NEWS ANALYSIS: Tylenol, Generics and Trust

After a wide recall of children’s drugs, many parents are questioning the value, and sense of security, when buying a name brand over cheaper generic medicines.

http://nyti.ms/dCJkWO

Teaching Physicians the Price of Care

Until recently, most medical schools provided little information on financial factors, like how the insurance system works and how treatment costs affect patients’ behavior.

http://nyti.ms/b0lzKK

Poll Shows Most in U.S. Want Overhaul of Immigration Laws

The number of Americans who describe illegal immigration as a serious problem has grown, and a slim majority supports Arizona’s stringent new law, according to a New York Times/CBS News poll.

http://nyti.ms/a4ngph

One of the reasons that American newspapers see themselves as superior to their British counterparts is the political balance they seek to achieve and, moreover, they think they are achieving.

Here, for example, is the editor-in-chief of the Atlanta Journal-Constitution, Julia Wallace, explaining her paper’s commitment to fairness after, apparently, asking the readers what they wanted.

They don’t want us to be a newspaper with a strong point of view. But what they do want is, they want balance. If we have a view to the right, they want a balance of a view to the left.

Do readers really want that? Or have they been persuaded, or persuaded themselves, that this mechanistic form of right-left argument is good enough?

Anyway, what does right and left mean in the United States? Given that President Obama’s modest health care reform, built around the provision of private insurance, was seen as socialistic and even communistic, it hardly suggests the US left matches the British left, or the left anywhere in Europe.

As for the right, does that mean Senator MCain, the Christian fundamentalists, the tea party movement, Sarah Palin, or Fox News?

Left and right are meaningless, relative terms. Anyway, even if we accept them as some sort of rough-and-ready guide, it squeezes out more more subtle arguments of whatever persuasion.

What it most certainly does, having read many a US paper, is eliminate from their op-ed pages those who dare to argue against capitalism, the conduct of the state of Israel or the invasion of Iraq.

Even so, there is a phoney argument played out endlessly by commentators and the authors of scores of books about whether the US media is liberal or not. (Liberal is code for left, of course).

All that newspapers (and the network broadcasters) have achieved, while trying to appear fair, is in attracting scorn from the public they claim to serve. People perceive the bias they wish to perceive.

For example, a survey last year by the Pew Research Centre found a historic low level of trust in the accuracy of the US news media.

Similar studies in Britain routinely come up with that result about lack of trust too. No matter how hard publishers and editors lay claim to balance, fairness and objectivity, there will always be a proportion of the public that disagrees.

So what should be done? First, we have to accept that “balance” (especially in the sense of the Atlanta paper’s working definition) is fake. Second, while retaining objectivity as some kind of nebulous but well-meaning aim in reportage, we must encourage accompanying debate and analysis that strays far beyond the tired constraints of zero-sum argument.

Third, and in this I do agree with the Atlanta editor, we need to be more transparent, so that readers cannot be anything other than aware of the agenda pursued by the paper, its staff and contributors.

Fourth, and especially at a time of crisis for newsprint newspapers, we have to look harder at, and learn lessons from, regular internet users who either ignore papers or denigrate them…

Roy Greenslade: US newspapers aim for balance, but it’s all fake

Sources: NPR/Pew Centre

Is it time to reform the U.S. electoral structure? Should more views be represented? Do narrow interests have too much power? What do you think?

Global Ethics Corner: Should American Elections be Reformed?

U.S. Public Willing to Accept Some Civil Rights Violations in Immigration Crackdown

A fatally wounded man left dying on a New York sidewalk was ignored for nearly two hours. Would you have stopped to help?

New York has been shaken by the murder of a 31-year-old Guatemalan immigrant, Hugo Tale-Yax, who was stabbed to death on a Queens street last week. What has really shocked people is not so much the fact of a homicidal assault, or even that Tale-Yax appears to have been killed while trying to come to the aid of a woman who was herself being attacked, but that more than 20 passersby walked past the dying man and nearly two hours passed before anyone did anything and the emergency services arrived.

Recently, Balaji Ravichandran raised similar issues about the phenomenon of urban-dwellers’ apparent immunity from a moral imperative to intervene, when he related his experience of being racially abused while bystanders pretended it wasn’t happening. In that case, though, at least bystanders had the rational excuse of self-preservation and reluctance to place themselves in harm’s way. In Tale-Yax’s case, a “good Samaritan” who had himself intervened to help another was ignored and stepped around by passersby, as he lay dying.

Do you know how you’d behave in such circumstances? Do you have any experience to share? Are you confident that you would stop to help, or do you fear you’d be another who would walk on by?

And should we be worried in a larger sense about the state of a society where this can happen?

Would you be a good Samaritan? | Open thread

My eggs are ripe for the taking – I am a 22-year-old female Yale graduate. On a semi-regular basis in college, I opened the school newspaper to find advertisements soliciting my demographic to donate. Some ads were more specific than others, requiring a Jewish or an Asian donor, an SAT score of greater than 1400 math and verbal, someone “attractive” or with athletic ability, or a height of at least 5’9”. Nearly all offered high sums of money for prospective donors, ranging from $5,000 to $35,000.

In a recent study in the Hastings Center Report, Georgia Tech researcher Aaron Levine showed that my experience at Yale was not unique. Looking at 105 advertisements found in 63 college newspapers, Levine found that nearly half offered payments to potential egg donors of $5,000 or more, with some reaching as high as $35,000 and specifying donor characteristics. Many of these advertisements violated guidelines issued by an ethics committee of The American Society for Reproductive Medicine (ASRM), which state that “total payments to donors in excess of $5,000 require justification and sums above $10,000 are not appropriate.”

The foundation of ASRM recommendations seems to be protection, for a number of parties: prospective donors, prospective recipients, potential offspring, and society at large. According to the ethics committee’s report, high payments could lead to “undue inducement and exploitation” that cause women to discount the physical and emotional risks associated with donation. Such payments could also lead prospective donors to conceal medical information relevant to their biological offspring, make donor oocytes available only to the very wealthy, commodify gametes and devalue human life, or promote the birth of persons with traits deemed “socially desirable.”

Demographically speaking, I am a prospective oocyte donor, and ASRM guidelines regarding inducement and exploitation are aimed at me. Based on my experiences and conversations I’ve had at college, I’ve found that my friends and acquaintances primarily fall into three groups: 1) those who would never donate for moral reasons, regardless of payment offered, 2) those who would donate for sums that fall within ASRM guidelines, and 3) those who are open to being “induced” by high enough payments. ASRM guidelines are targeted at the last two groups, but unfortunately they “protect” the third at the second’s expense.

There are many reasons why young women should consider carefully whether they want to donate their eggs. The process is long and intrusive. To stimulate her ovaries to produce eggs, a donor receives injections of hormones and other fertility medications for several weeks. Eggs are retrieved by surgery. A donor may suffer complications such as bleeding, puncture of the bowels or bladder, infections, adverse reactions to fertility medications (which are in some cases life-threatening), or in rare cases liver failure.

Although long-term risks are unknown, some evidence has shown a link between egg donation and developing cancer or a decrease in fertility. In addition to physical risks, young women face psychological ones, such as stress caused by feelings of attachment to the eggs or resulting offspring. The ASRM hopes that if payments for such a procedure are kept low enough, young women who would otherwise donate will either forgo the process entirely or think more carefully about whether such a process is worth her time and risk.

But what of the young women who choose to undergo the procedure anyway? They are facing the same risks and time commitments, yet they are being paid less than market price for their services. A woman who would donate for $5,000 is more likely to have pressing financial concerns than the one who would only donate for $25,000 or $35,000. So while ASRM guidelines may turn away some women who have comparatively little interest in donating and probably no great financial need, they will cause the woman who actually donates to be vastly underpaid.

The recommendations may even have the opposite effect of what is intended: if a woman is getting paid less than she would otherwise, she may be induced to donate more frequently, putting herself at greater risk. Women are generally advised to donate no more than six times, but the rule is rarely enforced and there is little to prevent a woman from exceeding this limit.

How did the ASRM come up with a specific dollar amount in the first place? The ethics committee used a 1993 analysis that estimated that oocyte donors spent 56 hours in the medical setting, undergoing interviews, counseling, and medical procedures related to the process. The same analysis estimated sperm donors’ time at just an hour. (The ASRM report acknowledged that this failed to consider time spent by sperm donors undergoing interviewing and screening.)

In 2000, the average payment to sperm donors was $60 to $75, and an extrapolation suggests that a payment of $3,360 to $4,200 to oocyte donors is justified. The committee justified the higher payment of $5,000 for oocyte donation on the basis of a lengthier total time commitment and greater physical intrusion and risk.

This analysis is problematic because it compares two processes that are not directly analogous. Its foundation rests mainly on time spent rather than risk incurred in the donation process. The amount of physical risk faced by sperm donors amounts to zero, while risk faced by oocyte donors varies.

By capping the amount that egg donors can be compensated for undergoing this risk, the ASRM is effectively assigning a value to it (and a small one at that). As a deterrent for women who would not consider their physical well-being as worth just a few thousand dollars, the guidelines may work. For women who make the choice to donate anyway, the guidelines heavily undervalue their physical risks.

Who am I? I am not someone who would donate for $5,000. In fact, I don’t know my “price,” or if I even have one. But I also know that there are those who do donate for that sum. My friends, my classmates, and my coworkers could someday be among them. To the ASRM I would like to say: I appreciate your thought behind the guidelines. I understand that they are designed to protect those like me, those who have a price higher than $5,000. But please also consider those who do not.

Shara Yurkiewicz, a 2009 graduate of Yale College, is an editorial intern at The Hastings Center who will enter Harvard Medical School in the fall.

$35,000 for One of My Eggs?

Under reimbursement rules, IV chemo counts as a medical benefit, but oral treatments fall under the (usually less comprehensive) drug benefit.

Is ‘Chemo Parity’ a Good Idea?

States Warn of ‘Obamacare’ Scams

Con artists are taking advantage of confusion over the recent health care overhaul, with one plan offering protection against “death panels.”

http://nyti.ms/9mj0Q9