Ethics, Information Technology, and Public Health: New Challenges for the Clinician-Patient Relationship

Increasingly widespread adoption of health information technology tools in clinical care increases interest in ethical and legal issues related to the use of these tools for public health and the effects of these uses on the clinician-patient relationship. It is argued that patients, clinicians, and society have generally uncontroversial duties to support civil society's public health mission, information technology supports this mission, and the effects of automated and computerized public health surveillance are likely to have little if any effect on the clinician-patient relationship. It is also suggested, nevertheless, that electronic public health surveillance raises interesting and important ethical issues, some of which can be addressed if not resolved by empirical research, especially regarding patient preferences about secondary use of health data and their moral obligation to contribute to population- based health.     

The EU’s response to the global financial crisis and sovereign debt crisis

Since the sovereign crisis erupted in the autumn of 2009 when the true scale of the Greek fiscal deficit was revealed, the European Union (EU), and especially the euro area, has staggered from crisis to crisis. Major initiatives have, however, been taken to improve economic governance and to put in place a more resilient framework for the euro. This article assesses how the EU has responded to the crisis and offers explanations for why the reform process has been slow and indecisive. It shows that potentially enduring solutions are on the table, but that they have been hard to introduce because of differing national perspectives and disagreements about how the burdens of adjustment should be shared. The article concludes by setting out plausible options and explaining what they entail.     

Can Strict Criminal Liability for Responsible Corporate Officers be Justified by the Duty to Use Extraordinary Care?

The responsible corporate officer (RCO) doctrine is, as a formal matter, an instance of strict criminal liability: the government need not prove the defendant’s mens rea in order to obtain a conviction, and the defendant may not escape conviction by proving lack of mens rea. Formal strict liability is sometimes consistent with retributive principles, especially when the strict liability pertains to the grading of an offense. But is strict liability consistent with retributive principles when it pertains, not to grading, but to whether the defendant has crossed the threshold from noncriminal to criminal conduct? In this essay, I review the two most plausible arguments supporting an affirmative answer in the context of the RCO doctrine. First, perhaps this doctrine reflects a rule-like form of negligence, akin to a rule that prohibits selling alcohol to a minor. Second, perhaps this doctrine expresses a duty to use extraordinary care to prevent a harm. Neither argument is persuasive. The first argument, although valid in some circumstances, fails to explain and justify the RCO doctrine. The second argument, a duty to use extraordinary care, is also inadequate. If “extraordinary care” simply means a flexibly applied negligence standard that considers the burdens and benefits of taking a precaution, it is problematic in premising criminal liability on ordinary negligence. If instead it refers to a higher duty or standard of care, it has many possible forms, such as requiring only a very slight deviation from a permissible or justifiable standard of conduct, placing a “thumb” on the scale of the Learned Hand test, identifying an epistemic standard more demanding than a reasonable person test, or recognizing a standard that is insensitive to individual capacities. However, some of these variations present a gratuitous or incoherent understanding of “negligence,” and none of them sufficiently explain and justify the RCO doctrine.     

The maharishi effect: A model for social improvement. Time series analysis of a phase transition to reduced crime in merseyside metropolitan area

Abstract

Time series analysis was used to test the hypothesis that Merseyside crime rate was reduced by a group practising Maharishi Mahesh Yogi's Transcendental Meditation and TM-Sidhi programme. Previous research suggests that a phase transition to increased orderliness u evidenced by reduced crime rate should occur when the group size approaches the square root of 1% of the total population. Analysis of Merseyside monthly crime data and coherence group size from 1978 to 1991 shows that a phase transition occurred during March 1988 with a 13.4% drop in crime when the group size first exceeded the √1 % or Maharishi Effect threshold (p < 0.00006). Up to 1992, Merseyside crime rate has remained steady in contrast to the national crime rate which has increased by 45%. In 1987 Merseyside had the third highest rime rate of the eleven largest Metropolitan Areas in England and Wales; by 1992 it had the lowest crime rate. 40% below levels predicted by the previous behaviour of the series. There were 255,000 less crimes in Merseyside from 1988 to 1992 than would have been expected had Merseyside continued to follow the national crime trend. Home Office figures indicate savings to Merseyside could exceed £1250 million for the five year period. Demographic changes, economic variables, police practice, and other factors could not account for the changes.     

Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach

Low back pain (LBP), a leading cause of disability, has been linked with profound economic, personal, and social costs (Hills 2006; World Health Organization 2003). This significant effect propels research in identifying modifiable risk factors that protract LBP; these factors can be targeted in early intervention (EI) (Pransky, Journal of Occupational & Environmental Medicine, 49(3):249–251, 2007; Schultz et al., Journal of Occupational Rehabilitation, 17:327–352, 2007, Journal of Occupational Rehabilitation, 18(2), 140–151, 2008; White et al. 2013). This randomized controlled study evaluated the effectiveness of two approaches, fixed versus flexible, in delivering proactive, interdisciplinary EI with 63 workers within a workers' compensation interdisciplinary case management setting (i.e., WorkSafeBC, Canada). Off-work 4 to 10 weeks post-back injury, the workers were also at risk of protracted work disability (N?=?24 at high risk; N?=?39 at moderate risk). Fixed, protocol-driven, interdisciplinary, multimodal, clinical, occupational, and case management-based EI was compared with a flexible, individual need-driven EI with the same modalities as the fixed approach. Results showed a significant narrowing of the outcome gap between the two interventions. High-risk injured workers tended to benefit more from a fixed, protocol-driven approach, as shown in the pilot study (Schultz et al. Journal of Occupational Rehabilitation, 18(2), 140–151, 2008). The results indicated that moderate-risk workers benefitted from a more flexible, need-based, individual, and low-intensity approach as compared with a fixed approach. The flexible approach for moderate-risk workers was also less costly and consumed fewer rehabilitation and health care resources. Recommendations for future research and practice included larger sample sizes, controllability of research interventions, risk for disability-EI matching, and conditions under which a flexible delivery of multimodal EI is more efficacious than a fixed approach, and vice versa.     

Networking in the Penumbra: Public Management,Cooptative Links,and Distributional Consequences

ABSTRACT

Recently, some researchers have begun to emphasize that governance networks can have a “dark” side as well as a relatively benign one. This work thus far has mostly emphasized illegal and violent forms of action. But even networks that operate in accord with the law often include covert, or at minimum difficult-to-observe, ties and pathways of influence. Likewise, managers involved in networking engage in behavior that is only partially observable. They can use their discretion to shape network action in ways that are hard to discern—and therefore analyze. Research on such subjects is limited, and the practical results of such behavior can include lack of accountability as well as inequitable distribution of outputs and outcomes. This article shows that individual network nodes can work to bias the actions of the organization in ways that are likely to benefit the organization's more advantaged clientele. This study reports on tests for differential impacts of managerial interactions of and with various network partners. The argument is supported with an analysis of performance data from 500 organizations over an eight-year period. Networks and managerial networking can generate considerable benefits but can also have a less palatable impact that managers and scholars need to consider seriously.     

Devolution as Process: Institutional Structures,State Personnel and Transport Policy in the United Kingdom

Abstract. Devolution has been described as a key ‘global trend’ over recent decades as governments have decentralised power and responsibilities to subordinate regional institutions. UK devolution is characterised by its asymmetrical nature with different territories granted different institutional arrangements and powers. This paper seeks to examine the role of state personnel in mobilising the new institutional machinery and managing the process of devolution, focusing on transport policy. The research presented shows a clear contrast between London and Northern Ireland, on the one hand, and Scotland and Wales, on the other, in terms of the effectiveness of political leaders in creating clear policy priorities and momentum in transport.     

The Political Economy of Improving Health Care for the Poor in Rural Africa: Institutional Solutions to the Principal–Agent Problem

Both governments and private for-profit markets have been disappointing in meeting the needs of the African poor for health care. NGO services provide a much more attractive alternative for this clientele, despite the fees they charge. They do so because they represent an institutional solution to the ‘imperfect information’ problem in health care. Through simulations based on data from Cameroon, we demonstrate that if fee-charging NGOs replace the highly subsidised but poorly managed facilities operated by African governments the poor would be better off. Those NGOs that are decentralised in their financial and personnel management are most effective. The politics of making the recommended changes are assessed.     

The Privatization of Public Safety in Urban Neighborhoods: Do Business Improvement Districts Reduce Violent Crime Among Adolescents?

The business improvement district (BID) is a popular economic development and urban revitalization model in which local property and business owners must pay an assessment tax that funds supplementary services, including private security. BIDs constitute a controversial form of urban revitalization to some because they privatize economic development and public safety efforts in public space. This study examines whether BIDs provide tangible benefits beyond their immediate boundaries to local residents in the form of reduced violence among adolescents. The empirical analysis advances an existing literature dominated by evaluation studies by introducing a theoretically driven dataset with rich information on individual and neighborhood level variables. The analysis compares violent victimization among youths living in BID neighborhoods with those in similarly situated non‐BID neighborhoods. We find no effect of BIDs on violence. However, we do find that youth violence is strongly correlated with neighborhood collective efficacy and family‐related attributes of social control. In conclusion, we argue that BIDs may be an agent of crime reduction, but this benefit is likely concentrated only in their immediate boundaries and does not extend to youths living in surrounding neighborhoods.