land he passed,
Trampling to a mire of blood
The adoring multitude.

And with a mighty troop around
With their trampling shook the ground,
Waving each a bloody sword,
For the service of their Lord.

And with glorious triumph they
Rode through Texas proud and gay,
Drunk as with intoxication
Of wine of wanton destruction.

And each dweller, panic-stricken,
Felt his heart with terror sicken
Hearing the tempestuous cry
Of the triumph of Anarchy.

For from pomp to meet him came,
Clothed in arms like blood and flame,
The hired murderers, who did sing
‘Thou art God, and Law, and King.

‘We have waited weak and lone
For thy coming, Mighty One!
Our purses are empty, our swords are cold,
Give us glory, and blood, and gold.’

And Anarchy, the Skeleton,
Bowed and grinned to every one,
As well as if his education
Had cost billions to the nation.

When one fled past, a maniac maid,
And her name was Hope, she said:
But she looked more like Despair,
And she cried out in the air:

‘My father Time is weak and gray
With waiting for a Change this day;
So long as Anarchy rages on still,
The world awaits a reborn will!

‘He has had child after child,
And the dust of death is piled
Over every one but me—
Misery, oh, Misery!’

Then she lay down in the street,
Right before the horses feet,
Expecting, with a patient eye,
Murder, Fraud, and Anarchy.

And the prostrate multitude
Looked—and ankle-deep in blood,
Hope, that maiden most serene,
Was walking with a quiet mien:

To an accent unwithstood,—
As if her heart cried out aloud:
‘People of conscience, heirs of Glory,
Heroes of unwritten story,

‘Rise like Lions after slumber
In unvanquishable number.
Shake your chains to earth like dew
Which in sleep had fallen on you—

You are many—they are few.
‘What is Freedom?—you can tell
That which slavery is, too well—
For its very name has grown
To an echo of your own.

But change rose as a two-headed monster
Each head struggling to devour the other
But Hope nourishes the stricken half
And leaves Gold with a dark epitaph

“Let not this monster rise again.
Squelch the greed that lies within.”
We are not, as impostors say,
A shadow soon to pass away.

We ‘Rise like Lions after slumber
In unvanquishable number—
Shake our chains to earth like dew
We are many—they are few.’

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Nussbaum and Rand on the Politics of Love

R. Horton1 Comment

I’m currently reading Martha Nussbaum’s Political Emotions: Why Love Matters for Justice. Love is an important focus of the book, but it is certainly not the only emotion that Nussbaum considers important to a minimally decent society. Still, love (and its relevant associate, compassion) is an integral part of a stable and humane democratic society.

English: Photograph of Martha C. Nussbaum take...

Nussbaum suggests that it is entirely appropriate for governments to encourage the development of political emotions that are absolutely necessary for a functioning society. Of course, totalitarian, repressive regimes often rise to power on waves of extreme patriotism coupled with xenophobia and violent anger. This is a risk of the state cultivating emotions, but it is also likely that inappropriate emotions arise because we shirk our duty to cultivate the correct emotions. Who decides which emotions are correct? Why, we political liberals, of course. Nussbaum is more optimistic than I about the ability to create a state that will encourage the appropriate arts and literature to cultivate emotions that will engender empathy and promote democratic feeling. Still, we are obligated to make every effort to counter those who would work to destroy both compassion and democracy.

Nussbaum recognizes the potential for paradox in her claim, but she defends her position with depth and detail. The fact that I agree with both her goals and method make it quite easy for me to follow along and hope, against all odds, that is possible to create a more decent society than what I currently see around me, even if I feel we must go it alone without the full support of government.

Ayn Rand

But all this talk of love got me thinking of Ayn Rand, of course, as many things these days get me thinking of Ayn Rand. She said that we should be selfish and never sacrifice ourselves to others. In contrast, many of us have foolishly believed that to love someone was, in fact, to be willing to sacrifice ourselves for his or her well-being. On this point, I think Ayn Rand was able to explain herself quite clearly. When asked whether we shouldn’t be selfless in our romantic relationships, she said,

“When you are in love, it means that the person you love is of great personal, selfish importance to you and to your life. If you were selfless, it would have to mean that you derive no personal pleasure or happiness from the company and the existence of the person you love, and that you are motivated only by self-sacrificial pity for that person’s need of you.”

She makes a good point. We sacrifice for those we love because we value them so much that their loss is a personal loss to us, and their suffering is a suffering we share. We do not love out of duty; we love for the pleasure it brings us.

For Rand, altruistic concern for strangers entails a denial of self-satisfaction and an indenture to others. By living for the needs of others, we deny our responsibility to determine and seek our own needs. It does not occur to Rand, as it does to Nussbaum, that is possible to value other humans with a love that extends beyond our realm of personal contact. It is possible that I want to preserve the lives of strangers thousands of miles away because I value them, even if abstractly, to the point that their suffering causes me suffering.

I don’t want to live in a world where millions of people starve to death each year, and I do not believe they are starving because of the poor choices they have made. I believe they are starving because of structural economic violence against them. In many cases, the world’s resources have been stolen by brute force (did farmers and fishers in Africa foolishly give their land to oil companies?). Poverty, addiction, and disease are largely a result of violence against people who are not recognized as being fully human, fully deserving of respect.

We don’t have to accept this reality. As Nussbaum says, “We should surely not assume that the form emotions take in the corporate culture of the United States reveals a universal and timeless truth about how things must be.” No, we can work to ensure that our moral imagination can perceive other human beings as beings worthy of respect, dignity, and, yes, love. If we seek to respect ourselves, we must demand respect for all.

Love is possible.

It is Time to Shed Sunshine on Informed Consent

R. Horton1 Comment

Most patients realize doctors receive gifts from the pharmaceutical and device-

A patient having his blood pressure taken by a...
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

manufacturing industry. When we see industry logos on pens, clocks and posters, we don’t assume the doctors ordered these items from the merch page of these companies, but most of us aren’t aware of how lucrative the payments to doctors can be.

A story that ran in the New York Times described the experience of Dr. Alfred J. Tria, who made $940,857 in about two years for promoting products and training doctors in Asia to use them. The article notes that Tria’s experience may be exceptional, but in two and a half years, industry paid out $76 million to doctors practicing in Massachusetts alone.  I’ve been reading about this subject for a while, and even I was surprised that someone could make half a million dollars in a year on a side job.

In a slightly different type of payout, Oregon recently concluded a court case against two doctors who “put heart implants into patients without telling them that a manufacturer’s training program put a sales representative into the operating room.” The doctors would receive between $400 and $1,250 each time they completed a surgery using Biotronik defibrillators and pacemakers. The state argued that patients should know when doctors’ recommendations may not be based entirely on the needs of the patient. One of the doctors in the case earned more than $131,000 from 2007 to 2011 through implant surgeries. Doctors also received speaking fees, expensive meals, and other gifts.

As part of the Affordable Care Act (Obamacare), the Sunshine Act now requires industry to start collecting data on payments to doctors now, and the information will be made available to the public next year on a government website. This will enable patients to learn how much their doctor receives from the industry each year, though there may still be hidden incentives.

For example, doctors may be in profit-sharing arrangements with facilities or they may actually be the owners of the facility. A recent study by Dr. Matthew Lungren found that doctors who had a financial stake at an imaging facility ordered tests with negative results at a much higher rate (33 percent) than doctors with no financial stake. In other words, it appears that doctors order unneeded tests because they are making money off of them, not because the patients need them. Lundgren suggests that patients should ask whether they are being referred to a facility in which the doctor has a financial stake. I say the doctor should volunteer the information.

Beginning next year, the Sunshine Act will make it much easier for patients to discover their doctors’ financial relationships with industry, and I’m thrilled for this development. For those who think Obamacare is a complete disaster, just take a minute to relish this one positive development.  Still, I think the movement should go further. I think financial disclosure should be part of the informed consent process. When your doctor is telling you all the risks and benefits of treatment, I think he or she should also say, “I get paid $1,000 to do this surgery,” “I will make $100 off this MRI,” or “I own stock in the company conducting this medical research.”

I believe patients want this information, and I don’t think they feel it is their responsibility to search for it. True informed consent is only possible in light of complete financial disclosure.

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Corporate Greed Is Not The Problem

R. Horton1 Comment

English: Coalition of Immokalee Workers logo

In the battle between conservatives and progressives, we are generally presented with a false dilemma. We are expected to choose between two positions: 1. Corporate greed is evil. 2. Profit is what drives innovation and improvements to our standards of living. Unfortunately, it is the progressives who are making the mistake here. Greed is only a problem because it results in human rights abuses, criminality, and grave injustice. We do better to focus on the abuses rather than the rather nebulous harm of greed itself.

When I talk to conservatives about specific instances of corporate criminality, they generally acknowledge that something should be done in such cases. For example, seven court cases from 1997 to 2008 resulted in convictions for slavery in Florida.  Those convicted of slavery “threatened the immigrants, held their identification documents, created debit accounts they couldn’t repay and hooked them on alcohol to keep them working.” The workers were also beaten and forced to live in substandard conditions.

As the accounts of slavery came to light, activists organized and demanded that restaurants pay more for tomatoes in order to provide an actual wage for tomato workers. By May 2008, Burger King had joined McDonalds and Yum! Brands in meeting the demands of the Coalition of Immokalee Workers and paying more for tomatoes. It was a notable success, but the activism of the CIW continues. After progressive strides with fast-food restaurants, the coalition ran in to resistance from grocery giant Publix, which refused to join any agreements to improve working conditions. In 2010, a Publix spokesperson said, “If there are some atrocities going on, it is not our business.”  Publix has not budged yet, but the Coalition of Immokalee Workers continue their work and will receive 2013 Freedom from Want Medal from the Roosevelt Institute.

When progressives argue that corporate greed leads to great evil, they may be correct, but they make it too easy for conservatives to simply point out all the innovation and convenience the profit motive has produced. When we argue against slavery, however, we force conservatives to either defend slavery or admit that the industry must be reformed in one way or another. It is not likely that progressives and conservatives will agree on what kind of reform is necessary, but at least the conversation has begun with some possibility of tangible results, as we see in the case of the Immokalee workers. Knowing of specific abuses, such as in the FoxConn factory in China or the sweatshops in Bangladesh, most consumers, both progressives and conservatives, demand reform, and corporations do listen to them. Progress is slow and frustrating, but it is progress.

It may be possible that severe and systemic structural reforms are required to eliminate slavery and other forms of corporate abuse, but it is the abuse and the desire to eliminate abuse that must motivate the change.

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